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Li XM, Chen ZH, Wang KY, Chen JN, Yao ZN, Yao YH, Zhou XW, Lin N. Mazabraud's syndrome in female patients: Two case reports. World J Orthop 2024; 15:593-601. [PMID: 38947265 PMCID: PMC11212541 DOI: 10.5312/wjo.v15.i6.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Mazabraud's syndrome (MS) is a rare and slowly progressive benign disease characterized by the concurrent presence of fibrous dysplasia of bone and intramuscular myxoma, and is thought to be associated with mutations of the GNAS gene. To date, only about 100 cases of MS have been reported in the literature, but its standard treatment strategy remains unclear. CASE SUMMARY We report two cases of MS in young women who underwent different treatments based on their symptoms and disease manifestations. The first patient, aged 37, received internal fixation and intravenous bisphosphonate for a pathological fracture of the right femoral neck, excision of a right vastus medialis myxoma was subsequently performed for pain control, and asymptomatic psoas myxomas were monitored without surgery. Genetic testing confirmed a GNAS gene mutation in this patient. The second patient, aged 24, underwent right vastus intermedius muscle myxoma resection, and conservative treatment for fibrous dysplasia of the ilium. These patients were followed-up for 17 months and 3 years, respectively, and are now in a stable condition. CONCLUSION Various treatments have been selected for MS patients who suffer different symptoms. The main treatment for myxomas is surgical resection, while fibrous dysplasia is selectively treated if the patient experiences pathological fracture or severe pain. However, given the documented instances of malignant transformation of fibrous dysplasia in individuals with MS, close follow-up is necessary.
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Affiliation(s)
- Xiu-Mao Li
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Orthopedics Research Institute, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, Zhejiang Province, China
| | - Ze-Hao Chen
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Orthopedics Research Institute, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Ke-Yi Wang
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Orthopedics Research Institute, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Jun-Nan Chen
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Songyang Branch of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Lishui 331124, Zhejiang Province, China
| | - Zhao-Nong Yao
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Yu-Hong Yao
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Wei Zhou
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Nong Lin
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Kašpar L, Balko J, Strnadová M, Krsková L, Máška D, Zámečník J. Mazabraud's syndrome: A case report supported by molecular studies and review of the literature. Bone Rep 2023; 18:101685. [PMID: 37250204 PMCID: PMC10220459 DOI: 10.1016/j.bonr.2023.101685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
Mazabraud's syndrome represents rare benign disorder characterized by simultaneous occurrence of fibrous dysplasia of bone and intramuscular myxomas within surrounding soft tissue. Mutations of GNAS1 gene were proven to be causative for this condition. Here, we present a case report of a patient with unusual manifestation of this disease, who developed a pathological fracture of the femur in the setting of monostotic fibrous dysplasia. The intramuscular myxoma of the thigh was discovered during the following orthopedic operation, where the intraoperative diagnosis became a pitfall of the case, as the intramuscular myxoma was initially diagnosed as a low-grade sarcoma from the frozen section. Apart from clinical findings, the diagnosis of Mazabraud's syndrome was further proven by histopathological evaluation and molecular studies of GNAS1 gene. This case raises awareness of such condition as it can easily become a diagnostic pitfall.
