1
|
Evsyukov A, Kosimshoev M, Kubetskyi Y, Nikitenko E, Rzaev J. Surgical treatment of a patient with Gorham-Stout disease of craniovertebral junction: case report and literature review. Br J Neurosurg 2024; 38:972-977. [PMID: 34585642 DOI: 10.1080/02688697.2021.1981244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
The paper discusses a case of a 58-year-old male suffering from a destructive process affecting the cranial bone and craniovertebral junction. A pathological fracture of the axial vertebrae led to a progressing atlantoaxial dislocation combined with pain syndrome and orthopedic disturbances. After symptom assessment, he was diagnosed to have developed the Gorham-Stout disease (GSD), a rare syndrome accompanied by massive osteolysis. The paper considers GSD etiology and observes the main pathogenetic theories.
Collapse
Affiliation(s)
- Aleksey Evsyukov
- Federal State Budgetary Institution "National Ilizarov Medical Research Centre for Traumatology and Ortopaedics" Ministry Healthcare, Novosibirsk, Russian Federation
| | - Murodzhon Kosimshoev
- "Federal Center of Neurosurgery", The Ministry of Health, Novosibirsk, Russian Federation
| | - Yuliy Kubetskyi
- "Federal Center of Neurosurgery", The Ministry of Health, Novosibirsk, Russian Federation
| | - Evgeniy Nikitenko
- Autonomous Non-profit Organization Regional Center of High Medical Technologies, Novosibirsk, Russian Federation
| | - Jamil Rzaev
- "Federal Center of Neurosurgery", The Ministry of Health, Novosibirsk, Russian Federation
| |
Collapse
|
2
|
Wojciechowska-Durczynska K, Zygmunt A, Mikulak M, Ludwisiak M, Lewinski A. Difficult Therapeutic Decisions in Gorham-Stout Disease-Case Report and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811692. [PMID: 36141975 PMCID: PMC9517245 DOI: 10.3390/ijerph191811692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 05/30/2023]
Abstract
Gorham-Stout disease (GSD) is a very rare, life-threatening condition characterized by the proliferation of lymphatic vessels and osteolysis. Unfortunately, no standard treatment has been determined for management of GSD. The available therapies are not equally effective and carry substantial side-effects. We report a 42-year-old female with GSD manifested in multifocal osteolysis and chronic chylothorax and ascites. The combined treatment with sirolimus and zoledronic acid due to its synergism of action was introduced. To our knowledge, this is the first Polish case report of adult patients with Gorham-Stout disease.
Collapse
Affiliation(s)
- Katarzyna Wojciechowska-Durczynska
- Department of Endocrinology and Metabolic Disease, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| | - Arkadiusz Zygmunt
- Department of Endocrinology and Metabolic Disease, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| | - Marta Mikulak
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| | - Marta Ludwisiak
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| | - Andrzej Lewinski
- Department of Endocrinology and Metabolic Disease, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| |
Collapse
|
3
|
Solorzano E, Alejo AL, Ball HC, Magoline J, Khalil Y, Kelly M, Safadi FF. Osteopathy in Complex Lymphatic Anomalies. Int J Mol Sci 2022; 23:ijms23158258. [PMID: 35897834 PMCID: PMC9332568 DOI: 10.3390/ijms23158258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022] Open
Abstract
Complex Lymphatic Anomalies (CLA) are lymphatic malformations with idiopathic bone and soft tissue involvement. The extent of the abnormal lymphatic presentation and boney invasion varies between subtypes of CLA. The etiology of these diseases has proven to be extremely elusive due to their rarity and irregular progression. In this review, we compiled literature on each of the four primary CLA subtypes and discuss their clinical presentation, lymphatic invasion, osseous profile, and regulatory pathways associated with abnormal bone loss caused by the lymphatic invasion. We highlight key proliferation and differentiation pathways shared between lymphatics and bone and how these systems may interact with each other to stimulate lymphangiogenesis and cause bone loss.
Collapse
Affiliation(s)
- Ernesto Solorzano
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA; (E.S.); (A.L.A.); (H.C.B.); (J.M.); (Y.K.); (M.K.)
- Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - Andrew L. Alejo
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA; (E.S.); (A.L.A.); (H.C.B.); (J.M.); (Y.K.); (M.K.)
- Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - Hope C. Ball
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA; (E.S.); (A.L.A.); (H.C.B.); (J.M.); (Y.K.); (M.K.)
- Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - Joseph Magoline
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA; (E.S.); (A.L.A.); (H.C.B.); (J.M.); (Y.K.); (M.K.)
- Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - Yusuf Khalil
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA; (E.S.); (A.L.A.); (H.C.B.); (J.M.); (Y.K.); (M.K.)
- Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
| | - Michael Kelly
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA; (E.S.); (A.L.A.); (H.C.B.); (J.M.); (Y.K.); (M.K.)
- Department of Pediatric Hematology Oncology and Blood, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Fayez F. Safadi
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA; (E.S.); (A.L.A.); (H.C.B.); (J.M.); (Y.K.); (M.K.)
- Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH 44308, USA
- School of Biomedical Sciences, Kent State University, Kent, OH 44243, USA
- Correspondence: ; Tel.: +1-330-325-6619
| |
Collapse
|
4
|
Suzuki N, Cintra FF, Cintra ML, Maciel MG, Amstalden EMI, Teixeira F, Kubba F. "A case of vanishing bone disease complicated by chylothorax- diagnosis and treatment". JRSM Open 2022; 13:20542704221103912. [PMID: 35774987 PMCID: PMC9237928 DOI: 10.1177/20542704221103912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 16-year old girl with Gorham-Stout disease is presented. She had progressive replacement of the bones of her left arm and shoulder girdle by fibroadipose tissue and numerous proliferated, non-neoplastic, lymphatic channels. The clinico-pathologic features of this condition are discussed, as are its possible complications and available therapeutic modalities.
