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Bhari N, Agarwal A, Asritha CVV, Panda M, Mahajan R. Vascular Malformations. Indian Dermatol Online J 2024; 15:415-430. [PMID: 38845674 PMCID: PMC11152494 DOI: 10.4103/idoj.idoj_633_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 06/09/2024] Open
Abstract
Vascular malformations are intricate anomalies of the circulatory system, presenting a diverse array of clinical manifestations, and posing significant challenges in diagnosis and treatment. The pathogenesis of vascular malformations is explored through the lens of genetic and molecular mechanisms, shedding light on the pivotal role of somatic mutations and dysregulated signaling pathways. Clinical presentations of vascular malformations are widely variable, ranging from cosmetic concerns to life-threatening complications. The utility of imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and angiography, are discussed in detail, emphasizing their role in precise delineation and characterization. Therapeutic strategies for vascular malformations are multifaceted, considering factors such as lesion size, location, potential complications, and patient-specific factors. Traditional interventions, including surgical excision and embolization, are appraised alongside emerging approaches like targeted molecular therapies and minimally invasive procedures. The manuscript underscores the need for an individualized treatment approach, optimizing outcomes while minimizing risks and complications. In summation, this manuscript offers a comprehensive analysis of vascular malformations, encompassing their underlying pathogenesis, clinical nuances, diagnostic methods, and therapeutic considerations. By synthesizing current knowledge and highlighting gaps in understanding, this review serves as a valuable resource for clinicians, researchers, and medical practitioners, fostering an enhanced comprehension of vascular malformations and paving the way for improved patient care and innovative research endeavors.
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Affiliation(s)
- Neetu Bhari
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Akash Agarwal
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - C. V. V. Asritha
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Maitreyee Panda
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Rahul Mahajan
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rossi M, Terreri S, Battafarano G, Rana I, Buonuomo PS, Di Giuseppe L, D'Agostini M, Porzio O, Di Gregorio J, Cipriani C, Jenkner A, Gonfiantini MV, Bartuli A, Del Fattore A. Analysis of circulating osteoclast and osteogenic precursors in patients with Gorham-Stout disease. J Endocrinol Invest 2024:10.1007/s40618-024-02365-8. [PMID: 38556572 DOI: 10.1007/s40618-024-02365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Gorham-Stout disease is a very rare disorder characterized by progressive bone erosion and angiomatous proliferation; its etiopathogenesis is still unknown, and diagnosis is still performed by exclusion criteria. The alteration of bone remodeling activity has been reported in patients; in this study, we characterized circulating osteoclast and osteogenic precursors that could be important to better understand the osteolysis observed in patients. METHODS Flow cytometry analysis of PBMC (Peripheral Blood Mononuclear Cells) was performed to characterize circulating osteoclast and osteogenic precursors in GSD patients (n = 9) compared to healthy donors (n = 55). Moreover, ELISA assays were assessed to evaluate serum levels of bone markers including RANK-L (Receptor activator of NF-κB ligand), OPG (Osteoprotegerin), BALP (Bone Alkaline Phosphatase) and OCN (Osteocalcin). RESULTS We found an increase of CD16-/CD14+CD11b+ and CD115+/CD14+CD11b+ osteoclast precursors in GSD patients, with high levels of serum RANK-L that could reflect the increase of bone resorption activity observed in patients. Moreover, no significant alterations were found regarding osteogenic precursors and serum levels of BALP and OCN. CONCLUSION The analysis of circulating bone cell precursors, as well as of RANK-L, could be relevant as an additional diagnostic tool for these patients and could be exploited for therapeutic purposes.
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Affiliation(s)
- M Rossi
- Bone Physiopathology Research Unit, Translational Pediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - S Terreri
- Bone Physiopathology Research Unit, Translational Pediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - G Battafarano
- Bone Physiopathology Research Unit, Translational Pediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - I Rana
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P S Buonuomo
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - L Di Giuseppe
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - M D'Agostini
- Clinical Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - O Porzio
- Clinical Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - J Di Gregorio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - A Jenkner
- Pediatric Palliative Care Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M V Gonfiantini
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Bartuli
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Del Fattore
- Bone Physiopathology Research Unit, Translational Pediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy.
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Yu MH, Hyun D, Shin SH, Ha SY. Role of Lymphatic Embolization in Chylothorax Associated with Gorham-Stout Disease: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:451-455. [PMID: 38617872 PMCID: PMC11009133 DOI: 10.3348/jksr.2023.0044] [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: 04/24/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 04/16/2024]
Abstract
A 45-year-old male patient with spontaneous chylothorax and osteolysis in the right 1st and 2nd ribs was diagnosed with Gorham-Stout disease based on clinical manifestations and bone biopsy. The chylothorax temporarily decreased after a successful selective lymphatic embolization. The patient presented with recurrent chylothorax, mild chest discomfort, and progressive osteolysis (despite administering sirolimus) during the follow-up period of 15 months.
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Solorzano E, Alejo AL, Ball HC, Robinson GT, Solorzano AL, Safadi R, Douglas J, Kelly M, Safadi FF. The Lymphatic Endothelial Cell Secretome Inhibits Osteoblast Differentiation and Bone Formation. Cells 2023; 12:2482. [PMID: 37887326 PMCID: PMC10605748 DOI: 10.3390/cells12202482] [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: 05/11/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
Complex lymphatic anomalies (CLAs) are a set of rare diseases with unique osteopathic profiles. Recent efforts have identified how lymphatic-specific somatic activating mutations can induce abnormal lymphatic formations that are capable of invading bone and inducing bone resorption. The abnormal bone resorption in CLA patients has been linked to overactive osteoclasts in areas with lymphatic invasions. Despite these findings, the mechanism associated with progressive bone loss in CLAs remains to be elucidated. In order to determine the role of osteoblasts in CLAs, we sought to assess osteoblast differentiation and bone formation when exposed to the lymphatic endothelial cell secretome. When treated with lymphatic endothelial cell conditioned medium (L-CM), osteoblasts exhibited a significant decrease in proliferation, differentiation, and function. Additionally, L-CM treatment also inhibited bone formation through a neonatal calvaria explant culture. These findings are the first to reveal how osteoblasts may be actively suppressed during bone lymphatic invasion in CLAs.
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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.); (G.T.R.); (A.L.S.)
- Musculoskeletal Research Group, NEOMED, Rootstown, OH 44272, USA;
- Basic and Translational Biomedicine (BTB) Graduate Program, College of Graduate Studies, 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.); (G.T.R.); (A.L.S.)
| | - 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.); (G.T.R.); (A.L.S.)
- Musculoskeletal Research Group, NEOMED, Rootstown, OH 44272, USA;
- Basic and Translational Biomedicine (BTB) Graduate Program, College of Graduate Studies, NEOMED, Rootstown, OH 44272, USA;
| | - Gabrielle T. Robinson
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA; (E.S.); (A.L.A.); (H.C.B.); (G.T.R.); (A.L.S.)
- Musculoskeletal Research Group, NEOMED, Rootstown, OH 44272, USA;
- Basic and Translational Biomedicine (BTB) Graduate Program, College of Graduate Studies, NEOMED, Rootstown, OH 44272, USA;
| | - Andrea L. Solorzano
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA; (E.S.); (A.L.A.); (H.C.B.); (G.T.R.); (A.L.S.)
| | - Rama Safadi
- College of Arts and Sciences, Kent State University, Kent, OH 44243, USA;
| | - Jacob Douglas
- Musculoskeletal Research Group, NEOMED, Rootstown, OH 44272, USA;
| | - Michael Kelly
- Basic and Translational Biomedicine (BTB) Graduate Program, College of Graduate Studies, NEOMED, Rootstown, OH 44272, USA;
- 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.); (G.T.R.); (A.L.S.)
