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Owhonda RA, Wells JE, Lloyd EW, Mumm S, Kimonis V. A Case Report of a 44-Year-Old Woman With Camurati-Englemann Disease: A Case Report. JBJS Case Connect 2020; 10:e19.00400. [PMID: 32668141 DOI: 10.2106/jbjs.cc.19.00400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 44-year-old woman presented with easy fatigability, diplopia, dizziness, and a 2-year history of pelvic, hip, and lower extremity aching and pain. Radiograph, magnetic resonance imaging, computed tomography, and histopathologic imaging studies were obtained. Hypersclerosis of the affected bones led to the initiation of a sclerotic bone dysplasia workup and sequencing of the transforming growth factor beta 1 gene located on chromosome 19q13 revealed a heterozygous rare missense variant in exon-4, leading to a final diagnosis of Camurati-Engelmann disease (CED). Medical treatment thus far has had a minimal effect on her symptoms, and the patient continues to be followed. CONCLUSIONS This specific mutation has been reported only once previously in a patient with CED. This case report expands the typical phenotype associated with CED in association with the c.667T>C, p.Cys223Arg variant.
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Affiliation(s)
- Rebisi A Owhonda
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas
| | - Joel E Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas
| | - Eric W Lloyd
- Boca Raton Orthopedics Group, Boca Raton, Florida
| | - Steven Mumm
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital and Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children-St. Louis, St. Louis, Missouri
| | - Virginia Kimonis
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California
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2
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Kim YM, Kang E, Choi JH, Kim GH, Yoo HW, Lee BH. Clinical characteristics and treatment outcomes in Camurati-Engelmann disease: A case series. Medicine (Baltimore) 2018; 97:e0309. [PMID: 29620655 PMCID: PMC5902284 DOI: 10.1097/md.0000000000010309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Camurati-Engelmann disease is an extremely rare disease characterized by hyperostosis of multiple long bones. This condition is caused by heterozygous mutations in the TGFB1 gene. METHODS We describe the clinical and genetic characteristics of 4 Korean patients with this rare disease diagnosed at Asan Medical Center in Korea between June 2012 and May 2016, to increase awareness about this condition among general physicians and orthopedists. The presenting features, biochemical findings, radiographic and nuclear imaging findings, molecular analysis, and treatment outcomes of 4 patients were reviewed retrospectively. RESULTS Two patients had sporadic disease, whereas the other 2 were familial cases. The average age at symptom onset was 8.8 ± 5.5 (4-14) years. Symptoms included waddling gait or leg pain. Bone pain and easy fatigability were documented in all patients. Skeletal deformities such as osteoporosis, genu valgum, and severe scoliosis were observed. Visual and otologic manifestations presenting as exophthalmos, retinal detachment, and vestibulopathy were found in 3 patients. Skeletal survey showed diaphyseal expansion with diffuse cortical thickening of long bones in all patients. Bone scintigraphy images showed increased uptake of radioactive material in the calvarium and diaphysis of long bones. The mean erythrocyte sedimentation rate was 46.5 ± 22.2 (20-72) mm/h. Sequence analysis of TGFB1 revealed the previously reported mutations p.Arg218His, p.Arg218Cys, and p.Glu169Lys. Corticosteroid was effective in relieving pain, and losartan was used as maintenance therapy. CONCLUSIONS Our experience suggests that this rare condition can be suspected in patients with characteristic symptoms and skeletal findings. Considering the presence of effective medical treatment, efforts are needed to identify more cases.
