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Yalin GY, Dogansen SC, Canbaz B, Gul N, Bilgic B, Uzum AK. INCIDENTAL PAGET'S DISEASE DISGUISED AS BONE METASTASIS IN A PATIENT WITH ENDOMETRIUM CARCINOMA. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:111-114. [PMID: 31149157 DOI: 10.4183/aeb.2017.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Paget's disease is a disorder of aging bone which occurs in the setting of accelarated bone remodelling. In the presented case we discuss the difficulties in the diagnosis of Paget's disease in a 77 year old patient with coexisting endometrium carcinoma. The patient was initially diagnosed with metastatic bone disease due to endometrium adenocarcinoma when she was admitted to oncology clinic with pelvic pain. Bone scintigraphy with Tc99 and (18)F fluorodeoxyglucose positron emission tomography/CT revealed an increased uptake on the bone lesions which were reported as metastatic bone involvement. Although the (18)F-FDG uptake was much higher than the levels that would generally be anticipated in a case with Paget's disease, high levels of bone turnover markers indicated further evaluation in the differential diagnosis and the definitive diagnosis of Paget's disease was established with the pathological evaluation of bone biopsy.
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Affiliation(s)
- G Y Yalin
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
| | - S C Dogansen
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
| | - B Canbaz
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
| | - N Gul
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
| | - B Bilgic
- Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Turkey
| | - A K Uzum
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Turkey
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Gu JM, Zhang ZL, Zhang H, Hu WW, Wang C, Yue H, Ke YH, He JW, Hu YQ, Li M, Liu YJ, Fu WZ. Thirteen Chinese patients with sporadic Paget's disease of bone: clinical features, SQSTM1 mutation identification, and functional analysis. J Bone Miner Metab 2012; 30:525-33. [PMID: 22491873 DOI: 10.1007/s00774-012-0352-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 02/23/2012] [Indexed: 12/18/2022]
Abstract
To increase awareness of the rarity of Paget's disease of bone (PDB) in the Chinese population, we characterized the clinical manifestations and features of 13 Chinese sporadic PDB patients. The clinical features of our Chinese PDB patients show similarities with cases reported in Western countries. The most common lesion sites were the pelvis, femur, and tibia; the next most common lesion sites were the spine and skull. Most patients had a higher serum alkaline phosphatase (ALP) level. Treatment with bisphosphonates was effective. In addition, we screened for PDB-causing mutations and performed a functional analysis in an attempt to elucidate the molecular pathogenesis of PDB. A total of 216 persons, including 13 sporadic PDB patients, three unaffected relatives of 1 patient, and 200 healthy donors, were recruited. All eight exons and exon-intron boundaries of the SQSTM1 gene were amplified by polymerase chain reaction (PCR) and directly sequenced. We identified a 53-year-old man who harbored a heterozygous T-to-C transversion at position 1250 in exon 8 (1250T > C), which resulted in a methionine-to-threonine (ATG > ACG) substitution at codon 404 (M404T). The M404T mutant SQSTM1 protein exhibited increased NF-κB activation and drove a significantly increased number of osteoclast-like cells (OLCs) that formed in response to RANKL and an increased number of OLC nuclei. This is the first report of an SQSTM1 genetic mutation that contributes to the pathogenesis of PDB in Chinese patients. These results may partially explain the mechanism by which this SQSTM1 mutation contributes to the pathogenesis of sporadic PDB in Chinese patients.
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Affiliation(s)
- Jie-Mei Gu
- Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
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WOO JH, KIM S, CHOI SJ, LEE YH, JI JD, SONG GG. Diagnosis of Paget’s disease of the pelvis using F-18 FDG PET/CT. Int J Rheum Dis 2010; 13:e51-4. [DOI: 10.1111/j.1756-185x.2010.01538.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Takigami I, Ohara A, Matsumoto K, Fukuta M, Shimizu K. Functional bracing for delayed union of a femur fracture associated with Paget's disease of the bone in an Asian patient: a case report. J Orthop Surg Res 2010; 5:33. [PMID: 20459871 PMCID: PMC2881078 DOI: 10.1186/1749-799x-5-33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 05/12/2010] [Indexed: 11/13/2022] Open
Abstract
Paget's disease of the bone is a common metabolic bone disease in most European countries, Australia, New Zealand, and North America. Conversely, this disease is rare in Scandinavia, Asia, and Africa. In Japan, it is extremely rare, with a prevalence of 0.15/100000. Paget's disease is a localized disorder of bone remodeling. Excessive bone resorption and abnormal bone formation result in biomechanically weakened bone and predispose patients to fracture. Delayed union and non-union of fractures have been reported in patients with Paget's disease. Therefore, open reduction and internal fixation of fractures has been recommended to prevent such complications. Here we report an unusual case of a 63-year-old Asian woman with delayed union of a femur fracture secondary to Paget's disease, which was treated successfully by functional bracing.