- Musculoskeletal Research Group, NEOMED, Rootstown, OH 44272, USA;
- Basic and Translational Biomedicine (BTB) Graduate Program, College of Graduate Studies, NEOMED, Rootstown, OH 44272, USA;
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH 44308, USA
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Xiang J, Zhong W. The molecular mechanism of Gorham syndrome: an update. Front Immunol 2023; 14:1165091. [PMID: 37215116 PMCID: PMC10196207 DOI: 10.3389/fimmu.2023.1165091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Gorham syndrome, also known as "vanishing osteopathy" and "invasive hemangiomatosis," is a rare clinical syndrome whose etiology is unknown and can invade the whole-body skeleton. At present, more than 300 cases have been reported at home and abroad, usually manifesting as spontaneous chronic osteolysis with no periosteal reaction at the lysis site and occult onset, often with fractures, scoliosis, chylothorax, etc. When waiting for medical treatment, the condition is serious, and the prognosis is poor. At present, there is no effective treatment. The main pathological manifestations of Gorham syndrome are the non-neoplastic abnormal proliferation of lymphatic vessels or blood vessels and osteolysis caused by osteoclast proliferation or increased activity. At present, there is no unified conclusion regarding Gorham syndrome's pathogenesis. This paper starts with the two most studied osteolysis methods at present, osteoclast osteolysis and osteolysis caused by vascular and lymphatic proliferation and summarizes the corresponding most possible molecular mechanisms in recent years to provide more ideas for Gorham syndrome treatment.
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Affiliation(s)
- Juqin Xiang
- Chongqing Medical University, Chongqing, China
| | - Weiyang Zhong
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lee Y, Lee S, Hur S, Jeong YS, Suh DI, Moon J, Kim MJ, Choi YH, Cheon JE. The spectrum of imaging manifestations of Gorham-Stout disease: a novel dynamic contrast-enhanced MR lymphangiography. Orphanet J Rare Dis 2023; 18:96. [PMID: 37101303 PMCID: PMC10131433 DOI: 10.1186/s13023-023-02704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/20/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND To describe the radiological features of Gorham-Stout disease (GSD) as evaluated using plain radiography and dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) imaging techniques. METHODS Clinical and conventional imaging data were retrospectively reviewed for 15 patients with GSD between January 2001 and December 2020. After December 2018, DCMRL examinations were performed for lymphatic vessel evaluation in patients with GSD and reviewed in four patients. RESULTS The median age at diagnosis was 9 years (range: 2 months-53 years). The clinical manifestations were dyspnea in seven patients (46.7%), sepsis in 12 (80.0%), orthopedic problems in seven (46.7%), and bloody chylothorax in seven (46.7%). The common sites of osseous involvement were the spine (73.3%) and pelvic bone (60.0%). Among the non-osseous involvements, peri-osseous infiltrative soft-tissue abnormalities adjacent to the area of bone involvement were the most common (86.7%), followed by splenic cysts (26.7%) and interstitial thickening (26.7%). DCMRL demonstrated weak central conducting lymphatic flow in two patients with abnormal giant tortuous thoracic ducts and no flow in one patient. All patients who underwent DCMRL in this study presented with altered anatomical lymphatics and functional flow with collateralization. CONCLUSION DCMRL imaging and plain radiography are very useful for determining the extent of GSD. DCMRL is a novel imaging tool for the visualization of abnormal lymphatics in patients with GSD, which helps in further treatment. Therefore, in patients with GSD, it might be necessary to obtain not only plain radiographs but also MR and DCMRL images.
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Affiliation(s)
- Yuna Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yun Soo Jeong
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Man Jin Kim
- Department of Laboratory Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Arora S, Kashyap A, Maini L, Prakash A, Saran RK. Chondromyxoid Fibroma of Clavicle Presenting as Radiological Disappearance of Bone. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2023. [DOI: 10.1055/s-0043-1764435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Abstract
Case Presentation Chondromyxoid fibroma (CMF) is a relatively rare bone tumor of cartilaginous origin and it comprises less than 1% of all primary bony tumors. Clavicle is an unusual site of involvement for any bone tumor and may produce diagnostic dilemma. Approximately only 1% of all primary bone tumors may involve the clavicle. The literature on clinical features and outcome of CMF clavicle remains sparse.
Conclusion We present an unusual case of CMF clavicle in which the medial aspect of the clavicle gradually disappeared on radiographs. CMF should be included in the differential diagnoses of disappearing bone disease.
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Affiliation(s)
- Sumit Arora
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Abhishek Kashyap
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Lalit Maini
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - R. K. Saran
- Department of Pathology, GIPMER Associated with Maulana Azad Medical College, New Delhi, India
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Zhang L, Li J, Yao F, Chen Y, Zhang S, Lv H, Jing J. Treatment of gorham-stout disease with bisphosphonates and total hip arthroplasty: A case report. Front Surg 2023; 10:1078869. [PMID: 36793315 PMCID: PMC9922857 DOI: 10.3389/fsurg.2023.1078869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/11/2023] [Indexed: 02/03/2023] Open
Abstract
Background Gorham-Stout disease (GSD) is a rare osteolytic disease with unknown etiology, varied clinical manifestations and unpredictable prognosis. This disease is characterized by progressive massive local osteolysis and resorption caused by intraosseous lymphatic vessel structure and thin-walled vascular proliferation. The diagnosis of GSD has not yet formed a uniform standard, but the combination of clinical manifestations, radiological features and unique histopathological examinations and excluding other diseases contribute to early diagnosis. Although medical therapy, radiotherapy and surgical interventions or combinations have been used for the treatment of GSD, there is currently still no recommended standardized treatment regimen. Case report This paper presents a case of a previously healthy 70-year-old man presented with a 10-year history of severe right hip pain and progressive walking disorder of the lower limbs. Based on the patient's clear clinical presentation, unique radiological features, and histological findings, a diagnosis of GSD was made with the exclusion of other potential diseases. The patient was treated with bisphosphonates to slow the progression of the disease followed by total hip arthroplasty to help restore walking function. At the 3-year follow-up, the patient returned to normal walking and no recurrence was observed. Conclusion Bisphosphonates combined with total hip arthroplasty may be an effective method for the treatment of severe GSD in the hip joint.
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Affiliation(s)
- LiQian Zhang
- Department of Orthopaedics & Joint Reconstruction Surgery, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - JianJian Li
- Department of Orthopaedics & Joint Reconstruction Surgery, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Fei Yao
- Department of Orthopaedics & Joint Reconstruction Surgery, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - YiHao Chen
- Department of Orthopaedics & Joint Reconstruction Surgery, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Shuo Zhang
- Department of Orthopaedics & Joint Reconstruction Surgery, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Hao Lv
- Department of Orthopaedics & Joint Reconstruction Surgery, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China,Correspondence: Hao Lv JueHua Jing
| | - JueHua Jing
- Department of Orthopaedics & Joint Reconstruction Surgery, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China,Correspondence: Hao Lv JueHua Jing
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Wang MX, Kamel S, Elsayes KM, Guillerman RP, Habiba A, Heng L, Revzin M, Mellnick V, Iacobas I, Chau A. Vascular Anomaly Syndromes in the ISSVA Classification System: Imaging Findings and Role of Interventional Radiology in Management. Radiographics 2022; 42:1598-1620. [DOI: 10.1148/rg.210234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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.
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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
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Gorham-Stout disease, a diagnosis of exclusion. Radiol Case Rep 2022; 17:3243-3246. [PMID: 35814817 PMCID: PMC9256995 DOI: 10.1016/j.radcr.2022.06.016] [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: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 11/20/2022] Open
Abstract
Gorham-Stout disease (GSD) also known as vanishing bone disease is an idiopathic and rare condition characterized by gross and progressive bone loss along with excessive growth of vascular and lymphatic tissue. Very little is known about the pathogenesis of GSD, which makes the diagnosis challenging and often diagnosed by elimination. We report a case of GSD in a 41-year-old male patient. He presented with bone pain and initial imaging showed widespread osteolytic lesions in the cervical and mid thoracic spine, ribs, sternum, clavicles, scapula, and humerus. Two percutaneous bone biopsies were performed, followed by an open spine biopsy of the lumber 2 spinous process for histological examination. Unfortunately, no diagnosis was reached. Although, he was treated symptomatically, he kept enduring pain and presented again after 7 months. His laboratory values were out of the normal range which prompted thorough investigations. New imaging and bone biopsy revealed multiple osteolytic lesions and vascular lesion with cavernous morphology respectively. GSD was diagnosed after ruling out a neoplastic process and confirming the cavernous morphology with immunohistochemical stain. He was treated symptomatically with immunomodulators, bisphosphonates, and supplements. Patient was counseled to see the specialist regularly. This case will help to increase familiarity and shed insights in the diagnosis of GSD.
