Eosinophilic granuloma of bone and its relationship to Hand-Schüller-Christian and Letterer-Siwe syndromes.

Eosinophilic granuloma was formerly mistaken for “eosinophilic myeloma” (Finzi 1929) or for “osteomyelitis with eosinophilic reaction” (Schairer 1938). It was described as a new distinct entity by Otani and Ehrlich (1940) under the denomination solitary granuloma of bone and by Jaffe and Lichtenstein (1944) as eosinophilic granuloma ofbone. Farber(l94l) and Green and Farber (1942) showed that eosinophilic granuloma could appear also in multiple locations and did not represent an entity but was related to Hand-SchUller-Christian’s disease and Letterer-Siwe’s disease. They introduced the term destructive granuloma of bone. Galeotti-Flori and Parenti (1937) and Wallgren (1940) had previously suggesied that Hand-Sch#{252}ller-Christian disease and Letterer-Siwe’s disease were the chronic and acute manifestations of the same basic process-namely a systemic reticulo-endothelial granulomatosis : they described transitional cases. The concept that these entities are only different clinical manifestations of a single pathological disorder has gained wide acceptance (Gross and Jacox 1942; Jaffe and Lichtenstein 1944; Engelbreth-Holm, Teilum and Christensen 1944; Schajowicz and Polak 1947; Ponsetti 1948 ; Nezelof and Guibert 1963 ; Enriquez, Dahlin, Hayles and Henderson 1967 ; Cheyne 1971). Schajowicz and Polak proposed the general term histiocytic granuloma for this group of disorders, which may appear without any or with only isolated eosinophils (pure histiocytic granuloma), or, more commonly, with more or less numerous eosinophilic leucocytes (eosinophilic histiocytic granuloma) involving a single or several bones. On the other hand some of the histiocytes may transform themselves into lipid-bearing xanthoma cells (histiocytic