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Wein MN, Yang Y. Actionable disease insights from bedside-to-bench investigation in fibrodysplasia ossificans progressiva. J Bone Miner Res 2024; 39:375-376. [PMID: 38644656 DOI: 10.1093/jbmr/zjae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Marc N Wein
- Endocrine Unit, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Yingzi Yang
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, United States
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Murugesu S, Jones BP, Serhal P, Ben-Nagi J. Successful preimplantation genetic testing for fibrodysplasia ossificans progressiva: a case report. J Med Case Rep 2024; 18:227. [PMID: 38664849 PMCID: PMC11046953 DOI: 10.1186/s13256-024-04504-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/10/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE OF THE STUDY Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant condition that leads to significant disability and morbidity, characterised by the formation of heterotopic hard tissues within connective tissues. The condition has an incidence of approximately one per two million people worldwide. There is no known single effective treatment available for FOP. We report the world's first case of a healthy infant born following in vitro fertilisation (IVF) and preimplantation genetic testing for monogenic disorder (PGT-M) using Karyomapping for FOP. CASE PRESENTATION A 30-year-old Caucasian female with FOP presented with her partner seeking IVF with PGT-M to achieve a healthy pregnancy with an embryo unaffected by FOP. METHODS The couple underwent IVF and PGT-M using Karyomapping as the testing method. A multi-disciplinary team approach was utilised in planning this case, considering the additional risks of oocyte retrieval, pregnancy and childbirth in women with FOP. MAIN FINDINGS The oocyte retrieval was covered with a 5-day course of prednisolone to reduce the risk of a localised inflammatory reaction, which could result in subsequent heterotopic ossification. This was subsequently weaned down with reducing doses every two days. The patient underwent uncomplicated oocyte retrieval, yielding 12 mature oocytes. Following intracytoplasmic sperm injection (ICSI), ten zygotes having two pro-nuclei were cultured, and six underwent trophoectoderm biopsy and vitrification 5-6 days after retrieval. PGT-M via Karyomapping revealed four out of six (66.7%) of blastocysts were not carriers of the maternal high-risk FOP allele. In total, the patient had three separate embryo transfers. Pregnancy was achieved following the third frozen embryo transfer, which went to 37 weeks' gestation, and delivered by Caesarean section. The baby was born in excellent condition and is unaffected by FOP. CONCLUSION IVF/ICSI and PGT-M using Karyomapping was successfully implemented to identify embryos carrying the high-risk FOP allele resulting in a healthy livebirth.
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Affiliation(s)
- Sughashini Murugesu
- Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London, W12 0HS, UK.
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK.
| | - Benjamin P Jones
- Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London, W12 0HS, UK
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Paul Serhal
- Centre for Reproductive and Genetic Health, 230-232 Great Portland Street, London, W1W 5QS, UK
| | - Jara Ben-Nagi
- Centre for Reproductive and Genetic Health, 230-232 Great Portland Street, London, W1W 5QS, UK
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Li L, Lu M, He X, Zou C, Zheng C, Wang Y, Tang F, Luo Y, Zhou Y, Min L, Tu C. Pay Attention to the Osteochondromas in Fibrodysplasia Ossificans Progressiva. Orthop Surg 2024; 16:781-787. [PMID: 38185793 PMCID: PMC10925518 DOI: 10.1111/os.13956] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Fibrodysplasia ossificans progressiva (FOP) is an extremely rare disease characterized by malformation of the bilateral great toes and progressive heterotopic ossification. The clinical features of FOP occur due to dysfunction of the bone morphogenetic protein (BMP) signaling pathway induced by the mutant activin A type I receptor/activin-like kinase-2 (ACVR1/ALK2) which contributes to the clinical features in FOP. Dysregulation of the BMP signaling pathway causes the development of osteochondroma. Poor awareness of the association between FOP and osteochondromas always results in misdiagnosis and unnecessary invasive operation. CASE PRESENTATION In this study, we present a case of classical FOP involving osteochondroma. An 18-year-old male adolescent, born with deformity of bilateral big toes, complained multiple masses on his back for 1 year. The mass initially emerged with a tough texture and did not cause pain. It was misdiagnosed as an osteochondroma. After two surgeries, the masses became hard and spread around the entire back region. Meanwhile, extensive heterotopic ossification was observed around the back, neck, hip, knee, ribs, and mandible during follow-up. Osteochondromas were observed around the bilateral knees. No abnormalities were observed in the laboratory blood test results. Whole exome sequencing revealed missense mutation of ACVR1/ALK2 (c.617G > A; p.R206H) in the patient and confirmed the diagnosis of FOP. CONCLUSION In summary, classical FOP always behaves as a bilateral deformity of the big toes, as well as progressive ectopic ossification and osteochondromas in the distal femur and proximal tibia. An understanding of the association between osteochondromas and FOP aids in diagnosis and avoids unnecessary invasive management in patients.
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Affiliation(s)
- Longqing Li
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Minxun Lu
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Xuanhong He
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Chang Zou
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Chuanxi Zheng
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yitian Wang
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Fan Tang
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yi Luo
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yong Zhou
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Li Min
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Chongqi Tu
- Department of Orthopedics, Orthopedics Research Institute, West China HospitalSichuan UniversityChengduChina
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Zarei A, Rahimi F, Khadem M, Moradi M, Rahmani K. Disease aggravation following surgery in a rare patient suspected to Fibrodysplasia (Myositis) ossificans progressiva: a case report. J Med Case Rep 2023; 17:500. [PMID: 38044456 PMCID: PMC10694942 DOI: 10.1186/s13256-023-04253-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Fibrodysplasia ossificans progressiva (FOP) as a rare and heritable disorder with the infrequent genetic transmission of the condition is a catastrophic disorder of heterotopic ossification (HO) and a cause of extraskeletal bone formation in humans. Given the lack of effective treatment for this disease, the important point is to avoid aggravating factors such as bone biopsy, surgery, and intramuscular injection. CASE PRESENTATION In this report, we present a 52-year-old female patient, Kurdish ethnic, suspected to FOP who had a surgical intervention on the second toe of the right foot, which subsequently, it caused further deterioration of the disease in the person including necrosis and amputation of the distal phalanx of the second toe. CONCLUSIONS Although, based on our investigation and the available scientific evidence, surgery may a cause for faster progression and worsening of the FOP disorder, but its proof requires further studies.
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Affiliation(s)
- Amir Zarei
- Department of Orthopedic Surgery, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Foad Rahimi
- Department of Orthopedic Surgery, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mehryar Khadem
- Department of Orthopedic Surgery, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mansour Moradi
- Department of Orthopedic Surgery, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Khaled Rahmani
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Khashaba M, Shawky M. Patient-specific PEEK implant for treatment of temporal myositis ossificans (five years follow-up): A case report. J Stomatol Oral Maxillofac Surg 2023; 124:101593. [PMID: 37567345 DOI: 10.1016/j.jormas.2023.101593] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Abstract
Myositis ossificans of the temporalis muscle results in a cosmetic problem both before and after treatment because of the preoperative swelling and the postoperative defect respectively. The authors hypothesized that a patient-specific Polyether-ether ketone implant can be appropriate for immediate obliteration and reconstruction of such defect benefiting from the accuracy of CAD/CAM technology and computer-guided maxillofacial surgery. A Forty-year-old male patient with myositis ossificans affecting the left temporalis muscle was treated with a computer-guided surgical approach, a patient-specific implant was fabricated to obliterate the defect and avoid temporal hollowing using PEEK material. The functional and cosmetic results were satisfactory both immediately and at the 5-year follow-up, except that the skin over the implant was noticed to be stretched after 5 years. Hence, it can be concluded that virtual surgical planning and PEEK patient-specific implants are reliable in the immediate reconstruction of post-surgical temporal hollowing.