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Toivonen LA, Neva MH, Sioris T, Isomäki P, Metso S. Gorham-Stout disease with life-threatening pleural effusion treated with a pleuro-peritoneal shunt: a case report. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0101. [PMID: 35642669 PMCID: PMC9175580 DOI: 10.1530/edm-21-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022] Open
Abstract
Summary Gorham-Stout disease (GSD) is a rare bone disease characterized by massive osteolysis and lymphatic proliferation. The origin of the condition is unknown, and no established treatment protocol exists. Massive pleural effusion is a frequent complication of GSD in the thoracic region. We present the case of a 23-year-old male with thoracic GSD, subsequent paraparesis, and life-threatening pleural effusion. The patient was managed by a multidisciplinary team with a good recovery. The pleural effusion was successfully treated with a pleuro-peritoneal shunt. This is the first report of the use of this mini-invasive technique in the management of pleural effusion related to GSD. Further, we present the potential role of interleukin-6 and bone resorption markers in the measurement of the disease activity. Learning points Multidisciplinary approach is important in the management of rare and severe disorders such as Gorham-Stout disease. Pleuro-peritoneal shunting is a valuable option in the treatment of pleural effusion related to GSD. Interleukin-6 and bone resorption markers appear useful in measuring the disease activity of GSD.
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Affiliation(s)
- Leevi A Toivonen
- Department of Orthopaedic and Trauma Surgery, Department of Internal Medicine
| | - Marko H Neva
- Department of Orthopaedic and Trauma Surgery, Department of Internal Medicine
| | - Thanos Sioris
- Department of Cardiothoracic Surgery, Department of Internal Medicine
| | - Pia Isomäki
- Centre for Rheumatic Diseases, Department of Internal Medicine
| | - Saara Metso
- Unit of Endocrinology, Department of Internal Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, Tampere, Finland
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Krishnan A, Raj A, Degulmadi D, Mayi S, Rai R, Bali SK, Parmar V, Amin PC, Krishnan P, Dave M, Dave B. Gorham-Stout disease: A multirod lumbar reconstruction with off-label suppression-remission therapy. Surg Neurol Int 2022; 13:136. [PMID: 35509593 PMCID: PMC9062908 DOI: 10.25259/sni_221_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gorham-Stout disease (GSD), a fibro-lymphovascular entity in which tissue replaces the bone leading to massive osteolysis and its sequelae, rarely leads to spinal deformity/instability and neurological deficits. Here, we report a 12-year-old female who was diagnosed and treated for GSD. CASE DESCRIPTION A 12-year-old female presented with back pain, and the inability to walk, sit, or stand attributed to three MR/CT documented L2-L4 lumbar vertebral collapses. Closed biopsies were negative. However, an open biopsy diagnosed GSD. She underwent a dorsal-lumbar-to-pelvis fusion (i.e., T5-T12 through L5/S1/S2) using multilevel pedicle screw/rod stabilization and human leukocyte antigens (HLAs) matched allograft (i.e. from her father). Postoperatively, she was treated with "off-label" teriparatide injections, bisphosphonates, and sirolimus. Four years later, while continuing the bisphosphonate therapy, she remained stable. CONCLUSION Surgical multirod stabilization from T5 to S2, supplemented with HLA compatible allograft, and multiple medical "off-label" therapies (i.e., teriparatide, sirolimus, and bisphosphonates) led to a good 4-year outcome in a 12-year-old female with GSD.
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Affiliation(s)
- Ajay Krishnan
- Corresponding author: Ajay Krishnan, Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.
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14
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Wu BT, Stein-Wexler R, Li STT. Chest Mass in a Newborn Infant. Pediatr Rev 2022; 43:e1-e5. [PMID: 34970691 DOI: 10.1542/pir.2020-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Brenda T Wu
- School of Medicine, University of California Davis, Sacramento, CA
| | | | - Su-Ting T Li
- Department of Pediatrics, University of California Davis Health, Sacramento, CA
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15
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Hyseni F, Vokshi V, Kola E, Fathma S, Guy A, Bushati F, Ahmetgjekaj I, Hla D, Saliaj K, Ikram S, Mohamed EA, Bajwa IA, Nasir F, Musa J. The importance of computed tomography (CT) scans in the early diagnosis of Gorham-Stout Disease - A case report. Radiol Case Rep 2021; 17:492-495. [PMID: 34950281 PMCID: PMC8671801 DOI: 10.1016/j.radcr.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022] Open
Abstract
Gorham Stout disease (GSD) or vanishing bone disease is an infrequent entity in clinical practice characterized by gross and progressive bone loss along with excessive growth of vascular and lymphatic tissue. Very little is known about the pathogenesis of GSD, which makes the diagnosis challenging. Due to the rarity of the disease, no treatment guidelines have been created yet. We report a case of GSD in a 53-year-old male patient. He presented with bone pain and initial imaging showed widespread osteolytic lesions in the cervical and mid thoracic spine, ribs, sternum, clavicles, scapula and humerus. Two percutaneous bone biopsies were performed, followed by an open spine biopsy of the L2 spinous processes for histological examination. Unfortunately, no diagnosis was established. Although, he was treated symptomatically, he kept enduring pain and presented again after seven months. His laboratory values were out of the normal range which prompted thorough investigations. New imaging and bone biopsy revealed multiple osteolytic lesions and vascular lesions with cavernous morphology. GSD was diagnosed after ruling out a neoplastic process and confirming the cavernous morphology with immunohistochemical stain. He was treated symptomatically with immunomodulators, bisphosphonates and supplements. Regular follow-up with a specialist was recommended. We hope this case will raise awareness of GSD in common clinical practice and shed some insight on its clinical presentation and the role CT and other imaging modalities play in the diagnosis of GSD.
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Affiliation(s)
- Fjolla Hyseni
- Medical Researcher, NYU Langone Health, New York, USA
| | - Valon Vokshi
- Department of Anesthesiology, University Clinical Center of Kosovo
| | - Erisa Kola
- Department of Pathology, Gjirokaster, Albania
| | - Sawsan Fathma
- Critical Care Research, Department of Anesthesiology, Mayo Clinic, Rochester
| | - Ali Guy
- Clinical Instructor of Physical Medicine & Rehabilitation, New York University School of Medicine, NYU Medical Center, New York, NY, USA
| | - Fiona Bushati
- University of Medicine, Mother Theresa Hospital, Tirana
| | | | - Diana Hla
- Mayo Clinic Alix School of Medicine, Rochester, MN
| | | | - Samar Ikram
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Essa A Mohamed
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ibrahim A Bajwa
- FU Medical College, Foundation University, Islamabad, Pakistan
| | - Fareeha Nasir
- Department of Internal Medicine, Harlem Hospital Center, NY
| | - Juna Musa
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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16
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López García IM, Lorenzo Domínguez MT, Fernández Martínez AM, Cuesta Marcos MT. Massive osteolysis in a patient with Gorham-Stout syndrome. REUMATOLOGIA CLINICA 2021; 17:485-488. [PMID: 34625153 DOI: 10.1016/j.reumae.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/15/2020] [Indexed: 06/13/2023]
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17
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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 2021:1-6. [PMID: 34585642 DOI: 10.1080/02688697.2021.1981244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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.
