 | A large osetolytic lesion
is present in her left ilium. Some peripheral bone is present. This lesion could be confused with overlying gas shadows. Further studies
are needed. |
 | Loss of inner cortex with a small
amount of peripheral new bone is seen.
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 | This MRI clearly defines the lesion. The differential diagnosis would include Eosinophilic Granuloma and Ewing's Sarcoma. Infection is less likely because of the absence of marked reactive bone. Bone scan is sometimes cold in Eosinophilic Granuloma unless the lesion is healing spontaneously.
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 | The lesion was biopsied and after Eosinophillic Granuloma was diagnosed on a frozen section, the lesion was thoroughtly curretted. High power photomicrographs of the solid soft tissue revealed inflammatory cells and histiocytes. The combination of histiocytes and eosinophils was striking. Sometimes the eosinophils are sparse. Tissue was also sent to the Bacteriology Lab for culture. There was no growth. This was a solitary lesion. The term Histiocytosis X is the term often used today for these lesions.
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 | Patient became asymptomatic. She did not develop other lesions. Two years later, she had normal function, and radiographs revealed complete healing. Note the gas shadow overlying part of the left ilium.
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