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Affiliation(s)
- Iori Takigami
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
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Ocguder A, Tecimel O, Firat A, Bozkurt M. Silent swelling of the tibia in a 43-year-old man. Clin Orthop Relat Res 2008; 466:2565-9. [PMID: 18273675 PMCID: PMC2584303 DOI: 10.1007/s11999-008-0157-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2007] [Accepted: 01/23/2008] [Indexed: 01/31/2023]
Affiliation(s)
- Ali Ocguder
- Diskapi Yildirim Beyazit Training and Research Hospital, Third Orthopaedics and Traumatology Clinic, Ankara, Turkey
| | - Osman Tecimel
- Siirt State Hospital, Orthopaedics and Traumatology Clinic, Siirt, Turkey
| | - Ahmet Firat
- Siirt State Hospital, Orthopaedics and Traumatology Clinic, Siirt, Turkey
| | - Murat Bozkurt
- Diskapi Yildirim Beyazit Training and Research Hospital, Third Orthopaedics and Traumatology Clinic, Ankara, Turkey ,Tirebolu Sokak, 27/18, Yukariayranci, TR-06550 Ankara, Turkey
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Hung HC, Ou HY, Huang JS, Chuang MC, Wu TJ. Tumor-Associated Hypercalcemia in a Patient with Paget's Disease. Kaohsiung J Med Sci 2008; 24:152-6. [DOI: 10.1016/s1607-551x(08)70143-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abelson A. A review of Paget's disease of bone with a focus on the efficacy and safety of zoledronic acid 5 mg. Curr Med Res Opin 2008; 24:695-705. [PMID: 18226324 DOI: 10.1185/030079908x260899] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Paget's disease of bone, the second most common metabolic bone disease in the United States, is characterized by localized areas of excessive bone resorption coupled with accelerated bone formation, resulting in new bone that is less structurally organized and is weaker than normal bone. Complications of Paget's disease can include bone pain, osteoarthritis, skeletal deformity, hearing loss, and fractures. The objective of this review is to provide a comprehensive overview of current standards of treatment in Paget's disease. SCOPE A review of literature from 1974 to 2007 was performed on topics such as epidemiology, etiology, treatment of Paget's disease of bone, and bisphosphonates. FINDINGS Paget's disease affects an estimated 2-7% of persons of age 55 years or older in North America and western Europe. Antiresorptive treatment with bisphosphonates is the standard treatment, but there may be limitations to oral therapy. Intravenous pamidronate is efficacious and has long been available, but its use is hindered by an impractical recommended dosing regimen of 30 mg IV over 4 h for three consecutive days. In two identical, double-blind, 6-month trials, 96% of patients treated with a one-time intravenous treatment of zoledronic acid 5 mg achieved therapeutic response, compared with 74% treated with 60 days of daily oral treatment with risedronate 30 mg (p < 0.001). One limitation of this review is that historical data are not reviewed in the same level of detail as newer treatments, because recent advances in pharmacotherapy of Paget's disease have reduced the clinical utility of the older drugs. CONCLUSION The etiology of Paget's disease is unclear, but some evidence suggests genetic and viral components. Bisphosphonates restore normal bone turnover and relieve bone pain, but oral formulations may be limited by complicated dosing regimens and poor gastrointestinal absorption. The bisphosphonate, zoledronic acid is administered as a single intravenous infusion and offers antiresorptive efficacy and longer-lasting remission.
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Affiliation(s)
- Abby Abelson
- Center for Osteoporosis and Metabolic Bone Disease, Department of Rheumatic and Immunologic Diseases, Orthopaedic and Rheumatology Institute, The Cleveland Clinic, Cleveland, OH 44195, USA.
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Sherwood A. Diagnosis & Management of Paget Disease of the Bone. J Nurse Pract 2008. [DOI: 10.1016/j.nurpra.2007.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Edward Calif
- The Unit of Hand Surgery, Rambam Medical Center, P.O. Box 9602, Haifa 31096, Israel.