Collapse
Affiliation(s)
- N Suzuki
- Department of Dermatology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - FF Cintra
- Department of Orthopedics, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - ML Cintra
- Department of Pathology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - MG Maciel
- Department of Dermatology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - EMI Amstalden
- Department of Pathology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - F Teixeira
- Department of Pathology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - F Kubba
- Department of Pathology, London Northwest University Healthcare NHS Trust, UK
| |
Collapse
|
5
|
Di H, Zhang B, Xu N, Yin Y, Han X, Zhang Y, Zeng X. Refractory serositis in Gorham–Stout syndrome. Orphanet J Rare Dis 2022; 17:152. [PMID: 35379268 PMCID: PMC8981938 DOI: 10.1186/s13023-022-02307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Gorham–Stout syndrome (GSS) is a rare disorder with various presentations and unpredictable prognoses. Previous understandings of GSS mainly focused on progressive bone destruction, while we identified a group of GSS patients with serous effusion as the first symptom. This study aimed to investigate the clinical characteristics of patients with GSS having serous effusion as the first symptom. Methods Patients diagnosed with GSS were identified through the Peking Union Medical College Hospital Medical Record System. The demographic, clinical, laboratory, and imaging data were collected. Patients who first presented with serous effusion were recruited into the serous group, while those with bone destruction were recruited into the bone group. Results Of the 23 patients with GSS enrolled, 13 were in the bone group and 10 in the serous group. The median disease duration was shorter and exercise tolerance was lower in the serous group. Despite less frequent bone pain in the serous group, the frequency of bone involvement was similar to that in the bone group. Patients in the serous group had higher rates of bilateral pleural effusion and multiple serous effusion. However, serous effusion also developed with disease progression in the bone group. Of the 17 patients treated with bisphosphonates, 14 reached bone-stable state. However, 5 out of 10 patients with serous effusion still had refractory effusions after bisphosphonates treatment. Three patients received sirolimus treatment, with an improvement in serous effusion. Seventeen patients were followed up; three patients died, two in the bone group and one in the serous group. Conclusions This study discovered that GSS could first be presented with serous effusion. We believe that this may be a new phenotype of the disease. Sirolimus might help in controlling serous effusion and improving prognosis.
Collapse
|
6
|
Potential biomarkers of kaposiform lymphangiomatosis. Pediatr Blood Cancer 2019; 66:e27878. [DOI: 10.1002/pbc.27878] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 01/05/2023]
|
7
|
Kaissi AA, Bouchoucha S, Shboul M, Kenis V, Grill F, Ganger R, Kircher SG. Massive Axial and Appendicular Skeletal Deformities in Connection with Gorham-Stout Syndrome. MEDICINES 2019; 6:medicines6020054. [PMID: 31067823 PMCID: PMC6631250 DOI: 10.3390/medicines6020054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 11/16/2022]
Abstract
: Background: Etiological understanding is the corner stone in the management of skeletal deformities. Methods: Multi-centre study of patients with deformities in connection with diverse etiological backgrounds. We aimed to study four patients (one boy and three girls) with variable axial and appendicular deformities in connection with a vanishing bone disorder. Results: Axial deformities such as scoliosis, kyphoscoliosis, compressed fused vertebrae, appendicular fractures, dislocations, and vicious disorganization deformities of the joints were in connection with the vanishing bone disorder, namely Gorham-Stout syndrome. Conclusions: It is mandatory to establish proper clinical and radiological phenotypic characterization in children and adults presented with unusual skeletal deformities. Identifying the reason behind these deformities is the key factor to draw a comprehensive management plan.
Collapse
Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, at the Hanusch Hospital of WGKK and, AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital, 1090 Vienna, Austria.
- Orthopaedic Hospital of Speising, Paediatric department, 1090 Vienna, Austria.
| | - Sami Bouchoucha
- Paediatric Orthopedic Surgery-Children Hospital, Tunis 1029, Tunis-Tunisia.
| | - Mohammad Shboul
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Vladimir Kenis
- Department of Foot and Ankle Surgery, Neuroorthopaedics and Systemic Disorders, Pediatric Orthopedic Institute n.a. H. Turner, Parkovaya str., 64-68, Pushkin, Saint Petersburg, Russia.
| | - Franz Grill
- Orthopaedic Hospital of Speising, Paediatric department, 1090 Vienna, Austria.
| | - Rudolf Ganger
- Orthopaedic Hospital of Speising, Paediatric department, 1090 Vienna, Austria.
| | - Susanne Gerit Kircher
- Department of Medical Chemistry, Medical University of Vienna, 1090 Vienna, Austria.
| |
Collapse
|
8
|
Matsumoto T, Naito M, Hirose J, Nakada I, Morikawa T, Tanaka S. Gorham-Stout Syndrome of the Shoulder Girdle Successfully Controlled by Antiresorptive Agents: A Report of 2 Cases. JBJS Case Connect 2019; 9:e0285. [PMID: 31211750 DOI: 10.2106/jbjs.cc.18.00285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CASE Gorham-Stout disease (GSD) is a rare disorder characterized by massive bone destruction. Consensus is lacking on the effective treatment strategies for GSD. This report presents 2 cases of GSD, a 47-year-old man and a 72-year-old woman, involving the shoulder girdle which were successfully controlled by antiresorptive agents including bisphosphonates and denosumab, the antireceptor activator of nuclear factor-κB ligand antibody. CONCLUSIONS These 2 cases suggest that antiresorptive agents targeting osteoclasts can be efficacious therapeutic options for GSD. This is the first case of GSD we are aware of which showed good response to denosumab treatment.