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Affiliation(s)
- Mohammed Khashaba
- Department of oral and maxillofacial surgery, faculty of dentistry, New Giza University, Giza, Egypt.
| | - Mohamed Shawky
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Egyptian Russian University, Cairo, Egypt
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Seefried L, Banholzer D, Fischer R, Grafe I, Hüning I, Morhart R, Oheim R, Semler O, Siggelkow H, Stockklausner C, Hoyer-Kuhn H. [Recommendations for the healthcare of patients with FOP]. Orthopadie (Heidelb) 2023; 52:924-930. [PMID: 37603129 PMCID: PMC10622346 DOI: 10.1007/s00132-023-04425-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] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Fibrodysplasia ossificans progressiva (FOP) is a very rare, severe genetic disorder triggered by a gain-of-function mutation in the ACVR1 gene that codes for the type I bone morphogenetic protein (BMP) receptor ACVR1 (activin A receptor-type 1), also known as ALK2 (activin receptor-like kinase-2). It leads to the onset and progression of heterotopic ossification (HO) in soft and connective tissue. HO is often preceded by episodes of soft tissue swelling or flare-ups. Flare-ups, characteristic of FOP, may be induced by trauma, infection, vaccination, or other medications, as well as surgical procedures or may occur spontaneously. As patients age, they develop severe mobility limitations due to progressive HO formation, including immobility, causing a shortened life expectancy. FOP's first characteristic clinical sign is the congenital malformation of one or both big toes with valgus axis deviation, which is present in almost all patients. To confirm the diagnosis, molecular genetic analysis of the ACVR1 gene is possible. AIM OF THE RECOMMENDATIONS This white paper aims to provide an overview of the necessary prerequisites and conditions for the care of patients with FOP and positively contribute to patients with FOP by improving the overall availability of knowledge. To achieve this, relevant aspects of the care of the very rare disease FOP are presented, from the initial diagnosis to the care in regular care based on the authors' knowledge (German FOP network) and the international FOP Treatment Guidelines. The recommendations presented here are addressed to all actors and decision-makers in the health care system and are also intended to inform patients and the public.
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Affiliation(s)
- L Seefried
- Osteologie/Klinische Studieneinheit, Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland.
| | - D Banholzer
- Sozialpädiatrisches Zentrum, Standort Mitte - Olgahospital, Haus M - Pädiatrie 1, Klinikum Stuttgart, Kriegsbergstr. 60, 70174, Stuttgart, Deutschland
| | - R Fischer
- FOP e. V., c/o Ralf Fischer, Frankfurter Landstr. 11a, 61440, Oberursel, Deutschland
| | - I Grafe
- Medizinische Klinik und Poliklinik III, Bereich Endokrinologie und Stoffwechsel, Diabetes, Knochenerkrankungen, UniversitätsCentrum für Gesundes Altern, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Zentrum für Metabolisch-Immunologische Erkrankungen und Therapietechnologien Sachsen (MITS), Technische Universität Dresden, Dresden, Deutschland
| | - I Hüning
- Institut für Humangenetik, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - R Morhart
- , Triftstr. 12, 82467, Garmisch-Partenkirchen, Deutschland
| | - R Oheim
- Institut für Osteologie und Biomechanik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - O Semler
- Medizinische Fakultät und Uniklinik Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für seltene Erkrankungen, Universität zu Köln, Köln, Deutschland
| | - H Siggelkow
- Zentrum für Endokrinologie, Osteologie, Rheumatologie, Nuklearmedizin und Humangenetik, MVZ ENDOKRINOLOGIKUM Göttingen, 37075, Göttingen, Deutschland
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Stockklausner
- Abteilung Kinder & Jugendmedizin, Klinikum Garmisch-Partenkirchen, Auenstr. 6, 82467, Garmisch-Partenkirchen, Deutschland
| | - H Hoyer-Kuhn
- Medizinische Fakultät und Uniklinik Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität zu Köln, Köln, Deutschland.
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O'Hara KR, Zwemer EK, Archer MC. Pain in the Neck: Diagnosing a Painful Neck Mass. J Pediatr 2023; 260:113480. [PMID: 37182654 DOI: 10.1016/j.jpeds.2023.113480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Kathleen R O'Hara
- Department of Pediatrics, UNC Children's - North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Eric K Zwemer
- Division of Pediatric Hospital Medicine, UNC Children's - North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Madison C Archer
- Division of Pediatric Hospital Medicine, UNC Children's - North Carolina Children's Hospital, Chapel Hill, North Carolina
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Assis S, Garcia J. A rare femoral heterotopic bone formation in a 14th-19th century female skeleton from Constância (Portugal). Int J Paleopathol 2023; 40:93-98. [PMID: 36628891 DOI: 10.1016/j.ijpp.2022.12.004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/27/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This paper aims to: (1) document a rare femoral heterotopic ossification (HO), and (2) discuss its aetiology and impact on the individual's locomotion and daily living activities. MATERIALS Adult female skeleton (SG.14-SK.7) from the village of Constância (Portugal), and dated from the 14th-19th centuries CE. METHODS The biological profile and the macroscopic analysis of the bone changes were assessed using standardized methods. RESULTS The macroscopic analysis revealed a large bony mass (8 cm length) located immediately inferior to the small trochanter of the right femur. The lesion exhibited a compact, tubular appearance located at the site of attachment of the pectineus muscle. No signs of bone fracture were observed. CONCLUSIONS The morphology of the SG.14-SK.7 femoral lesion is compatible with a probable case of myositis ossificans traumatica (MOT), secondary to acute trauma of the pectineus muscle. The underlying trauma episode, such as random accidental and/or occupation-related injury, is unknown. However, it is highly possible that this self-limiting condition significantly impaired the individual's daily life and mobility. SIGNIFICANCE Evidence of severe acute muscle trauma is a rare finding compared with HO secondary to bone trauma and other minor muscle injuries. Moreover, no cases of MOT affecting the pectineus muscle have been reported in the paleopathological literature to date. LIMITATIONS Although unlikely, a case of neurogenic or burn-related HO cannot be completely disregarded. It was not possible to undertake radiography as part of this study. SUGGESTIONS FOR FURTHER RESEARCH The use of imaging techniques to complement the paleopathological description is advised.
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Affiliation(s)
- Sandra Assis
- CRIA - Centro em Rede de Investigação em Antropologia, Faculdade de Ciências Sociais e Humanas, Universidade NOVA de Lisboa, Lisboa, Portugal; CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.
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Pignolo RJ, Kimel M, Whalen J, Kawata AK, Artyomenko A, Kaplan FS. The Fibrodysplasia Ossificans Progressiva Physical Function Questionnaire (FOP-PFQ): A patient-reported, disease-specific measure. Bone 2023; 168:116642. [PMID: 36526263 DOI: 10.1016/j.bone.2022.116642] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the reliability and validity of age-specific versions of the Fibrodysplasia Ossificans Progressiva Physical Function Questionnaire (FOP-PFQ), developed to measure the impact of FOP on physical function and activities of daily living. METHODS FOP-PFQ development included a literature review, two iterative phases of qualitative work involving individuals with FOP, and clinical expert review. The analysis used pooled FOP-PFQ data from an FOP natural history study (NCT02322255), a patient registry (NCT02745158), and phase II trials (NCT02190747; NCT02279095; NCT02979769). Item-level and factor analysis informed item retention and determined factor structure. Reliability was evaluated using Cronbach's alpha and intraclass correlation coefficients. Convergent validity was assessed by comparing scores with age, the Cumulative Analogue Joint Involvement Scale (CAJIS), the Patient-Reported Outcomes Measurement Information System Global Health Scale (PROMIS), and heterotopic ossification (HO) volume. Known-groups validity assessment used age, CAJIS, and HO volume. RESULTS Factor analysis confirmed a two-factor solution: Mobility and Upper Extremity. Results reflected high internal consistency and were supportive of test-retest reliability; correlation coefficients >0.90 demonstrated FOP-PFQ scores were stable over a one- to three-week period. The majority of scores were moderately (r = 0.30-0.50) to highly (r ≥ 0.50) correlated with CAJIS and HO volume, supporting convergent validity. With the exception of some age-based and functional groups, FOP-PFQ scores were significantly worse in groups with more severe disease, demonstrating known-groups validity. CONCLUSION The FOP-PFQ was demonstrated to be a reliable, valid measure that may be responsive to change in individuals with FOP, although some results were inconclusive for pediatric versions.