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Affiliation(s)
- Ludvík Kašpar
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Jan Balko
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Martina Strnadová
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Lenka Krsková
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - David Máška
- Department of Adult and Pediatric Orthopaedic Surgery and Traumatology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Josef Zámečník
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
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Hagelstein-Rotman M, Appelman-Dijkstra NM, Boyce AM, Chapurlat R, Dur NBJ, Gensburger D, Majoor BCJ, van de Sande MAJ, Dijkstra PDS. Extent of Extraskeletal Manifestations of Fibrous Dysplasia/McCune-Albright Syndrome in Patients with Mazabraud's Syndrome. Calcif Tissue Int 2022; 110:334-340. [PMID: 34854944 DOI: 10.1007/s00223-021-00918-0] [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: 07/03/2021] [Accepted: 09/20/2021] [Indexed: 11/27/2022]
Abstract
Mazabraud's syndrome (MZB) is a rare condition in which fibrous dysplasia of bone/the McCune-Albright syndrome (FD/MAS) co-exists with intramuscular myxomas. Both FD and the myxomas harbor the GNAS-mutation. Recent studies have shown that extraskeletal, GNAS-related features are associated with a more severe phenotype of FD/MAS. However, patients with MZB are often only seen by orthopedic surgeons. We therefore evaluated MZB patients seen in tertiary referral centers from the Netherlands (LUMC), USA (National Institutes of Health) and France (INSERM UMR 1033 (Lyos), Hôpital Edouard Herriot). All FD/MAS patients known in these centers with an additional diagnosis of a myxoma were included. Demographic information and data on disease extent and extraskeletal manifestations of FD/MAS such as precocious puberty (PP) or café-au-lait patches (CAL) were retrieved from patient's medical records. Thirty MZB patients were included: 20 women (67%) and 10 men (33%). Patients received a diagnosis of MZB (median 42 years, range 16-19) significantly later than the diagnosis of FD/MAS (median 30 years, range 0-60), p < 0.01. Twenty-six patients were diagnosed with polyostotic disease (87%). In 97% the myxoma was located near the skeletal FD lesion. The combination of MZB and MAS was made in 13 patients in whom PP (n = 7), CAL (n = 7), GH-excess (n = 3) and hyperthyroidism (n = 3) were present. Other extraskeletal features were (multinodular) goiter (n = 2) and thyroid cysts (n = 1). Furthermore, in this cohort of patients with MZB several (pre-)malignant tumors were observed; ductal carcinoma in situ of the breast in 3 patients (10%), breast cancer in 1 patient (3.3%), intra pancreatic mucinous neoplasms in 3 patients (10%) and liver adenomas in 2 patients (6.6%). A total of 47% of patients with MZB had an additional extraskeletal feature such as an endocrinopathy. In MZB, 87% of patients suffer from polyostotic FD, 43% of patients have extraskeletal GNAS-features such as an hyperfunctioning endocrinopathy and 30% (pre-)malignant tumors. We therefore advocate that MZB patients should undergo a complete screening and long-term follow-up for extent of bone disease, but also extraskeletal GNAS features of FD/MAS.
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Affiliation(s)
- M Hagelstein-Rotman
- Department of Medicine: Division of Endocrinology, Centre for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands.
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - N M Appelman-Dijkstra
- Department of Medicine: Division of Endocrinology, Centre for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| | - A M Boyce
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - R Chapurlat
- UMR 1033, INSERM, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - N B J Dur
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - D Gensburger
- UMR 1033, INSERM, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - B C J Majoor
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - M A J van de Sande
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - P D S Dijkstra
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
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Majoor BCJ, van de Sande MAJ, Appelman-Dijkstra NM, Leithner A, Jutte PC, Vélez R, Perlaky T, Staals EL, Bovée JVMG, Hamdy NAT, Dijkstra SPD. Prevalence and Clinical Features of Mazabraud Syndrome: A Multicenter European Study. J Bone Joint Surg Am 2019; 101:160-168. [PMID: 30653046 DOI: 10.2106/jbjs.18.00062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mazabraud syndrome is a rare disorder, characterized by the presence of fibrous dysplasia (FD) with associated intramuscular myxomas. Data are scarce on the prevalence, clinical features, and natural history of this disorder and outcomes. In this multicenter study, we evaluated a series of patients from 6 European centers. METHODS All centers affiliated with the European Musculo-Skeletal Oncology Society (EMSOS) were invited to include data on all patients with Mazabraud syndrome who were seen between 1980 and 2015. The study investigated the prevalence of Mazabraud syndrome, the type, severity, and localization of FD lesions in relation to myxomas, the histopathology of myxomas, and results of GNAS-mutation analysis, when available. RESULTS Thirty-two patients (22 female) from 6 centers were included. The prevalence of Mazabraud syndrome was 2.2% in the combined cohort of 1,446 patients with FD, and the syndrome