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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
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18
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Forero Saldarriaga S, Vallejo C, Urrea Pineda L, Osma A, Bonilla Gonzalez C. Gorham-Stout Disease with Clinical Response to Sirolimus Treatment. Eur J Case Rep Intern Med 2021; 8:002740. [PMID: 34527618 DOI: 10.12890/2021_002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 11/05/2022] Open
Abstract
Gorham-Stout disease (GSD) is a rare clinical entity of unknown aetiology, with osseous resorption, vascular structure proliferation and inflammation of adjacent soft tissues. The clinical spectrum varies from asymptomatic patients to patients with pain, functional limitation or deformity. GSD may affect 1 or multiple bones in any location; however, predilection for the maxillofacial area and upper limbs has been described. We present the case report of a 33-year-old male patient with facial pain and loss of dental pieces; imaging showed extensive lytic involvement of the mandible and cranial bones. After exclusion of malignant, metabolic, infectious, or autoimmune disease, a diagnosis of GSD was made. Treatment with sirolimus was prescribed, achieving a symptomatic improvement and stability of imaging findings. The importance of the knowledge of this orphan disease is highlighted, to achieve a prompt diagnosis and medical treatment. LEARNING POINTS Gorham-Stout syndrome constitutes an orphan disease with an unknown aetiology, it must be considered in young patients with osteolysis of unknown cause.The diagnosis of Gorham-Stout syndrome is an exclusion one.Drugs with antiproliferative and antiangiogenic activity such as mTOR inhibitors are an attractive option for the management of this disease.
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Affiliation(s)
| | - Camilo Vallejo
- Internal Medicine Department, Universidad de Antioquia, Medellìn, Colombia
| | | | - Anderson Osma
- Clinical Oncology, National Cancer Institute, Bogotà, Colombia
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19
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Rossi M, Rana I, Buonuomo PS, Battafarano G, De Martino V, D'Agostini M, Porzio O, Cipriani C, Minisola S, De Vito R, Vecchio D, Gonfiantini MV, Jenkner A, Bartuli A, Del Fattore A. Stimulation of Treg Cells to Inhibit Osteoclastogenesis in Gorham-Stout Disease. Front Cell Dev Biol 2021; 9:706596. [PMID: 34513837 PMCID: PMC8430039 DOI: 10.3389/fcell.2021.706596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
Gorham-Stout disease (GSD) is a very rare syndrome displaying excessive bone erosion and vascular lesion. Due to the rarity of the disease and to the limited studies, its etiopathogenesis is not entirely known. The involvement of immune system in the progressive osteolysis was recently suggested. Indeed, extensive reciprocal interactions between the immune and skeletal systems have been demonstrated. This study aimed to evaluate alterations of immune cells in GSD. An increase of CD8+ cells and reduction of CD4+ and CD4+CD25+CD127low cells was revealed in patients. Interestingly, patients’ regulatory T cells maintain the ability to respond to extracellular stimuli and to regulate osteoclastogenesis; GSD cells proliferate under aCD3/CD28 signal reaching similar levels to those observed in control culture and exert their immunomodulatory activity on effector T cells. GSD Treg cells preserved their inhibitory effects on the osteoclastogenesis. These results suggest that stimulation of Treg cells could open the way for the identification and testing of new therapeutic approaches for patients affected by GSD.
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Affiliation(s)
- Michela Rossi
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ippolita Rana
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Sabrina Buonuomo
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Battafarano
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Viviana De Martino
- Department of Clinical, Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Matteo D'Agostini
- Clinical Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ottavia Porzio
- Clinical Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Salvatore Minisola
- Department of Clinical, Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Rita De Vito
- Department of Histopathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Vecchio
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Alessandro Jenkner
- Division of Immunology and Infectious Diseases, Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Bartuli
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Del Fattore
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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20
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Cherian KE, Kapoor N, Paul TV. Vanishing Bone Disease of the Thoracic Cage: Challenges in the Management of a Rare Entity. AACE Clin Case Rep 2021; 8:65-68. [PMID: 35415229 PMCID: PMC8984204 DOI: 10.1016/j.aace.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/22/2021] [Accepted: 09/10/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Thomas V. Paul
- Address correspondence to Dr Thomas V. Paul, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Ida Scudder Road, Vellore 632004, Tamil Nadu, India.
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21
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Gorham-Stout Disease with Multiple Bone Involvement-Challenging Diagnosis of a Rare Disease and Literature Review. ACTA ACUST UNITED AC 2021; 57:medicina57070681. [PMID: 34356962 PMCID: PMC8304881 DOI: 10.3390/medicina57070681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022]
Abstract
Gorham-Stout disease is a rare disorder, which may result in a poor prognosis. This disease, a rare lymphangiomatosis, is defined by progressive bone disappearance due to massive unicentric and multicentric osteolysis. Osteolytic lesions of the spine and pleura effusion are poor prognostic factors. Herein, we will present a case where the onset of disease occurred at the age of 18 with asthenia, myalgia, and major bone pain, followed by incomplete motor deficiency in the lower limbs and, later, in the upper limbs. Imaging studies (CT scan and MRI) of the patient revealed osteolytic lesions (cervical and thoracic vertebrae, rib, and clavicle) and a pathological fracture of the C7 vertebra. Surgical procedures undertaken involved replacing the affected vertebrae with bone grafting and prosthesis. The investigations performed allowed for the exclusion of inflammation, thyroid or parathyroid disease, lymphoma, neoplasia, or autoimmune disorders. A bone marrow biopsy showed osteolysis, the replacement of bone tissues with connective tissue, and chronic non-specific inflammation. The evolution was negative with almost complete osteolysis of the left clavicle, the emergence of new osteolysis areas in the lumbar vertebrae, pelvic bones, and the bilateral proximal femur, splenic nodules, chylothorax, and associated major neurological deficits. Unfortunately, this negative evolution resulted in the patient’s death a year after onset.
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22
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Stiefel K, Gangwani P, Cox D, Kolokythas A. Ill-defined extensive radiolucent lesion of the left posterior mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:129-137. [PMID: 34364827 DOI: 10.1016/j.oooo.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Kyle Stiefel
- Private Practice, Oral and Maxillofacial Surgery, Plaistow, NH, USA
| | - Pooja Gangwani
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Eastman Institute of Oral Health, University of Rochester, Rochester, NY, USA.
| | - Darren Cox
- Professor, Diagnostic Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA
| | - Antonia Kolokythas
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Eastman Institute of Oral Health, University of Rochester, Rochester, NY, USA
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23
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Gui C, Rocos B, Lohkamp LN, Cheung A, Bleakney R, Massicotte E. Utility of the spinal instability neoplastic score to identify patients with Gorham-Stout disease requiring spine surgery. Surg Neurol Int 2021; 12:227. [PMID: 34221558 PMCID: PMC8247937 DOI: 10.25259/sni_311_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Gorham-Stout disease (GSD) is a rare syndrome presenting with progressive osteolysis which in the spine can lead to cord injury, instability, and deformity. Here, the early spine surgery may prevent catastrophic outcomes. Case Description: A 25-year-old male with GSD involving the T2 to T6 levels presented with acute traumatic kyphoscoliosis at T3 and T4 and left lower extremity paraparesis. The CT scan 4 weeks before this showed progressing osteolysis versus the CT 5 years ago. Unfortunately, the patient underwent delayed treatment resulting in permanent neurological sequelae. Surgery included a laminectomy and vertebrectomy of T3/T4 with instrumented fusion from T1-10. The use of the spinal instability neoplastic score (SINS) is a useful tool to prompt early referral to spine surgeons. Conclusion: We recommend using the SINS score in GSD patients who develop spinal lesions to prompt early referral for consideration of surgery.
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Affiliation(s)
- Chloe Gui
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Brett Rocos
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Laura-Nanna Lohkamp
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Angela Cheung
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Robert Bleakney
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Eric Massicotte
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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24
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Toga A, Watanabe K, Suzuki S, Nori S, Tsuji O, Nagoshi N, Okada E, Yagi M, Fujita N, Nakamura M, Matsumoto M. Gorham-Stout Disease Resulting in Spinal Deformity Treated by Fusion Surgery Combined With Everolimus Therapy: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00038. [PMID: 33657060 DOI: 10.2106/jbjs.cc.20.00296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Gorham-Stout disease (GSD) is a rare disorder characterized by progressive localized osteolysis and lymphatic malformation. A 26-year-old woman with GSD presented to our hospital with a Cobb angle of 100° and a kyphosis angle of 88°. Everolimus therapy was initiated to control the disease prior to surgery. After halo-gravity traction for 4 weeks, we performed anterior and posterior spinal fusion. Postoperative computed tomography revealed satisfactory bone union and no significant loss of correction 1 year post-surgery. CONCLUSION This case suggests that anterior and posterior spinal fusion combined with everolimus therapy can be a therapeutic option for GSD.