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Affiliation(s)
| | | | | | | | | | - Frederick S Kaplan
- Departments of Orthopaedic Surgery and Medicine, The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Slouma M, Abbes M, Amorri W, Dhahri R, Metoui L, Jrad GB, Lamine K, Boujemaa H, Gharsallah I, Louzir B. Myositis Ossificans: A Rare Etiology of Sciatica. J Clin Rheumatol 2022; 28:e678-e679. [PMID: 32101909 DOI: 10.1097/rhu.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Rim Dhahri
- From the Departments of Internal Medicine
| | | | - Ghofrane Ben Jrad
- Emergency, Military Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Khaled Lamine
- Emergency, Military Hospital, Tunis El Manar University, Tunis, Tunisia
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Cruz-Escutia NK, Mendoza-Álvarez SA, Hernández-Montez ZI, Palafox-Vargas ML. [Progressive myositis ossificans: Case report]. Rev Med Inst Mex Seguro Soc 2022; 60:96-103. [PMID: 35274918 PMCID: PMC10395904] [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] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/22/2021] [Indexed: 06/14/2023]
Abstract
Background Myositis ossificans progressiva (MOP) is a low prevalence hereditary connective tissue disease (1:2,000,000 habitants). It is characterized by heterotopic ossification with an uncertain behavior that has been exceptionally related to neoplasms. The objective was to know the coexistence of MOP with neoplasms of mesodermal origin, so that they can be considered in the diagnosis of other patients, as well as formulate hypotheses to clarify their association. Clinical case 27-year-old female with right gluteal and ischitiobial muscle pain that increased with exercise, without remission with analgesics until limiting the mobility of both extremities. A bone series was requested where areas of heterogeneous radiolucency were evidenced in the region of, both, thighs and pelvis in an irregular manner, similar to bone density, which was compatible with the ultrasound and tomographic findings; we concluded that they were images of myositis ossificans of the hip. The patient reported gastric symptoms and an endoscopy was requested, which histopathologically reported diffuse gastric carcinoma with signet ring cells; cabinet images showed an ovarian tumor. Conclusion MOP is a low prevalence disease, which is why its knowledge and suspicion are essential for the diagnosis. We found little literature that involves the three entities; therefore, their pathophysiology and understanding is limited. Regarding MOP, at this moment there is no curative treatment; however, an accurate diagnosis allows to start rehabilitation in a timely manner with an improvement in the quality of life.
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Affiliation(s)
- Nydia Karen Cruz-Escutia
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Sergio Alberto Mendoza-Álvarez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Zenia Irais Hernández-Montez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Martha Leticia Palafox-Vargas
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Patología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Goyal C, Roychowdhury J. Bone chip versus myositis ossificans after supracondylar fracture of humerus. Pan Afr Med J 2022; 41:218. [PMID: 35721631 PMCID: PMC9167484 DOI: 10.11604/pamj.2022.41.218.31732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/06/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Chanan Goyal
- Government Physiotherapy College, Raipur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
- Corresponding author: Chanan Goyal, Government Physiotherapy College, Raipur, India.
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Abstract
Fibrodysplasia ossificans progressiva (FOP) is an extremely rare autosomal dominant inherited disorder leading to mature ossification within soft tissues. We report a 62-year-old female with a 3-week history of a rapidly enlarging left neck mass with no associated symptoms. A neck CT showed a ~10 cm solid-appearing non-calcified left neck mass that markedly decreased in size on a one-month follow-up neck MRI, but with new extensive edema/intense enhancement in floor of the mouth. Prior radiographs documented hallux valgus and heterotopic ossification of the psoas/paraspinal muscles and shoulder girdle. In this case of FOP, no intervention was implemented and the symptoms improved over time and thus paralleled other such cases for flare-ups. Clinicians should be aware of this rare entity, as it is frequently misdiagnosed as cancer or other benign entities such as infection, resulting in biopsies that can often hasten disease progression.
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Affiliation(s)
- Ghiam Yamin
- Department of Radiology, University of California San Diego School of Medicine, San Diego, CA, USA
- Department of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, CA, USA
| | - Shadi Daghighi
- Department of Radiology, University of California San Diego School of Medicine, San Diego, CA, USA
- Department of Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, USA
| | - Mahmood Mafee
- Department of Radiology, University of California San Diego School of Medicine, San Diego, CA, USA
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de Ruiter RD, Smilde BJ, Pals G, Bravenboer N, Knaus P, Schoenmaker T, Botman E, Sánchez-Duffhues G, Pacifici M, Pignolo RJ, Shore EM, van Egmond M, Van Oosterwyck H, Kaplan FS, Hsiao EC, Yu PB, Bocciardi R, De Cunto CL, Longo Ribeiro Delai P, de Vries TJ, Hilderbrandt S, Jaspers RT, Keen R, Koolwijk P, Morhart R, Netelenbos JC, Rustemeyer T, Scott C, Stockklausner C, ten Dijke P, Triffit J, Ventura F, Ravazzolo R, Micha D, Eekhoff EMW. Fibrodysplasia Ossificans Progressiva: What Have We Achieved and Where Are We Now? Follow-up to the 2015 Lorentz Workshop. Front Endocrinol (Lausanne) 2021; 12:732728. [PMID: 34858325 PMCID: PMC8631510 DOI: 10.3389/fendo.2021.732728] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare progressive genetic disease effecting one in a million individuals. During their life, patients with FOP progressively develop bone in the soft tissues resulting in increasing immobility and early death. A mutation in the ACVR1 gene was identified as the causative mutation of FOP in 2006. After this, the pathophysiology of FOP has been further elucidated through the efforts of research groups worldwide. In 2015, a workshop was held to gather these groups and discuss the new challenges in FOP research. Here we present an overview and update on these topics.
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Affiliation(s)
- Ruben D. de Ruiter
- Department of Internal Medicine, Section Endocrinology, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- *Correspondence: Ruben D. de Ruiter, ; Elisabeth M. W. Eekhoff,
| | - Bernard J. Smilde
- Department of Internal Medicine, Section Endocrinology, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Gerard Pals
- Department of Clinical Genetics and Bone Histomorphology, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nathalie Bravenboer
- Department of Clinical Chemistry, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Petra Knaus
- Freie Universität Berlin, Institute for Chemistry and Biochemistry, Berlin, Germany
| | - Ton Schoenmaker
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Esmée Botman
- Department of Internal Medicine, Section Endocrinology, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | | | - Maurizio Pacifici
- Translational Research Program in Pediatric Orthopaedics, Abramson Research Center, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Eileen M. Shore
- Department of Orthopaedic Surgery and Genetics, and the Center for Research in FOP and Related Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Marjolein van Egmond
- Department of Molecular Cell Biology and Immunology, Cancer Center Amsterdam, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hans Van Oosterwyck
- Division of Biomechanics, Department of Mechanical Engineering, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Prometheus division of skeletal tissue engineering, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Frederick S. Kaplan
- Department of Orthopaedic Surgery and Medicine, Center for Research in FOP and Related Disorders, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Edward C. Hsiao
- Department of Endocrinology and Metabolism, and the Institute for Human Genetics, Department of Medicine, University of California, San Francisco, CA, United States
| | - Paul B. Yu
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Renata Bocciardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Università degli Studi di Genova, Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Carmen Laura De Cunto
- Rheumatology Section, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Teun J. de Vries
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Susanne Hilderbrandt
- Freie Universität Berlin, Institute for Chemistry and Biochemistry, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité Medical University of Berlin, Berlin, Germany
| | - Richard T. Jaspers
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Richard Keen
- Centre for Metabolic Bone Disease, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Peter Koolwijk
- Department of Physiology, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Rolf Morhart
- Department of Pediatrics, Garmisch-Partenkichen Medical Center, Garmisch-Partenkirchen, Germany
| | - Jan C. Netelenbos
- Department of Internal Medicine, Section Endocrinology, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam University Medical Center (AmsterdamUMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Christiaan Scott
- Division of Paediatric Rheumatology, Departmet of Paediatrics and Child Heath, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Clemens Stockklausner
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Peter ten Dijke
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - James Triffit
- Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Francesc Ventura
- Departamento de Cièncias Fisiológicas, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, Spain
| | - Roberto Ravazzolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Università degli Studi di Genova, Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Dimitra Micha
- Department of Clinical Genetics and Bone Histomorphology, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Elisabeth M. W. Eekhoff
- Department of Internal Medicine, Section Endocrinology, Amsterdam University Medical Center (Amsterdam UMC), Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- *Correspondence: Ruben D. de Ruiter, ; Elisabeth M. W. Eekhoff,
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Abstract
RATIONALE Fibrodysplasia ossificans progressiva (FOP) is rare genetic disease featuring progressive heterotopic ossification of soft tissues of the musculoskeletal system which leads to severe disability and premature death. Recognition of this disease is important since invasive diagnostic procedures can promote disease progression. However, despite its distinctive clinical manifestations, diagnosis can be difficult because of its rarity PATIENT CONCERNS:: A 20-year-old woman was referred to rheumatology clinic for management of "ankylosing spondylitis". The patent had begun to have hard subcutaneous nodules when she was 1 year old, and subsequently developed hip joint pain and flexion contractures of knees and hips leading to disability. DIAGNOSES Based on characteristic bilateral great toe deformities and radiographic images of ossification of soft tissues, a clinical diagnosis of FOP was made. This was confirmed by genetic test showing a heterozygous mutation (c.G617A) of the activin receptor 1A gene (ACVR1). INTERVENTIONS The patient was treated symptomatically and with supportive measures, and her condition remained stable. LESSONS Diagnosis of FOP can be difficult, despite its distinctive clinical manifestations, because of its rarity. Recognition of this disease is important to avoid invasive diagnostic procedures which can promote progression.