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Briesacher BA, Orwig D, Seton M, Omar M, Kahler KH. Medical care costs of Paget's disease of bone in a privately insured population. Bone 2006; 38:731-7. [PMID: 16364708 DOI: 10.1016/j.bone.2005.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 09/22/2005] [Accepted: 10/11/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Medical care costs are difficult to calculate in diseases such as Paget's disease because they have low detection rates and a wide range of clinical manifestations that commonly occur in aging patient populations. MATERIALS AND METHODS Using 2001-2002 MarketScan Research databases, this study linked medical claims, prescription records, and encounter data on 2.8 million active and retired employees to create a longitudinal panel with 24 months of observation. Patients with Paget's disease were identified by ICD-9 code 731.0. Matched controls (MC) were identified through an exact match procedure using gender, age, and predicted Medicare costs estimated with a risk adjuster. Diagnostic and expenditure records were extracted for the sample and prevalence rates calculated for 20 conditions with well-documented associations to Paget's disease. Comorbidities and health care costs of Paget's disease patients were compared to those of the MCs, and the differences tested using Chi-square and t tests. RESULTS Our study identified 244 matched pairs. The average age was 72.7 years; 50.8% were female. Significantly higher comorbidities (P < 0.05) were detected in Paget's disease patients relative to MCs for: pathological fractures (4.9% vs. 0.4%), heart murmurs (3.3% vs. 0.4%), low back pain (19.7% vs. 8.6%), spinal stenosis (16.4% vs. 9.8%), and hearing loss (13.5% vs. 5.7%), respectively. Biannual per patient outpatient costs were significantly higher in Paget's disease patients (Paget's disease $9301 vs. MC $6339, P < 0.05), especially for services associated with physician visits and diagnostic tests. Prescription costs for antiresportive agents and analgesics were also higher (Paget's disease $1115 vs. MC $507, P < 0.05). Inpatient costs (Paget's disease $16,144 vs. MC $21,480) were comparable. CONCLUSION This study is the first to describe the excessive costs of Paget's disease, based on known patterns of disease expression, evaluation, and treatment.
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Affiliation(s)
- Becky A Briesacher
- University of Massachusetts Medical School, Division of Geriatric Medicine, Biotech Four, Suite 315, 377 Plantation Street, Worcester, MA 01605, USA.
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Wang WC, Cheng YSL, Chen CH, Lin YJ, Chen YK, Lin LM. Paget's disease of bone in a Chinese patient: A case report and review of the literature. ACTA ACUST UNITED AC 2005; 99:727-33. [PMID: 15897860 DOI: 10.1016/j.tripleo.2004.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although it is fairly common in the Western countries, Paget's disease of bone is very rare in Chinese individuals. Through an extensive literature search, only 8 Chinese Paget's disease cases were found in the English language literature and all were reported in local medical journals of Asia that may not be accessible to international readers. To enhance the awareness of the rarity of Paget's disease in Chinese individuals to pathologists worldwide, we present a case of Paget's disease in a 54-year-old Chinese male. We also compare the clinical features of Paget's disease reported in Chinese patients to Paget's disease reported in the Western countries. No familial cases and no malignant transformation are found in the reported cases of Paget's disease in Chinese patients. In addition, more often skull involvement, higher frequency of monostotic cases, and symptomatic cases are observed in this limited number of Paget's disease cases reported in Chinese individuals.
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Affiliation(s)
- Wen-Chen Wang
- Oral Pathology Department, School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
Although osteosarcoma is a well-known complication of Paget's disease of bone, it uncommonly develops in the jaw bones. We present an osteosarcoma arising in Paget's disease of the mandible with unique features of a normal serum alkaline phosphatase level, and histologic features of telangiectatic change in the osteosarcoma and association with cemento-osseous dysplasia. Sixteen reported cases of osteosarcoma arising in Paget's disease of the jaw bones (OPJ) are also reviewed and compared to osteosarcoma arising in Paget's disease occurring in the entire skeleton (OPS) and osteosarcoma arising de novo in the jaw bones (OJ). Females are more commonly involved in OPJ in contrast to a male predominance in OPS and OJ. OPJ also has a distinctively higher percentage involving blacks compared to OPS. The prognosis of OPJ is poor, with 69% of patients dying within two years after diagnosis. Early recognition, early and aggressive treatment are important to improve the prognosis and are hence emphasized.
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Affiliation(s)
- Yi-Shing Lisa Cheng
- Diagnostic Sciences, Baylor College of Dentistry-TAMUSHSC, 3302 Gaston Avenue, Dallas, TX 75246, USA.