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Affiliation(s)
| | | | | | - Gu-Hwan Kim
- Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
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3
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Baroncelli GI, Ferretti E, Pini CM, Toschi B, Consolini R, Bertelloni S. Significant Improvement of Clinical Symptoms, Bone Lesions, and Bone Turnover after Long-Term Zoledronic Acid Treatment in Patients with a Severe Form of Camurati-Engelmann Disease. Mol Syndromol 2017; 8:294-302. [PMID: 29230158 DOI: 10.1159/000479859] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 11/19/2022] Open
Abstract
Camurati-Engelmann disease (CED) is an ultrarare autosomal dominant bone dysplasia. Cortical thickening of the diaphyses of the long bones with narrowing of the medullary cavity are associated with bone pain, waddling gait, muscular weakness, easy fatigability, and a marfanoid body habitus. There is no specific treatment for CED. Nonsteroidal anti-inflammatory drugs or glucocorticoids are ineffective in improving bone lesions. A family with a mild to severe form of CED is described. Two patients received long-term bisphosphonate treatment: the 19-year-old female proband was treated with zoledronic acid for 2.2 years; the 4-year-old male proband was treated with neridronic acid for 16 months and with zoledronic acid for an additional 18 months. In both probands, zoledronic acid treatment significantly improved the clinical symptoms, bone lesions, ambulation, and body habitus. Before treatment, both probands showed a marked increase in serum levels of osteocalcin, procollagen type I N-terminal propeptide, and cross-linked carboxyterminal telopeptide of type I collagen, reflecting an increased bone turnover. Bone marker levels returned to their normal values during treatment. Zoledronic acid treatment may be an important therapeutic option in patients with severe CED. Biochemical markers of bone turnover could be considered as surrogate indexes of CED activity.
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Affiliation(s)
- Giampiero I Baroncelli
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Elena Ferretti
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Cecilia M Pini
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Benedetta Toschi
- Laboratory of Molecular Genetics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Rita Consolini
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Silvano Bertelloni
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
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4
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Fyrgiola M, Lianou V, Katoumas K, Dimopoulos I. A Rare Sporadic Case of Camurati-Engelmann Disease With Jaw Involvement. J Oral Maxillofac Surg 2017; 75:2385-2390. [PMID: 28499806 DOI: 10.1016/j.joms.2017.03.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 11/27/2022]
Abstract
Camurati-Engelmann disease (CED), or progressive diaphyseal dysplasia, is an uncommon bone dysplasia that is inherited in an autosomal-dominant pattern. The disease mainly affects the diaphyses of the long bones but can induce sclerotic changes to the facial skeleton and skull base. The diagnosis of CED is based on clinical and radiologic features. This article presents the clinical and radiologic characteristics of the jaws as visualized on cone-beam computed tomograms of a 46-year-old woman diagnosed with CED.
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Affiliation(s)
- Maria Fyrgiola
- Resident, Department of Oral and Maxillofacial Surgery, Georgios Gennimatas General Hospital, Athens, Greece.
| | - Violetta Lianou
- Senior Registrar, Department of Oral and Maxillofacial Surgery, Georgios Gennimatas General Hospital, Athens, Greece
| | - Konstantinos Katoumas
- Resident, Department of Oral and Maxillofacial Surgery, Georgios Gennimatas General Hospital, Athens, Greece
| | - Ioannis Dimopoulos
- Head, Department of Oral and Maxillofacial Surgery, Georgios Gennimatas General Hospital, Athens, Greece
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5
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Zhang LL, Jiang WM, Yang HL, Luo ZP. Treatment of Ribbing disease with 5-year follow-up and literature review. Osteoporos Int 2017; 28:1499-1502. [PMID: 28101629 DOI: 10.1007/s00198-016-3896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
Ribbing disease, or multiple diaphyseal sclerosis, is a rare diaphyseal sclerosis of unknown etiology. Patients with this pathology usually present with asymmetric pain limited to the lower extremities. Though all efforts are made to relieve the progressive pain associated with Ribbing disease, no medical or surgical treatments have been established yet. In this case report, we followed up a Ribbing case with sclerotic bone fenestration for 5 years. The radiological changes and the clinical effects are described, and the different Ribbing treatments are then briefly reviewed.
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Affiliation(s)
- L L Zhang
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, 708 Renmin Rd, Suzhou, Jiangsu, 215007, People's Republic of China
| | - W M Jiang
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, 708 Renmin Rd, Suzhou, Jiangsu, 215007, People's Republic of China
| | - H L Yang
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, 708 Renmin Rd, Suzhou, Jiangsu, 215007, People's Republic of China
| | - Z-P Luo
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, 708 Renmin Rd, Suzhou, Jiangsu, 215007, People's Republic of China.