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Affiliation(s)
- Xiaofei Shi
- Department of Rheumatology and Immunology, The First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, China
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University and VA Portland Health Care System, Portland, OR
| | - Liqing Zhou
- Department of Rheumatology and Immunology, The First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, China
| | - Jingjing Shang
- Department of Rheumatology and Immunology, The First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, China
| | - Ke Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, China
| | - Cong-Qiu Chu
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University and VA Portland Health Care System, Portland, OR
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Treurniet S, Eekhoff EMW, Schmidt FN, Micha D, Busse B, Bravenboer N. A Clinical Perspective on Advanced Developments in Bone Biopsy Assessment in Rare Bone Disorders. Front Endocrinol (Lausanne) 2020; 11:399. [PMID: 32714279 PMCID: PMC7344330 DOI: 10.3389/fendo.2020.00399] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/18/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction: Bone biopsies have been obtained for many centuries and are one of the oldest known medical procedures in history. Despite the introduction of new noninvasive radiographic imaging techniques and genetic analyses, bone biopsies are still valuable in the diagnosis of bone diseases. Advanced techniques for the assessment of bone quality in bone biopsies, which have emerged during the last decades, allows in-depth tissue analyses beyond structural changes visible in bone histology. In this review, we give an overview of the application and advantages of the advanced techniques for the analysis of bone biopsies in the clinical setting of various rare metabolic bone diseases. Method: A systematic literature search on rare metabolic bone diseases and analyzing techniques of bone biopsies was performed in PubMed up to 2019 week 34. Results: Advanced techniques for the analysis of bone biopsies were described for rare metabolic bone disorders including Paget's disease of bone, osteogenesis imperfecta, fibrous dysplasia, Fibrodysplasia ossificans progressiva, PLS3 X-linked osteoporosis, Loeys-Diets syndrome, osteopetrosis, Erdheim-Chester disease, and Cherubism. A variety of advanced available analytical techniques were identified that may help to provide additional detail on cellular, structural, and compositional characteristics in rare bone diseases complementing classical histopathology. Discussion: To date, these techniques have only been used in research and not in daily clinical practice. Clinical application of bone quality assessment techniques depends upon several aspects such as availability of the technique in hospitals, the existence of reference data, and a cooperative network of researchers and clinicians. The evaluation of rare metabolic bone disorders requires a repertoire of different methods, owing to their distinct bone tissue characteristics. The broader use of bone material obtained from biopsies could provide much more information about pathophysiology or treatment options and establish bone biopsies as a valuable tool in rare metabolic bone diseases.
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Affiliation(s)
- Sanne Treurniet
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Elisabeth M. W. Eekhoff
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Felix N. Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dimitra Micha
- Department of Clinical Genetics, Amsterdam University Medical Center, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nathalie Bravenboer
- Bone and Calcium Metabolism Lab, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
- *Correspondence: Nathalie Bravenboer
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17
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Affiliation(s)
- Pir Abdul Ahad Aziz
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
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18
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Igrutinovic G, Mladenovic J, Jakovljevic A, Dimic S, Elek Z, Milosavljevic S. Non-traumatic myositis ossificans of the thigh. A case report. Ann Ital Chir 2019; 8:S2239253X19030111. [PMID: 31112518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Myositis ossificans (MO) is an ectopic ossification characterized by an appearance of bone formation predominantly in muscle tissue. Trauma is the most common etiological factor, observed in almost 60-75% of cases, whereas a non-traumatic MO is rarely described in the literature. A diagnosis is based on clinical and radiological findings. PRESENTATION OF CASE A 75-year old female patient has been admitted to our clinic with a localized swelling of the posterior femoral compartment, presented on magnetic resonance as a calcification in the biceps femoris muscle. Laboratory test results were within the normal range. Surgical procedure consisted of excision of the tumor mass with primary wound reconstruction and drainage. The post-operative period was uneventful, and the patient was discharged from hospital on the seventh postoperative day. The pathohistology findings have shown the MO. DISCUSSION A non-traumatic MO is scarcely described in the literature. A chronic microtrauma, tissue ischaemia and inflammation are listed as causal mechanisms of a non-traumatic MO. MO non-traumatica occurs more often in patients with a parallel, subdural or epidural haemorrhage and a hip surgery. Our case did not present any family history, trauma or associated anomalies of hands or fingers. CONCLUSION Myositis ossificans should be considered as the differential diagnosis of all soft tissue tumor masses, even if known risk factors are not present in the anamnesis. Surgery is a reasonable therapeutic strategy in the presence of a tumor mass in soft tissues, and definite diagnosis can be set only based on pathohistological findings. KEY WORDS Ectopic ossification, Non traumatic myositis, Surgery.
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Hanisch M, Hanisch L, Fröhlich LF, Werkmeister R, Bohner L, Kleinheinz J. Myositis ossificans traumatica of the masticatory muscles: etiology, diagnosis and treatment. Head Face Med 2018; 14:23. [PMID: 30373608 PMCID: PMC6206835 DOI: 10.1186/s13005-018-0180-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/15/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Myositis ossificans describes a heterotopic bone formation within a muscle. Thereby myositis ossificans is classified in two different groups: myositis ossificans progressiva (MOP) which describes a genetic autosomal dominant rare disease and myositis ossificans traumatica (MOT). The exact pathogenesis of MOT is unclear. The aim of this article was to analyse and interpret the existing literature reporting MOT of masticatory muscles and compare the results with our own clinical experience with MOT. Risk-factors, etiology, clinical features, diagnostic imaging, as well as different treatment options were evaluated and recommendations for the prevention, diagnosis, and therapy of MOT of the masticatory muscles were given. METHODS Following the PRISMA-Guidelines, a systematic search within the PubMed/Medline database with a view to record literature of MOT of the masticatory muscles was performed. Furthermore, the database of our own clinic was screened for cases of MOT. RESULTS In total, 63 cases of MOT of the masticatory muscles which were reported in English-based literature were included in this study. Overall, 25 female and 37 male patients could be analysed whereas one patient's gender was unknown. Complication of wisdom-tooth infection (n = 3) as well as the results of dental procedures like dental extraction (n = 7), mandibular nerve block (n = 4), periodontitis therapy (n = 1) were reported as MOT cases. From the 15 reported cases that appeared after dental treatment like extraction or local anesthesia the medial pterygoid (n = 10) was the most affected muscle. Hereof, females were more affected (n = 9) than males (n = 6). The most reported clinical symptom of MOT was trismus (n = 54), followed by swelling (n = 17) and pain (n = 13). One clinical case provided by the authors was detected. CONCLUSIONS Dental procedures, such as local anesthesia or extractions, may cause MOT of the masticatory musculature. Demographical analyses demonstrate that females have a higher risk of developing MOT with respect to dental treatment. The most important treatment option is surgical excision. Subsequent physical therapy can have beneficial effects. Nevertheless, a benefit of interpositional materials and drugs as therapy of MOT of the masticatory muscles has not yet been proven. Myositis ossificans progressiva has to be excluded.
