1 case of ostice acidosis granomasinis in the cervical spine, which was mainly complained about by cervical pain.

Neck pain is common in cervical vertebral lesions, inflammation of soft tissue in the neck, thyroiditis, neck malignancy, etc, and is a common clinical symptomDue to the increasing level of pain treatment in recent years, the number of patients who are treated in the pain department with pain or other symptoms is increasingThe early manifestations of these diseases are atypical and can lead to misdiagnosisThis paper reviews 1 case of rare cervical vertebrae eosic granoma, summarizes clinical experience and reviews the literature, in order to improve clinicians' knowledge of neck pain diagnosis and treatment, reduce misdiagnosis, miss diagnosis, so that patients can get early and effective treatment1Case Information, a woman, aged 33, was admitted to hospital for eight hours due to sudden neck painNo night night night sweats, no wasting, no cough, no sputum, no fever, no hemorrhage, no upper limb pain, numbness, no stool disorder, no double lower limb weakness, etcPhysical fitness; 20 years of smoking history, 10 units/dayadmission to the hospital: vital signs are stableShenqing, check body cooperation, to answer the question, two-sided pupils and other large iso-circular diameter 3mm, normal reflection of light, two-sided forehead symmetry, nasal lip groove is not shallow, teeth, tongue center, pharynx reflection normalThe body and limbs have no sense loss, the muscle strength and muscle tone of the limbs are normal, the reflection of the two-sided tendon is normal, and the pathological signs are negativeThere were no abnormalities in the heart and lung abdominal examinationspecialist examination: neck forced upright position, cervical front flex, back extension, laterflexand rotation activity is obviously limited; C3-6 bilateral vertebrae and echidna tenderness, local muscle reflexocenceVisual simulation score (visualanaloguescale, VAS) 8 points Auxiliary examination: normal blood-indicatant red blood cell count, hemoglobin increase (155g/L, normal reference value 115 to 150g/L), white blood cell count increase (17.95 x 109/L, normal reference value: 3.50 to 9.50 x 109g/L), neutrophil percentage increase (93%, normal reference value: 45.0 to 75.5%) 7%, normal reference value: 20.0 to 50.0%), percentage reduction of single-core cells (1.1%, normal reference value: 3.0 to 10.0%), periacid osteoblasts percentage decrease (0.1%, normal reference value: 0.4 to 8.0%), total platelet increase (409 x 109g/L, normal reference value: 100 to 300 x 109g negative protein) Calcitonin, urine protein negative this week Cervical X-piece: cervical curvature antibow, two-sided C3/4, C4/5 intervertebral hole slightly narrowed (see Figure 1) Figure 1 Cervical X-piece flat sweep image left and right sacroon show C3/4, C4/5 vertebrae hole slightly narrowed from the patient's symptom signs and auxiliary examination results, as well as the perspective of frequent diseases, the preliminary consideration of cervical vertebral disease? However, the patient's initial seizure, rapid onset and persistent pain, no sleeping posture, pillow discomfort, neck over-twisting, neck cold and other causes, so further identification Auxiliary examination: blood sinking is normal, TB bacteria test (PPD test) :( plus) TB infection T cell detection, oral glucose tolerance test (OGTT) negative Cervical MRI shows C3 vertebral lesions (see Figure 2) Vertebral CT flat sweep plus enhancement and 3D flat sweep show C3 vertebral bone damage associated with suspicious bone formation, considering the possibility of infection (nodules) (see Figure 3, 4) Figure 2 Cervical MRI A-B cervical curvature straightens, partial vertebral edge increases in varying degrees, C3 vertebral lower edge visible limitation depression; C3 vertebral bone signal is slightly lower T1W, T2W slightly higher signal shadow; C pressure lipid phase lesions are unevenly high Signal, cervical disc T2 signal decreased, C3/4-C6/7 intervertebral disc puffed out, the epidural frontal pressure of the epidural is wave-like change, the cervical myelin signal is normal, C2-C4 level vertebral disc strip length T2 signal Figure 3 Vertebral CT Flat Sweep plus Enhanced A, B: C3 vertebral body see irregular group flaky bone damage area, boundary under-clearing, uneven density, bone damage area visible spot-like high density shadow, C3 vertebral lower edge and prefrontal bone cortex discontinuous; Figure 4 Vertebral CT Flat Sweep and 3D Reconstruction C3 vertebral local bone incontining bone density is not uniform, visible spot flaky bone damage area, pre-vertebral soft tissue slightly thickened; A for the front and front side view, B for the rear side and back view chest CT, abdominal color super, gynecology and breast color super did not see obvious abnormalities At this point, we believe that the patient's neck pain cause complex, not simply cervical vertebral disease Due to the small number of malignant tumors originating in the vertebral body, metastatic tumors also did not find the vertebral