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Alkhaibary A, Alharbi A, Khairy S. Calvarial multiple myeloma: Raindrop skull. Surg Neurol Int 2024; 15:34. [PMID: 38468661 PMCID: PMC10927176 DOI: 10.25259/sni_874_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 03/13/2024] Open
Abstract
Background The "Raindrop skull" appearance represents the multiple punched-out and lytic lesions hitting a surface and creating a scattered splash pattern. Case Description A 73-year-old female presented with multiple painless lumps over the forehead and head. The patient reported unintentional weight loss, fatigability, loss of appetite, fever, night sweats, and back pain for seven months (B symptoms). The examination revealed multiple, nonmobile, calvarial lesions with defined borders, measuring approximately 1 × 1 cm. Laboratory investigations of serum-free light chains showed a free kappa level of 12.91 mg/L, a lambda level of 4549.28 mg/L, and a free kappa/lambda ratio of 0.00. Radiological imaging of the skull and brain showed a "raindrop skull" appearance and multiple calvarial osteolytic lesions. The patient underwent a right superior iliac crest bone marrow aspirate and trephine biopsy. The laboratory and histopathological sections were compatible with multiple myeloma. A diagnosis of multiple myeloma (free light chain lambda) was rendered. Conclusion Calvarial multiple myeloma is rare and requires a high index of suspicion to diagnose. "Raindrop skull" appearance is pathognomonic of calvarial multiple myeloma.
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Affiliation(s)
- Ali Alkhaibary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahoud Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Sami Khairy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Shao Y, Shen M, Peng D, Cheng W, Mao C, Zhang H, Sun Y. Observation of a Bone Invasion Model of Aspergillus fumigatus In Vitro and Analysis of the Antifungal Susceptibility. Mycopathologia 2024; 189:4. [PMID: 38231458 DOI: 10.1007/s11046-023-00817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Recently, the prevalence of invasive fungal infections has been on the rise, and one of the prevalent symptoms frequently observed is bone deterioration and bone loss. MATERIALS AND METHODS Using an in vitro model we studied how Aspergillus fumigatus invades the bone. Pathological analysis was then employed to observe the structure and distinctive features of the invading fungal elements within the bone invasion model. Meanwhile, the antifungal effects of itraconazole, voriconazole, posaconazole, and amphotericin B were evaluated. RESULTS The pathological findings showed that in the experimental group, fungal spores and hyphae invaded the bone tissue or were observed growing in the vicinity of the bone edge tissues, as indicated by both HE and PAS staining. In contrast, no fungal elements were observed in the control group, indicating that the in vitro bone invasion model of A. fumigatus was successfully constructed. Furthermore, the findings from the antifungal sensitivity test demonstrated that the lowest effective concentrations of antifungal drugs against the bone invasion model were as follows: 4 μg/ml for itraconazole, 0.5 μg/ml for voriconazole, 2 μg/ml for posaconazole, and 2 μg/ml for amphotericin B. DISCUSSION The successful construction of the bone invasion model of A. fumigatus has provided a solid basis for future investigations into the mechanisms underlying A. fumigatus bone invasion and the study of its virulence factors. Utilizing bone models is of utmost importance in advancing the development of novel antifungal treatment approaches, as well as in effectively preventing and treating fungal bone invasion and osteolytic diseases.
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Affiliation(s)
- Yan Shao
- Department of Orthopedics, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Min Shen
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Dan Peng
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Wenxu Cheng
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Chenggang Mao
- Department of Otolaryngology Head and Neck Surgery, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
| | - Heng Zhang
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, Hubei, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434020, Hubei, China.
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Mallio CA, Greco F, Gaudino F, Beomonte Zobel B, Quattrocchi CC. Computed tomography density changes of bone metastases after concomitant denosumab. Skeletal Radiol 2023:10.1007/s00256-023-04326-3. [PMID: 36961572 DOI: 10.1007/s00256-023-04326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE To evaluate bone density changes at the level of normal trabecular bone and bone metastases (BMs) after denosumab (DM) treatment in oncologic patients. MATERIALS AND METHODS We retrospectively evaluated 31 consecutive adult patients with histologically confirmed solid tumors with at least one newly diagnosed bone metastatic lesion detected at CT. Patients received treatment with DM, 120 mg subcutaneous every 28 days for at least 6 months. Bone density was determined at the level of BMs and at the level of normal trabecular bone of lumbar vertebrae using a region of interest (ROI)-based approach. RESULTS A progressive increase in CT bone density was demonstrated at the level of normal trabecular bone at 6 months (18% ± 5%) and 12 months (23% ± 7%) after the treatment begins. BMs showed a significant increase in CT bone density (p < 0.05) as compared to baseline after 6 months (57% ± 15%) and 12 months (1.06 ± 0.25 times higher) after treatment. CONCLUSION We have found that long-term treatment with DM increases bone density progressively in oncologic patients. This effect can be observed not only at the level of secondary lesions but also at the level of apparently normal trabecular bone and is more pronounced for osteolytic metastases.