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Affiliation(s)
- Akira Toga
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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25
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Esper A, Alhoulaiby S, Emran A, Youssef S, Alshehabi Z. Gorham Stout disease: a case report from Syria. Oxf Med Case Reports 2021; 2021:omaa121. [PMID: 33469472 PMCID: PMC7802812 DOI: 10.1093/omcr/omaa121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/13/2020] [Accepted: 10/31/2020] [Indexed: 11/14/2022] Open
Abstract
Gorham-Stout disease (GSD) is a rare entity that destroys the bone matrix resulting mainly in osteolysis, pain and pathologic fractures among a broader clinical picture. We report a case of a 60-year-old female with a sudden discovery of pathologic fractures in the pelvis and the absence of the left femoral head. On biopsy, no cellular atypia was found, instead disturbed bone formation with prominent vascularity with scattered foci of necrosis & osteolysis, which lead to the diagnosis of GSD. Possible differential diagnoses were discussed and excluded. The patient was put on Bisphosphonate that led to a relative improvement in the symptoms. This disease needs a more thorough investigation to identify the key cause, what is beyond the scope of this report.
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Affiliation(s)
- Asil Esper
- Neurology Department, Tishreen University Hospital, Halap street, Latakia, Syria
| | | | - Areege Emran
- Pulmonary Department, Tishreen University Hospital, Latakia, Syria
| | - Safwan Youssef
- Orthopedics Department, Tishreen University Hospital, Latakia, Syria
| | - Zuheir Alshehabi
- Pathology Department, Tishreen University Hospital, Latakia, Syria
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Kamble P, Sathe A, Mohanty S, Rathod T. A Rare Case of Vanishing Bone Disease of Metacarpals. J Orthop Case Rep 2021; 11:101-103. [PMID: 34141653 PMCID: PMC8046473 DOI: 10.13107/jocr.2021.v11.i01.1982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Vanishing bone disease is rare phenomenon of idiopathic origin that leads to extensive osteolysis of bone. Prognosis of disease is unpredictable and definitive guidelines for management are still unknown. The vanishing bone disease has been reported for multiple other bones, however, this probably is the 1st time that vanishing bone disease of the metacarpals is being reported. Case Report A 22-year-old male presented with shortening middle finger and poor grip strength of the left hand. Serial radiographs revealed progressive concentric reduction of third and then fourth metacarpal shaft, with a sucked candy appearance. All the blood parameters were normal including calcium and parathormone levels. There was no evidence of any tumor elsewhere in the body. Biopsy showed myxoid areas, proliferating vessels interposed with skeletal muscles. Thus, based on clinical, radiological, and histopathological findings, we made the diagnosis of vanishing bone disease. The patient was treated with autologous non-vascularized fibula graft and was fixed with transverse k-wires to adjacent metacarpals. At 2-year follow-up, graft was completely incorporated and the patient gained full functional recovery. Conclusion Vanishing bone disease affecting the metacarpals is very rarely reported in the literature. The diagnosis should be made by excluding all the other conditions such as primary bone tumors or secondary from other sites. There are no fixed treatment guidelines. However, we could treat this condition successfully with autologous non-vascularized fibular graft.
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Affiliation(s)
- Prashant Kamble
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Ashwin Sathe
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Shubhranshu Mohanty
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Tushar Rathod
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
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27
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López García IM, Lorenzo Domínguez MT, Fernández Martínez AM, Cuesta Marcos MT. Massive Osteolysis in a Patient with Gorham-Stout Syndrome. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30189-3. [PMID: 32868245 DOI: 10.1016/j.reuma.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
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28
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Jha V, Jha A. Unusual case of chylothorax with unilateral limb swelling. BMJ Case Rep 2020; 13:13/2/e230379. [PMID: 32047079 DOI: 10.1136/bcr-2019-230379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Here, we present an unusual case of 26-month male toddler who presented with swelling of right lower limb with painless hyperpigmented patch over right groin of 18 months duration associated with recent onset respiratory distress. Evaluation revealed right chylothorax and MRI revealed altered signal intensity in bones and muscles of right lower limb. Lymphoscintigraphy revealed absence of lymphatic channels in right lower limb. Skin biopsy from hyperpigmented patch was suggestive of vasoformative lesion favouring lymphangiomatosis. A diagnosis of Gorham's syndrome was made, and our patient was managed with drainage of chylothorax followed by pleurodesis, parenteral nutrition and radiotherapy.
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Affiliation(s)
- Vishal Jha
- Department of Medicine, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Aditi Jha
- Department of Anaesthesiology, General Hospital, Ladakh, India
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Stephens S, Squires L, Campbell R, Davies J, Chaseling R. Multifocal Gorham-Stout disease associated with Chiari I malformation and recurrent aseptic meningitis: Case report and review of literature. J Clin Neurosci 2020; 72:486-492. [PMID: 31911110 DOI: 10.1016/j.jocn.2019.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/27/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
Gorham-Stout disease is a rare condition of uncertain aetiology characterised by lymphatic proliferation within osseous structures and subsequent massive osteolysis. This report describes the index case of a patient with multifocal Gorham-Stout disease involving the skull base with Chiari I malformation and recurrent aseptic meningitis without fistula. A five-year-old male presented following decompression of a Chiari I malformation with headaches, vomiting, and stiff neck and cerebrospinal fluid pleocytosis without growth of a pathogenic organism. Ongoing symptoms prompted a further three presentations over several months revealing persistent aseptic cerebrospinal fluid monocytic pleocytosis. Further investigation revealed multifocal osseous cystic disease and subsequent bone biopsy suggested Gorham-Stout disease. Suboccipital decompression was not repeated despite craniocervical junction re-stenosis. A literature review demonstrated the extreme rarity of Gorham-Stout disease associated with Chiari I malformation and meningitis. Potential mechanisms of these entities occurring in concert are discussed. Consideration of Gorham-Stout disease as a secondary cause for Chiari I malformation is important amid local bone changes or cerebrospinal fluid leakage prior to pursuing suboccipital decompression considering the poor outcomes reported.
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Affiliation(s)
- Sean Stephens
- Neurosurgery Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
| | - Lisa Squires
- Anatomical Pathology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Robert Campbell
- Neurosurgery Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Janene Davies
- Anatomical Pathology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Raymond Chaseling
- Neurosurgery Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
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30
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Rossi M, Buonuomo PS, Battafarano G, Conforti A, Mariani E, Algeri M, Pelle S, D'Agostini M, Macchiaiolo M, De Vito R, Gonfiantini MV, Jenkner A, Rana I, Bartuli A, Del Fattore A. Dissecting the mechanisms of bone loss in Gorham-Stout disease. Bone 2020; 130:115068. [PMID: 31525474 DOI: 10.1016/j.bone.2019.115068] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 12/17/2022]
Abstract
Gorham-Stout disease (GSD) is a rare disorder characterized by progressive osteolysis and angiomatous proliferation. Since the mechanisms leading to bone loss in GSD are not completely understood, we performed histological, serum, cellular and molecular analyses of 7 patients. Increased vessels, osteoclast number and osteocyte lacunar area were revealed in patients' bone biopsies. Biochemical analysis of sera showed high levels of ICTP, Sclerostin, VEGF-A and IL-6. In vitro experiments revealed increased osteoclast differentiation and activity, and impaired mineralization ability of osteoblasts. To evaluate the involvement of systemic factors in GSD, control cells were treated with patients' sera and displayed an increase of osteoclastogenesis, bone resorption activity and a reduction of osteoblast function. Interestingly, GSD sera stimulated the vessel formation by endothelial cells EA.hy926. These results suggest that bone cell autonomous alterations with the cooperation of systemic factors are involved in massive bone loss and angiomatous proliferation observed in GSD patients.
