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THREE other reports concerning eosinophilic granulomas of the skin appear concurrently with mine in this issue. In them collectively, a full perspective of the world's literature and the history of this disease can be gained, and accordingly these phases of the subject need not be repeated in detail. The same is largely true of the bibliography; the reader is referred to Lever's comprehensive one, which leads into the ten European reports. Incidentally, the reader will be impressed by the abruptness with which the subject has appeared in the American literature and the confusion which exists as to its pathologic significance. Accordingly, this communication can be confined largely to its reports of cases and emphasis on the pathology. PRIORITY AND NOMENCLATURE It is important to determine priority because it is necessary in the attempt to establish a definition for eosinophilic granuloma of the skin. According to the laws of priority in

EOSINOPHILIC granuloma of the bone has been established as a disease entity by Otani and Ehrlich 1 and by Lichtenstein and Jaffe, 2 in 1940. The eosinophilic granulomas of the skin as reported in the literature have recently been reviewed by Weidman, 3 Lewis and Cormia, 4 Lever 5 and Dobes and Weidman. 6 The cutaneous manifestations of eosinophilic granuloma have varied so widely in their clinical and histopathologic features that the disease is not yet considered as a disease entity. REPORT OF A CASE V. M., 7 an 11 year old white girl, was first seen at the University of Chicago Clinics on Jan. 9, 1947. She complained of tender tumefactions and ulcerations of the skin on the upper part of the chest and scalp. She had been well until the age of 2 years, when she became ill with measles and mumps at the same time. During this

DURING the past few years the attention of American dermatologists has been directed toward a rather wide variety of cutaneous lesions which have been difficult to catalogue in the previously accepted classifications of disorders of the skin but which have in common a granulomatous aspect and structure in which are found, on histologic examination, a striking number of eosinophils. As a purely descriptive convention, it has been convenient to adopt a term which was first used by Nanta and Gadrat, 1 in the European literature, namely, eosinophilic granulomas of the skin. Lewis 2 was the first to present a case under this title in this country, and Weidman 3 and Lewis and Cormia 4 read excellent articles on this unusual condition before this association in 1946. A study of the cases which have been reported with this designation reveals such variations with respect to appearance, course and association with other findings that it is readily apparent

SYSTEMIC reticuloendothelial granuloma is the generic term used by Wallgren 1 in 1940 to include Letterer-Siwe disease and Schuller-Christian disease. During the past two decades there have been numerous articles devoted to this subject, largely by pathologists, pediatrists, internists and orthopedists. Dermatologists, however, have apparently paid little attention to the cutaneous manifestations of systemic reticuloendothelial granuloma, judging from the paucity of articles which have appeared in dermatologic journals. In articles written within the past few years, Farber, 2 Mallory 3 and Jaffe and Lichtenstein 4 also included eosinophilic granuloma of bone in the group of systemic reticuloendothelial granulomas. The following classification was proposed by Mallory: 3 The disease may mainfest itself in infancy or early childhood in a rapidly fatal form in which the lesions are widely distributed both through the soft tissues (especially the lymphoid tissues) and the skeleton (so-called Letterer-Siwe disease, reticulosis or nonlipid histiocytosis). It

THE term "eosinophilic granuloma" has been used in recent years so often and with such widely different meanings that it is fast losing its diagnostic significance. Weidman, 1 following Nanta and Gadrat's 2 original usage, suggested that "eosinophilic granulomas" be made a generic term by use in the plural form and that the group be subdivided into several types. In the classification which Weidman drew up he singled out 3 cases, those of Wigley, 3 Buley 4 and Lever, 5 as modifications of erythema elevatum diutinum. Recently, Lever, Lane, Downing and Spangler 6 reported 3 additional cases. At least 2 more similar cases were meanwhile presented at dermatologic society meetings in this country by Hand 7 and Cooper. 8 The purpose of this paper is to report another case and to add evidence that these cases present a well defined clinical picture and rather uniform histologic features. The relation of

EOSINOPHILIC granuloma of the skin is a new and not yet well defined disease entity. Occasional case reports under this diagnosis have appeared in the European literature since 1937. In the United States the disease received little attention until 1946. Since then, however, five papers on this subject have been published, 1 among them one from Boston. 1d Nineteen cases in which the disease was diagnosed as eosinophilic granuloma of the skin are now recorded in the literature. Three additional cases have recently been seen in Boston. The appearance in these cases, clinically as well as histologically, was almost identical with that in the first case reported from Boston. 1d In fact, the clinical features of these 4 cases were so characteristic that in 1 instance (case 2) the diagnosis was made before biopsy. REPORT OF CASES Case 1.— A 52 year old man first noticed in 1942 a small