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6
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Chen Y, Xie W, Hu F, Chen J, Zheng H, Zhou H, Ni B, Li W, Zhou J. Clinical diagnosis and mutation analysis of a Chinese family with Camurati-Engelmann disease. Mol Med Rep 2016; 15:235-239. [PMID: 27959412 PMCID: PMC5355693 DOI: 10.3892/mmr.2016.6024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/04/2016] [Indexed: 11/05/2022] Open
Abstract
Camurati-Engelmann disease (CED) is a rare autosomal dominant bone disorder caused by a mutation in transforming growth factor β1 (TGFβ1). The present study aimed to identify a Chinese family with suspected CED based on the clinical symptoms, including pain in extremities, waddling gait, muscle weakness, cortical thickening of the diaphysis of the long bones, and sclerosis of the skull, facial bone, and pelvis. Molecular analysis revealed the presence of the p.Glu169Lys (E169K) mutation in exon 2 of TGFβ1 in patients when compared with the controls. Therefore, the Chinese family was diagnosed with CED due to the presence of the E169K mutation. The present study emphasized the importance of clinical and genetic evidence for the diagnosis of CED. The data presented in the present study are of significance to clinicians, as well as genetic counselors, in the prenatal screening of CED.
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Affiliation(s)
- Yong Chen
- Key Laboratory of Genetics and Birth Health of Hunan Province, Family Planning Research Institute of Hunan, Changsha, Hunan 410126, P.R. China
| | - Wanqin Xie
- Key Laboratory of Genetics and Birth Health of Hunan Province, Family Planning Research Institute of Hunan, Changsha, Hunan 410126, P.R. China
| | - Feng Hu
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Jia Chen
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Hexin Zheng
- Key Laboratory of Genetics and Birth Health of Hunan Province, Family Planning Research Institute of Hunan, Changsha, Hunan 410126, P.R. China
| | - Haiyan Zhou
- Key Laboratory of Genetics and Birth Health of Hunan Province, Family Planning Research Institute of Hunan, Changsha, Hunan 410126, P.R. China
| | - Bin Ni
- Key Laboratory of Genetics and Birth Health of Hunan Province, Family Planning Research Institute of Hunan, Changsha, Hunan 410126, P.R. China
| | - Wanmeng Li
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Jianda Zhou
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
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7
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Puranik AD, Singh N, Maheshwari S, Gupta N, Wali P. Intramedullary osteosclerosis of right femur confirmed on triphasic bone SPECT/CT in a patient with equivocal radiological features. Indian J Nucl Med 2016; 31:39-41. [PMID: 26917893 PMCID: PMC4746840 DOI: 10.4103/0972-3919.172357] [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] [Indexed: 11/04/2022] Open
Abstract
Sclerotic bone dysplasias are diagnosed based on clinical and radiological features; however, in some instances pose a dilemma. We herewith report a case of a 38-year-old female who presented with right lower extremity pain, and was detected to have sclerotic diaphyseal lesion on X-ray. Triphasic 99mTc methylene diphosphonate (MDP) Bone scan helped in confirming the diagnosis of intramedullary osteosclerosis, a dysplastic bone disorder.
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Affiliation(s)
- Ameya D Puranik
- Department of Nuclear Medicine and PET Imaging, P.D. Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Natasha Singh
- Department of Nuclear Medicine and PET Imaging, P.D. Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Shailendra Maheshwari
- Department of Radiology, P.D. Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Nitin Gupta
- Department of Nuclear Medicine and PET Imaging, P.D. Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Pravin Wali
- Department of Radiology, P.D. Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India
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8
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Boulet C, Madani H, Lenchik L, Vanhoenacker F, Amalnath DS, de Mey J, De Maeseneer M. Sclerosing bone dysplasias: genetic, clinical and radiology update of hereditary and non-hereditary disorders. Br J Radiol 2016; 89:20150349. [PMID: 26898950 DOI: 10.1259/bjr.20150349] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
There is a wide variety of hereditary and non-hereditary bone dysplasias, many with unique radiographic findings. Hereditary bony dysplasias include osteopoikilosis, osteopathia striata, osteopetrosis, progressive diaphyseal dysplasia, hereditary multiple diaphyseal sclerosis and pyknodysostosis. Non-hereditary dysplasias include melorheostosis, intramedullary osteosclerosis and overlap syndromes. Although many of these dysplasias are uncommon, radiologists should be familiar with their genetic, clinical and imaging findings to allow for differentiation from acquired causes of bony sclerosis. We present an overview of hereditary and non-hereditary bony dysplasias with focus on the pathogenesis, clinical and radiographic findings of each disorder.