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Affiliation(s)
- Michela Rossi
- Bone Physiopathology Group, Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Giulia Battafarano
- Bone Physiopathology Group, Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Conforti
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Eda Mariani
- Research Laboratories, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mattia Algeri
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Marina Macchiaiolo
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Rita De Vito
- Histopathology, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Alessandro Jenkner
- Division of Immunology and Infectious Diseases Department of Pediatrics, Bambino Gesù Children Hospital, Rome, Italy
| | - Ippolita Rana
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Bartuli
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Del Fattore
- Bone Physiopathology Group, Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital, Rome, Italy.
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31
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Fares MY, Fares J, Fares Y, Abboud JA. Gorham-Stout Disease of the Shoulder: Clinical, Pathologic and Therapeutic Considerations. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:58-69. [PMID: 32090147 PMCID: PMC7007711 DOI: 10.22038/abjs.2019.37156.1990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gorham-Stout disease (GSD) is a rare skeletal disorder characterized by massive osteolysis of a bony area in the body. When it hits the shoulder, the patient is faced with a debilitating limitation in terms of motion, stability and quality of life. GSD etiology and pathology are unknown and, as a result, therapeutic modalities remain unclear. The aim of this paper is to explore and offer medical insight into the possible etiologies, pathologies and therapeutic modalities of GSD in the shoulder. METHODS We explored PubMed/Medline for GSD cases in the shoulder. The search involved all articles published from database inception until February 1, 2019. Only articles published in English were included. Demographics and clinical information extrapolated from the reported cases were analyzed to deduce patterns and infer conclusions. RESULTS Only 32 studies met our criteria, with a total of 37 cases (n=37). Males predominated in 21 cases (57%). Twelve cases (32%) were younger than 18 years, and 18 cases (49%) were aged between 18 and 65 years. Shoulder pain was the predominant reporting symptom. The humerus was the most common shoulder site affected (54%), followed by the scapula (35%) and the clavicle (30%). Almost half of the cases affected the right shoulder (51%), the left shoulder was affected in 16 cases (43%). Conservative treatment was opted in 17 cases (46%), while surgery was performed in 13 cases (35%). Good outcomes were reported in 28 cases (76%), while death occurred twice (5%). CONCLUSION Understanding the demographics and clinical characteristics of GSD in the shoulder region will help in formulating better therapeutic interventions and preventive health policies.
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Affiliation(s)
- Mohamad Y. Fares
- The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Joseph A. Abboud
- The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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de Keyser CE, Saltzherr MS, Bos EM, Zillikens MC. A Large Skull Defect Due to Gorham-Stout Disease: Case Report and Literature Review on Pathogenesis, Diagnosis, and Treatment. Front Endocrinol (Lausanne) 2020; 11:37. [PMID: 32117063 PMCID: PMC7012895 DOI: 10.3389/fendo.2020.00037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/20/2020] [Indexed: 11/13/2022] Open
Abstract
A 24-year old man was referred to the Erasmus MC Bone Center because of an asymptomatic increasing skull defect of the left parietal bone. The defect was first noticed at the age of six, and gradually increased over the years. His medical history was unremarkable, without any known trauma and a negative family history for bone diseases. Laboratory tests showed a low vitamin D level without other abnormalities. Particularly, there was no increase in markers of inflammation or bone turnover. CT-scans of the skull showed an osteolytic region of the parietal skull bone, with a two-centimeter increase in diameter over 9 years. Contrast enhanced MRI showed lymphangiogenic invasion, which was compatible with our suspicion of Gorham-Stout disease. The patient was referred to the neurosurgeon for treatment with a bone graft while considering additional drug treatment. Gorham-Stout or vanishing bone disease is a rare entity characterized by progressive osteolysis with lymphangiogenic bone invasion. Although already reported in 1838, currently the diagnosis and treatment of Gorham-Stout disease is still challenging. The underlying pathophysiology is not clarified yet and several theories exist. The disease usually affects persons younger than 40 years and the majority present with bone disease of the maxillofacial region, the upper extremities or the torso. The clinical presentation includes most frequently pain, swelling, and functional impairment of the affected region, but the disease can also be asymptomatic. Laboratory investigations are usually normal, and diagnosis is based upon imaging and sometimes pathology examination of affected bone tissue. Treatment is experimental and there is no general consensus about the best option due to lack of randomized controlled trials. Case reports showed patients treated with bisphosphonates, interferon-alpha, anti-VEGF therapy, mTOR inhibitors, and radiotherapy. There are some reports of surgery with prosthetic or bone grafts but no long-term follow-up data exist. This paper describes a unique case of Gorham-Stout disease of the parietal skull bone and discusses the current state of knowledge about this rare bone disease.
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Affiliation(s)
- Catherine E. de Keyser
- Department of Internal Medicine, Bone Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Michael S. Saltzherr
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eelke M. Bos
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - M. Carola Zillikens
- Department of Internal Medicine, Bone Center, Erasmus University Medical Center, Rotterdam, Netherlands
- *Correspondence: M. Carola Zillikens
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Moore PE, Boyer D, Perkins R, Katz ES, Castro-Codesal ML, MacLean JE, Akil N, Esther CR, Kaslow J, Lewis TC, Krone KA, Quizon A, Simpson R, Benscoter D, Spielberg DR, Melicoff E, Kuklinski CA, Blatter JA, Dy J, Rettig JS, Horani A, Gross J. American Thoracic Society 2019 Pediatric Core Curriculum. Pediatr Pulmonol 2019; 54:1880-1894. [PMID: 31456278 DOI: 10.1002/ppul.24482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/04/2019] [Indexed: 11/07/2022]
Abstract
The American Thoracic Society Pediatric Core Curriculum updates clinicians annually in pediatric pulmonary disease in a 3 to 4 year recurring cycle of topics. The 2019 course was presented in May during the Annual International Conference. An American Board of Pediatrics Maintenance of Certification module and a continuing medical education exercise covering the contents of the Core Curriculum can be accessed online at www.thoracic.org.
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Affiliation(s)
- Paul E Moore
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Debra Boyer
- Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan Perkins
- Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eliot S Katz
- Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria L Castro-Codesal
- Division of Pediatric Respirology, Pulmonary, and Asthma, Department of Pediatrics, University of Alberta, Alberta, Canada
| | - Joanna E MacLean
- Division of Pediatric Respirology, Pulmonary, and Asthma, Department of Pediatrics, University of Alberta, Alberta, Canada
| | - Nour Akil
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles R Esther
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jacob Kaslow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toby C Lewis
- Department of Pediatrics, University of Michigan Medical School, Ann Harbor, Michigan
| | - Katie A Krone
- Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Annabelle Quizon
- Division of Pediatric Pulmonology, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Ryne Simpson
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dan Benscoter
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David R Spielberg
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ernestina Melicoff
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Cadence A Kuklinski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua A Blatter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jamie Dy
- Department of Pediatrics, UCSF, San Francisco, California
| | - Jordan S Rettig
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amjad Horani
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jane Gross
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, National Jewish Hospital, Denver, Colorado
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Radiation-Induced Sarcoma on 18F-FDG PET/CT After Treatment of Gorham-Stout Disease of the Maxilla. Clin Nucl Med 2019; 44:e607-e608. [PMID: 31490314 DOI: 10.1097/rlu.0000000000002761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Gorham-Stout disease is a rare disorder characterized by proliferation of lymphatic and vascular channels within bone resulting in osteolysis. A 53-year-old man with Gorham-Stout disease involving the left maxilla underwent previous treatment including radiation therapy and intralesional chemotherapeutic injections. He later presented with anemia, facial pain, weight loss, and nasal cavity hemorrhage. CT imaging demonstrated a mass centered within the right maxillary sinus with locoregional involvement. PET/CT showed prominent FDG activity involving the mass centered in the right maxillary sinus with low-grade avidity involving the contralateral maxilla in regions of treated Gorham-Stout disease. Biopsy of the mass confirmed radiation-induced sarcoma.