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Affiliation(s)
- Carlo A Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.
| | - Federico Greco
- U.O.C. Diagnostica per Immagini Territoriale Aziendale, Cittadella della Salute Azienda Sanitaria Locale di Lecce, Lecce, Italy
| | - Francesco Gaudino
- U.O.S.D Diagnostica per Immagini Emergenza Urgenza, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Alkhaibary A, Alharbi A, Khairy S. Diffuse Calvarial Hyperstosis. World Neurosurg 2023; 174:129-130. [PMID: 36948247 DOI: 10.1016/j.wneu.2023.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/24/2023]
Abstract
Calvarial hyperstosis can be an idiopathic benign finding or secondary to a metabolic pathology. We herein describe a case of diffuse calvarial hyperstosis. A 26-year-old man known to have end-stage renal disease on regular hemodialysis, tertiary hyperparathyroidism, extensive brown tumors, and severe developmental impairment with skeletal deformities was referred to us for macrocephaly. On examination, the patient was chairbound, with speech and motor developmental delay, and frontal bossing. Brain computed tomography revealed diffuse hyperstosis of the calvarium and facial bones expansion with multiple sclerotic and lytic areas, causing subsequent narrowing of the basilar skull foramina. Brain magnetic resonance imaging demonstrated an extensive expansile bone marrow abnormality in the calvarium and skull base. There was mild generalized prominence of cortical sulci and ventricular system. The findings were in keeping with his known hypermetabolic state and tertiary hyperparathyroidism. The patient was managed conservatively with regular follow-up in the clinic.
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Affiliation(s)
- Ali Alkhaibary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahoud Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Sami Khairy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Luque-Cabal M, Obregón-Martínez E, Díez-Blanco M, Álvarez-García M, Fernández-Pérez G. Multicentric infantile myofibromatosis with extensive involvement limited to bone. Skeletal Radiol 2022; 51:1503-10. [PMID: 34865192 DOI: 10.1007/s00256-021-03968-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 02/02/2023]
Abstract
Infantile myofibromatosis (IM) is the most common benign fibrous tumor of infancy, characterized by the development of single or multiple nodules in the skin, soft tissues, bone, and/or viscera. Multicentric forms are less frequent and can affect different tissues simultaneously and their prognosis depends on their extension and visceral involvement. Rarely, these forms are limited to the skeleton, in which case the absence of extraosseous lesions makes it difficult to suspect this entity. We present the case of an infant with multiple radiolucent lesions involving the skull, ribs, spine, and long bones, discovered in a radiological study performed after a minor trauma. A broad differential diagnosis was considered based on the osteolytic and polyostotic nature of the lesions on imaging studies. This report details and illustrates the typical radiological findings in bony involvement of IM, which suggest this disorder over other diagnostic options.
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Austah ON, Lillis KV, Akopian AN, Harris SE, Grinceviciute R, Diogenes A. Trigeminal neurons control immune-bone cell interaction and metabolism in apical periodontitis. Cell Mol Life Sci 2022; 79:330. [PMID: 35639178 PMCID: PMC9156470 DOI: 10.1007/s00018-022-04335-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 12/14/2022]
Abstract
Abstract Apical periodontitis (AP) is an inflammatory disease occurring following tooth infection with distinct osteolytic activity. Despite increasing evidence that sensory neurons participate in regulation of non-neuronal cells, their role in the development of AP is largely unknown. We hypothesized that trigeminal ganglia (TG) Nav1.8+ nociceptors regulate bone metabolism changes in response to AP. A selective ablation of nociceptive neurons in Nav1.8Cre/Diphtheria toxin A (DTA)Lox mouse line was used to evaluate the development and progression of AP using murine model of infection-induced AP. Ablation of Nav1.8+ nociceptors had earlier progression of AP with larger osteolytic lesions. Immunohistochemical and RNAscope analyses demonstrated greater number of macrophages, T-cells, osteoclast and osteoblast precursors and an increased RANKL:OPG ratio at earlier time points among Nav1.8Cre/ DTALox mice. There was an increased expression of IL-1α and IL-6 within lesions of nociceptor-ablated mice. Further, co-culture experiments demonstrated that TG neurons promoted osteoblast mineralization and inhibited osteoclastic function. The findings suggest that TG Nav1.8+ neurons contribute to modulation of the AP development by delaying the influx of immune cells, promoting osteoblastic differentiation, and decreasing osteoclastic activities. This newly uncovered mechanism could become a therapeutic strategy for the treatment of AP and minimize the persistence of osteolytic lesions in refractory cases. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00018-022-04335-w.
