EURORAD ESR

Case 13720

Osteolytic lesion in tibial diaphysis in a child (ECR 2016 Case of the Day)

Author(s)
Gian Michele Magnano, Maria Beatrice Damasio

G. Gaslini Institute,
Radiology;
Largo G. Gaslini 5
16147 Genoa, Italy; E
mail:michelemagnano@gaslini.org
 
Patient
male, 5 year(s)
 
 
  • Figure 1
    Diagnostic imaging
     

    Anteroposterior radiograph of the right femur: osteolytic area without sclerotic margin in the cancellous bone, with "scalloping" of endosteal profile. Fusiform continuous periosteal reaction is present.

     
    Area of Interest: Bones; Imaging Technique: Conventional radiography; Procedure: Education; Special Focus: Inflammation;

    MRI. T1-weighted TSE sequence coronal image of the right femur. Presence of a hypointense lesion associated with diaphyseal periosteal thickening with an extensive alteration of the signal of adjacent cancellous bone.

     
    Area of Interest: Bones; Imaging Technique: MR; Procedure: Education; Special Focus: Inflammation;

    MRI. 3D contrast-enhanced GRE sequence with fat saturation. Coronal image of the right femur. The femoral diaphyseal lesion, periostelal reaction, and adjacent soft tissues present strong contrast enhancement.

     
    Area of Interest: Bones; Imaging Technique: MR; Procedure: Education; Special Focus: Inflammation;
     
     
  • Figure 2
    Bone biopsy
     

    Histological sections of bone biopsy with replacement by an infiltrative process.

     
    Area of Interest: Bones; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Infection;

    Proliferation of polymorphic histiocytic elements commingled with variable number of eosinophils, neutrophils, lymphocytes and plasma cells; few scattered giant multinucleated cells.

     
    Area of Interest: Bones; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Inflammation;

    Proliferation of the histiocytic elements, note the rich component of eosinophilic granulocytes. The histiocytes have indented or lobulated nuclei with large eosinophilic cytoplasm.

     
    Area of Interest: Bones; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Inflammation;

    IH PS100 40x: histiocytic elements have strong cytoplasmic positivity for S100 protein.

     
    Area of Interest: Bones; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Inflammation;

    IHCD1a 40 x: histiocytic elements have strong cytoplasmic positivity for the cluster of differentiation CD1a.

     
    Area of Interest: Bones; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Inflammation;
     
     
  • Figure 3
    Skeletal sites commonly involved

    Langerhans cell histiocytosis: skeletal sites commonly involved, age and incidence ratio F:M. The femoral region has been circled, showing the object of our case [1].

     
    Area of Interest: Bones; Imaging Technique: Experimental; Procedure: Education; Special Focus: Inflammation;
     
     
Anteroposterior radiograph of the right femur: osteolytic area without sclerotic margin in the cancellous bone, with "scalloping" of endosteal profile. Fusiform continuous periosteal reaction is present.
 
MRI. T1-weighted TSE sequence coronal image of the right femur. Presence of a hypointense lesion associated with diaphyseal periosteal thickening with an extensive alteration of the signal of adjacent cancellous bone.
 
MRI. 3D contrast-enhanced GRE sequence with fat saturation. Coronal image of the right femur. The femoral diaphyseal lesion, periostelal reaction, and adjacent soft tissues present strong contrast enhancement.
 
Histological sections of bone biopsy with replacement by an infiltrative process.
 
Proliferation of polymorphic histiocytic elements commingled with variable number of eosinophils, neutrophils, lymphocytes and plasma cells; few scattered giant multinucleated cells.
 
Proliferation of the histiocytic elements, note the rich component of eosinophilic granulocytes. The histiocytes have indented or lobulated nuclei with large eosinophilic cytoplasm.
 
IH PS100 40x: histiocytic elements have strong cytoplasmic positivity for S100 protein.
 
IHCD1a 40 x: histiocytic elements have strong cytoplasmic positivity for the cluster of differentiation CD1a.
 
Langerhans cell histiocytosis: skeletal sites commonly involved, age and incidence ratio F:M. The femoral region has been circled, showing the object of our case [1].
 
 
 
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