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Affiliation(s)
- Marcel Hanisch
- Department of Cranio-Maxillofacial Surgery, Research Unit Rare Diseases with Orofacial Manifestations (RDOM), University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
| | - Lale Hanisch
- Department of Orthodontics, Faculty of Health, School of Dentistry, Witten/Herdecke University, Alfred-Herrhausen-Strasse 44, 58455 Witten, Germany
| | - Leopold F. Fröhlich
- Department of Cranio-Maxillofacial Surgery, AG VABOS, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
| | - Richard Werkmeister
- Department of Oral and Maxillofacial Surgery, Central German Armed Forces Hospital, Rübenacher Strasse 170, 56072 Koblenz, Germany
| | - Lauren Bohner
- Department of Cranio-Maxillofacial Surgery, Research Unit Rare Diseases with Orofacial Manifestations (RDOM), University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, Research Unit Rare Diseases with Orofacial Manifestations (RDOM), University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, D-48149 Münster, Germany
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20
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Pacifici M. Acquired and congenital forms of heterotopic ossification: new pathogenic insights and therapeutic opportunities. Curr Opin Pharmacol 2018; 40:51-58. [PMID: 29614433 PMCID: PMC6015534 DOI: 10.1016/j.coph.2018.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/20/2018] [Indexed: 12/27/2022]
Abstract
Heterotopic ossification (HO) involves the formation and accumulation of extraskeletal bone tissue at the expense of local tissues including muscles and connective tissues. There are common forms of HO that are triggered by extensive trauma, burns and other bodily insults, and there are also rare congenital severe forms of HO that occur in children with Fibrodysplasia Ossificans Progressiva or Progressive Osseous Heteroplasia. Given that HO is often preceded by inflammation, current treatments usually involve anti-inflammatory drugs alone or in combination with local irradiation, but are not very effective. Recent studies have provided novel insights into the pathogenesis of acquired and genetic forms of HO and have used the information to conceive and test new and more specific therapies in animal models. In this review, I provide salient examples of these exciting and promising advances that are undoubtedly paving the way toward resolution of this debilitating and at times fatal disease.
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MESH Headings
- Animals
- Anti-Inflammatory Agents/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Bone Diseases, Metabolic/diagnosis
- Bone Diseases, Metabolic/genetics
- Bone Diseases, Metabolic/physiopathology
- Bone Diseases, Metabolic/therapy
- Bone and Bones/drug effects
- Bone and Bones/pathology
- Bone and Bones/physiopathology
- Bone and Bones/radiation effects
- Drug Discovery/methods
- Genetic Predisposition to Disease
- Humans
- Molecular Targeted Therapy
- Myositis Ossificans/diagnosis
- Myositis Ossificans/genetics
- Myositis Ossificans/physiopathology
- Myositis Ossificans/therapy
- Ossification, Heterotopic/diagnosis
- Ossification, Heterotopic/genetics
- Ossification, Heterotopic/physiopathology
- Ossification, Heterotopic/therapy
- Osteogenesis/drug effects
- Osteogenesis/genetics
- Osteogenesis/radiation effects
- Phenotype
- Skin Diseases, Genetic/diagnosis
- Skin Diseases, Genetic/genetics
- Skin Diseases, Genetic/physiopathology
- Skin Diseases, Genetic/therapy
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Affiliation(s)
- Maurizio Pacifici
- Translational Research Program in Pediatric Orthopaedics, Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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21
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Saini I, Bagri N, Gupta N. My Phenotype speaks: please do not harm me with biopsy needle. Acta Reumatol Port 2018; 43:156-158. [PMID: 30091961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Fibrodysplasia ossificans progressiva is characterized by congenital skeletal anomalies and progressive heterotopic ossification. We present a 4 year old male patient who underwent unnecessary harmful multiple biopsies before the diagnosis of fibrodysplasia ossificans progressiva is made. Though rare, diagnosis of fibrodysplasia ossificans progressiva should be considered whenever characteristic radiographic features of multifocal heterotopic bone formation is seen along with the valgus deformities of the big toes.
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Affiliation(s)
- Isha Saini
- All India Institute of Medical Sciences, New Delhi, India
| | - Narendra Bagri
- All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Gupta
- All India Institute of Medical Sciences, New Delhi, India
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22
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Abstract
BACKGROUND Flare-ups of the hips are among the most feared and disabling complications of fibrodysplasia ossificans progressiva (FOP) and are poorly understood. In order to better understand the nature of hip flare-ups in FOP, we evaluated 25 consecutive individuals with classic FOP (14 males, 11 females; 3-56years old, median age, 17years old) who presented with acute unilateral hip pain. RESULTS All 25 individuals were suspected of having a flare-up of the hip based on clinical history and a favorable response to a four day course of high-dose oral prednisone. Ten individuals (40%) experienced rebound symptoms of pain and/or stiffness within seven days after discontinuation of prednisone and all ten subsequently developed heterotopic ossification (HO) or decreased mobility of the affected hip. None of the 14 individuals who experienced sustained relief of symptoms following a course of oral prednisone experienced HO or decreased mobility. Incidental radiographic findings at the time of presentation were multifactoral and included osteochondromas of the proximal femur (18/25; 72%), degenerative arthritis (17/25; 68%), developmental hip dysplasia (15/25; 60%), previously existing heterotopic ossification (12/25; 48%), intra-articular synovial osteochondromatosis (8/25; 32%) or traumatic fractures through pre-existing heterotopic bone (1/25; 4%). CONCLUSIONS Developmental joint pathology may confound clinical evaluation of hip pain in FOP. The most useful modality for suspecting an ossification-prone flare-up of the hip was lack of sustained response to a brief course of oral prednisone. Evaluation of soft tissue edema by ultrasound or magnetic resonance imaging showed promise in identifying ossification-prone flare-ups and warrants further analysis in prospective studies.
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Affiliation(s)
- Frederick S Kaplan
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Mona Al Mukaddam
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Clinical Medicine, Division of Endocrinology, Diabetes and Metabolism, Center for Research in FOP & Related Disorders, Penn Medicine University City, 3737 Market Street, 3rd floor, United States.
| | - Robert J Pignolo
- Department of Medicine, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, United States.
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23
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Abstract
Fibrodyplasia ossificans progressiva (FOP) is an ultra-rare genetic condition of heterotopic ossification (HO) that results in progressive loss of joint function, ultimately rendering movement impossible. Death is most commonly the result of thoracic insufficiency syndrome, or complications related to recurrent respiratory infections. There are no current treatments for FOP, but early and emerging clinical trials offer hope for this devastating disease. With the recent reporting of a comprehensive global natural history study, scales to assess joint dysfunction, and a more accurate prediction of joint survival, it is now possible to construct a conceptual framework for the clinical staging of FOP. Based on assessment of FOP features in seven areas, it is possible to assign five clinical stages. FOP features include flare-up activity, body regions affected, thoracic insufficiency, other complications, activities of daily living (ADLs), ambulatory status, and the cumulative joint involvement scale (CAJIS) score. Assessments of these features assign an individual with FOP to early/mild, moderate, severe, profound, or late-stage disease. These criteria seek to be flexible enough to be used by clinicians without reliance on advanced imaging or specialized testing, as well as by investigators involved in research or clinical trial studies who would have these tools available. These staging measures for FOP assess the influence of HO and accelerated joint dysfunction (due to congenital abnormalities) on the ability to perform common functional activities, and thus a delay or lack of progression from one stage to the next represents the ultimate test of efficacy for drug trials. This framework will serve both as a prediction tool for FOP progression as well as a critical opportunity to substantiate therapeutic interventions. The staging system proposed here will permit an accurate assessment of severity to appropriately develop or revise clinical plans of care, define operational research criteria, and identify the effectiveness of interventions. Ultimately, this clinical staging will aid the field in moving toward earlier intervention at a stage where disease-modifying therapies may be most efficacious.
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Affiliation(s)
- Robert J Pignolo
- Department of Medicine, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Frederick S Kaplan
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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24
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Abstract
Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare and devastating disorder characterized by cumulative episodes of progressive heterotopic ossification. It is estimated that there exist 600-700 patients in Mainland China. Nevertheless, due to the rarity, many FOP patients were initially misdiagnosed. Until now fewer than 150 patients have been identified in Mainland China. This review summarizes the epidemiology and clinical features of FOP patients, the progress of clinical and basic research in China, and the future of FOP care in China.
