Pathologic fracture of odontoid process secondary to amyloid deposition

Cervical amyloidoma of C2. Case report and review of the literature

STUDY DESIGN

Second published report of a patient with amyloidoma of the upper cervical spine.

OBJECTIVES

To describe a patient with rare radiculopathy to alert other physicians to consider amyloid tumor as a differential diagnosis of locally destructive spine lesions.

SUMMARY OF BACKGROUND DATA

Localized amyloid tumor of the bone is a rare disease. Only seven cases of spine involvement have been reported. Appropriate tissue sampling is required to establish the diagnosis. Histopathologic examination shows pathognomonic apple-green birefringence under polarized light. When bone is involved with amyloid, it is most commonly associated with multiple myeloma or other plasma cell-dyscrasias.

METHOD

This case was described, and pertinent literature was reviewed.

RESULTS

The patient showed persistent neurologic improvement after transoral complete tumor removal, followed by a secondary posterior stabilization procedure using transarticular C1-C2 screws.

CONCLUSIONS

Amyloidomas are benign lesions with no associated documented risk for the development of plasmocytoma-related diseases. The clinical and radiographic manifestations of this lesion are nonspecific. A cure is possible with complete resection of the tumor and no adjuvant management procedures.

Primary cardiac amyloidosis with pathologic hip fracture secondary to bone amyloid

A rare combination of primary cardiac amyloidosis and bone amyloidosis is described in a 39-year-old female. The presenting features were restrictive heart disease and a destructive bone lesion. The diagnosis was confirmed with the help of endomyocardial and bone biopsy.

Destructive bone lesions in primary amyloidosis

We describe a patient with primary amyloidosis in whom multiple osteolytic lesions caused by amyloid bone tumours developed, and review the clinical features of the 18 cases with primary amyloidosis in whom destructive bone lesions have been reported. In contrast to amyloidosis associated with multiple myeloma, destructive lesions in the primary disease are mainly located to long bones; joint involvement is common, and radionuclide bone scan shows pronounced uptake of 99mTc-PP by the destructive bone lesions. Despite the superficial similarity between the destructive bone lesions associated with primary amyloidosis and multiple myeloma, distinction between these entities on clinical grounds is possible and may be easily confirmed by direct aspiration of the osteolytic infiltrates.

Pathologic hip fractures secondary to amyloidoma. Case report and review of the literature

Amyloidoma primarily involving bone and lymph node is described in a 60-year-old male patient. The patient had pathologic fractures of both hips through a deposit of amyloid in the neck of the femur. The prolonged insidious course of the disease was uncomplicated by hypercalcemia, hematologic abnormalities, or renal failure so characteristic of untreated myeloma. The bone marrow contained less than 10 percent plasma cells in different stages of maturity. Radionuclide bone scanning demonstrated other osseous amyloid lesions that were not detected by routine radiologic examination. This is the first reported case of pathologic fractures of both hips secondary to amyloidoma.