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Affiliation(s)
- Obadah N Austah
- Department of Endodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.,Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Katherine V Lillis
- Department of Endodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Armen N Akopian
- Department of Endodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Stephen E Harris
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ruta Grinceviciute
- Department of Endodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
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Abstract
OBJECTIVES Bone metastases are of high clinical relevance because they are a frequent complication of most types of common cancers, such as breast and prostate. The metastatic process is complex, requiring the completion of several different steps to allow successful dissemination and homing. In addition, preparation of the metastatic niche changes the constant cycle of bone matrix formation and degradation, leading to the clinical phenotypes of lytic and sclerotic lesions. We review our current knowledge on this topic and briefly explain the current treatment landscape of bone metastasis. DATA SOURCES These include PubMed, international guidelines, and clinician experience. CONCLUSION Bone metastases remain a clinical challenge that negatively impacts patients prognosis and quality of life. A comprehensive understanding of the complex molecular mechanisms that results in bone metastasis is the basis for successful treatment of affected patients. The disruption of bone matrix metabolism is already recognized as the prerequisite for metastasis formation, but many open questions remain that need to be addressed in future research to establish individually tailored treatment approaches. IMPLICATIONS FOR NURSING PRACTICE Patient-centered therapy of bone metastases requires suitable pharmacological options, and importantly a holistic approach in care delivery across the multidisciplinary team. Nurses provide the cornerstone of the multidisciplinary team and provide the closest and the most frequent contact to the patient and their families to provide timely intervention. Nurses require a basic understanding of the complex physiology of metastasis to inform practice.
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Affiliation(s)
- Romy M Riffel
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Andy Göbel
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Tilman D Rachner
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany.
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Otsuru M, Soutome S, Hayashida S, Yanamoto S, Sasaki M, Takagi Y, Sumi M, Umeda M. Imaging findings and treatment outcomes of a rare subtype of medication-related osteonecrosis of the jaw. J Bone Miner Metab 2022; 40:150-156. [PMID: 34510261 DOI: 10.1007/s00774-021-01267-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In our previous study, we found a rare type of medication-related osteonecrosis of the jaw (MRONJ), which shows periosteal reaction (PR) at a site distant from osteolytic lesions or the extraction site (periosteal reaction dominant type, PRd type), even though the osteolytic lesions in the bone marrow are localized. The causes and treatment of MRONJ remain unclear; hence, this study aimed to describe the imaging and clinical features of the PRd type. MATERIALS AND METHODS MRONJ patients who visited Nagasaki University Hospital between 2009 and 2020 and received conservative therapy as initial treatment were included in this study. The PR site, imaging findings, initial symptoms, outcome, and time to progression were examined. RESULTS Among 59 MRONJ patients treated with conservative therapy, 38 did not show PR (PR- type), 15 showed PR near the osteolytic region (PR + type), and 6 had the PRd type. All patients with the PRd type had submental abscesses, and computed tomography (CT) images demonstrated PR on the lingual side of the anterior mandible. Osteolytic lesions progressed in 6/6 PRd type (100%), 5/15 PR + type (33.3%), and 2/38 PR- type (5.3%) patients. Time to progression for the osteolytic region on CT was short for the PRd type, at 56-148 days (median 79 days). CONCLUSION Among the MRONJ types, the PRd type has a poor prognosis. Therefore, accumulating and analyzing more PRd cases in the future is warranted. This is the first report to describe the presence of this specific subtype of MRONJ.
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Affiliation(s)
- Mitsunobu Otsuru
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-Ken, 852-8588, Japan.
| | - Sakiko Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-Ken, 852-8588, Japan
| | - Saki Hayashida
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-Ken, 852-8588, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-Ken, 852-8588, Japan
| | - Miho Sasaki
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-Ken, 852-8588, Japan
| | - Yukinori Takagi
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-Ken, 852-8588, Japan
| | - Misa Sumi
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-Ken, 852-8588, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-Ken, 852-8588, Japan
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Kesler M, Kerzhner K, Druckmann I, Kuten J, Levine C, Sarid D, Keizman D, Yossepowitch O, Even-Sapir E. Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement. Eur J Nucl Med Mol Imaging 2021; 49:2077-2085. [PMID: 34957528 DOI: 10.1007/s00259-021-05655-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the study was to elaborate the incidence and type of skeletal involvement in a large cohort of patients with newly diagnosed prostate cancer (PCa) referred for Ga-68 PSMA-11 PET/CT staging in a single center. METHODS Study cohort included 963 consecutive patients with newly diagnosed PCa referred for Ga-68 PSMA-11 PET/CT study for staging. The incidence of bone involvement, type of bone metastases, and extent of disease were determined and correlated with the ISUP Grade Group (GG) criteria and PSA levels. RESULTS Bone metastases were found in 188 (19.5%) of 963 patients. Bone metastases were found in 10.7% of patients with PSA < 10 ng/dL and in 27.4% of patients with PSA > 10 ng/dL and in 6.1% of patients with GG ≤ 2/3 and in 8.9% of patients with GG 4/5. In 7.6% of the patients, skeletal involvement was extensive, while 11.9% of patients had oligometastatic disease. Osteoblastic type metastases were the most common type of bone metastases presented in 133 of the patients with malignant bone involvement (70.7%). More than half of them had only osteoblastic lesions (72 patients (38.3%)), while the other (61 patients (32.5%)) had also intramedullary and/or osteolytic type lesions. Intramedullary metastases were found in 97 patients (51.6%), while 41 (21.8%) of them were only intramedullary lesions. Osteolytic metastases were detected in 36 patients (19.2%), of which 8 were only osteolytic lesions. CONCLUSION Although traditionally bone metastases of PCa are considered osteoblastic, osteolytic and intramedullary metastases are common, as identified on PET with labeled PSMA. Skeletal spread may be present also in patients with GG ≤ 2/3 and PSA < 10 ng/dL.