THE TERM "eosinophilic granuloma" usually refers to a specific bone lesion considered by some (particularly Jaffe and Lichtenstein 1 ) to be the early monosymptomatic form of Hand-Schuller-Christian disease. This concept is well supported by Holm, Teilum and Christensen's 2 report of 6 cases showing a gradual transition from the early solitary lesion to the picture of Hand-Schuller-Christian disease. However the term "eosinophilic granuloma" has not been confined to this entity. It has been applied to other conditions, apparently different from Hand-Schuller-Christian disease. Curtis and Cawley 3 reported the case of a girl whose condition was similar to a seborrheic dermatitis with small, red, discrete and coalescent papules on the buttocks and eroded patches in the mouth. In each axilla weeping, sharply demarcated erythematous papules were noted. Roentgenologic examination showed destructive lesions of a rib and the ilium. Biopsy specimens of the lesions of the skin

THE CASE to be presented has many clinical and histologic features in common with erythema elevatum diutinum and with eosinophilic granuloma of the skin. Eosinophilic granuloma has been described as a disease of the skin and of the bone, but whether the two diseases are related is not yet certain. In the following report the clinical and histologic appearance of erythema elevatum diutinum, eosinophilic granuloma of the skin and eosinophilic granuloma of the bone will be reviewed and the possibility of a relationship discussed. REPORT OF A CASE A 47 year old woman first noticed in 1935 a small purple patch in the left malar region. In 1939 two additional lesions appeared, one on the right cheek and one just below the first lesion on the left cheek. All three patches gradually increased in size, and by 1942 the two on the left cheek had united. The lesions were not

A PATIENT with bizarre, recurrent, eosinophilic tumefactions of the skin has been under observation for the past three and one-half years. The clinical findings, in comparison to those noted in previous reports, are unique inasmuch as the individual lesions have been of relatively short duration with a tendency to spontaneous disappearance, are acutely inflammatory in nature and are completely insensitive to irradiation with roentgen rays. As a background for discussion of this case, the pertinent literature will first be summarized. Following the presentation of the case, an attempt will be made to link up the various eosinophilic tumefactions into a logical pattern and to clarify the relationship between these lesions and eosinophilia in general. SUMMARY OF ANALOGOUS CASES The first case of cutaneous eosinophilic granuloma to be reported was that of Freund 1 in 1930. His patient had active pulmonary tuberculosis. For six years there were present livid red, semicircular

INTEREST of pathologists and orthopedic surgeons has within recent years been focused on a newly classified group of diseases, comprising Hand-Schuller-Christian disease, a relative newcomer, assigned the eponym Letterer-Siwe disease, and a third, variously known as eosinophilic or destructive granuloma of bone. Occurrence of both cutaneous lesions and visceral involvement as prominent accompaniments of these processes recommends further study and investigation by dermatologist and internist. Letterer-Siwe disease, so titled because of the original description by Letterer and the subsequent collection and grouping of cases by Siwe1appears to be the severest, eosinophilic granuloma the mildest and Hand-Schuller-Christian disease the intermediate manifestation of an identical underlying basic disease.2This classification necessitates withdrawal of Hand-Schuller-Christian disease from its previously held position in the group known as diseases of lipid metabolism, remaining members of which are Gaucher's disease and Niemann-Pick disease. Recent investigations lend weight to the accuracy of this reshuffling.

EOSINOPHILIC granuloma of the skin has been since 1946 a frequently discussed topic in the American dermatologic literature. 1 At first a good deal of confusion prevailed since entirely different cutaneous lesions were described under this diagnosis; recently, however, it has become apparent that the cutaneous lesions described under the term eosinophilic granuloma can be divided into three groups, namely (1) cases associated with and identical in pathogenesis with eosinophilic granuloma of the bone, (2) cases characterized by torpid, asymptomatic, purplish patches on the face and (3) a heterogeneous group of cases having in common nothing but a large percentage of eosinophils in a granulomatous infiltrate. The third group, on account of its varying etiology, does not deserve the diagnostic term eosinophilic granuloma. However, elimination of this group still leaves two entirely different diseases endowed with the same diagnostic term. In this paper, 1 case of the first