Collapse
Affiliation(s)
- Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masashi Naito
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Jun Hirose
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Izumi Nakada
- Department of Orthopaedic Surgery, Tokyo Metropolitan Bokuto General Hospital, Sumida-ku, Tokyo, Japan
| | - Teppei Morikawa
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
9
|
Zhang S, Wu D, Shi L, Zhang Y, Long K, Fan Y, Zhu B, Jin X, Ren Y, Zhang C, Wang P. Gorham disease of the mandible: a report of two cases and a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:e71-e76. [PMID: 30266374 DOI: 10.1016/j.oooo.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 07/03/2018] [Accepted: 08/23/2018] [Indexed: 11/15/2022]
Abstract
Gorham disease, a rare disorder of unknown etiology, is characterized by the clinical and radiologic disappearance of bone. Because the etiology is unknown, diagnosis is difficult. Therefore, radiographic manifestations play a vital role in the diagnosis of this disease. Thus far, there has been no completely effective treatment. Most remedies are limited to symptom management. Despite the fact that any bone can be affected, one of the most prevalent sites is the maxillofacial region. In this paper, 2 cases of Gorham disease involving the maxillofacial region are reported, including preoperative and postoperative radiographic features.
Collapse
Affiliation(s)
- Sheng Zhang
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Dandan Wu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China
| | - Liqiang Shi
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China
| | - Yuxing Zhang
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Kaiping Long
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Yun Fan
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China
| | - Bing Zhu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China
| | - Xiaohang Jin
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Yan Ren
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Chunli Zhang
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Pei Wang
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China.
| |
Collapse
|
10
|
Liu M, Liu W, Qiao C, Han B. Mandibular Gorham-Stout disease: A case report and literature review. Medicine (Baltimore) 2017; 96:e8184. [PMID: 29049202 PMCID: PMC5662368 DOI: 10.1097/md.0000000000008184] [Citation(s) in RCA: 14] [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] [Received: 07/03/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Gorham-Stout disease (GSD) is characterized by aggressive bone resorption, proliferation of vascular or lymphatic vessels, and soft-tissue swelling. Bones that initially appear normal start to resorb, partially or completely. However, the etiology of GSD is unknown. PATIENT CONCERNS A 29-year-old man with a chief complaint of toothache and mobility in the lower right mandible for the previous 1 year. DIAGNOSES Gorham-Stout disease (GSD). INTERVENTIONS The RANK-ligand inhibitor denosumab was suggested to use to inhibit the development of osteoclasts and slow mandibular resorption. In addition, we proposed resection of the remaining mandible and reconstruction via vascularized bone graft, after resorption of the mandible had become stationary. OUTCOMES Regular follow-ups were advised to this patient to monitor the stability of bone resorption prior to any surgical intervention. LESSONS We strongly recommend that every attempt should be made for early diagnosis and prompt effective medical and surgical management. The failure to do so results in further complications and poor prognosis.
Collapse
Affiliation(s)
- Min Liu
- Department of Oral and Maxillofacial Surgery
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling
| | - Weiwei Liu
- Department of Oral and Maxillofacial Surgery
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling
| | - Chunyan Qiao
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling
- Department of Oral Pathology, School and Hospital of Stomatology, Jilin University, Changchun, China
| | - Bing Han
- Department of Oral and Maxillofacial Surgery
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling
| |
Collapse
|
11
|
Abstract
Gorham-Stout disease (GSD) is a rare angiomatous disorder characterized by osteolysis. We report the case of a 66-year-old woman who developed sudden left eye proptosis and facial pain. Neuroimaging demonstrated a destructive mass involving the roof and lateral wall of the left orbit with adjacent abnormal orbital soft tissue. An initial biopsy of the soft tissue was nondiagnostic; however, transcranial biopsy of the orbital roof revealed an intraosseous cavernous angioma, with infiltration of orbital fat by angiomatous tissue. Despite resection of the orbital roof and lateral wall, the orbital lesion continued to expand, leading to signs of a compressive optic neuropathy. The patient then reported severe back pain, prompting imaging that demonstrated disseminated bony involvement of the axial skeleton, eventually leading to the diagnosis of GSD. The patient was treated with a bisphosphonate and a vascular endothelial growth factor inhibitor with stabilization of disease.
Collapse
|
12
|
Wang W, Wang H, Zhou X, Li X, Sun W, Dellinger M, Boyce BF, Xing L. Lymphatic Endothelial Cells Produce M-CSF, Causing Massive Bone Loss in Mice. J Bone Miner Res 2017; 32:939-950. [PMID: 28052488 PMCID: PMC5413433 DOI: 10.1002/jbmr.3077] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/22/2016] [Accepted: 12/30/2016] [Indexed: 11/08/2022]
Abstract