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Affiliation(s)
- Cedric Boulet
- 1 Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Hardi Madani
- 2 Department of Radiology, Royal Free Hospital, London, UK
| | - Leon Lenchik
- 3 Department of Radiology, Wake Forest University, Winston Salem, NC, USA
| | - Filip Vanhoenacker
- 4 Department of Radiology, Universitair Ziekenhuis Anwerpen, Antwerpen, Belgium
| | - Deepak S Amalnath
- 5 Department of Medicine, Indira Gandhi Medical College and Research Institute, Pondicherry, India
| | - Johan de Mey
- 1 Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Michel De Maeseneer
- 1 Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
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9
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Touraine S, Parlier-Cuau C, Bousson V, Sverzut JM, Genah I, Petrover D, Laredo JD. Tibial hyperostosis: a diagnostic approach. Eur J Radiol 2013; 82:2286-95. [PMID: 24041433 DOI: 10.1016/j.ejrad.2013.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/25/2013] [Accepted: 08/05/2013] [Indexed: 11/25/2022]
Abstract
Tibial hyperostosis may be encountered in musculoskeletal imaging, incidentally or during the investigation of a leg pain. Hyperostosis involves the exuberant production of osseous tissue and results in cortical, periosteal and/or endosteal thickening of the bone. As a long bone with thick cortices, the tibia has a significant probability of being affected by ubiquitous bone diseases. As a tubular long bone, the tibia is likely to be involved in extensive infectious conditions such as osteomyelitis. As a bone of the lower limb, the tibia undergoes high stresses and may be affected by decrease in bone strength or repetitive submaximal stress. The tibia is also particularly involved in some bone sclerosing dysplasias and Paget's disease. In this work, we aim at highlighting the main conditions leading to tibial hyperostosis and try to provide key elements to narrow down the several diagnostic possibilities. Osteoid osteomas, fatigue or insufficiency fractures, infectious conditions, vascular lesions, sclerosing bone dysplasias and Paget's disease represent the main challenging diagnoses to discuss.
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Affiliation(s)
- Sébastien Touraine
- Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
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10
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Meczekalski B, Czyzyk A, Podfigurna-Stopa A, Rydzewski B, Sroczynski J, Lipinska M, Sokalski J, Krawczynski M, Jamsheer A, Katulski K, Genazzani A. Hypothalamic amenorrhea in a Camurati-Engelmann disease--a case report. Gynecol Endocrinol 2013; 29:511-4. [PMID: 23368730 DOI: 10.3109/09513590.2012.760196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE A case report of a patient diagnosed with Camurati-Engelmann Disease (CED) in association with the functional hypothalamic amenorrhea disturbances. CED is a very rare genetically determined disorder classified as a type of bone dysplasia. DESIGN Case report. SETTING Department of Gynecological Endocrinology, 3rd grade Medical University Hospital. PATIENT Twenty-one years old female patient with CED admitted to the hospital because of primary amenorrhea. Her history revealed skeletal deformities and hearing impairment. METHODS Clinical examination, ultrasound, laboratory evaluations (including serum gonadotropins (FSH, LH) at basal state and after stimulation with gonadotropin-releasing hormone, serum basal estradiol) radiological studies (X-ray of the head, the lumbar spine and lower extremities; a computed tomography of the head), G-banding karyotype, polymerase chain reaction and DNA sequencing. Hormonal serum evaluations were made using an enzyme-linked immunosorbent assay. The exon 4 of the transforming growth factor beta 1 gene was amplified by a polymerase chain reaction and the product was directly sequenced. RESULTS The hormonal analysis was characteristic for the hypogonadotropic hypogonadism. Radiological and molecular analyses confirmed CED diagnosis. CONCLUSIONS The hypothalamic amenorrhea in a patient with CED may be explained as a consequence of fat hypotrophy and very low body mass index. Therefore, impairment within hypothalamic-pituitary axis in patients with CED should be treated with special attention.
