Eosinophilic Granuloma

Eosinophilic Granuloma is a benign bone tumor that causes a disease that creates too many immune cells. They are not a cause of cancer or an abnormal mass of tissue (neoplasm). This may come from any site within any bone in the body.

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What is an Eosinophilic Granuloma?

Eosinophilic Granuloma is a type of damage that occurs on bones (lesions) due to an overgrowth of immune cells called Langerhans cells. These cells can malfunction and develop into bone tumors on different bones and different areas on those bones. If multiple lesions occur, then there is a risk of organs being involved.

Biological Behavior
Biological Behavior
  • • This disorder typically acts benign but can cause damage to bones and eventually organs.
  • • Recurrence can potentially happen, but is uncommon.
Causes
Causes
  • • Some studies link this condition to a mutation in the BRAF V600E gene and/or MAP2K1 mutations. 
Signs and Symptoms
Signs and Symptoms
  • • Pain and swelling in the region of the affected area
  • • Elevated levels of white blood cells (eosinophilia)
  • • Temporal bone disease
  • • Fever
Common Bones Involved
Common Bones Involved
  • • Skull
  • • Pelvis
  • • Humerus
  • • Flat Bones (front of face)
Who is usually affected?
Who is usually affected?
  • • 85% of case occur anywhere from birth to 30 years old.
  • • 60% of cases occur from birth to 10 years old.
  • • Men are more commonly affected.
  • • Rare; 4 to 5 case per million a year in children and 1 to 2 cases per million a year in adults.
Diagnosis
Diagnosis
  • • The work-up often consists of a physical examination, X-rays, CT scans, MRI, and sometimes bone scans are required. 
  • • The diagnosis is often confirmed with a biopsy, which means taking a sample of tumor and having it analyzed under a microscope by a pathologist.

Risk to your limbs

Eosinophilic Granulomas are benign tumors that lead to bone destruction and potential organ involvement. 

Radiographic imaging is used to help form a diagnosis. These include X-Ray, MRI, CT and Bone Scans

An example of an Eosinophilic Granuloma MRI is shown.

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Treatment of

Eosinophilic Granuloma

The majority of patients are cured by scooping the tumor out of the bone (curettage) and bone grafting or injecting a steroid within the tumor. Low dose radiation may also be used for damage to the bone (lesion) that is unaccessible.

Intralesional Curettage
Intralesional Curettage

Intralesional Curettage means to scoop the tumor out using a spoon-like tool called a curette. This is a surgery that aims to remove the mass and restore the bone so that the patient can get back to normal function. The eosinophilic granuloma is identified within the bone and scooped, or curetted, out. The cavity is then shaved down with a Midas Rex Drill, which is similar to a dental drill. This drill removes more tumor cells.

Bone Grafting and Fixation
Bone Grafting and Fixation

The empty bone cavity is usually filled with bone graft or bone cement. Bone can be donated (allograft) or taken from the patient themselves (autograft). Fixation devices, such as a plate and screws, may be used in specific situations to prevent postoperative fracture. 

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Hey! I am Dr. Wittig.

Myself and my amazing team are dedicated to saving your life and your limb. Losing a limb because of a tumor can be a terrifying experience. But, it does not have to be the only option. I’ve spent 20+ years as a Board-Certified Orthopedic Surgeon and Orthopedic Oncologist.

I’ve devoted my career to helping children and adults afflicted with bone and soft tissue masses by performing complex limb saving surgeries. Most patients can have their limb saved, which may require innovative techniques.

Patients afflicted with musculoskeletal tumors have complex conditions that are best taken care of at large hospitals. I am the Chairman of Orthopedics and Chief of Orthopedic Oncology at Morristown Medical Center. My philosophy is a multidisciplinary team approach, working together to tailor treatment to individual patients. Education and research are essential to my practice, providing the best setting for extraordinary patient care. Because of this, we have some of the top results in the country.