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Affiliation(s)
- Mikhail Kesler
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Kosta Kerzhner
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Ido Druckmann
- Department of Radiology-Musculoskeletal Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel
| | - Jonathan Kuten
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Charles Levine
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - David Sarid
- Department of Oncology (Uro-Oncology Section), Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, 6423906, Tel Aviv, Israel
| | - Daniel Keizman
- Department of Oncology (Uro-Oncology Section), Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, 6423906, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
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Rummel K, Benson J, Roller L. Prostate adenocarcinoma with osteolytic metastases: Case report and review of the literature. Radiol Case Rep 2021; 16:3565-8. [PMID: 34567333 DOI: 10.1016/j.radcr.2021.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Prostate cancer is one of the most common malignancies among males and commonly metastasizes to bone in advanced stages. Although such osseous metastases are typically osteoblastic, osteolytic lesions are also seen. Here, we present a case of an 81-year-old male with known prostate cancer who presented due to a pathologic right humerus fracture. After skeletal survey and further workup, he was found to have two osteolytic lesions within his right femur. Bone curettage of the right femur revealed metastatic adenocarcinoma from a prostate primary. This case exemplifies the importance of recognizing the potential for prostate cancer metastases to present as osteolytic lesions.
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Yamashita S, Fujita A, Kohta M, Sasayama T, Kohmura E. Bone-destructive osseous arteriovenous fistula at the jugular bulb mimicking a glomus jugular tumor. Neurochirurgie 2021; 68:525-529. [PMID: 34536438 DOI: 10.1016/j.neuchi.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/16/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some reports have described intraosseous arteriovenous fistulas showing osteolytic changes, but an osseous arteriovenous fistula (AVF) at the jugular bulb showing extensive bone destruction is a very rare disease. CASE DESCRIPTION A 60-year-old man presented with pulsatile tinnitus and right facial nerve palsy. Radiological imaging showed a large homogenously enhanced osteolytic lesion at the right jugular foramen. A cerebral angiogram showed a high-flow vascular lesion of the jugular bulb associated with retrograde sinus reflux, resulting in venous congestion of the deep venous system. These findings led us to misdiagnose this lesion as a glomus jugular tumor. However, combined arterial and venous angiography after transarterial embolization revealed the precise angioarchitecture, and we finally diagnosed this lesion as a high-flow osseous AVF at the jugular bulb. We performed transvenous embolization using a triple catheter technique. The lesion was successfully obliterated, and the 6-months angiogram showed no recurrence. CONCLUSION A rare case of high flow osseous AVF at the jugular bulb associated with osteolytic changes in the surrounding bony structure is reported. Although many hypervascular lesions at the jugular bulb are glomus tumors, bone destructive osseous AVF at the jugular bulb should be considered.
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Affiliation(s)
- S Yamashita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - A Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - M Kohta
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - T Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - E Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Trent SM, Krumme JW, Henshaw RM. Metastatic prostate carcinoma: A rare presentation initially misdiagnosed as a rib fracture. Radiol Case Rep 2020; 15:1795-1798. [PMID: 32793320 PMCID: PMC7413992 DOI: 10.1016/j.radcr.2020.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/17/2022] Open
Abstract
Metastatic prostate carcinoma mainly occurs in bone as an osteoblastic lesion or lesions in the pelvis, spine, or chest wall. We present a unique case of a singular metastatic osteolytic lesion in the rib initially misdiagnosed as a fracture in a 61-year-old male. A single rib fracture in a patient with no history of trauma should raise suspicion for metastatic disease. We would encourage prostate cancer to be included in the differential diagnosis for an osteolytic lesion in a male over the age of 40. We review the current literature on this rare presentation of bone metastasis as well as the pathogenesis of metastatic prostate carcinoma as it relates to a solitary metastatic osteolytic lesion.