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Affiliation(s)
- Dunmin She
- Department of Endocrinology and Metabolism, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Keqin Zhang
- Department of Endocrinology and Metabolism, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
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25
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Muñoz Gómez MDM, Novella Navarro M, Ruiz Santiago F, Raya Álvarez E. Fibrodysplasia ossificans progressiva: Case report of a Terminally-ill patient. Reumatol Clin 2017; 13:303-304. [PMID: 27282280 DOI: 10.1016/j.reuma.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/18/2016] [Accepted: 04/22/2016] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - Fernando Ruiz Santiago
- Sección de Radiología Musculoesquelética, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Enrique Raya Álvarez
- Departamento de Reumatología, Hospital Universitario San Cecilio, Granada, España
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26
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Peeters CMM, Sluimer JC, Gosens T. [A hardening in the forearm after an olecranon fracture]. Ned Tijdschr Geneeskd 2017; 161:D1350. [PMID: 28745249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 77-year-old male who had had an olecranon fracture 15 years ago presented himself with mild pain of the right elbow. Physical examination revealed painless hardening of the finger and wrist flexors in an area of 10 cm from the origin. Conventional radiographs showed a mature myositis ossificans.
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Affiliation(s)
- C M M Peeters
- Elisabeth-Tweesteden Ziekenhuis, Afd. Orthopedie en Traumachirurgie, Tilburg
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27
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Abstract
Myositis ossificans of the hand is extremely rare. We report an unusual case of myositis ossificans of the thenar muscles and discuss the diagnostic pitfalls whereby this condition can be mistaken for malignancy or infection.
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28
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Abstract
Intraabdominal myositis ossificans (IMO) is a rare benign disorder characterized by reactive bone formation in intraabdominal soft tissue that should be distinguished from a malignant condition. We retrospectively searched our patient records and report 9 new cases of IMO. The lesions occurred in 7 men and 2 women with a mean age of 50 years (range, 24-76 years), 5 of whom had previous abdominal surgery. Histologically, all the cases were similar, consisting of a reactive mesenchymal process in adipose tissue. Mitosis was observed, but with no atypical forms, and the lesions lacked malignant cytologic features. IMO is an uncommon benign lesion that develops relatively rapidly. The pathogenesis is related to intraabdominal surgical procedures, but the exact mechanism remains to be determined.
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Affiliation(s)
- Renata Q Zamolyi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905, USA
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29
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Taam I, Boussouni K, Redouane B, Amil T, Saouab R. [Myositis ossificans circumscripta, an unusual location: about a case and review of the literature]. Pan Afr Med J 2016; 24:71. [PMID: 27642411 PMCID: PMC5012724 DOI: 10.11604/pamj.2016.24.71.9043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/08/2016] [Indexed: 11/12/2022] Open
Abstract
Myositis ossificans circumscripta (MOC) is a rare condition characterized by nontumoral heterotopic ossification of the soft tissues. This condition affects young subjects, occurring mainly after trauma. It is ubiquitous, predominantly located in girdles and limbs. We report the case of a young patient with paravertebral MOC without traumatic context; the aim of this study was to recall diagnostic criteria and imaging aspects.
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Affiliation(s)
- Ikram Taam
- Service d'Imagerie Médicale, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Khouloud Boussouni
- Service d'Imagerie Médicale, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Bouchaib Redouane
- Service d'Imagerie Médicale, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Touriya Amil
- Service d'Imagerie Médicale, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Rachida Saouab
- Service d'Imagerie Médicale, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
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30
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Singh A, Pradhan G, Kumari C, Kapoor S. Early Recognition of Fibrodysplasia Ossificans Progressiva-Important For the Clinician. JNMA J Nepal Med Assoc 2016; 54:91-93. [PMID: 27935932] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Fibrodysplasia ossificans progressiva is a rare disorder of heterotopic ossification. Procedures like biopsy and surgery are known to be aggravating factors in promoting heterotopic ossification Clues to clinical diagnosis may therefore be a great advantage to treating orthopedician. Valgus deformity of great toe is an important diagnostic clue for treating physicians and thus aids in preventing the clinicians from subjecting the patients to unnecessary invasive and traumatic procedures. Hence clinical clues to early diagnosis are important in establishing the correct diagnosis and directing future management.
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Affiliation(s)
- A Singh
- Maulana Azad Medical College, New Delhi, India
| | - G Pradhan
- Maulana Azad Medical College, New Delhi, India
| | - C Kumari
- Maulana Azad Medical College, New Delhi, India
| | - S Kapoor
- Maulana Azad Medical College, New Delhi, India
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31
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Abstract
Soft tissue lesions can contain bone or cartilage matrix as an incidental, often metaplastic, phenomenon or as a diagnostic feature. The latter category includes a diverse group ranging from self-limited proliferations to benign neoplasms to aggressive malignancies. Correlating imaging findings with pathology is mandatory to confirm that a tumor producing bone or cartilage, in fact, originates from soft tissue rather than from the skeleton. The distinction can have dramatic diagnostic and therapeutic implications. This content focuses on the gross, histologic, radiographic, and clinical features of bone or cartilage-producing soft tissue lesions. Recent discoveries regarding tumor-specific genetics are discussed.
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Affiliation(s)
- Soo-Jin Cho
- Pathology, UCSF Medical Center Mission Bay, 1825 4th Street, Room M2354, San Francisco, CA 94158, USA
| | - Andrew Horvai
- Pathology, UCSF Medical Center Mission Bay, 1825 4th Street, Room M2354, San Francisco, CA 94158, USA.
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32
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Abstract
An 18-year-old man presented with mid left thigh pain after sequential lacrosse injuries 1 month and 2 weeks prior. Physical examination was significant for a tender mass in the mid left thigh.
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33
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Magu NK, Mukhopadhyay R, Gogna P, Singh A, Singla R, Rohilla R. Atraumatic Myositis Ossificans of Iliopsoas Excised through an ASIS Osteotomy: Case Report and Description of a Novel Technique. Bull Hosp Jt Dis (2013) 2015; 73:57-60. [PMID: 26517003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
With a well-established incidence of 15% to 20% following a spinal injury, the occurrence of neurogenic myositis ossificans of the hip is quite rare. The most widely accepted theory supporting its occurrence is the repeated microtrauma by forceful passive mobilization during rehabilitation. An extensive involvement around the hip is quite disabling to the patient. We present the case of a 41-year-old man with an extensive involvement of the right iliopsoas following an incident of head injury with no primary injury to the hip, with a disabling restriction of movement. Computed tomography images and its 3D reconstruction were used to define the exact extent of involvement. The mass was excised piece meal using the iliofemoral approach with an osteotomy of the anterior superior iliac spine, which allowed us to have a better visualization to the extensive mass. Postoperatively the patient regained a good range of motion. In addition to adding a rare case of atraumatic myositis ossificans of the iliopsoas to literature, this reports describes a novel approach for its excision.
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34
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Abstract
Soft tissue aneurysmal bone cyst is a rare entity, with about 20 cases reported in literature, only 3 of which are in patients over 40 years of age. We present a case of a 41 year old Latin American female who presented for evaluation of atraumatic chest pain with radiation to the left shoulder. Her initial workup was negative, including radiographic imaging of the chest and left shoulder. 4 months later, she presented to her orthopedic surgeon with a palpable mass and mild left shoulder pain. Radiographs acquired at that time demonstrated a 7.0 × 5.5 × 6.7 cm mass with rim calcification in the region of the upper triceps muscle. Subsequent CT imaging showed central areas of hypodensity and thin septations, a few of which were calcified. MR evaluation showed hemorrhagic cystic spaces with multiple fluid-fluid levels and enhancing septations. Surgical biopsy was performed and pathology was preliminarily interpreted as cystic myositis ossificans, however on final review the diagnosis of soft tissue aneurysmal bone cyst was made. The lesion was then surgically excised and no evidence of recurrence was seen on a 3 year post-op radiograph. Following description of our case, we conduct a literature review of the imaging characteristics, diagnosis, and treatment of soft tissue aneurysmal bone cyst.
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Affiliation(s)
- Kevin S Baker
- Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Elaine S Gould
- Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Hiten B Patel
- Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Sonya J Hwang
- Department of Pathology, Stony Brook University Medical Center, Stony Brook, NY, USA
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35
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Awais M, Rehman A, Baloch NUA. Fibrodysplasia ossificans progressiva misdiagnosed as cervical exostosis. Intern Med 2015; 54:867-8. [PMID: 25832962 DOI: 10.2169/internalmedicine.54.3858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Muhammad Awais
- Department of Radiology, Aga Khan University Hospital, Pakistan
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36
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Abstract
This chapter deals with a few of the important childhood bone disorders associated with high bone mass as well as conditions associated with fragility fractures and limb deformities that have not been addressed in previous chapters. A couple of skeletal dysplasias that can sometimes be confused with rickets are also dealt with in this chapter.
