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Shyam K, Thippeswamy PB, Kamashi J, Kanakeshwar RB, Rajasekaran S. Multivertebral Kaposiform hemangioendothelioma presenting as scoliosis - A case report and review of literature. J Clin Orthop Trauma 2023; 39:102147. [PMID: 37021123 PMCID: PMC10068252 DOI: 10.1016/j.jcot.2023.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare, locally invasive vascular tumour of childhood that may occur in soft tissue or bones, and is associated with cutaneous plaques and Kasabach-Merritt phenomenon (KMP). We present an instance of a 9-year-old girl with primary vertebral involvement of KHE, whose clinical presentation was with painless, progressive scoliosis alone, sans cutaneous markers. We highlight the imaging features of this rare manifestation and importance of histopathological diagnosis for optimal management.
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Affiliation(s)
- Karthik Shyam
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Jayanthi Kamashi
- Department of Pathology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Raja Bhaskara Kanakeshwar
- Department of MSK Oncology, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopedics and Spine Surgery, Ganga Medical Center and Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
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Krishnan A, Raj A, Degulmadi D, Mayi S, Rai R, Bali SK, Parmar V, Amin PC, Krishnan P, Dave M, Dave B. Gorham-Stout disease: A multirod lumbar reconstruction with off-label suppression-remission therapy. Surg Neurol Int 2022; 13:136. [PMID: 35509593 PMCID: PMC9062908 DOI: 10.25259/sni_221_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gorham-Stout disease (GSD), a fibro-lymphovascular entity in which tissue replaces the bone leading to massive osteolysis and its sequelae, rarely leads to spinal deformity/instability and neurological deficits. Here, we report a 12-year-old female who was diagnosed and treated for GSD. CASE DESCRIPTION A 12-year-old female presented with back pain, and the inability to walk, sit, or stand attributed to three MR/CT documented L2-L4 lumbar vertebral collapses. Closed biopsies were negative. However, an open biopsy diagnosed GSD. She underwent a dorsal-lumbar-to-pelvis fusion (i.e., T5-T12 through L5/S1/S2) using multilevel pedicle screw/rod stabilization and human leukocyte antigens (HLAs) matched allograft (i.e. from her father). Postoperatively, she was treated with "off-label" teriparatide injections, bisphosphonates, and sirolimus. Four years later, while continuing the bisphosphonate therapy, she remained stable. CONCLUSION Surgical multirod stabilization from T5 to S2, supplemented with HLA compatible allograft, and multiple medical "off-label" therapies (i.e., teriparatide, sirolimus, and bisphosphonates) led to a good 4-year outcome in a 12-year-old female with GSD.
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Affiliation(s)
- Ajay Krishnan
- Corresponding author: Ajay Krishnan, Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
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Ferreiro L, Suárez-Antelo J, Rábade C, Abdulkader I, Bermúdez-Naveira A, Fernández-García A, Valdés L. Chylothorax as a debut form of Gorham-Stout disease. Pulmonology 2019; 25:195-197. [DOI: 10.1016/j.pulmoe.2019.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/20/2018] [Accepted: 01/31/2019] [Indexed: 11/17/2022] Open
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Du CZ, Li S, Xu L, Zhou QS, Zhu ZZ, Sun X, Qiu Y. Spinal Gorham-Stout syndrome: radiological changes and spinal deformities. Quant Imaging Med Surg 2019; 9:565-578. [PMID: 31143648 DOI: 10.21037/qims.2019.03.17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Gorham-Stout syndrome (GSS) involving the spine is a rare clinical entity, and there is a paucity of comprehensive study on its radiological features. We aimed to present the radiological changes and spinal deformities in patients with spinal GSS. Methods From January 2005 to December 2017, 11 consecutive GSS patients with spinal deformity were identified. Their medical records and imaging features were retrospectively reviewed. Computed tomography (CT) and magnetic resonance imaging (MRI) were used for a precise evaluation of spinal involvement. Posteroanterior and lateral standing radiographs were used to evaluate the spinal deformity. Results CT showed multi-level generalized osteolytic lesions, with ill-defined fluid attenuation adjacent to the osseous changes. MRI demonstrated hyperintense signals on both T1- and T2-weighted images, while the unaffected segments showed normal signal intensity. Seven patients (63.6%) had a dominant feature of kyphosis, and 4 (36.4%) had scoliosis when spinal GSS was diagnosed. Kyphosis variably spanned from C7 to L1, averaged 94° (range, 53° to 158°), and was associated with sagittal imbalance in 4 cases. In our series, the apex of kyphosis and scoliosis coincided within the most seriously osteolytic segment. All patients received medication for GSS. Two adolescents taking Boston braces showed a relatively stable deformity. Four patients received long posterior spinal fusion, but two had fusion failure. Conclusions CT and MRI investigations are important in the initial diagnosis and continued management for spinal GSS. A typical spinal deformity secondary to GSS presents as kyphosis or kyphoscoliosis, which is usually highly variable but highly concordant with osteolysis in terms of span and apex.