Gorham-Stout disease (GSD) is a rare bone disorder characterized by aggressive osteolysis associated with lymphatic vessel invasion within bone marrow cavities. The etiology of GSD is not known, and there is no effective therapy or animal model for the disease. Here, we investigated if lymphatic endothelial cells (LECs) affect osteoclasts (OCs) to cause a GSD osteolytic phenotype in mice. We examined the effect of a mouse LEC line on osteoclastogenesis in co-cultures. LECs significantly increased receptor activator of NF-κB ligand (RANKL)-mediated OC formation and bone resorption. LECs expressed high levels of macrophage colony-stimulating factor (M-CSF), but not RANKL, interleukin-6 (IL-6), and tumor necrosis factor (TNF). LEC-mediated OC formation and bone resorption were blocked by an M-CSF neutralizing antibody or Ki20227, an inhibitor of the M-CSF receptor, c-Fms. We injected LECs into the tibias of wild-type (WT) mice and observed massive osteolysis on X-ray and micro-CT scans. Histology showed that LEC-injected tibias had significant trabecular and cortical bone loss and increased OC numbers. M-CSF protein levels were significantly higher in serum and bone marrow plasma of mice given intra-tibial LEC injections. Immunofluorescence staining showed extensive replacement of bone and marrow by podoplanin+ LECs. Treatment of LEC-injected mice with Ki20227 significantly decreased tibial bone destruction. In addition, lymphatic vessels in a GSD bone sample were stained positively for M-CSF. Thus, LECs cause bone destruction in vivo in mice by secreting M-CSF, which promotes OC formation and activation. Blocking M-CSF signaling may represent a new therapeutic approach for treatment of patients with GSD. Furthermore, tibial injection of LECs is a useful mouse model to study GSD. © 2017 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Wensheng Wang
- The 1st Affiliated Hospital, Xinxiang Medical University, Xinxiang, China.,Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hua Wang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Institute of Stomatology, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
| | - Xichao Zhou
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Xing Li
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Wen Sun
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Dellinger
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brendan F Boyce
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Lianping Xing
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
13
|
Vascular Lung Diseases. PATHOLOGY OF LUNG DISEASE 2017. [PMCID: PMC7120439 DOI: 10.1007/978-3-662-50491-8_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
14
|
Srivastava SK, Aggarwal RA, Nemade PS, Bhoale SK. Vanishing bone disease of chest wall and spine with kyphoscoliosis and neurological deficit: A case report and review of literature. Indian J Orthop 2017; 51:107-114. [PMID: 28216760 PMCID: PMC5296840 DOI: 10.4103/0019-5413.197559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Vanishing bone disease is an extremely rare disorder of unknown etiology characterized by idiopathic osteolysis of bone. We describe a case of vanishing bone disease of chest wall and spine with kyphoscoliosis and neurological deficit. A 17-year-old male presented with gradually progressive deformity of back and dorsal compressive myelopathy with nonambulatory power in lower limbs. Radiographs revealed absent 4th-7th ribs on the right side with dorsal kyphoscoliosis and severe canal narrowing at the apex. The patient was given localized radiotherapy and started on a monthly infusion of 4 mg zoledronic acid. Posterior instrumented fusion with anterior reconstruction via posterolateral approach was performed. The patient had a complete neurological recovery at 5 weeks following surgery. At 1 year, anterior nonunion was noted for which transthoracic tricortical bone grafting was done. Bone graft from the patient's mother was used both times. At 7 months following anterior grafting, the alignment was maintained and the patient was asymptomatic; however, fusion at graft-host interface was not achieved. Bisphosphonates and radiotherapy were successful in halting the progress of osteolysis.
Collapse
Affiliation(s)
- Sudhir Kumar Srivastava
- Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Rishi Anil Aggarwal
- Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India,Address for correspondence: Dr. Rishi Anil Aggarwal, Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai - 400 012, Maharashtra, India. E-mail:
| | - Pradip Sharad Nemade
- Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sunil Krishna Bhoale
- Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
15
|
Sato T, Muroya K, Asakura Y, Yachie A, Nishimura G, Aida N, Machida J, Tanaka Y, Hasegawa T, Adachi M. Polyostotic osteolysis and hypophosphatemic rickets with elevated serum fibroblast growth factor 23: A case report. Am J Med Genet A 2015; 167A:2430-4. [PMID: 26059403 DOI: 10.1002/ajmg.a.37193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/20/2015] [Indexed: 11/07/2022]
Abstract
We report on a boy who presented with hypophosphatemic rickets with elevated serum fibroblast growth factor 23 (FGF23) and polyostotic osteolytic lesions at age 2 years. Tumor-induced hypophosphatemic rickets was suspected; however, bone biopsy for osteolytic changes revealed no tumorous change, except for irregularly dilated vessels associated with osteoclasts and fibrous proliferation. Venous sampling failed to point to FGF23-producing foci. After alfacalcidol and phosphate supplementation, the rachitic skeletal changes improved, but FGF23 increased and new osteolytic lesions developed. Serum levels of neopterin and a few cytokines, including plasma transforming growth factor-β and soluble tumor necrosis factor receptor type II, were elevated. At age 4 years, high doses of phosphate resulted in increased serum phosphate levels, decreased neopterin and cytokines, decreased FGF23, and stabilization of osteolysis. We excluded germline mutations in PHEX, FGF23, DMP1, and ENPP1 (genes for hereditary hypophosphatemic rickets) and somatic mutations in the GNAS and HRAS/KRAS (the disease-causing genes for McCune-Albright syndrome and linear nevus sebaceous syndrome, respectively). We could not perform octreotide scintigraphy or fluorodeoxyglucose-positron emission tomography, and thus could not completely exclude occult FGF23-producing tumors. However, considering the course of the disease, it is intriguing to assume that dysregulation of osteoclast-macrophage lineage may have induced increased neopterin levels, increased cytokine levels, osteolytic process, and possibly FGF23 overproduction.