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Affiliation(s)
- Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland.
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11
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Meyer S, Gortner L, Varon R, Ziegler K, Kutschke G, Larsen A. A 17-year-old adolescent with anorexia and gait abnormalities: Camurati-Engelmann syndrome. Acta Paediatr 2012; 101:e387-8. [PMID: 22712665 DOI: 10.1111/j.1651-2227.2012.02749.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Fritz J, Fishman EK, Carrino JA, Horger MS. Advanced imaging of skeletal manifestations of systemic mastocytosis. Skeletal Radiol 2012; 41:887-97. [PMID: 22366736 DOI: 10.1007/s00256-012-1374-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/26/2012] [Accepted: 01/27/2012] [Indexed: 02/02/2023]
Abstract
Systemic mastocytosis comprises a group of clonal disorders of the mast cell that most commonly involves the skeletal system. Imaging can be helpful in the detection and characterization of the osseous manifestations of this disease. While radiography and bone scans are frequently used for this assessment, low-dose multidetector computed tomography and magnetic resonance imaging can be more sensitive for the detection of marrow involvement and for the demonstration of the various disease patterns. In this article, we review the pathophysiological and clinical features of systemic mastocytosis, discuss the role of imaging for staging and management, and illustrate the various cross-sectional imaging appearances. Awareness and knowledge of the imaging features of this disorder will increase the accuracy of image interpretation and can contribute important information for management decisions.
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Affiliation(s)
- J Fritz
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA.
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13
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Whyte MP, Wenkert D, McAlister WH, Novack DV, Nenninger AR, Zhang X, Huskey M, Mumm S. Dysosteosclerosis presents as an "osteoclast-poor" form of osteopetrosis: comprehensive investigation of a 3-year-old girl and literature review. J Bone Miner Res 2010; 25:2527-39. [PMID: 20499338 PMCID: PMC3179286 DOI: 10.1002/jbmr.131] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/12/2010] [Accepted: 05/05/2010] [Indexed: 12/03/2022]
Abstract
Dysosteosclerosis (DSS), an extremely rare dense bone disease, features short stature and fractures and sometimes optic atrophy, cranial nerve palsy, developmental delay, and failure of tooth eruption in infancy or early childhood consistent with osteopetrosis (OPT). Bone histology during childhood shows unresorbed primary spongiosa from deficient osteoclast action. Additionally, there is remarkable progressive flattening of all vertebrae and, by adolescence, paradoxical metaphyseal osteopenia with thin cortical bone. Reports of consanguinity indicate autosomal recessive inheritance, yet more affected males than females suggest X-linked recessive inheritance. We investigated a nonconsanguineous girl with DSS. Osteosclerosis was discovered at age 7 months. Our studies, spanning ages 11 to 44 months, showed weight at approximately 50th percentile, and length diminishing from approximately 30th percentile to -2.3 SD. Head circumference was +4 SD. The patient had frontal bossing, blue sclera, normal teeth, genu valgum, and unremarkable joints. Radiographs showed orbital and facial sclerosis, basilar thickening, bone-in-bone appearance of the pelvis, sclerotic long bone ends, and fractures of ribs and extremities. Progressive metaphyseal widening occurred as vertebrae changed from ovoid to flattened and became beaked anteriorly. A hemogram was normal. Consistent with OPT, serum parathyroid hormone (PTH) concentrations reflected dietary calcium levels. Serum bone alkaline phosphatase, osteocalcin, and TRACP-5b were subnormal. The iliac crest contained excessive primary spongiosa and no osteoclasts. No mutations were identified in the splice sites or exons for the genes encoding chloride channel 7, T-cell immune regulator 1, OPT-associated transmembrane protein 1, and monocyte colony-stimulating factor (M-CSF) and its receptor C-FMS, ANKH, OPG, RANK, and RANKL. Genomic copy-number microarray was unrevealing. Hence, DSS is a distinctive OPT of unknown etiology featuring osteoclast deficiency during early childhood. How osteopenia follows is an enigma of human skeletal pathobiology.
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Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St Louis, MO 63131, USA.
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