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Affiliation(s)
- Chang-Zhi Du
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Song Li
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Liang Xu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Qing-Shuang Zhou
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Xu Sun
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - Yong Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
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Kato H, Ozeki M, Fukao T, Matsuo M. MR imaging findings of vertebral involvement in Gorham–Stout disease, generalized lymphatic anomaly, and kaposiform lymphangiomatosis. Jpn J Radiol 2017; 35:606-612. [DOI: 10.1007/s11604-017-0674-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/01/2017] [Indexed: 01/29/2023]
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El-Kouba G, de Araújo Santos R, Pilluski PC, Severo A, Lech O. GORHAM-STOUT SYNDROME: PHANTOM BONE DISEASE. Rev Bras Ortop 2015; 45:618-22. [PMID: 27026974 PMCID: PMC4799205 DOI: 10.1016/s2255-4971(15)30313-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 10/18/2010] [Indexed: 11/06/2022] Open
Abstract
Gorham-Stout syndrome is a disease that presents idiopathic osteolysis of a bone or closely contiguous area. The etiology is unknown. It is a rare condition that is difficult to diagnose, and its treatment is controversial. It affects individuals irrespective of age or sex. In this study, we conducted a bibliographic review of the disease, specifically focusing on the differential diagnosis, and we demonstrated the follow-up on a patient with this syndrome from the time of its diagnosis, through treatment, to its current state of evolution.
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Affiliation(s)
- Gabriel El-Kouba
- Resident in the Shoulder and Elbow Surgery Service, Institute of Orthopedics and Traumatology, Passo Fundo, RS
| | - Romilton de Araújo Santos
- Resident in the Shoulder and Elbow Surgery Service, Institute of Orthopedics and Traumatology, Passo Fundo, RS
| | - Paulo César Pilluski
- Preceptor of the Medical Residence Service, Institute of Orthopedics and Traumatology, Passo Fundo, RS
| | - Antonio Severo
- Instructor in the Hand Surgery Service, Institute of Orthopedics and Traumatology, Passo Fundo, RS
| | - Osvandré Lech
- Head of the Medical Residence Service, Institute of Orthopedics and Traumatology, Passo Fundo, RS
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Ohla V, Bayoumi AB, Hefty M, Anderson M, Kasper EM. Complex single step skull reconstruction in Gorham's disease - a technical report and review of the literature. BMC Surg 2015; 15:24. [PMID: 25880917 PMCID: PMC4365769 DOI: 10.1186/s12893-015-0014-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/24/2015] [Indexed: 11/13/2022] Open
Abstract
Background Gorham’s disease is a rare osteolytic disorder characterized by progressive resorption of bone and replacement of osseous matrix by a proliferative non-neoplastic vascular or lymphatic tissue. A standardized treatment protocol has not yet been defined due to the unpredictable natural history of the disease and variable clinical presentations. No single treatment has proven to be superior in arresting the course of the disease. Trials have included surgery, radiation and medical therapies using drugs such as calcium salts, vitamin D supplements and hormones. We report on our advantageous experience in the management of this osteolyic disorder in a case when it affected only the skull vault. A brief review of pertinent literature about Gorham’s disease with skull involvement is provided. Case presentation A 25-year-old Caucasian male presented with a skull depression over the left fronto-temporal region. He noticed progressive enlargement of the skull defect associated with local pain and mild headache. Physical examination revealed a tender palpable depression of the fronto-temporal convexity. Conventional X-ray of the skull showed widespread loss of bone substance. Subsequent CT scans showed features of patchy erosions indicative of an underlying osteolysis. MRI also revealed marginal enhancement at the site of the defect. The patient was in need of a pathological diagnosis as well as complex reconstruction of the afflicted area. A density graded CT scan was done to determine the variable degrees of osteolysis and a custom made allograft was designed for cranioplasty preoperatively to allow for a single step excisional craniectomy with synchronous skull repair. Gorham’s disease was diagnosed based on histopathological examination. No neurological deficit or wound complications were reported postoperatively. Over a two-year follow up period, the patient had no evidence of local recurrence or other systemic involvement. Conclusions A single step excisional craniectomy and cranioplasty can be an effective treatment for patients with Gorham’s disease affecting the skull vault only. Preoperative planning by a density graded CT aids to design a synthetic bone flap and is beneficial in skull reconstruction. Systemic involvement is variable in this patient’s population.
