Mandible eosinophilic lesion regression after endodontic treatment: one year follow-up

• Published in: Annali di stomatologia 2017-01, Vol.8, p.74-74
• Main Authors: Dedola, A, Zhurakivska, K, Tesei, A, Melillo, M, Mastran, F
• Format: Article
• Language: English
• Subjects: Biopsy; Case reports; Cell proliferation; Cortical bone; Cytoplasm; Dendritic cells; Diagnosis; Etiology; Granuloma; Histiocytosis; Inflammation; Langerhans cell histiocytosis; Langerhans cells; Lesions; Leukocytes (eosinophilic); Leukocytes (granulocytic); Lymphocytes; Lymphocytes T; Mandible; Mucosa; Nuclei; Nuclei (cytology); Oral cavity; Organs; Pain; Periodontics; Remission; Teeth
• ISSN: 1824-0852; 1971-1441

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by lesions containing CD207+ dendritic cells and an inflammatory infiltrate. The etiology is still unclear, but dis-regulation of T suppressor lymphocytes, neoplastic proliferation of Langerhans cells and some genetic components are involved. The disease can result in a highly variable of clinical evidences, ranging from a single lesion to potentially fatal disseminated disease when involves high-risk organs. Sometimes, the oral cavity may be the first or the unique site affected by LCH site, and it is possible to find ulceration of the oral mucosa, periodontal defects, dental hypermobility or premature tooth loss. The diagnosis is related to histological report, supported by clinical and radiological examination. Here we report a case of 23 years old healthy male diagnosed with eosinophilic granuloma. The patient came to our observation for pain and swelling in correspondence of the right side oi the mandibular body. After the initial endodontic treatment of the 4.6, a Cone Beam Dentalscan examination revealed a generalized and diffused multifocal radiotransparency area with aggressive feature able to determine erosion of the cortical bone of the lower edge and the mandible lingual wall beneath the miloioid line. Incisional biopsy was performed in order to obtain a proper diagnosis. The histological examination revealed a proliferation of medium/large cells with large cytoplasm and irregular nucleus, with the presence of eosinophilic granulocytes and some lymphocytes. The diagnosis of Eosinophilic granuloma (EG) was formulated. After 7 month, a new CT Dentalscan revealed important signs of remission without other treatment. After 6 months a new additional control by Cone Beam showed further signs of improvement. Although limited to a single clinical case, it can be assumed that in selected cases where the eosinophilic granuloma is associated with necrotic teeth, a conservative endodontic treatment followed by a careful observation may be useful. However, more studies are needed to investigate the origin and development of such lesions.