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35
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Jagtap R, Gupta S, Lamfon A, Ruprecht A, Schlott B, Hardeman J, Kashtwari D. Gorham-Stout disease of the mandible: case report and review of literature of a rare type of osteolysis. Oral Radiol 2019; 36:389-394. [PMID: 31741281 DOI: 10.1007/s11282-019-00417-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/06/2019] [Indexed: 12/01/2022]
Abstract
Gorham-Stout disease (GSD) is a rare form of osteolysis, the aetiology and pathogenesis of which remains controversial to this date. Although more than 200 cases of GSD have been reported so far, this disease continues to go undiagnosed in the initial stages owing to its varied clinical presentations and rarity. Through this case report of GSD in a 3-year-old boy, we discuss the slow progression of the disease over a period of 13 years. The literature review is also done with an emphasis on the role of an oral and maxillofacial radiologist in understanding the disease at its incipient stage.
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Affiliation(s)
- Rohan Jagtap
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL, 32610, USA.
| | - Swati Gupta
- Department of Periodontology, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL, 32610, USA
| | - Abdullah Lamfon
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL, 32610, USA
| | - Axel Ruprecht
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL, 32610, USA.,Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, University of IOWA, S351 Dental Science Building, Iowa City, IA, 52242, USA
| | - Benjamin Schlott
- Department of Oral and Maxillofacial Surgery, Southern Illinois University School of Dental Medicine, 2800 College Avenue, Alton, IL, 62002, USA
| | - John Hardeman
- Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL, 32610, USA
| | - Deeba Kashtwari
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL, 32610, USA
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Tassemeier T, Haversath M, Brandenburger D, Schutzbach M, Serong S, Jäger M. [Atraumatic fractures of the spine : Current strategies for diagnosis and treatment]. DER ORTHOPADE 2019; 48:879-896. [PMID: 31511916 DOI: 10.1007/s00132-019-03804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atraumatic fractures of the spine are a common orthopedic disease condition that can be asymptomatic or associated with complaints of varying intensity and quality. The risk factors for such fracture forms are often metabolic and genetic diseases, which have a direct or indirect effect on bone metabolism and therefore secondarily affect the stability of the spinal vertebrae. Furthermore, benign and malignant tumors as well as infectious diseases can also be causative for atraumatic spinal fractures; however, those factors that are attributable to lifestyle habits should also not be underestimated. The treatment of affected patients is complex and nearly always interdisciplinary. In addition to purely symptom-oriented treatment concepts, orthoses in particular and when indicated surgical treatment procedures can be implemented. This article summarizes the important clinical, diagnostic and therapeutic aspects of atraumatic spinal fractures.
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Affiliation(s)
- T Tassemeier
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland.
| | - M Haversath
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
| | - D Brandenburger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
| | - M Schutzbach
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
| | - S Serong
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - M Jäger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
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37
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Barbagli G, Barni I, Romoli S. A rare case of spine disappearing bone disease: Lesson learned and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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38
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Riley LE, Ataya A. Clinical approach and review of causes of a chylothorax. Respir Med 2019; 157:7-13. [PMID: 31454675 DOI: 10.1016/j.rmed.2019.08.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 12/16/2022]
Abstract
A chylothorax, also known as chylous pleural effusion, is an uncommon cause of pleural effusion with a wide differential diagnosis characterized by the accumulation of bacteriostatic chyle in the pleural space. The pleural fluid will have either or both triglycerides >110 mg/dL and the presence of chylomicrons. It may be encountered following a surgical intervention, usually in the chest, or underlying disease process. Management of a chylothorax requires a multidisciplinary approach employing medical therapy and possibly surgical intervention for post-operative patients and patients who have failed medical therapy. In this review, we aim to discuss the anatomy, fluid characteristics, etiology, and approach to the diagnosis of a chylothorax.
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Affiliation(s)
- Leonard E Riley
- University of Florida College of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Gainesville, FL, USA
| | - Ali Ataya
- University of Florida College of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Gainesville, FL, USA.
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Willemsen K, Nizak R, Noordmans HJ, Castelein RM, Weinans H, Kruyt MC. Challenges in the design and regulatory approval of 3D-printed surgical implants: a two-case series. LANCET DIGITAL HEALTH 2019; 1:e163-e171. [PMID: 33323186 DOI: 10.1016/s2589-7500(19)30067-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Additive manufacturing or three-dimensional (3D) printing of metal implants can provide novel solutions for difficult-to-treat conditions, yet legislation concerning patient-specific implants complicates the implementation of these techniques in daily practice. In this Article, we share our acquired knowledge of the logistical and legal challenges associated with the use of patient-specific 3D-printed implants to treat spinal instabilities. METHODS Two patients with semiurgent cases of spinal instability presented to our hospital in the Netherlands. In case 1, severe kyphotic deformity of the thoracic spine due to neurofibromatosis type 1 had led to incomplete paralysis, and a strong metallic strut extending from C6 to T11 was deemed necessary to provide long-term anterior support. In case 2, the patient presented with progressive paralysis caused by cervicothoracic dissociation due to vanishing bone disease. As the C5-T1 vertebral bodies had mostly vanished, an implant spanning the anterior spine from C4 to T2 was required. Because of the complex and challenging nature of both cases, conventional approaches were deemed inadequate; instead, patient-specific implants were designed with use of CT scans and computer-aided design software, and 3D printed in titanium with direct metal printing. For each implant, to ensure patient safety, a comprehensive technical file (describing the clinical substantiation, technical and design considerations, risk analysis, manufacturing process, and labelling) was produced in collaboration with a university department certified for the development and manufacturing of medical devices. Because the implants were categorised as custom-made or personalised devices under the EU Medical Device Regulation, the usual procedures for review and approval of medical devices by a notified body were not required. Finite-element analyses, compression strength tests, and cadaveric experiments were also done to ensure the devices were safe to use. FINDINGS The planning, design, production, and insertion of the 3D-printed personalised implant took around 6 months in the first patient, but, given the experience from the first case, only took around 6 weeks in the second patient. In both patients, the surgeries went as planned and good positioning of each implant was confirmed. Both patients were discharged home within 1 week after the surgery. In the first patient, a fatigue fracture occured in one of the conventional posterior fusion rods after 10 months, which we repaired, without any deformation of the spine or signs of failure of the personalised implant observed. No other adverse events occurred up to 25 months of follow-up in case 1 and 6 months of follow-up in case 2. INTERPRETATION Patient-specific treatment approaches incorporating 3D-printed implants can be helpful in carefully selected cases when conventional methods are not an option. Comprehensive and efficient interactions between medical engineers and physicians are essential to establish well designed frameworks to navigate the logistical and regulatory aspects of technology development to ensure the safety and legal validity of patient-specific treatments. The framework described here could encourage physicians to treat (once untreatable) patients with novel personalised techniques. FUNDING Interreg VA Flanders-The Netherlands programme, Applied and Engineering Sciences research programme, the Netherlands Organisation for Scientific Research, and the Dutch Arthritis Foundation VIDEO ABSTRACT.