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37
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Abstract
La myosite ossifiante progressive est une maladie génétique rare. On rapporte le cas d'un jeune garçon de 10 ans qui présentait de multiples tuméfactions douloureuses d'apparition spontanée et progressive au niveau du dos et des membres supérieurs. Ces tuméfactions étaient associées à une fébricule et un hallux valgus bilatéral. Les aspects radiologiques et tomodensitométriques étaient largement suffisants pour confirmer le diagnostic. Le traitement était purement médical. L’évolution était marquée par l'apparition d'autres ossifications des fascias et des muscles aboutissant à des raideurs articulaires très invalidantes. Les circonstances de découverte, les aspects épidémiologiques, étiopathogénique, diagnostique, évolutive et thérapeutique sont discutées à travers une revue de la littérature.
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Affiliation(s)
- Hicham Sator
- Hôpital des Enfants, Service de Radiologie, CHU Ibn Sina, Rabat, Maroc
| | - Rachida Dafiri
- Hôpital des Enfants, Service de Radiologie, CHU Ibn Sina, Rabat, Maroc
| | - Latifa Chat
- Hôpital des Enfants, Service de Radiologie, CHU Ibn Sina, Rabat, Maroc
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38
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Stock H. Tumoral calcinosis and its mimics. Conn Med 2014; 78:497-499. [PMID: 25314891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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39
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Schultzel MM, Johnson MH, Rosenthal HG. Bilateral deltoid myositis ossificans in a weightlifter using anabolic steroids. Orthopedics 2014; 37:e844-7. [PMID: 25350630 DOI: 10.3928/01477447-20140825-92] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/04/2013] [Indexed: 02/03/2023]
Abstract
A 40-year-old male weightlifter presented with a 6-month history of a painless mass in the right deltoid. He had no history of trauma to the shoulder other than an arthroscopic rotator cuff repair a few weeks earlier. Physical examination showed a firm, nontender mass located longitudinally and coinciding with the deltoid, measuring 12×14×4 cm. There was no limitation in range of motion or functioning. Magnetic resonance imaging (MRI) and computed tomography (CT) scans suggested a lobulated, heterogeneous mass with multiple areas of calcification that raised suspicion for soft tissue sarcoma vs myositis ossificans. Marginal resection of the soft tissue mass was performed, and pathologic studies confirmed the diagnosis of xanthogranulomatous myositis ossificans with dystrophic calcifications and central cystic degeneration. At 2-week follow-up, the patient had improved range of motion and pain, but he noted a second soft tissue mass in the left deltoid. The MRI and CT scans showed a 10.5×16×3.4-cm linear, lobulated lesion with multiple calcifications, similar in appearance to the contralateral deltoid. The patient admitted to frequently injecting anabolic steroids into his deltoids. Because the patient was asymptomatic on the left side and the MRI appearance of the left deltoid mass was similar to that of the myositis ossificans seen on the right side, the patient opted for nonsurgical treatment. This is a rare case of myositis ossificans occurring bilaterally in the deltoids after repeated injections of anabolic steroids. There is currently no known association between anabolic steroids and myositis ossificans. This condition often mimics malignant neoplasms, illustrating the necessity of resection for diagnostic confirmation.
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40
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Crăciun CC, Azamfirei L, Coroş MF, Gyorgy-Fazakas I, Hintea A. Anterior transperitoneal laparoscopic approach of retroperitoneal tumour - clinical case. Chirurgia (Bucur) 2014; 109:689-692. [PMID: 25375060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 06/04/2023]
Abstract
We present our personal experience in the anterior transperitoneal laparoscopic approach of a retroperitoneal tumour.The case we have in view is that of a 48-year old female patient P.V., with congenital single left kidney. The patient has a retroperitoneal tumour mass of the right flank. Following investigations (ultrasound, CT with contrast), the tumour appeared well defined, of small dimensions (approximately 6-7cm diameter) and without anatomical relationships with large retroperitoneal vessels (inferior vena cava). For the laparoscopic excision of the tumour, we used an operating device adapted from the one used in right hemi-colectomy. After the coloparietal dissection, the access into the right retroperitoneal flank by means of laparoscopy is achieved by applying our procedure.The surgical intervention was quick and of a minimally invasive nature. Postoperative evolution was favourable, without any complications; the patient was discharged after 48 hours. In anatomic situations where the tumour anatomy is well defined and its size is acceptable, without dangerous anatomic relationships with large retroperitoneal vessels, attempted laparoscopic transperitoneal removal is the preferred option.
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41
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Önal M, Bajin MD, Yılmaz T. Fibrodysplasia ossificans progressiva: a case report. Turk J Pediatr 2014; 56:561-564. [PMID: 26022598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare, severely disabling, autosomal dominant disease characterized by recurrent painful episodes of soft tissue swelling and the development of heterotopic ossification. The main target is the axial musculature, but eventually ectopic bone formation occurs in the ligaments, the fascia, the tendons and the joint capsules. Small soft tissue traumas and intramuscular injections exacerbate this extraskeletal bone formation. We present a 16-year-old male patient who has osseous lesions beginning from the left ramus mandible and extending along the sternocleidomastoid muscle, vertebral region and deltoid, with visible restriction in temporomandibuler joint movement. Surgery was not performed due to parental concerns. Unfortunately, no effective medical therapy for FOP is known. These patients may require extra care during some oral surgery and anesthetic procedures. In this report, the importance of the decision to perform surgery has been stressed.
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Affiliation(s)
- Merih Önal
- Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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42
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Baliga M, Baptist J. Myositis ossificans of infraorbital musculature in uncontrolled diabetic. N Y State Dent J 2014; 80:47-49. [PMID: 24851394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Myositis ossificans traumatica is a form of dystrophic calcification that leads to heterotopic ossification of intramuscular connective tissue. It is rare in the orofacial region. A history of trauma, conventional radiography and computed tomography, along with histopathological examination, can be used effectively to diagnose this condition. We present a unique case of infected myositis ossificans traumatica in the infraorbital region in an uncontrolled diabetic.
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43
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Houben RH, Hamdy NAT, van Dissel JT, Schipper IB. [A woman with chronic infection of the upper legs]. Ned Tijdschr Geneeskd 2014; 158:A7322. [PMID: 24988158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 58-year-old woman with myositis ossificans traumatica came to our trauma outpatient clinic because of cutaneous perforation of one of the ossifications. This patient developed myositis ossificans traumatica after liposuction of both upper legs 30 years ago, which condition was complicated by a chronic infection of the ossified right quadriceps muscle, a walking limitation, and a loss of range of motion. Myositis ossificans traumatica is a rare disorder associated with trauma- triggered ossification of otherwise normal muscle tissue.
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44
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Gokkus K, Sagtas E, Suslu FE, Aydin AT. Myositis ossificans circumscripta, secondary to high-velocity gunshot and fragment wound that causes sciatica. BMJ Case Rep 2013; 2013:bcr2013201362. [PMID: 24136914 PMCID: PMC3822215 DOI: 10.1136/bcr-2013-201362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This report concerns an unusual cause of sciatica. The case presented is of a young man with myositis ossificans that resulted in sciatica and was treated with en bloc excision and low-dose radiotherapy and indomethacine. The aim of this study was to explain the different diagnostic properties of myositis ossificans around the hip and non-classic causes of sciatica.
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Affiliation(s)
- Kemal Gokkus
- Department of Orthopaeidcs, Ozel Antalya Memorial Hospital, Antalya, Turkey
| | - Ergin Sagtas
- Department of Radiology, Ozel Antalya Memorial Hospital, Antalya, Turkey
| | - Feride Ekimler Suslu
- Department of Physical Treatment and Rehabilitation, Ozel Antalya Memorial Hospital, Antalya, Turkey
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45
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PIOMBINO P, ORABONA GDELL, ABBATE V, FINI G, LIBERATORE G, MICI E, BELLI E. Circumscribed myositis ossificans of the masseter muscle: report of a case. G Chir 2013; 34:271-274. [PMID: 24629814 PMCID: PMC3926482] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Myositis Ossificans (MO) is an unusual pathological entity still largely unknown, characterized by dystrophic calcification leading to heterotopic ossification of intramuscular connective tissue. The masticatory muscles are exceptionally involved. Four distinct types of myositis ossificans have been described: MO Progressiva, which is a genetic disorder involving several muscular groups; MO Circumscripta, limited to a single muscle and generally due to calcification of an intramuscular haematoma following severe trauma and progressive ossification; MO Pseudo-malignant limited to soft tissue and not associated to any trauma; MO associated to paraplegia. A case of circumscribed myositis ossificans of the masseter muscle in a 62 years-old woman is reported.