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Affiliation(s)
- Victoria Ohla
- Department of Neurochirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Germany.,Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, LMOB Suite 3B, Boston, MA, 02215, USA
| | - Ahmed B Bayoumi
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, LMOB Suite 3B, Boston, MA, 02215, USA
| | - Markus Hefty
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Matthew Anderson
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, LMOB Suite 3B, Boston, MA, 02215, USA.
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Daneshvar Kakhaki A, Khodadad K, Pejhan S, Karimi S, Arab M, Saghebi R, Behgam Shadmehr M, Farzanegan R. Gorham's Disease With Chest Wall Involvement: A Case Report and a Review of the Literature. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e12180. [PMID: 25763205 PMCID: PMC4329932 DOI: 10.5812/ircmj.12180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 01/26/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022]
Abstract
Introduction: Gorham's disease is a rare disorder characterized by osteolysis and abnormal vascular growth within bones. Diagnosis of Gorham's disease is often delayed and for accurate and early diagnosis high clinical suspicion is crucial. No specific treatment is available. Management options include surgery, radiation therapy and medical therapy. We aimed to present the first case of Gorham’s disease with chest wall involvement in Iran. By review of the literature we discussed important issues of this rare disease including clinical findings, diagnosis and treatment options. Case Presentation: We present a 48-year-old man with a history of dyspnea following a blunt chest trauma who was admitted to our clinic several times due to reaccumulation of pleural fluid and chylothorax. Gorham's disease was finally established according to clinical manifestations and radiological findings including massive osteolysis in his left ribs and also histological examination. Discussion: According to review of the literature and considering all treatment modalities the patients was successfully treated with a combination of radiotherapy, pamidronate and thalidomide. We suggest that this disease should be considered among differential diagnoses of patients with chest pain, pleural effusion and/or chylothorax with an unknown reason and more importantly history of chest trauma. In suspected cases, it is essential to examine biopsy specimens of the bone adjacent to the inflammated tissues in order to confirm diagnosis.
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Affiliation(s)
- Abolghasem Daneshvar Kakhaki
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Kian Khodadad
- Chronic Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Saviz Pejhan
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Saviz Pejhan, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2127121000, Fax: +98-2126109484, E-mail:
| | - Shirin Karimi
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences Tehran, IR Iran
| | - Mehrdad Arab
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Reza Saghebi
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Behgam Shadmehr
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Roya Farzanegan
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Tavakoli Darestani R, Sharifzadeh A, Bagherian Lemraski M, Farhang Zanganeh R. A Rare Case of Gorham's Disease: Primary Ulnar Involvement with Secondary Spread to the Radius and Elbow. Trauma Mon 2013; 18:41-5. [PMID: 24350149 PMCID: PMC3860655 DOI: 10.5812/traumamon.9905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 02/12/2013] [Accepted: 03/17/2013] [Indexed: 11/20/2022] Open
Abstract
Introduction Gorham’s disease is a rare musculoskeletal disease which causes progressive osteolysis and is characterized by massive bone destruction due to proliferation of vascular elements along with a great number of osteoclasts. The etiology of the disease is unknown. Gorham’s disease is essentially rare in the forearm bones. As far as we know, only 2 cases of Gorham’s disease of the forearm have been reported with 1 of them in the radius and the other starting in the radius and spreading to the lower portion of the humerus. Case Presentation This case report shows that Gorham’s disease may affect the ulna primarily and spread to adjacent bones despite the fact that there are no such reports in the literature. Conclusions Gorham’s disease has several manifestations as primary bone involvement. As in this rare case the ulna may be affected first and then the disease may spread to adjacent bones. More studies are needed to better recognize the behavior of this rare disease.