Collapse
MESH Headings
- Cell Proliferation
- Child, Preschool
- Cytokines/blood
- Cytokines/genetics
- Fibroblast Growth Factor-23
- Fibroblast Growth Factors/blood
- Fibroblast Growth Factors/genetics
- Fibroblasts/drug effects
- Fibroblasts/metabolism
- Fibroblasts/pathology
- Fibrous Dysplasia, Polyostotic/blood
- Fibrous Dysplasia, Polyostotic/drug therapy
- Fibrous Dysplasia, Polyostotic/genetics
- Fibrous Dysplasia, Polyostotic/pathology
- Gene Expression Regulation
- Humans
- Hydroxycholecalciferols/therapeutic use
- Male
- Neopterin/blood
- Neopterin/genetics
- Osteoclasts/drug effects
- Osteoclasts/metabolism
- Osteoclasts/pathology
- Osteolysis/blood
- Osteolysis/drug therapy
- Osteolysis/genetics
- Osteolysis/pathology
- Phosphates/therapeutic use
- Receptors, Tumor Necrosis Factor, Type II/blood
- Receptors, Tumor Necrosis Factor, Type II/genetics
- Rickets, Hypophosphatemic/blood
- Rickets, Hypophosphatemic/drug therapy
- Rickets, Hypophosphatemic/genetics
- Rickets, Hypophosphatemic/pathology
- Transforming Growth Factor beta/blood
- Transforming Growth Factor beta/genetics
Collapse
Affiliation(s)
- Takeshi Sato
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Koji Muroya
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yumi Asakura
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Akihiro Yachie
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Gen Nishimura
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Noriko Aida
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Jiro Machida
- Department of Orthopedic Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yukichi Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Masanori Adachi
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
| |
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Rockson SG. Laboratory models for the investigation of lymphangiomatosis. Microvasc Res 2014; 96:64-7. [DOI: 10.1016/j.mvr.2014.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/17/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
|
19
|
Maillot C, Cloche T, Le Huec JC. Thoracic osteotomy for Gorham-Stout disease of the spine: a case report and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 27:2285-2290. [PMID: 25331037 DOI: 10.1007/s00586-014-3613-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/28/2014] [Accepted: 10/02/2014] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Gorham-Stout syndrome is an aggressive, non-heritable skeletal disease characterized by osteolysis following minor trauma. The primary involvement of the spine is less common (10 %) and has been described in only about 20 cases; there is no consensus about the best way to treat this condition. PURPOSE OF THE STUDY To report a case of Gorham-Stout syndrome involving the thoracic spine and to review the literature to suggest a post-operative treatment to prevent osteolysis. CASE REPORT A thirty-year-old female patient was admitted to the unit in March 2013 for a pathologic T4 fracture. X-rays and CT scan revealed the onset of T4 osteolysis and an increase in thoracic kyphosis (the local kyphosis was up to 100°). We performed surgery by posterior approach, combining posterior fixation with screws and rods from T3 to T9, decompression and vertebral osteotomy of 65°. The immediate outcome of surgery was good and the patient returned home after 24 days. At 6 and 12 months of follow-up, the patient was walking normally with no neurological sequelae. CONCLUSION We report a case of Gorham-Stout syndrome involving the thoracic spine that was successfully treated by interpedicular osteotomy associated with a 6 month follow-up. We suggest that this strategy can provide good results, because after fusion, the disease process remains stable. Because of the lack of cases reported, surgeons must be careful when using multiple treatments, because these treatments have many side effects. LEVEL OF EVIDENCE Level IV case report.
Collapse
Affiliation(s)
- C Maillot
- Department Ortho Rachis 2, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - T Cloche
- Department Ortho Rachis 2, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - J-C Le Huec
- Department Ortho Rachis 2, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France. .,Orthopaedic and Spinal Department and Surgical Research Laboratory, Bordeaux University Hospital, Bordeaux, France.
| |
Collapse
|
20
|
Liu Y, Zhong DR, Zhou PR, Lv F, Ma DD, Xia WB, Jiang Y, Wang O, Xing XP, Li M. Gorham-Stout disease: radiological, histological, and clinical features of 12 cases and review of literature. Clin Rheumatol 2014; 35:813-23. [DOI: 10.1007/s10067-014-2780-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/07/2014] [Indexed: 12/17/2022]
|
21
|
Findler M, Hirshberg A, Sharon E. Lymphangiomatosis with dental involvement. Lymphat Res Biol 2014; 13:62-5. [PMID: 25192473 DOI: 10.1089/lrb.2013.0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lymphangiomatosis characterized by lymphangiomatous proliferation is a rare disease of unknown etiology, which seems to be more aggressive than Gorham-Stout Syndrome, also known as "the vanished bone disease." METHODS AND RESULTS A woman presented with a lytic lesion in the tibia and multiple lytic lesions in teeth dentin. Upon autopsy, a single lytic bone lesion and fulminant lymphangiomatous proliferation were found in the pleura, pericardium, and peritoneum. The histological findings from a tooth lytic lesion included fibroblastic proliferation interspersed with vascular spaces embedded with fragments of lamellar bone and dentin containing osteoclast like multinucleated giant-cell lined resorption bays. CONCLUSIONS The histological findings support the notion that hard tissue resorption is conducted by lymphangiomatosis and osteoclastic activity.
Collapse
Affiliation(s)
- Mordechai Findler
- 1 Department of Hospital Oral Medicine, Hebrew University Hadassah , Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | | | | |
Collapse
|
22
|
Dellinger MT, Garg N, Olsen BR. Viewpoints on vessels and vanishing bones in Gorham-Stout disease. Bone 2014; 63:47-52. [PMID: 24583233 DOI: 10.1016/j.bone.2014.02.011] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/06/2014] [Accepted: 02/19/2014] [Indexed: 12/11/2022]
Abstract
Gorham-Stout disease (GSD) is a rare disorder characterized by the proliferation of endothelial-lined vessels in bone and the progressive destruction of bone. Although Jackson described the first case of GSD in 1838, the clinical and histological features of GSD were not defined until Gorham and Stout published their report on massive osteolysis in 1955. In the years since Gorham and Stout's groundbreaking publication, more than 300 cases of GSD have been described in the literature. These reports have revealed that the progressive resorption of bone in GSD causes severe physical deformities, disabilities, and life-threatening complications. Unfortunately, the underlying cause of GSD remains unknown and, as a result, the therapeutic options for individuals with GSD are limited. Here we review the latest advances in GSD research and present strategies to address basic and clinical research questions related to GSD.