progenitor lesions, and the patient has no systemic symptoms of the tumor, in addition, the evidence of tuberculosis is not sufficient, after giving diagnostic anti-infection treatment to monitor white blood cells and neutrophils have dynamic reduction but pain is not significantly improved, simple vertebral and soft tissue inflammation evidence is also Insufficient, so a further walk PET-CT examination, the results show: cervical 3 vertebral bone damage, fluoride deoxygenglucose (18F-FDG) metabolic abnormalincrease, consider benign lesions (nodules or eosinophily granuloma) is more likely, but can not be excluded from malignant tumors (myeloma) possible (see Figure 5) Figure 5 PET-CT scan A:C3 vertebral bone bone damage, bone damage area mixed with uneven high density shadow, vertebral leading edge contour is clear, no obvious soft tissue swelling around; B:FDG-PET see bone damage area is nodule-like radioactive intake increase stove, maximum SUV value is 8 .77, the average SUV value is 4.35, the maximum diameter is about 2.8cm post-puncture biopsy histopathology results: (C3 vertebral) a little cartilage and fibrous tissue show granulated inflammation, combined with morphology and immunohiscist dye, tending to eosinophilic granoma Immuno-grouped staining: CD1a ( , CD68), S-100 ( see Figure 6) After admission to the hospital, the patient was treated with neck brace braking, anti-infection, pain relief, etc., after conservative treatment, the patient's pain and activity restriction did not improve significantly, after the puncture biopsy found eostoic granuloma, the orthopaedic line "through the front road C3 vertebral sub-full-cut bone-fusion steel plate screw fixation"; the tissue pathology examination in Figure 6 HE x 10, the mirror can be seen a large number of Langehans cells immersion, scattered in the eosinophilic 2 Discussion On the basis of reviewing the relevant literature, we learned that eosinophilic granuloma (EG) is Langerhans cell growth (Eosinophilic granul) Langerhans cell histiocytosis, LCH) a subtype characterized by tissue cell hyperplasia and eosinophil leaching, is a rare antigen-borne cell disease with a incidence of approximately 4.0 to 5.4 per million people The lesions can affect the whole body bone, the spine is one of the good spots of the disease, the number of people affected by the cervical spine is relatively small, 80% of the cases to bone dissolution as the main manifestation, and asymmetrical, bone-soluble changes EG clinical symptoms are often lacking specificity, because they can affect the whole body bone, so it needs to be identified with bone tumors, tuberculosis imaging examination is helpful to clinical diagnosis and identification: CT examination activity period to bone damage performance mainly, the repair period is shown as bone damage reduction, bone hyperplial hardening increased, density increased, vertebral pressure-turned flat is wedged or significantly flattened in the coin shape, but all showed different degrees of bone-dissolution damage in the vertebral body MRI is mainly manifested in abnormal changes in the structure and signal of the lesions of the vertebral body, the vertebral body is spot-like bone bone damage, with the development of the disease, the vertebral compression becomes flat or disc-shaped, called "flat vertebrae" or "copper plate vertebrae", the image performance is specific, usually not tired and intervertebral disc The vertebrae are often accompanied by soft tissue lumps, and the enhancement is also significantly strengthened, and the signal change and strengthening methods are consistent with the lesions, which is of great value and is an important sign of diagnosis of eosinophilic granuloma in the spine treatment, EG because of its very low incidence, the current domestic and foreign treatment of simple and cervical vertebrae reported less, there is no standardized treatment guidelines, but with the study of EG continues to deepen, the current main use of conservative treatment for EG, chemical treatment, surgical treatment, the main purpose of treatment is to remove the swelling, maintain spinal stability, protect nerve function, relieve pain, improve prognosis, prevent secondary recurrence, clinical treatment options, the extent of the comprehensive , we think the diagnosis and treatment of patients with neck pain should pay attention to the following points: (1) neck pain, although a common clinical symptom, it seems common still can not preconceived, with experience subjective assumptions, but should carefully inquire about the medical history and medical examination and the corresponding auxiliary examination, further clear diagnosis, in order to avoid misdiagnosis; (2) Regular X tablets may also be missing; (3) patients with neck, shoulder and leg pain may also have the possibility of malignant tumors; (4) In addition to having pain expertise, clinicians should also have such knowledge as osteology, neurology, imaging, etc., which is of great significance to improve the level of clinical diagnosis and treatment and avoid delayed treatment