PERCUTANEOUS TECHNIQUES FOR THE DIAGNOSIS AND TREATMENT OF LOCALIZED LANGERHANS-CELL HISTIOCYTOSIS (EOSINOPHILIC GRANULOMA OF BONE)

We retrospectively studied the outcome of percutaneous needle biopsy a nd intralesional injection of a corticosteroid (methylprednisolone) in thirty-nine patients who had localized Langerhans-cell histiocytosis (eosinophilic granuloma of bone), All thirty-nine patients had a solit ary symptomatic lesion at presentation; a second lesion developed in t wo patients, two and four months after the first lesion was diagnosed, Therefore, there were forty-one lesions in thirty-nine patients. Fine -needle aspiration with or ,without core-needle biopsy was performed f or all forty one lesions, and the diagnosis of Langerhans-cell histioc ytosis was established for thirty-seven (90 per cent), A corticosteroi d was injected into thirty-five lesions. Twenty-nine received the inje ction at the time of the fine-needle aspiration on the basis of the cy tological findings in the aspirate. Six patients who had a solitary le sion had a two-stage procedure because the injection was delayed until the diagnosis was confirmed with histological evaluation of specimens obtained by core-needle biopsy, Thirty-four (97 per cent) of the thir ty-five lesions healed, The clinical symptoms associated with thirty-o ne lesions resolved within two weeks after a single injection of the c orticosteroid, There were no complications associated with either the biopsy or the injection, At a median of ninety months (range, twenty-f our to 199 months), no patient had recurrence of symptoms or of radiog raphic evidence of the lesion, All patients who had been managed with an intralesional injection of the corticosteroid had full range of mot ion of the affected extremity and had resumed unlimited activities, Al though the mechanism of action of intralesional injection of a cortico steroid has not been defined, use of percutaneous needle biopsy to dia gnose localized Langerhans-cell histiocytosis and treatment with intra lesional administration of methylprednisolone relieved pain expeditiou sly, enabled the patient to avoid an operative procedure, and resulted in osseous healing, The specific role of corticosteroid therapy remai ns to be determined by prospective, randomized studies.