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Affiliation(s)
- Sarah M. Trent
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA
- Corresponding author.
| | - John W. Krumme
- Department of Orthopaedic Surgery, Medstar Washington Hospital Center, 110 Irving Street NW Washington, DC 20010, USA
| | - Robert M. Henshaw
- Department of Orthopaedic Surgery, Medstar Washington Hospital Center, 110 Irving Street NW Washington, DC 20010, USA
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Li C, Wu Z, Yuan G, Fang Z, Lin X, Pu R, Kang Y, Li L, Shao S, Ding J, Zhao J, Liu Q, Qin A. Vx-11e protects against titanium-particle-induced osteolysis and osteoclastogenesis by supressing ERK activity. Biochem Biophys Res Commun 2019; 514:1244-1250. [PMID: 31109651 DOI: 10.1016/j.bbrc.2019.05.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/06/2019] [Indexed: 02/05/2023]
Abstract
Wear particle-induced osteolysis around the prosthesis is the most common long-term complication after total joint replacement surgery which often leads to aseptic loosening of the prosthesis. Osteoclasts play key roles in the osteolytic process. Currently there is a lack of clinically effective measures to prevent or treat peri-prosthetic osteolysis and thus identification of new agents that can inhibit the enhanced osteoclastic bone resorption is warranted. Through this study, we discovered that the specific and potent ERK1/2 inhibitor, Vx-11e, can protect against calvarial osteolysis caused by titanium (Ti) particles in vivo. Low doses of Vx-11e mildly reduced osteoclast resorption whilst no calvarial osteolysis was observed with high dose Vx-11e treatment. Histological examination showed fewer osteoclasts and reduced bone erosion in the Vx-11e treated groups. In vitro cellular analyses showed that Vx-11e inhibited osteoclast formation from BMM precursors in response to RANKL, as well as bone resorption by mature osteoclasts. Mechanistically, Vx-11e impaired RANKL-induced ERK1/2 signaling by inhibiting its kinase activity thereby blocking the phosphorylation of downstream substrates. Moreover, Vx-11e significantly reduced the expression of RANKL-mediated genes such as ACP5/TRAcP, CTR, MMP-9, CTSK. Collectively, our data provides evidence for the potential therapeutic use of Vx-11e for the treatment of osteolysis diseases caused by extremely actived osteoclastogenesis.
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Affiliation(s)
- Chen Li
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Zuoxing Wu
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Guixin Yuan
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Zhanfei Fang
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Xixi Lin
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Ruoyu Pu
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Yanbin Kang
- Research Centre for Regenerative Medicine, Department of Trauma Orthopedic and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, 530021, China
| | - Li Li
- Pharmaceutic College, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Siyuan Shao
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jiaxin Ding
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jinmin Zhao
- Research Centre for Regenerative Medicine, Department of Trauma Orthopedic and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, 530021, China
| | - Qian Liu
- Research Centre for Regenerative Medicine, Department of Trauma Orthopedic and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, 530021, China.
| | - An Qin
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China; Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
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Qiu Y, Zhang J, Tang Y, Zhong X, Deng J. Case report: Fever- pneumonia- lymphadenectasis- osteolytic- subcutaneous nodule: Disseminated chromoblastomycosis caused by phialophora. J Infect Chemother 2019; 25:1031-1036. [PMID: 31229375 DOI: 10.1016/j.jiac.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/05/2019] [Accepted: 05/07/2019] [Indexed: 11/26/2022]
Abstract
Chromoblastomycosis (CBM) is a chronic cutaneous and subcutaneous fungal infection caused by certain dematiaceous fungi (usually Fonsecaea, Phialophora, or Cladophialophora). Histologically, CBM is characterized by the presence of medlar bodies. However, the diagnosis is difficult because of the rarity of these pathognomonic presentations and the wide variety of presentations. Treatment of these infections is challenging as it lacks standardization. Herein, we report a case of chromoblastomycosis caused by Phialophora, in a 42-year-old immunocompetent male agriculturist from the humid and subtropical region of southern China. He had a 3-month history of pneumonia with intermittent fever, coughing, and expectoration. The infection subsequently spread to the bone and lymph nodes forming deep lesions and eventually resulting in osteolysis and lymphadenectasis. These subcutaneous nodules were observed after 9 months. Antifungal treatment was administered for 20 months leading to clinical improvement before the patient was lost to follow-up. This case is unique because such deep lesions are rare in immunocompetent individuals and because the initial onset was associated with pneumonia.
