Sadece biyopsi uygulanan uzun kemik ve pelvis yerleşimli eozinofilik granülomların uzun dönem takipleri

Year 2015, Volume: 49 Issue: 2, 144 - 150, 22.05.2015

Bulent Erol Omer Sofulu Mert Topkar Emrah Caliskan Huseyin Kemal Turkoz

https://doi.org/10.3944/AOTT.2015.14.0116

Abstract

 

Amaç: Uzun kemik ve pelvis yerleşimli eozinofilik granülomu olan ve biyopsi sonrası ilave tedavi uygulanmayan hastaların uzun dönem klinik ve radyolojik sonuçları değerlendirildi.

 

Çalışma planı: Uzun kemik ve pelvis yerleşimli eozinofilik granülomu olan 17 çocuk (11 erkek, 6 kız; ortalama yaş 8.5 [dağılım, 3.5–14 yaş]) biyopsi sonrası takip edildi. Femur (5), tibia (3), humerus (2), ulna (1), fibula (1), pelvis (3), skapula (1) ve klavikula (1) tutulan kemikleri oluşturdu. Biyopsiyle tanının teyit edilmesini takiben hastalara hiçbir ilave cerrahi girişim uygulanmadı. Preoperatif ve postoperatif MSTS ekstremite fonksiyon skorlaması ve VAS ölçümleriyle klinik takip yapıldı. Lezyonun iyileşmesi periyodik radyografilerle izlendi. Tutulan kemiklerde lezyona bağlı uzunluk farkı veya deformite gelişimi ile lezyonun progresyonu veya nüksü kaydedildi. Ortalama takip süresi 65 ay (dağılım, 28–115 ay) idi.

 

Bulgular: Hastaların preoperatif ortalama MSTS skoru %45 (dağılım, %30–56.6) iken, postoperatif 6., 12. ve 24. ay takiplerdeki ortalama değerler sırasıyla %76 (dağılım, %70–83.3), %88 (dağılım, %73.3–93.3) ve %94 (dağılım, %86.6–100) ölçüldü. Ortalama preoperatif VAS skoru değerlendirmesi 8.4 (dağılım, 6–10) hesaplanırken, bu değer 3., 6. ve 12. aylarda sırası ile 3.5 (dağılım, 2–5), 2.2 (dağılım, 1–3.5) ve 1.1 (dağılım, 0–2) olarak belirlendi. Radyografik takip lezyonların çoğunluğunda 12. ayda, yassı kemiklerde ise 24. ayda tam iyileşmeyi gösterdi. Hiçbir hastada ekstremite uzunluk farkı veya deformite gelişmedi. Lezyonların tamamı biyopsi sonrası gerileme gösterdi, progresyon veya nüks gözlenmedi.

 

Çıkarımlar: Eozinofilik granülom spontan remisyon potansiyeli olan ve biyopsiyle tanının teyit edilmesi sonrası ilave girişim yapılmadan iyi fonksiyonel ve radyolojik sonuçların elde edilebileceği bir lezyondur.

 

Keywords

Eozinofilik granülom; langerhans hücreli histiositoz.

Long-term follow-up of long and flat bone eosinophilic granulomas managed only with biopsy

Abstract

Objective: We evaluated long-term clinical and radiological follow-up results of patients with long and flat bone eosinophilic granulomas managed only with biopsy.
Methods: Seventeen patients [11 male, 6 female; average age 8.5 years (range: 3.5 to 14 years)] with long and flat bone eosinophilic granulomas were followed after biopsy. Involved bones were femur (5), tibia (3), humerus (2), ulna (1), pelvis (3), scapula (1) and clavicle (1). After confirmation of diagnosis by biopsy, no further surgical intervention was performed. Clinical follow-up was done with preoperative and postoperative MSTS and VAS scores. The healing process was followed with periodic radiographs. Limb-length discrepancy, deformity, and lesion progression or recurrence were recorded. Average follow-up was 65 months (range: 28 to 115 months).
Results: Average preoperative MSTS score was 45% (range: 30 to 56.6%), while postoperative 6, 12 and 24 months scores were measured as 76% (range: 70 to 83.3%), 88% (range: 73.3 to 93.3%) and 94% (range: 86.6 to 100%) respectively. Average VAS score, which was 8.4 (range: 6 to 10) preoperatively, had a tendency to decrease postoperatively, and was measured as 3.5 (range: 2 to 5), 2.2 (range: 1 to 3.5) and 1.1 (range: 0 to 2) at 3, 6, and 12 months. Even though the majority of lesions demonstrated complete radiographic healing at 12 months, the healing process extended to 24 months for flat bones. No patients experienced limb-length discrepancy or deformity. All lesions regressed following biopsy and no recurrence was seen.
Conclusion: Eosinophilic granuloma has a spontaneous healing potential, and confirming the diagnosis by biopsy is sufficient to obtain good functional and radiological results without any further
intervention.

Keywords

Eosinophilic granuloma, langerhans cell, histiocytosis

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