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Affiliation(s)
- Koen Willemsen
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands.
| | - Razmara Nizak
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Herke Jan Noordmans
- Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - René M Castelein
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Moyo C Kruyt
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, Netherlands
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40
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Hickmann S, Busato VB, Gomes da Silveira R, Guilherme Schaefer P, Bredemeier M. A patient with a mediastinal mass and diffuse asymptomatic osteolytic lesions. Rheumatology (Oxford) 2019; 58:1314-1315. [PMID: 30649564 DOI: 10.1093/rheumatology/key381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sheila Hickmann
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vanessa Barrili Busato
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Romulo Gomes da Silveira
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Guilherme Schaefer
- Pathology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Markus Bredemeier
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Rio Grande do Sul, Brazil
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41
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Tena-Sanabria ME, Jesús-Mejenes LY, Fuentes-Herrera G, Álvarez-Martínez FA, Victorio-García NP, Núñez-Enríquez JC. A report of two children with Gorham-Stout disease. BMC Pediatr 2019; 19:206. [PMID: 31234820 PMCID: PMC6591827 DOI: 10.1186/s12887-019-1561-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/28/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Gorham-Stout disease is a rare condition characterized by unifocal and massive type IV osteolysis (variant of idiopathic nonhereditary osteolytic disease) with a slow progression, which is self-limiting for some years. It is characterized by recurrent vascular tumors with disruption of the anatomical architecture and intraosseous proliferation of vascular channels that leads to the destruction and resorption of the bone matrix. The aim of this study is to present the clinical features of this disease, as well as the importance of prompt diagnosis and treatment, with a review of the reported cases. CASE REPORTS We describe two cases of Gorham-Stout disease between 2013 and 2017 with surgical interventions, follow-up and results. Case one involves an 11-year-old male with involvement of the left iliac bone, with adequate evolution after a surgical procedure with a lyophilized cadaveric tricortical bone allograft. Case two involves a 6-year-old male with cervical spine C1-C3 repercussion; in the protocol for surgical treatment, he presented with signs of spinal cord compression and died. CONCLUSION Diagnosis of Gorham-Stout disease is made by exclusion, and its clinical presentation varies widely, from spontaneous remission to a fatal outcome.
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Affiliation(s)
- Mario Edgar Tena-Sanabria
- Unidad Médica de Alta Especialidad, Servicio de Ortopedia Pediátrica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Larisa Yarindy Jesús-Mejenes
- Unidad Médica de Alta Especialidad, Servicio de Ortopedia Pediátrica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gabriela Fuentes-Herrera
- Unidad Médica de Alta Especialidad, Servicio de Ortopedia Pediátrica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Félix Alejandro Álvarez-Martínez
- Unidad Médica de Alta Especialidad, Servicio de Ortopedia Pediátrica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Nora Patricia Victorio-García
- Unidad de Investigación en Epidemiología Clínica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Avenida Cuauhtémoc 330. Colonia Doctores Delegación Cuauhtémoc C.P, 06720, Mexico City, Mexico
| | - Juan Carlos Núñez-Enríquez
- Unidad de Investigación en Epidemiología Clínica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Avenida Cuauhtémoc 330. Colonia Doctores Delegación Cuauhtémoc C.P, 06720, Mexico City, Mexico.
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Ali M, Khan M, Abdi SR, Qadar LT, Lakho MT. The First Clinical Case of Gorham-Stout Syndrome of Humerus in an 18-year-old Female Reported in Pakistan. Cureus 2019; 11:e4832. [PMID: 31403018 PMCID: PMC6682343 DOI: 10.7759/cureus.4832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Gorham-Stout syndrome (GSS) is a rare disorder of complete bone resorption, characterized by lymphangiomatosis and angiomatosis of bone, with only around 200 cases reported from around the world till date. The diagnosis is made on clinical, radiological, and histopathological findings and exclusion of other common conditions, and treatment is based on the physician’s judgment and tailored to the needs of the individual. With the etiology unknown, diagnosis mostly of exclusion, an unpredictable prognosis, and no standardized treatment formed, the disease poses a challenge to physicians in appropriately diagnosing and managing the patient. Herein, we present a case of an otherwise healthy 18-year-old female diagnosed with GSS of humerus following a fracture to her left arm. To our knowledge, this is the first case report of the disorder from Pakistan.
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Affiliation(s)
- Maratib Ali
- Orthopaedics, Dr. Ruth KM Pfau Hospital, Karachi, PAK
| | - Maryam Khan
- Miscellaneous, Dow University of Health Sciences, Karachi, PAK
| | - Syeda Rida Abdi
- Internal Medicine, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Laila Tul Qadar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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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.
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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.
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Zanelli M, Zizzo M, Martino G, Bisagni A, De Marco L, Ascani S. Bone Marrow Biopsy Disclosing a Rare Osteolytic Disorder: Gorham-Stout Syndrome. Int J Surg Pathol 2019; 28:76-77. [PMID: 31018723 DOI: 10.1177/1066896919844319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Magda Zanelli
- Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Reggio Emilia, Italy.,University of Modena and Reggio Emilia, Modena, Italy
| | | | - Alessandra Bisagni
- Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Loredana De Marco
- Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Reggio Emilia, Italy
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A rare case of Gorham-stout syndrome involving the thoracic spine with progressive bilateral chylothorax: a case report. BMC Musculoskelet Disord 2019; 20:154. [PMID: 30961601 PMCID: PMC6454674 DOI: 10.1186/s12891-019-2542-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background Gorham-Stout syndrome (GSS) with spinal involvement is extremely rare, and bilateral chylothorax as a complication is usually fatal. In our case, pleural effusion appeared in the left hemithorax after ligating the right thoracic duct. Case presentation A 14-year-old patient presented with GSS affecting the thoracic spine with bilateral chylothorax. The case was successfully managed using combined conservative and surgical treatments. At the 2-year follow-up visit, the amount of pleural fluid was reduced, the patient’s respiratory function had improved, and the deformity on the thoracic spine had gradually stabilized. Conclusions GSS is a rare disorder of the musculoskeletal system that responds poorly to therapies and exhibits very high morbidity and mortality. Chylothorax is a common complication when lesions involve the thoracic spine, and physicians should be vigilant for possible serious pulmonary complications.
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Andrade RGF, Sperb APVFB, Hochhegger B, Serafini OA, Valduga SG. Gorham-Stout syndrome: the radiologic-pathologic correlation as a diagnostic pathway when bone is vanishing. Radiol Bras 2019; 52:131-133. [PMID: 31019347 PMCID: PMC6472849 DOI: 10.1590/0100-3984.2017.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Bruno Hochhegger
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | - Simone Gianella Valduga
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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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.
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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
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Syndromes that predispose to epistaxis. Eur Arch Otorhinolaryngol 2019; 276:939-944. [DOI: 10.1007/s00405-019-05310-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/19/2019] [Indexed: 01/10/2023]
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Jiang Y, Hou G, Cheng W. 99mTc-SC lymphoscintigraphy and SPECT/CT findings in a case report of Gorham-Stout disease presenting with chylothorax and bone pain. Medicine (Baltimore) 2019; 98:e15023. [PMID: 30946335 PMCID: PMC6456089 DOI: 10.1097/md.0000000000015023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Gorham-Stout disease (GSD) is a rare disorder characterized by multiple osteolytic lesions, sometimes complicated by chylothorax. The aim of this case report is to introduce a very rare case of Gorham-Stout syndrome, which involved several bones along with chylous pericardial and pleural effusions detected by Tc-sulfur colloid (SC) lymphoscintigraphy and single photon emission computed tomography/computed tomography (SPECT/CT). PATIENT CONCERNS A 15-year-old girl presented to our hospital complaining of shortness of breath and bone pain. DIAGNOSIS The CT showed multiple osteolytic lesions, left-sided pleural effusion, and pericardial effusion. Tc-SC lymphoscintigraphy showed discontinuation of thoracic duct and tracer accumulation on the left side chest. SPECT/CT revealed increased radioactivity uptake in pleural, pericardial effusions, and some thoracolumbar spines. Diagnostic thoracentesis to identify the nature of pleural effusion and histopathology of biopsy in the right femoral to that of the bone lesion were performed. Based on the clinical information, histopathologic, and radiographic findings, the diagnosis of GSD was made. INTERVENTIONS The patient received thoracic duct ligation and bisphosphonates treatment. OUTCOMES After receiving thoracic duct ligation and bisphosphonates treatment, the patient's symptoms of bone pain and dyspnea were relieved, and the pericardial and pleural fluid was diminished dramatically. At the 3-month and 9-month follow-up visit, the patient had nearly complete remission without any complication. LESSONS The Tc-SC lymphoscintigraphy and SPECT/CT could provide significant value assessing the lymphatic abnormity and evaluating the extent of disease, therefore aiding to guide decision making in the clinic.
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Affiliation(s)
- Yuanyuan Jiang
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Guozhu Hou
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Wuying Cheng
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
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