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Affiliation(s)
- Ye Qiu
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianquan Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| | - Yanping Tang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoning Zhong
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jingmin Deng
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Sun FH, He SC, Zhu HD, Fang W, Du RJ, Li SS, Guo JH, Deng G, Qin YL, Zhu GY, Teng GJ. [Cement augmentation for vertebral osteolytic metastatic lesions: an evaluation on postoperative CT]. Zhonghua Yi Xue Za Zhi 2018; 98:2661-2665. [PMID: 30220155 DOI: 10.3760/cma.j.issn.0376-2491.2018.33.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effectiveness of cement augmentation on the osteolytic lesion in patients with vertebral metastasis. Methods: A total of consecutive 132 patients with 268 vertebral metastatic lesions treated with PVP from January 2008 to December 2016 in Zhongda Hospital were enrolled in this study. Retrospective analysis of preoperative, postoperative 3 days, 3 months, 6 months, 12 months and ≥ 18 months imaging data on CT, the local control and progression of the tumor were evaluated by MDA response criteria. The local control rates were compared between the groups with the different rate of cement filling by Chi2-test. Results: Vertebroplasty procedures were performed successfully in all 268 vertebrae under DSA guidance, and the mean volume of PMMA injected in each vertebra was 0.7-8.5(3.9±1.5)ml.The rate of local control at 3 months, 6 months, 12 months and ≥18 months after PVP was respectively 98.9%, 95.1%, 91.8%, and 85.2%, the difference was statistically significant(all P<0.05). The local control rate showed a statistically significant relationship to the groups with the rate of cement filling at 6 months, 12 months and ≥18 months after PVP, but there was no statistical difference at postoperative 3 months. The rate of local control was higher in 68 patients with lung or gastrointestinal cancer than in 17 patients with liver or kidney cancer at 3 months, 6 months and 12 months, the difference was statistically significant (P<0.05). Conclusion: Cement augmentation has a local anti-tumor effect on vertebral osteolytic metastatic lesion, and the anti-tumor effect will decrease as the follow-up time extended.
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Affiliation(s)
- F H Sun
- Department of Radiology, the Affiliated Zhongda Hospital, Southeast University, Nanjing 210009, China
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Parzefall B, De Decker S, Carvalho S, Terry R, Leach J, Smith KC, Lara-Garcia A. Axial Multicentric Osteosarcoma in an English Cocker Spaniel. J Vet Intern Med 2016; 30:1720-1725. [PMID: 27519845 PMCID: PMC5032862 DOI: 10.1111/jvim.14555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- B Parzefall
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - S De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - S Carvalho
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - R Terry
- Department of Pathology and Pathogen Biology, Royal Veterinary College, University of London, Hatfield, UK
| | - J Leach
- Veterinary Diagnostic Services, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - K C Smith
- Department of Pathology and Pathogen Biology, Royal Veterinary College, University of London, Hatfield, UK
| | - A Lara-Garcia
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK.
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Marley K, Bracha S, Seguin B. Osteoprotegerin activates osteosarcoma cells that co-express RANK and RANKL. Exp Cell Res 2015; 338:32-8. [PMID: 26254896 DOI: 10.1016/j.yexcr.2015.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/17/2015] [Accepted: 08/04/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Osteosarcoma (OS) is an aggressive and often fatal cancer that afflicts over 1000 humans and 10,000 dogs per year in the United States. Recent evidence suggests deregulation in the signaling triad, receptor activator of nuclear factor kappa B (RANK), its activating ligand (RANKL), and the RANKL inhibitor, osteoprotegerin (OPG) plays a key role in the pathogenesis of OS. This study investigated the expression of RANK and RANKL in osteosarcoma tumors and cell lines and describes an activating effect of OPG on OS cells in vitro. RESULTS Canine OS tumors and cell lines co-express mRNA for both RANK and RANKL. Expression of these proteins in OS cell lines was confirmed by Western blot and immunofluorescence microscopy. Expression of the soluble form of RANKL was not detected in media from OS cells. OPG-Fc incubation increased the phosphorylation status of ERK, AKT and the p65 subunit of nuclear factor kappa B (NFκB) and induced NFκB translocation from the cytoplasm to the nucleus in canine OS cells. OPG increased proliferation in both canine and human derived OS cell lines. CONCLUSION RANKL is produced by OS tumors and cell lines that also express RANK. This data provides preliminary evidence for a potential autocrine and or paracrine activation pathway in canine OS. An activating effect of exogenous OPG on signal transduction proteins, NFκB and proliferation in OS is described. These data provide new information concerning aberrant signaling in OS and could be important to those considering OPG as a therapeutic agent for osteosarcoma.
