Imaging features,pathological characteristics,and surgical treatment of adult cranial eosinophilic granuloma

ZHANG Lingkun; WANG Weicheng; WANG Yuqing; MA Mengwei; JIAO Nanlin; DI Gangfu

doi:10.13798/j.issn.1009-153X.2025.10.003

Abstract：Objective To investigate the imaging features,pathological characteristics,and surgical treatment out-comes of adult cranial eosinophilic granuloma.Methods The clinical data of 10 adult patients with pathologically confirmed cranial eosinophilic granuloma from January 2014 to April 2024 were retrospectively analyzed,and relevant literature was re-viewed.Results The lesions were located in the parietal bone in 5 cases,frontal bone in 4 cases,and occipital bone in 1 case.Noncontrast CT showed roundlike osteolytic lesions with higher density than surrounding soft tissues.On MRI,lesions appeared hypointense on T1weighted imaging(T1WI)and hyperintense on T2weighted imaging(T2WI).All 10 patients underwent extend-ed resection of the cranial lesion combined with artificial titanium mesh cranioplasty.One patient underwent resection of a right frontal lobe lesion due to dural breach.Postoperative immunohistochemical staining showed positive expression of S100,langer-in/CD207,CD68,and CD1a.The Ki-67 index ranged from 1%to 30%,with a mean of(12±10)%.BRAFV600E mutation was detected in 2 cases.Postoperative cranial CT at 24 hours confirmed complete resection of the lesions without complications.No recurrence was observed during the followup period of 6-24 months.Conclusion Adult cranial eosinophilic granuloma exhibits characteristic imaging features.Immunohistochemical staining showing CD1a(+),langerin/CD207(+),and S100(+)is essential for diagnosing Langerhans cell histiocytosis(LCH).A typically high Ki67 index indicates relatively high proliferative activity.For unifocal cranial eosinophilic granuloma,extended resection combined with titanium mesh cranioplasty yields excellent outcomes.