Collapse
Affiliation(s)
- Michael T Dellinger
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; The Lymphatic Malformation Institute, Bethesda, MD, USA.
| | - Nupur Garg
- The Lymphatic Malformation Institute, Bethesda, MD, USA
| | - Bjorn R Olsen
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA.
| |
Collapse
|
23
|
Nir V, Guralnik L, Livnat G, Bar-Yoseph R, Hakim F, Ilivitzki A, Bentur L. Propranolol as a treatment option in Gorham-Stout syndrome: a case report. Pediatr Pulmonol 2014; 49:417-9. [PMID: 24000203 DOI: 10.1002/ppul.22869] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/29/2013] [Indexed: 11/10/2022]
Abstract
Gorham-Stout syndrome is a very rare syndrome characterized by progressive angiomatosis and lymphangiomas involving multiple organs. We describe herein a girl with progressive Gorham-Stout syndrome since the age of 13 years. Her disease involved the mediastinum, pericardium, vertebrae, ribs, and skull and did not respond to interferon and bisphosphonates. Propranolol administration was initiated at the age of 18 years and was associated with improvement in pulmonary function tests and involution of the mediastinal and hilar hemangiomatous lesions. The possible beneficial effect of propranolol in Gorham-Stout syndrome should be further investigated.
Collapse
Affiliation(s)
- Vered Nir
- Pediatric Pulmonary Unit, Meyer Children's Hospital, Rambam Health Care Campus, Israel; Pediatric Department, Hillel Yaffe Medical Center, Hadera, Israel
| | | | | | | | | | | | | |
Collapse
|
24
|
Hu P, Yuan XG, Hu XY, Shen FR, Wang JA. Gorham-Stout syndrome in mainland China: a case series of 67 patients and review of the literature. J Zhejiang Univ Sci B 2014; 14:729-35. [PMID: 23897792 DOI: 10.1631/jzus.b1200308] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Gorham-Stout syndrome (GSS) is a rare disorder of uncertain etiology and unpredictable prognosis. This study aims to present a comprehensive understanding of this rare entity. METHODS A literature search in PubMed and three Chinese databases was performed to screen histologically proven GSS cases among Chinese residents in the mainland. We analyzed the patients' clinical characteristics, the value of different treatment modalities and their influence on the clinical outcome. RESULTS Sixty-seven cases were finally enrolled. There were 43 men (64.2%) and 24 women (35.8%). The mean age at diagnosis was 28 years (1.5-71 years). The most common clinical symptoms included pain (n=40, 59.7%), functional impairment (n=13, 19.4%), and swelling (n=12, 17.9%). The radiographic presentation of 37 cases (55.2%) was disappearance of a portion of the bone. The others presented as radiolucent foci in the intramedullary or subcortical regions. A total of 42 cases provided data on therapy, these included surgery (n=27, 40.3%), radiation therapy (n=6, 9.0%), surgery combined with radiation therapy (n=2, 3.0%), and medicine therapy (n=7, 10.4%). For 30 of these 42 cases, follow-up data were available: 21 cases had the disorder locally controlled and 9 had a symptom progression. Fortunately, the disease is not fatal in the majority of cases. CONCLUSIONS GSS has no specific symptoms and it should be taken into consideration when an unclear massive osteolysis occurs. The efficacies of different treatment modalities are still unpredictable and further research is required to assess the values of different treatments.
Collapse
Affiliation(s)
- Po Hu
- Cardiovascular Key Lab of Zhejiang Province, Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
| | | | | | | | | |
Collapse
|
25
|
Hagendoorn J, Yock TI, Rinkes IHB, Padera TP, Ebb DH. Novel molecular pathways in Gorham disease: implications for treatment. Pediatr Blood Cancer 2014; 61:401-6. [PMID: 24214028 PMCID: PMC4123459 DOI: 10.1002/pbc.24832] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 09/27/2013] [Indexed: 12/17/2022]
Abstract
Rapid advances in evidence-based treatment schedules are a hallmark of modern oncology. In rare neoplastic diseases, however, clinical expertise is hard to build and evidence based on randomized trials almost impossible to collect. Gorham disease is a rare form of lymphatic proliferation accompanied by osteolysis, which usually occurs in young adults. Despite the fact that the clinical course of Gorham disease is often devastating and occasionally fatal, insights into its biological background are sparse and standardized treatment unavailable. Interestingly, recent knowledge on the mechanisms of lymphangiogenesis may help elucidate the pathophysiology of Gorham disease and lead to novel treatment targets. Here, we discuss our current understanding of Gorham disease, discuss established and emerging therapeutic strategies, and attempt to frame a treatment rationale.
Collapse
Affiliation(s)
- Jeroen Hagendoorn
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Torunn I. Yock
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States
| | - Inne H.M. Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Timothy P. Padera
- Edwin L. Steele Laboratory for Tumor Biology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States
| | - David H. Ebb
- Department of Pediatric Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States
| |
Collapse
|
26
|
Kakuta Y, Iizuka H, Kobayashi R, Iizuka Y, Takahashi T, Mohara J, Takagishi K. Gorham disease of the lumbar spine with an abdominal aortic aneurysm: a case report. Spine J 2014; 14:e5-9. [PMID: 24161363 DOI: 10.1016/j.spinee.2013.07.451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/27/2013] [Accepted: 07/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Reports of Gorham disease of the lumbar spine complicated by abdominal aortic aneurysms are rare. PURPOSE We herein report the case of a patient with Gorham disease of the lumber spine involving an abdominal aortic aneurysm (AAA). STUDY DESIGN Case report. METHODS A 49-year-old man had a 1-month history of right leg pain and severe low back pain. Plain lumbar radiography revealed an osteolytic lesion in the L4 vertebral body. Computed tomography images demonstrated the presence of an extensive osteolytic lesion in the L4 vertebral body and an AAA in front of the L4 vertebral body. RESULTS The patient underwent mass resection, spinal reconstruction, and blood vessel prosthesis implantation. During surgery, it was found that the wall of the aorta had completely disappeared and was shielded by the tumor mass; therefore, we speculated that the mass in the lumbar spine had directly invaded the aorta. CONCLUSIONS The patient was able to walk without right leg or low back pain 1 year after undergoing surgery. No recurrence was demonstrated in the magnetic resonance images taken 1 year and 10 months after surgery.