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Affiliation(s)
- Kevin Marley
- Department of Clinical Sciences Oregon State University, 105 Magruder Hall, Corvallis, OR 97331, USA.
| | - Shay Bracha
- Department of Clinical Sciences Oregon State University, 105 Magruder Hall, Corvallis, OR 97331, USA.
| | - Bernard Seguin
- Flint Animal Cancer Center, Department of Clinical Sciences Colorado State University, Fort Collins, CO 80523 USA.
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Lee KS, De Smet AA, Liu G, Staab MJ. High resolution ultrasound features of prostatic rib metastasis: a prospective feasibility study with implication in the high-risk prostate cancer patient. Urol Oncol 2013; 32:24.e7-11. [PMID: 23481369 DOI: 10.1016/j.urolonc.2012.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/31/2012] [Accepted: 08/13/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In a prior study, high resolution ultrasound (US) was shown to be accurate for evaluating rib metastasis detected on bone scan. However, that study did not address the specific US appearance typical of osteoblastic rib metastasis. Our objective was to determine the specific US imaging appearance of osteoblastic prostate carcinoma rib metastasis using osteolytic renal cell carcinoma rib metastasis as a comparison group. MATERIALS AND METHODS The Institutional Review Board approval and informed consent were obtained for this prospective feasibility study. We performed high resolution US of 16 rib metastases in 4 patients with prostate carcinoma metastases and compared them to 8 rib metastases in 3 male patients with renal cell carcinoma. All patients had rib metastases proven by radiographs and computed tomography (CT). High resolution US scanning was performed by a musculoskeletal radiologist using a 12-5 MHz linear-array transducer. Transverse and longitudinal scans were obtained of each rib metastasis. RESULTS All 16 prostate carcinoma metastases demonstrated mild cortical irregularity of the superficial surface of the rib without associated soft tissue mass, cortical disruption, or bone destruction. 7 of 8 (88%) renal cell carcinoma rib metastases demonstrated cortical disruption or extensive bone destruction without soft tissue mass. One of 8 (12%) renal cell carcinoma rib metastases demonstrated only minimal superficial cortical irregularity at the site of a healed metastasis. CONCLUSION Osteoblastic prostate carcinoma rib metastases have a distinctive appearance on US. Our success in visualizing these lesions suggests that US may be a useful tool to characterize isolated rib abnormalities seen on a bone scan in high-risk prostate cancer patients who are being evaluated for curative surgery or radiation treatment.
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Affiliation(s)
- Kenneth S Lee
- University of Wisconsin School of Medicine and Public Health, Department of Radiology, 600 Highland Avenue CSC E3/311, Madison, WI 53792-3252.
| | - Arthur A De Smet
- University of Wisconsin School of Medicine and Public Health, Department of Radiology, 600 Highland Avenue CSC E3/311, Madison, WI 53792-3252
| | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Division of Hematology/Oncology
| | - Mary Jane Staab
- University of Wisconsin Carbone Cancer Center, Division of Hematology/Oncology
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Quattrocchi CC, Dell'Aia P, Errante Y, Occhicone F, Longo D, Virzì V, Tonini G, Napoli N, Santini D, Beomonte Zobel B. Differential effect of zoledronic acid on normal trabecular and cortical bone density in oncologic patients with bone metastases. J Bone Oncol 2012; 1:24-9. [PMID: 26909251 PMCID: PMC4723329 DOI: 10.1016/j.jbo.2012.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate bone density changes at the level of normal bone and bone metastases after zoledronic acid (ZA) treatment in oncologic patients. Materials and methods We retrospectively evaluated 72 consecutive adult patients with histologically confirmed solid tumors with at least 1 newly diagnosed bone metastatic lesion. Bone metastases were diagnosed by bone scans and confirmed with computed tomography (CT). Patients received intravenous ZA, 4 mg, by 15-min infusion every 28 day through a peripheral or a central venous access and were monitored for at least 3 months and a maximum of 24 months. Bone density was determined at the level of bone metastases and at the level of normal trabecular and cortical bone using a ROI-based approach. Results A significant increase was demonstrated at the level of normal trabecular bone of the calvarium and the femoral neck. No significant increase of density was observed at the level of the normal cortical bone. Bone metastases showed a significant increase in CT density as compared to baseline up to 24 months after zoledronic acid. Conclusion We have found that long term treatment with ZA increases trabecular bone density in oncologic patients whereas normal cortical bone changes are not detectable.