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Affiliation(s)
- Reza Tavakoli Darestani
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Reza Tavakoli Darestani, Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel.: +98-2177558081, Fax: +98-2177557069, E-mail:
| | - Amir Sharifzadeh
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Ramin Farhang Zanganeh
- Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Zacharia B, Chundarathil J, Meethal KC, Ramakrishnan V, Krishnankutty RM, Veluthedath R, Puthezhath K, Korah P, Kovilakam RK. Gorham's disease of the fibula: a case report. J Foot Ankle Surg 2009; 48:347-52. [PMID: 19423035 DOI: 10.1053/j.jfas.2009.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2007] [Indexed: 02/03/2023]
Abstract
UNLABELLED Gorham's disease, or massive osteolysis, is a rare condition characterized by the spontaneous onset of osteolysis in an otherwise healthy individual. Such osteolysis is related to localized endothelial proliferation of lymphatic vessels (lymphangiomatous osteolysis) resulting in destruction and absorption of bone, and is commonly thought to affect primarily cancellous bone. In this article, we describe a case of Gorham's disease involving the fibula in a 13-year-old boy with a 2-year history of pain and a 1-year history of muscle atrophy. The patient was treated with analgesics and anti-inflammatory drugs, and a period of immobilization. At the 3-year follow-up visit, the patient was ambulating without restrictions, although he experienced occasional episodes of pain and swelling localized to the left ankle; and follow-up radiographs revealed no further progression of the disease. Current literature suggests that the fibula, being primarily cortical bone, is not likely to be affected by Gorham's disease and that fibular grafts may be used in the treatment of the disorder. However, since this case depicts the disorder localizing to the distal fibula, we believe further studies are needed to validate the usefulness of fibular grafts in the treatment of the condition. Because the course of the disease is unpredictable and may arrest spontaneously, and based on the results observed in the patient described in this article, conservative treatment may be appropriate for Gorham's disease localized to the distal fibula. LEVEL OF CLINICAL EVIDENCE 4.
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Atalabi OM, Fishman SJ, Kozakewich HP, Alsamarah AY, Alomari AI. A lethal form of Gorham disease associated with extensive musculoskeletal pneumatosis: case report and review of the literature. Skeletal Radiol 2008; 37:1041-6. [PMID: 18629462 DOI: 10.1007/s00256-008-0525-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 05/14/2008] [Accepted: 05/15/2008] [Indexed: 02/02/2023]
Abstract
We report here the imaging findings of a rare case of a lethal form of Gorham disease in a young female patient. Multimodality imaging findings over 13 year-follow-up demonstrated progressive wide spread skeletal and soft tissue abnormalities with permeative osteolysis, pathological fractures and severe skeletal deformities. Unusual extensive osseous and soft tissue pneumatosis was illustrated on cross-sectional studies. The progressive nature of this form of Gorham disease and the subsequent complications eventually culminated in patient's death.
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Affiliation(s)
- Omolola M Atalabi
- Department of Radiology, College of Medicine, University College Hospital, Ibadan, Ibadan, Oyo State, Nigeria
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Abstract
Gorham's-Stout disease is a rare but potentially debilitating disease consisting of massive bone osteolysis and bone resorption associated with vascular proliferation and increased osteoclastic activity. Although it can present in a wide variety of forms, it typically involves bones formed by intramembranous ossification such as the skull, pelvis, and scapula. It can occur spontaneously or after trauma. Most cases are monofocal and resolved spontaneously, although there are reports of multifocal and rapidly progressing disease. It typically presents as disuse muscle atrophy or pathologic fracture during the second through fourth decades of life, yet it has also been reported in childhood and in the elderly. The etiology of Gorham's disease remains to be fully elucidated. Gorham attributed the origin of the disease to uncontrolled proliferation of small vessels eating away bone tissue. Other authors attribute the cause of the disease to increased osteoclastic activity mediated by elevated cytokine levels and increased osteoclastic differentiation. Treatment is not established and focuses at stopping osteoclastic activity and angiogenic proliferation. Radiation therapy, chemotherapy, bone grafting, and antiresorptives medications have all been used with different degrees of success. In an effort to further characterize this elusive disease, we report on an unusual presentation of a patient with Gorham's disease of the radius spreading to the ulna and then the proximal humerus with a 13-year follow-up. To our knowledge this is the first report in the literature of a saltatory type of Gorham's disease spreading from bone to bone across a joint.