Collapse
Affiliation(s)
- Yohei Kakuta
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Haku Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.
| | - Ryoichi Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Toru Takahashi
- Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Jun Mohara
- Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| |
Collapse
|
27
|
Gorham-Stout syndrome affecting the temporal bone with cerebrospinal fluid leakage. Int J Pediatr Otorhinolaryngol 2013; 77:1596-600. [PMID: 23827687 DOI: 10.1016/j.ijporl.2013.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/02/2013] [Indexed: 11/24/2022]
Abstract
Gorham-Stout syndrome is a rare disorder characterized by progressive osteolysis that leads to the disappearance of bone. Lymphvascular proliferation causes the local destruction of bony tissue. Owing to the low incidence of this syndrome, little is known about its etiology or treatment. We present an 11-year-old girl with Gorham-Stout syndrome that involved right petrous apex in temporal bone and upper clivus, which cause intracranial pressure increase and cerebrospinal fluid (CSF) leakage. The patient required surgical repair of CSF leakage by extradural middle fossa approach with temporal fascia flap. Combined treatment with interferon and propranolol prevented the progression of osteolysis.
Collapse
|
28
|
Leite I, Hernández-Martín A, Colmenero I, López-Gutiérrez JC, Torrelo A. Invasive lymphatic malformation (gorham-stout) of the pelvis with prominent skin involvement. Pediatr Dermatol 2013; 30:374-8. [PMID: 22823281 DOI: 10.1111/j.1525-1470.2012.01814.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Gorham-Stout syndrome is a rare disease characterized by progressive osteolysis leading to disappearance of the bone. Vascular proliferations have been implicated in the pathogenesis of this syndrome. The case of a 7-year-old girl with a prominent invasive lymphatic malformation on the lumbosacral area and massive osteolysis of the pelvic girdle is reported.
Collapse
Affiliation(s)
- Inês Leite
- Department of Dermatology, Hospital Niño Jesus, Madrid, Spain.
| | | | | | | | | |
Collapse
|
29
|
Zampetti A, Gnarra M, Borsini W, Giurdanella F, Antuzzi D, Piras A, Smaldone C, Pieroni M, Cadeddu C, de Waure C, Feliciani C. Vascular endothelial growth factor (VEGF-a) in Fabry disease: association with cutaneous and systemic manifestations with vascular involvement. Cytokine 2013; 61:933-9. [PMID: 23332617 DOI: 10.1016/j.cyto.2012.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/08/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Fabry disease is an X-linked inherited metabolic disorder characterized by the deficiency of lysosomal α-galactosidase A enzyme. This leads to the accumulation, into lysosomes through the body, of glycosphingolipids, mainly Gb3. Skin involvement and progressive multi-organ failure are usually observed. Endothelium is the preferential target of the Gb3 storage that determines endothelial dysfunction and vasculopathy leading to the clinical manifestations of the disease. The serum levels of Vascular Endothelial Growth Factor-A (VEGF-A), a specific endothelial cell mitogen, were analyzed in Fabry patients to explore a possible association to the clinical manifestations with vascular involvement. METHODS Thirty-five patients with a biochemical and genetic diagnosis of Fabry disease, along with an age-gender-matched healthy control group, were enrolled. Serum samples were collected and analyzed by ELISA. The genetic mutations, the specific organ dysfunction, and the cardiovascular risk factors such as dyslipidaemia, diabetes, smoking habits and hypertension were evaluated in Fabry patients. RESULTS The mean serum level of VEGF-A in Fabry patients group was significantly higher than in the control group (P=0.006). A statistical significant association, between VEGF-A levels and the skin manifestation including angiokeratomas, sweating abnormalities and Fabry Facies was found. An association was also found between high VEGF-A and specific GLA mutations, the male gender, the renal and neurological manifestations, the presence of eye vessels tortuosity, smoking habit and hypertension. CONCLUSIONS We detected increased VEGF-A levels in patients with Fabry disease compared to the controls, and we hypothesized that this could be a response to the vascular damage characterising this lysosomal disorder. However, further studies are necessary to clarify the role of VEGF-A in Fabry.
Collapse
Affiliation(s)
- Anna Zampetti
- Dermatology Department, Policlinico A. Gemelli, Università Cattolica, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Lopez-Gutierrez JC, Miguel M, Diaz M, Ros Z, Tovar JA. Osteolysis and Lymphatic Anomalies: A Review of 54 Consecutive Cases. Lymphat Res Biol 2012; 10:164-72. [DOI: 10.1089/lrb.2012.0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Miriam Miguel
- Department of Surgery, La Paz Children's Hospital, Madrid, Spain
| | - Mercedes Diaz
- Department of Surgery, La Paz Children's Hospital, Madrid, Spain
| | - Zoraida Ros
- Department of Surgery, La Paz Children's Hospital, Madrid, Spain
| | - Juan A Tovar
- Department of Surgery, La Paz Children's Hospital, Madrid, Spain
| |
Collapse
|
31
|
Huang Y, Wang L, Wen Y, Zhang Q, Li L. Progressively bilateral resorption of the mandible. J Craniomaxillofac Surg 2012; 40:e174-7. [DOI: 10.1016/j.jcms.2011.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/23/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022] Open
|
32
|
Gordon KD, Mortimer PS. Progressive lymphangiomatosis and Gorham's disease: case report and clinical implications. Lymphat Res Biol 2012; 9:201-4. [PMID: 22196286 DOI: 10.1089/lrb.2011.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Lymphangiomatosis is a rare proliferative disorder of the lymphatic system. The etiology is unknown, rendering it difficult to manage. This case report of lymphangiomatosis with features of Gorham's disease reveals the progressive and unexpected nature of the condition. It highlights the need for further research into the pathophysiology and management of lymphangiomatosis as current treatment options are limited.
