The grooved nuclei, lytic lesion in first decade suggests Langerhan's cell histiocytosis. LANGERHANS CELL HISTIOCYTOSIS (LCH): DE!STRUCTION DUE TO HISTIOCYTES, IDIOPATHIC1. Letterer-Siwe disease: a fulminant systemic disease, age group < 3 years, fatal2. Hand-Schuller-Christian disease: Triad of skull lesions (lytic lesion), Exophthalmos and diabetes insipidus. 3. Eosinophilic Granuloma: Solitary lesion of bone or lung (Pulmonary histiocytosis X) 1st decade of life. Skull is the most common site in skeletal system - Bevelled edge lytic lesion is seen in skull (double contour).Biopsy: Gold standard (cells with Birbeck's granules (tennis racket appearance) under election microscopy) grooved nuclei are seen. TreatmentSpontaneous resolution. Highly radiosensitive and Excision + Curettage for resistant cases.
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