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Affiliation(s)
- Ivan F Rubel
- SUNY Downstate-Kings County Medical Center, Department of Orthopedic Surgery and Rehabilitation Medicine, 451 Clarkson Ave, Room C-3125, Brooklyn, NY 11203, USA
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15
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Affiliation(s)
- Jannette Collins
- Department of Radiology, University of Wisconsin Hospital and Clinics, E3/311 Clinical Science Center, Madison, 53792-3252, USA.
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Abstract
Gorham's disease is a rare disorder characterized by proliferation of vascular channels that results in destruction and resorption of osseous matrix. Since the initial description of the disease by Gorham and colleagues (1954) and by Gorham and Stout (1955), fifty years have elapsed but still the precise etiology of Gorham's disease remains poorly understood and largely unknown. There is no evidence of a malignant, neuropathic, or infectious component involved in the causation of this disorder. The mechanism of bone resorption is unclear. The clinical presentation of Gorham's disease is variable and depends on the site of involvement. It often takes many months or years before the offending lesion is correctly diagnosed. A high index of clinical suspicion is needed to arrive at an early, accurate diagnosis. Patients with Gorham's disease may complain of dull aching pain or insidious onset of progressive weakness. In some cases, pathologic fracture often leads to its discovery. Gorham's disease is progressive in most patients; however, in some cases, the disease process is self-limiting. The clinical course is generally protracted but rarely fatal, with eventual stabilization of the affected bone being the most common sequelae. Chylous pericardial and pleural effusions may occur due to mediastinal extension of the disease process from the involved vertebra, scapula, rib or sternum, and can be life threatening. A high morbidity and mortality is seen in patients with spinal and/or visceral involvement. The medical treatment for Gorham's disease includes radiation therapy, anti-osteoclastic medications (bisphosphonates), and alpha-2b interferon. Surgical treatment options include resection of the lesion and reconstruction using bone grafts and/or prostheses. In most cases, bone grafts tend to undergo resorption and are not helpful. Surgical reconstruction and/or radiation therapy are used for management of patients who have large, symptomatic lesions with long-standing, disabling functional instability. Surgical stabilization may be required for unstable spinal lesions. Various treatment options, including pleurectomy, pleurodesis, thoracic duct ligation, radiation therapy, interferon therapy, and bleomycin, have been used for management of patients with Gorham's disease presenting with chylothorax. In general, no single treatment modality has proven effective in arresting the disease.
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Affiliation(s)
- Dipak V Patel
- Department of Orthopaedic Surgery, Department of Veterans Affairs, New Jersey Healthcare System, East Orange, NJ 07018-1095, USA.
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Stefanidou M, Ioannidou D, Panayotides J, Tosca A. Cutaneous vascular malformation associated with osteolysis or Gorham's sign. Int J Dermatol 2004; 43:958-61. [PMID: 15569032 DOI: 10.1111/j.1365-4632.2004.01985.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M Stefanidou
- Department of Dermatology, Heraklion University General Hospital, Heraklion, Crete, Greece.
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Khosrovi H, Ortiz O, Kaufman HH, Schochet SS, Reddy GN, Simmons D. Massive osteolysis of the skull and upper cervical spine. Case report and review of the literature. J Neurosurg 1997; 87:773-80. [PMID: 9347990 DOI: 10.3171/jns.1997.87.5.0773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Massive osteolysis is a type of idiopathic osteolysis in which there is spontaneous onset of bone resorption. Almost any bone in the body can be affected. The authors present the case of a 62-year-old man diagnosed with massive osteolysis of the occipital bone and the upper two cervical vertebrae. Despite extensive pneumocephalus, no neurological sign or spinal instability was evident. In this case 4000 cGy of radiation in 200-cGy fractions was administered to the diseased area while the patient was kept in a Miami-J collar. At the 2-year follow-up examination, arrest of the disease process and new bone formation was evident on radiographic studies.
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Affiliation(s)
- H Khosrovi
- Department of Neurosurgery, West Virginia University, Morgantown 26506, USA
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