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Affiliation(s)
- P. PIOMBINO
- ENT Unit, Second University of Naples, Naples, Italy
| | | | - V. ABBATE
- Maxillofacial Resident Department, “Federico II” University of Naples, Naples, Italy
| | - G. FINI
- Maxillofacial Unit, Faculty of Medicine and Psychology, “Sapienza“ University of Rome, Rome, Italy
| | - G.M. LIBERATORE
- Unit of Maxillo-Facial Surgery, Univerity of Pisa, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - E. MICI
- Maxillofacial Resident, Faculty of Medicine and Surgery, University of Messina, Messina, Italy
| | - E. BELLI
- Maxillofacial Unit, Faculty of Medicine and Psychology, “Sapienza” University of Rome, Rome, Italy
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46
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Pignolo RJ, Shore EM, Kaplan FS. Fibrodysplasia ossificans progressiva: diagnosis, management, and therapeutic horizons. Pediatr Endocrinol Rev 2013; 10 Suppl 2:437-48. [PMID: 23858627 PMCID: PMC3995352] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Fibrodysplasia ossificans progressiva (FOP), a rare and disabling genetic condition characterized by congenital malformations of the great toes and progressive heterotopic endochondral ossification (HEO) which is the most catastrophic of HEO disorders in humans. Flare-ups of FOP are episodic; immobility is cumulative. Heterozygous activating mutations in activin receptor IA/activin-like kinase-2 (ACVRI/ ALK2), a bone morphogenetic protein (BMP) type I receptor, exist in all sporadic and familial cases of FOP. The discovery of the FOP gene established a critical milestone in our understanding of FOP, and revealed a highly conserved therapeutic target in the BMP signaling pathway. This discovery has advanced efforts to develop novel therapies for this disabling disorder of tissue metamorphosis. While effective treatment of FOP will likely be based on interventions that modulate overactive ACVR1/ALK2 signaling, or that specifically block postnatal HEO, current management is focused on early diagnosis, assiduous avoidance of injury or iatrogenic harm, symptomatic amelioration of painful flare-ups, and optimization of residual function.
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Affiliation(s)
- Robert J. Pignolo
- The Department of Orthopaedic Surgery, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
- The Department of Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
- The Center for Research in FOP and Related Disorders, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
| | - Eileen M. Shore
- The Department of Orthopaedic Surgery, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
- The Department of Genetics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
- The Center for Research in FOP and Related Disorders, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
| | - Frederick S. Kaplan
- The Department of Orthopaedic Surgery, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
- The Department of Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
- The Center for Research in FOP and Related Disorders, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104
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47
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Rogoveanu O, Traistaru R, Streba CT, Stoica Z, Popescu R. Clinical, evolution and therapeutical considerations upon a case of fibrodysplasia ossificans progressiva (FOP). J Med Life 2013; 6:454-8. [PMID: 24868261 PMCID: PMC4034297 DOI: pmid/24868261] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/28/2013] [Indexed: 02/08/2023] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant genetic transmitted disease, with a rare incidence (1-2 cases/million persons) and it usually affects female patients. Its manifestations include acute pain episodes that tend to repeat, involving the soft tissue and the axial muscles with later appearance of ectopic bone tissue in ligaments, joints and tendons. In the great majority of times, the skeletal modifications are observed at birth but the first clinical symptoms occur at 2-4 years old. The clinical symptoms include pain and inflammation of the soft tissue, sometimes associated with fever and cutaneous erythema, joint symptoms--pain, stiffness most frequently concerning the scapular and pelvic girdle, bone malformations--short hallux, microdactilia, kyphoscoliosis, thorax malformations. The diagnosis is established based on the clinical symptoms and the imagistic investigations: CT, MRI - which indicate the joint modification and the ectopic bone tissue. Muscular biopsy is not indicated as it leads to new lesions in the already traumatized areas.
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Affiliation(s)
- O Rogoveanu
- Craiova University of Medicine and Pharmacy, Romania
| | - R Traistaru
- Craiova University of Medicine and Pharmacy, Romania
| | - C T Streba
- Craiova University of Medicine and Pharmacy, Romania
| | - Z Stoica
- Craiova University of Medicine and Pharmacy, Romania
| | - R Popescu
- Craiova University of Medicine and Pharmacy, Romania
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48
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Abstract
BACKGROUND Myositis ossificans (MO) is a rare non-neoplastic heterotopic ossification of soft tissue. Histological examination is the gold standard method for diagnosis, but fine needle aspiration (FNA) cytology may aid in presumptive diagnosis of this lesion. CASES Nine patients with chief complaint of soft tissue mass with clinically suspected MO were selected. FNA of the mass showed low to hypercellular smears, composed of some amorphous pink to bluish material on Wright-Giemsa stain. The predominant cells were oval to spindle-shaped, resembling fibroblasts. Some cells had a high nucleo-cytoplasmic ratio with hyperchromatic nuclei, an irregular nuclear border and prominent nucleoli. Bland-looking osteoblasts and uni- and binucleated chondrocytes were also noted. FNA diagnosis of 4 patients was suggestive of osteosarcoma and of 2 patients suggestive of chondrosarcoma, 2 patients were diagnosed with a benign process and 1 was deferred due to hypocellularity of the smears. Histological examination of the corresponding surgical specimen confirmed the diagnosis of MO. CONCLUSION MO cannot be diagnosed on FNA smears without analyzing the clinical and radiological findings. Experience shows that otherwise MO is mostly misdiagnosed as a malignant lesion.
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Affiliation(s)
- Maral Mokhtari
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.
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49
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Kohanzadeh S, LaFrenierre S, Nasseri Y, Silberman A, Kulber D. Myositis ossificans of the forearm after yoga. Am Surg 2012; 78:E361-E363. [PMID: 22856477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Som Kohanzadeh
- Cedars Sinai Medical Center, Los Angeles, California, USA.
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50
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Kitterman JA, Strober JB, Kan L, Rocke DM, Cali A, Peeper J, Snow J, Delai PLR, Morhart R, Pignolo RJ, Shore EM, Kaplan FS. Neurological symptoms in individuals with fibrodysplasia ossificans progressiva. J Neurol 2012; 259:2636-43. [PMID: 22752062 DOI: 10.1007/s00415-012-6562-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/10/2012] [Accepted: 05/17/2012] [Indexed: 11/26/2022]
Abstract
Fibrodysplasia ossificans progressiva (FOP), a rare, disabling condition caused by gain-of-function mutations of a bone morphogenetic protein (BMP) type I receptor, leads to episodes of heterotopic ossification and resultant immobility. Neurological problems have not been associated with FOP, but neurological symptoms are commonly reported by FOP patients. To determine the prevalence of neurological symptoms and their characteristics in individuals with FOP, we conducted a survey of the 470 patient members of the International FOP Association (IFOPA) using a questionnaire about neurological symptoms. There were 168 responses (105 females, 63 males; age 1.5-68 years) from 30 countries representing 36 % of IFOPA members. Chronic neurological symptoms were reported by 86 (51 %). Prevalence of neuropathic pain (NP) was significantly increased (P < 0.001) compared to the general population, and tenfold more common in females (15 %) than males (1.6 %). Of those with NP, 94 % reported other sensory abnormalities. Prevalence of recurrent severe headaches (HA) (26 %) was similar to that in the general population, but prevalence in females with FOP (36 %) was almost fourfold greater than in males. Prevalence of NP, HA, and other sensory abnormalities was substantially higher in post-pubertal females; 33 % reported symptoms worsened during menstrual periods. Worsening of neurological symptoms during FOP flare-ups was reported by 23 %. Three patients with FOP (1.8 %) reported myoclonus, a prevalence much greater than reported in the general population (P < 0.001). Our worldwide survey indicates that neurological symptoms are common in FOP. We speculate that these symptoms are related to effects of dysregulated BMP signaling on the central and/or peripheral nervous systems.
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Affiliation(s)
- Joseph A Kitterman
- Department of Pediatrics, University of California San Francisco, Box 0734, San Francisco, CA 94143, USA.
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