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Smith SE, Murphey MD, Motamedi K, Mulligan ME, Resnik CS, Gannon FH. From the archives of the AFIP. Radiologic spectrum of Paget disease of bone and its complications with pathologic correlation. Radiographics 2002; 22:1191-216. [PMID: 12235348 DOI: 10.1148/radiographics.22.5.g02se281191] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Paget disease of bone is a common disorder affecting approximately 3%-4% of the population over 40 years of age. The pathologic abnormality in Paget disease is excessive and abnormal remodeling of bone. Three pathologic phases have been described: the lytic phase (incipient-active), in which osteoclasts predominate; the mixed phase (active), in which osteoblasts cause repair superimposed on the resorption; and the blastic phase (late-inactive) in which osteoblasts predominate. Radiographic appearance of Paget disease reflects these pathologic changes and is often characteristic. Initially, there is osteolysis, particularly affecting the skull (osteoporosis circumscripta) and subchondral long bones, with subsequent development of trabecular and cortical thickening and enlargement of bone in the mixed phase of the disease. Finally, areas of sclerosis may develop in the blastic phase. Frequent sites of involvement include the skull (25%-65% of cases), spine (30%-75%), pelvis (30%-75%), and proximal long bones (25%-30%). Bone scintigraphy typically demonstrates marked increased uptake of radionuclide in all phases of Paget disease. Computed tomography and magnetic resonance imaging often show changes similar to those seen radiographically in noncomplicated Paget disease with maintenance of yellow marrow. Complications of Paget disease include the effects of osseous weakening (deformity and fracture), arthritis, neurologic symptoms, and neoplastic involvement. Sarcomatous transformation is the most feared complication, occurring in approximately 1% of cases, and is seen on images as focal bone destruction extending through the cortex with an associated soft-tissue mass. Recognition of the radiologic spectrum of the appearances of Paget disease usually allows prospective diagnosis and differentiation of its associated complications, which helps guide therapy and improve patient management.
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Affiliation(s)
- Stacy E Smith
- Department of Radiology, University of Maryland School of Medicine, Baltimore, USA
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Lyles KW, Siris ES, Singer FR, Meunier PJ. A clinical approach to diagnosis and management of Paget's disease of bone. J Bone Miner Res 2001; 16:1379-87. [PMID: 11499860 DOI: 10.1359/jbmr.2001.16.8.1379] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- K W Lyles
- GRECC, VAMC, and Duke University Medical Center, Durham, North Carolina 27710, USA
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Richards PS, Bargiota A, Corrall RJ. Paget's disease causing an Arnold-Chiari Type 1 malformation: radiographic findings. AJR Am J Roentgenol 2001; 176:816-7. [PMID: 11222238 DOI: 10.2214/ajr.176.3.1760816] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- P S Richards
- National Hospital for Neurology and Neurosurgery London WC1N 3BG, United Kingdom. Bristol Royal Infirmary Bristol BS6 8HW, United Kingdom
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Spina LD, Carvalho FCD, Eksterman LF, Torres SR, Janini MER, Farias MLFD. Doença de paget com manifestação nos maxilares. ACTA ACUST UNITED AC 2000. [DOI: 10.1590/s0004-27302000000300012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Discutimos um caso incomum de doença de Paget do osso, de apresentação nos maxilares. Esta forma rara de manifestação de uma doença sistêmica levou à dificuldade inicial em estabelecer o diagnóstico, sendo a etiologia firmada apenas pela biópsia da lesão. Utilizamos bisfosfonatos com boa resposta. Ressaltamos no artigo a necessidade do acompanhamento multidisciplinar desses pacientes devido às complicações odontológicas da doença quando localizada nos maxilares.
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Gold DT, Burchett BM, Shipp KM, Pieper CF, Lyles KW. Factors associated with self-rated health in patients with Paget's disease of bone. J Bone Miner Res 1999; 14 Suppl 2:99-102. [PMID: 10510224 DOI: 10.1002/jbmr.5650140221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Multiple studies show that poor self-rated health (SRH) increases the risk of mortality up to 5-fold when compared to excellent SRH. This powerful association remains even with objective health status and risk factors controlled. However, few studies have examined the determinants of SRH, especially as they relate to specific chronic diseases. Here we identify personal characteristics and disease-related attributes that are strongly associated with SRH in a sample of patients with Paget's disease of bone to determine whether any factors can be modified. Two thousand people randomly selected from the Paget Foundation mailing list received a survey asking for information on demographics, general health and functioning, and the impact of Paget's disease. Nine hundred and fifty-eight PD patients returned the completed survey and answered the question, "How would you rate your overall health?" Answers ranged from excellent (1) to poor (5). Ordinary least squares regression was used, with SRH as the dependent variable, to identify those variables significantly associated with SRH. The overall regression model was significant (p = 0.0001; R2 = 0.44). Age (p = 0. 005), satisfaction with family help (p = 0.0001), number of comorbid conditions (p = 0.0001), functional limitations (p = 0.0003), disease impact (p = 0.0002), health compared to 5 years ago (p = 0. 0001), and depressive symptoms (p = 0.012) were significant predictors. Of these, satisfaction with family help, functional limitations, disease impact, and depressive symptoms are potentially modifiable with appropriate interventions. Future longitudinal studies should examine the effectiveness of such interventions in improving SRH.
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Affiliation(s)
- D T Gold
- Department of Psychiatry and Behavioral Sciences and Duke University Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina 27710, USA
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