Collapse
Affiliation(s)
- K D Gordon
- Department of Dermatology, St George's Hospital, London, United Kingdom.
| | | |
Collapse
|
33
|
Brodszki N, Länsberg JK, Dictor M, Gyllstedt E, Ewers SB, Larsson MK, Eklund EA. A novel treatment approach for paediatric Gorham-Stout syndrome with chylothorax. Acta Paediatr 2011; 100:1448-53. [PMID: 21605166 DOI: 10.1111/j.1651-2227.2011.02361.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To expand the treatment options in paediatric Gorham-Stout syndrome (GSS) when conventional therapy is ineffective. METHOD Two children with biopsy confirmed GSS, a rare disorder with progressive lymphangiomatosis, were treated with a combination of interferon-α-2b, low anticoagulant, low molecular weight heparin, radiotherapy and surgery. RESULTS The combined therapy resolved the symptoms in the acute phase, and both patients have since been free of symptoms for >2 years. CONCLUSION The successful addition of a low anticoagulant, low molecular weight heparin (tafoxiparin) to the treatment protocol in two paediatric cases of the GSS may justify the use of this approach in similar cases.
Collapse
Affiliation(s)
- Nicholas Brodszki
- Department of Clinical Sciences, Section for Paediatrics, The BUT team, Lund University, Sweden
| | | | | | | | | | | | | |
Collapse
|
34
|
Venkatramani R, Ma NS, Pitukcheewanont P, Malogolowkin MH, Mascarenhas L. Gorham's disease and diffuse lymphangiomatosis in children and adolescents. Pediatr Blood Cancer 2011; 56:667-70. [PMID: 21298758 DOI: 10.1002/pbc.22948] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 11/08/2010] [Indexed: 11/11/2022]
Abstract
Gorham's disease is a rare disorder of unknown etiology and variable clinical presentation that is characterized by proliferation of thin-walled vascular channels resulting in destruction and resorption of osseous matrix. The condition is frequently under recognized or misdiagnosed. There is no standard treatment defined for this disease. Here we report on eight children diagnosed with Gorham's disease at our institution over a ten-year period. Soft tissue lymphangioma was present in seven and six children had splenic involvement. Disease stabilization and improvement was observed on treatment with interferon alpha-2b and bisphosphonate therapy.
Collapse
Affiliation(s)
- Rajkumar Venkatramani
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California 90027, USA
| | | | | | | | | |
Collapse
|
35
|
Hernández-Marqués C, Serrano González A, Cordobés Ortega F, Alvarez-Coca J, Sirvent Cerda S, Carceller Lechón F, Azorín Cuadrillero D. Gorham-Stout disease and cerebrospinal fluid otorrhea. Pediatr Neurosurg 2011; 47:299-302. [PMID: 22456030 DOI: 10.1159/000336877] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 01/01/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVE AND IMPORTANCE Gorham-Stout disease is a rare entity characterized by vascular proliferation causing local destruction of bone tissue. Owing to its low incidence and variable clinical presentation, the diagnosis requires a high degree of awareness by the clinician. CLINICAL PRESENTATION We present the case of a 2-year-old boy diagnosed of Gorham-Stout syndrome with involvement of the temporal bone and secondary cerebrospinal fluid (CSF) leakage. INTERVENTION Because of the CSF leakage, the patient required two surgical interventions. The second intervention included mastectomy and placement of a patch and a lumbar drainage device during 50 days, after which the leakage ceased. CONCLUSION Gorham-Stout disease is a rare condition that can affect the skull base and even present with CSF leakage.
Collapse
Affiliation(s)
- Carmen Hernández-Marqués
- Department of Pediatric Hematology-Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
36
|
Treatment of Gorham-Stout disease with zoledronic acid and interferon-α: a case report and literature review. J Pediatr Hematol Oncol 2010; 32:579-84. [PMID: 20962674 DOI: 10.1097/mph.0b013e3181edb464] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Gorham-Stout disease is a rare disease characterized by osteolysis, angiomatosis, and soft-tissue swelling. It is a diagnosis of exclusion and has an unknown etiology. Chylothorax is a common complication of the disease that is associated with a high mortality rate. There is no standard of treatment. We report a case of a 16-year-old female with Gorham-Stout disease and recurrent pleural effusions who was successfully treated with concurrent zoledronic acid and peg-interferon α-2b.
Collapse
|
37
|
Grunewald TGP, Damke L, Maschan M, Petrova U, Surianinova O, Esipenko A, Konovalov D, Behrends U, Schiessl J, Wörtler K, Burdach S, von Luettichau I. First report of effective and feasible treatment of multifocal lymphangiomatosis (Gorham-Stout) with bevacizumab in a child. Ann Oncol 2010; 21:1733-1734. [PMID: 20605931 DOI: 10.1093/annonc/mdq331] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- T G P Grunewald
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München; Laboratory of Functional Genomics and Transplantation Biology, Children's Cancer Research Center, Paediatric Oncology and Roman Herzog Comprehensive Cancer Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - L Damke
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München
| | - M Maschan
- Department of Haematology, Federal Clinical Research Center for Paediatric Haematology, Oncology and Immunology, Moscow
| | - U Petrova
- Department of Haematology-1, Russian Children's Clinical Hospital, Moscow
| | - O Surianinova
- Department of Haematology, Yaroslavl Regional Children's Hospital, Yaroslavl
| | - A Esipenko
- Department of Haematology, Yaroslavl Regional Children's Hospital, Yaroslavl
| | - D Konovalov
- Department of Pathology, Federal Clinical Research Center for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | - U Behrends
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München
| | - J Schiessl
- Department of Pathology, Klinikum Schwabing
| | - K Wörtler
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - S Burdach
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München; Laboratory of Functional Genomics and Transplantation Biology, Children's Cancer Research Center, Paediatric Oncology and Roman Herzog Comprehensive Cancer Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - I von Luettichau
- Department of Paediatrics, Klinikum rechts der Isar, Technische Universität München.
| |
Collapse
|