Eosinophilic granuloma of the cervical spine in a young adult: A rare case report

Abstract

Background: Spinal eosinophilic granulomas (EG) are rare tumors, mostly reported in the pediatric age group. They constitute <1% of primary bone neoplasms, and cervical spine involvement is uncommon.

Case description: A 20-year-old male presented with neck pain for a 4-month duration. Six years previously, he had received six cycles of vinblastine for biopsy-proven histiocytosis of an axillary lymph node; this resulted in incomplete remission. Present magnetic resonance/computed tomography (CT) imaging revealed a lytic C2 body lesion with atlantoaxial instability. When the CT-guided biopsy was suggestive of EG, he was managed with definitive surgery and adjuvant radiotherapy.

Conclusion: Cervical spine EG is rare in adults. CT-guided biopsy should confirm the diagnosis and should be followed by definitive surgery and adjuvant radiotherapy.

Keywords: Adults; Cervical spine; Eosinophilic granuloma; Spine.

Figure 1:

(a) Plain radiographs of the cervical spine showing an osteolytic destruction of the C2 vertebral body with atlanto-axial instability (white arrow). (b,c) Sagital CT-median and paramedian images showing destruction of the body and pedicles of C2 vertebra (white arrows). (d) Sagital T2 MRI showed iso to hypointense signal at the site of bony defect with evidence of thecal sac compression (white arrow). (e,f) Note that the disc spaces are not involved. Dorsal spine sagittal T2 MRI sequence showing features of vertebra plana of the T9 vertebral body (black arrow) and lytic destruction of the left femoral head (black arrow).

Figure 2:

(a,b) Photomicrograph showing clusters of large cells with abundant cytoplasm in a background of inflammatory cells (H&E, x200), which have abundant cytoplasm and indented/grooved nuclei (H&E, x400). (c,d) These cells are immunopositive for S100 and CD 1a (IHC, x400). IHC:immunohistochemistry, H&E:Haematoxylin and Eosin.