Percutaneous techniques for the diagnosis and treatment of localized Langerhans-cell histiocytosis (eosinophilic granuloma of bone)
Percutaneous techniques for the diagnosis and treatment of localized Langerhans-cell histiocytosis (eosinophilic granuloma of bone)
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DOI：
10.2106/00004623-199802000-00009
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发表时间：
1998-02-01
影响因子：
5.3
通讯作者：
Murray, JA
中科院分区：
文献类型：
--
作者：
Yasko, AW;Fanning, CV;Murray, JA
我们回顾性研究了经皮穿刺活检和病灶内注射皮质类固醇的结果（甲基强的松龙）在39例局限性朗格汉斯细胞组织细胞增生症患者中的应用骨嗜酸性肉芽肿，所有39例患者在就诊时有孤立的症状性病变;在第一个病变被诊断后的两个月和四个月，两名患者发生了第二个病变，因此，39名患者中有41处病变。对所有41个病灶进行了细针穿刺活检，其中37个（90%）被诊断为朗格汉斯细胞组织细胞增生症。35个病灶注射了皮质类固醇。29名患者在细针穿刺时根据穿刺物中的细胞学结果接受了注射。6例孤立性病变患者接受了两阶段手术，因为注射延迟到通过芯针活检获得的标本的组织学评价确诊，（97%）的35个病灶愈合，与31个病灶相关的临床症状在单次注射皮质类固醇后两周内消退，在中位数90个月时，没有与活检或注射相关的并发症（范围，24至199个月），没有患者复发症状或病变的放射学证据，所有接受皮质类固醇病灶内注射的患者，患肢的活动范围都很大，并恢复了无限制的活动，虽然病灶内注射皮质类固醇的作用机制尚未确定，但使用经皮穿刺活检诊断局限性朗格汉斯细胞组织细胞增生症和病灶内注射甲泼尼龙治疗可迅速缓解疼痛，使患者避免了手术，并导致骨愈合，皮质类固醇治疗的具体作用仍有待于前瞻性随机研究确定。
We retrospectively studied the outcome of percutaneous needle biopsy and 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 solitary symptomatic lesion at presentation; a second lesion developed in two 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 for all forty one lesions, and the diagnosis of Langerhans-cell histiocytosis was established for thirty-seven (90 per cent),A corticosteroid was injected into thirty-five lesions. Twenty-nine received the injection at the time of the fine-needle aspiration on the basis of the cytological findings in the aspirate. Six patients who had a solitary lesion 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 thirty-five lesions healed, The clinical symptoms associated with thirty-one lesions resolved within two weeks after a single injection of the corticosteroid, There were no complications associated with either the biopsy or the injection,At a median of ninety months (range, twenty-four to 199 months), no patient had recurrence of symptoms or of radiographic evidence of the lesion, All patients who had been managed with an intralesional injection of the corticosteroid had full range of motion of the affected extremity and had resumed unlimited activities,Although the mechanism of action of intralesional injection of a corticosteroid has not been defined, use of percutaneous needle biopsy to diagnose localized Langerhans-cell histiocytosis and treatment with intralesional administration of methylprednisolone relieved pain expeditiously, enabled the patient to avoid an operative procedure, and resulted in osseous healing, The specific role of corticosteroid therapy remains to be determined by prospective, randomized studies.