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Affiliation(s)
- Carlo C Quattrocchi
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Paola Dell'Aia
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Yuri Errante
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Filomena Occhicone
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Daniela Longo
- IRCCS Ospedale Pediatrico Bambino Gesù, Radiology, Piazza Sant'Onofrio, 4, Rome 00100, Italy
| | - Vladimir Virzì
- Oncology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Giuseppe Tonini
- Oncology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Nicola Napoli
- Endocrinology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Daniele Santini
- Oncology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
| | - Bruno Beomonte Zobel
- Radiology at University Campus Bio-Medico of Rome, via Alvaro del Portillo, 21, Rome 00128, Italy
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Kulkarni D, Shetty L, Kulkarni M, Mahajan B. Extensive giant cell tumour of the mandible: a case report with review. J Maxillofac Oral Surg 2011; 12:461-5. [PMID: 24431889 DOI: 10.1007/s12663-011-0220-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 03/27/2011] [Indexed: 10/18/2022] Open
Abstract
Giant Cell Tumour (GCT) is a rare benign, osteolytic, pseudocystic solitary localized lesion. The lesion is common in skeletal structure but not as common in craniofacial skeleton. They are composed of sinusoidal and vascular spaces filled with blood and surrounded by fibrous tissue septa. There is a controversy as to whether it is a distinct radiological and pathological entity or a pathological change superimposed on a preexisting lesion. We present a case of a 19 year old female patient who reported with swelling and pain in the right mandible associated with pain and gradual increase in size since 4 years. On the radiographic study expansive, multilocular lesion extending to right coronoid process was observed. Incisional biopsy showed the lesion to be a dental cyst, however, enucleation with curettage of the cyst confirmed it to be GCT. GCT are non neoplastic but locally aggressive tumors with occasional rapid growth that may be differentiated from other multilocular lesions like ameloblastoma, giant cell granuloma and sarcomas. There have been reports which have appeared regarding its pathogenesis, response to treatment. However many questions remain regarding its treatment and prognosis.
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Affiliation(s)
- Deepak Kulkarni
- Department of Oral and Maxillofacial Surgery, DR. D.Y. Patil Dental College and Hospital, Pimpri, Pune, 18 Maharashtra India
| | - Lakshmi Shetty
- Department of Oral and Maxillofacial Surgery, DR. D.Y. Patil Dental College and Hospital, Pimpri, Pune, 18 Maharashtra India
| | - Meena Kulkarni
- Department of Oral Pathology, DR. D.Y. Patil Dental College and Hospital, Pimpri, Pune, 18 Maharashtra India
| | - Bela Mahajan
- Department of Oral Pathology, DR. D.Y. Patil Dental College and Hospital, Pimpri, Pune, 18 Maharashtra India
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Moon HS, Jung S, Jung TY, Cao VT, Moon KS, Kim IY. Possible role of matrix metalloproteinase in osteolytic intracranial meningiomas. J Korean Neurosurg Soc 2010; 47:11-6. [PMID: 20157372 DOI: 10.3340/jkns.2010.47.1.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 09/09/2009] [Accepted: 12/26/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Abnormalities of the bone are frequently encountered in patients with meningioma, and hyperostosis and endostosis are common bone alterations in these tumors. Extensive bony destruction is very unusual in patients with meningioma. We report six cases of intracranial meningioma associated with an osteolytic lesion of the skull and discuss the underlying mechanisms that may be responsible for bone destruction in patients with meningioma. METHODS Six patients were classified into three groups, severe, moderate and mild, according to the degree of osteolytic bony destruction. The tumor was classified as intracranial or extracranial, depending on its location. We investigated the potential role of matrix metalloproteinase (MMP) in meningioma-associated osteolysis. The levels of MMP expression were determined by gelatin zymography, reverse transcription-quantitative PCR analysis (RT-PCR) and immunohistochemical analysis. RESULTS Complete surgical removal of the lesion was performed in each patient. Histological examination revealed benign meningioma in four cases, and two cases of atypical meningioma. Patients did not have a poor prognosis except one case of recurred atypical meningioma. Gelatin zymography and RT-PCR detected high levels of MMP-2 in almost all extracranial masses in comparison with the intracranial masses and MMP-9 in two. There was no difference in the severity of bone destruction. Immunohistochemical analysis revealed MMP-2 expression in the vicinity of the bone destruction, and a few MMP-9-positive stainings were observed. CONCLUSION Osteolysis of the skull in patients with meningiomas might not be indicative of malignant pathological features and poor prognosis. Invasion to the extracranial portion and osteolysis might be associated with MMP-2 expression in meningioma.
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Affiliation(s)
- Hyung-Sik Moon
- Department of Neurosurgery, Chonnam National University Hwasun Hospital & Medical School, Gwangju, Korea
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Abstract
Meningioma en plaque (MEP) is a rare tumor characterized more by its clinical and biological behavior than its histological appearance. Hyperostosis of the skull is one of the characteristic signs of MEP. This bony change can produce clinical symptoms and signs in MEP by pressing against adjacent structures. The authors report a rare case of an osteolytic MEP extending from the sphenoid wing into the orbital wall, middle fossa, and temporalis muscle.
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Affiliation(s)
- Jin-Uk Baek
- Department of Neurosurgery, Daegu Catholic University, School of Medicine, Daegu, Korea
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