Clinical Report
SPONTANEOUS REMISSION OF EOSINOPHILIC GRANULOMA OF THE MAXILLA AFTER
INCISIONAL BIOPSY: A CASE REPORT
Introduction and objectives
Langerhans cell histiocytosis (LCH), known formerly as Histiocytosis X, is a rare group of
disorders with a wide spectrum of clinical presentations, including solitary bone lesions known
as eosinophilic granuloma (EG), and other systemic presentations. This grouping has been
based on the similarities of the histopathologic appearance, but the etiology and proper
approach remains controversial. The purpose of this report is to describe a rare case of EG
healing after biopsy.
Methods
Patient 16y old, without significant morbid history, was derived by an osteolytic lesion in the left
maxillary region. Clinical examination showed only gingival inflammation. The patient had
previous studies, which included a biopsy report compatible with EG of bone (LCH). Cone
Beam CT showed inflammatory changes in the left maxillary sinus, with an area of osteolysis
in relation to the roots of molars, discontinuity of the sinus floor and the buccal bone plate,
compatible with post-surgical changes from the previous biopsy. Bone scintigraphy showed no
other foci of increased uptake. At 3 months from initial consultation, a new pre-surgical imaging
study showed a spontaneous remission after the biopsy.
Discussion
EG is the predominant clinical form of LCH and accounts for 50-60% of all cases of LCH, with
an incidence of one new case per 350,000 to 2 million per year, representing a rare condition
in the maxillofacial area.
Therapeutic combinations include surgery, chemotherapy and radiation, either individually or in
combination. Another approach is intralesional injection of steroids. Spontaneous remission
after biopsy is described, but so far few cases are reported.
Conclusions
Clinicians dealing with maxillofacial disorders must be aware of the possibilities for diagnosing
LCH and the subsequent spectrum of clinical presentations. Faced with monostotic lesions, as
in the case presented, a conservative approach appears to be satisfactory.