was diagnosed at a mean of 10.1 years after diagnosis of FD. The myxomas were predominantly localized in the upper leg. Excision was performed in 20 patients, recurrence occurred in 6 of these patients (30%) at a median of 8.5 years (range, 1.9 to 16.0 years), and revision surgery was necessary in 5 (25%). High cellularity of myxomas was associated with recurrence (p < 0.05). A GNAS mutation was identified in the myxoma tissue of 5 (83%) of 6 patients with GNAS-mutation analysis. CONCLUSIONS This study is the first, to our knowledge, to provide data on the prevalence of Mazabraud syndrome in a relatively large cohort. Although the outcomes of surgical resection were good, a quarter of the patients required revision surgery despite clear resection margins. High cellularity of myxomas was associated with recurrence. GNAS mutations were identified in 83% (5 of 6), emphasizing the shared origin of FD and myxomas. Our data show that patients with FD who have disproportionate complaints, irrespective of FD type, extent, or severity, should be investigated for the possible presence of myxomas. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bas C J Majoor
- Department of Orthopaedic Surgery (B.C.J.M., M.A.J.v.d.S., and S.P.D.D.), Endocrinology Division, Department of Medicine (N.M.A.-D. and N.A.T.H.), and Department of Pathology (J.V.M.G.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - Michiel A J van de Sande
- Department of Orthopaedic Surgery (B.C.J.M., M.A.J.v.d.S., and S.P.D.D.), Endocrinology Division, Department of Medicine (N.M.A.-D. and N.A.T.H.), and Department of Pathology (J.V.M.G.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - Natasha M Appelman-Dijkstra
- Department of Orthopaedic Surgery (B.C.J.M., M.A.J.v.d.S., and S.P.D.D.), Endocrinology Division, Department of Medicine (N.M.A.-D. and N.A.T.H.), and Department of Pathology (J.V.M.G.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - Andreas Leithner
- Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Roberto Vélez
- Department of Orthopaedic Surgery, Hospital Universitario Vall d'Hebron and Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Tamás Perlaky
- Department of Orthopaedic Surgery, Semmelweis University of Budapest, Budapest, Hungary
| | - Eric L Staals
- Department of Orthopaedic Surgery, Orthopaedic Institute Rizzoli, Bologna, Italy
| | - Judith V M G Bovée
- Department of Orthopaedic Surgery (B.C.J.M., M.A.J.v.d.S., and S.P.D.D.), Endocrinology Division, Department of Medicine (N.M.A.-D. and N.A.T.H.), and Department of Pathology (J.V.M.G.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - Neveen A T Hamdy
- Department of Orthopaedic Surgery (B.C.J.M., M.A.J.v.d.S., and S.P.D.D.), Endocrinology Division, Department of Medicine (N.M.A.-D. and N.A.T.H.), and Department of Pathology (J.V.M.G.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - Sander P D Dijkstra
- Department of Orthopaedic Surgery (B.C.J.M., M.A.J.v.d.S., and S.P.D.D.), Endocrinology Division, Department of Medicine (N.M.A.-D. and N.A.T.H.), and Department of Pathology (J.V.M.G.B.), Leiden University Medical Center, Leiden, the Netherlands
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Vescini F, Falchetti A, Tonelli V, Carpentieri M, Cipri C, Cosso R, Kara E, Triggiani V, Grimaldi F. Mazabraud's Syndrome: A Case Report and Up-To-Date Literature Review. Endocr Metab Immune Disord Drug Targets 2018; 19:885-893. [PMID: 30585553 DOI: 10.2174/1871530319666181226103700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Mazabraud's syndrome is a rare form of bone fibrous dysplasia associated with intramuscular myxomas. Fibrous dysplasia, is generally localized to pelvis and femur and it results in a fragile bone with deformities, pain, pathological fractures and functional impairment. Intramuscular myxomas, are rare benign mesenchymal neoplasms that exceptionally may evolve to malignant forms. METHODS This case report describes a 66-year-old woman with Mazabraud's Syndrome (MS), characterized both by monostotic right femur fibrous dysplasia and by a solitary intramuscular myxoma at the right quadriceps muscle, that underwent a long-term treatment (4 years) with intravenous zoledronic acid. RESULTS Zoledronic acid therapy rapidly lowered bone pain together with a reduction of intramuscular myxoma volume, but did not affect the extension of fibrous dysplasia. No adverse effects have been observed during treatment. CONCLUSION Highly active bisphosphonates are commonly used for the treatment of bone metabolic disorders and they are generally well tolerated. Zoledronic acid may represent a promising alternative to surgical intervention in MS, although its use in rare form of bone fibrous dysplasias is still controversial.
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Affiliation(s)
- Fabio Vescini
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Alberto Falchetti
- Villalba Clinic, Villa Maria Group, 40120 Bologna, Italy.,EndOsmet, Villa Donatello Private Hospital, 50100 Florence, Italy
| | - Veronica Tonelli
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Maria Carpentieri
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Claudia Cipri
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Roberta Cosso
- EndOsmet, Villa Donatello Private Hospital, 50100 Florence, Italy
| | - Elda Kara
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, 70100 Bari, Italy
| | - Franco Grimaldi
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy
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