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Nkie VE, Martin S. Fibrous Dysplasia of the Clivus: Case Report and Literature Review. Cureus 2023; 15:e45417. [PMID: 37854736 PMCID: PMC10581508 DOI: 10.7759/cureus.45417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023] Open
Abstract
Fibrous dysplasia is a benign, developmental bone disorder that causes fibrous replacement of normal skeletal tissue. This may lead to weakness, distortion, and tissue expansion. Fibrous dysplasia can occur anywhere in the body, including the craniofacial area. The clivus is a central skull bone formed by the bases of the sphenoid and occiput, respectively. The clivus is a rare, usually unrecognized, and seldom reported location for the development of fibrous dysplasia. Although fibrous dysplasia of the clivus (FDC) is usually discovered by incidental findings, it can sometimes present with clinical symptoms. In this case, we discuss a 30-year-old male who presents to the emergency room with headaches, altered mental status, and a prior presentation of location-related symptomatic epilepsy. Magnetic resonance imaging depicted a mass in the clivus, low in signal on T1 and mildly hypointense on T2 imaging. Follow-up computed tomography (CT) imaging, as recommended, revealed the classic presentation of FDC. In this paper, we discuss the significance of this condition and the importance of thorough investigation to rule out differential diagnoses that may present with similar acute symptoms as this patient.
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Affiliation(s)
- Veronica E Nkie
- Osteopathic Medicine-IV (OMS-IV), Alabama College of Osteopathic Medicine, Alabama, USA
| | - Sandra Martin
- Radiology, Coosa Valley Medical Center, Alabama, USA
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2
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Wadewale SN, Bhola ND, Agarwal A. Polyostotic Fibrous Dysplasia: A Case Report of Rarity. Cureus 2023; 15:e36403. [PMID: 37090354 PMCID: PMC10115768 DOI: 10.7759/cureus.36403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
A skeletal condition known as fibrous dysplasia (FD) is characterized by the replacement of healthy bone with fibrous bone tissue. One bone (monostotic) or several bones could be involved (polyostotic). Any bone in the body might become affected by FD. The skull and face bones are the most typical locations. It is connected to a GNAS1 gene mutation (20q13.2). It begins during childhood and could continue far into adolescence and adulthood. In this case study, a 22-year-old woman was identified as having polyostotic FD based on her clinical, radiological, and histological characteristics.
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Affiliation(s)
- Sanjana N Wadewale
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Nitin D Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Anchal Agarwal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
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3
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Dong X, Png NCY, Fortier MV, Lim JY, Wong KPL, Choo JTL, Tan EC, Jamuar SS. Fibrous dysplasia in cardio-facio-cutaneous syndrome: A case report and review of literature. Am J Med Genet A 2022; 188:2732-2737. [PMID: 35801299 DOI: 10.1002/ajmg.a.62879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023]
Abstract
Cardio-facio-cutaneous (CFC) syndrome (OMIM #:115150, 615278, 615279, 615280) is a rare genetic condition caused by variants in the RAS/mitogen-activated protein kinase (MAPK) signal transduction pathway. Up to 75% of cases are caused by mutations in the BRAF gene, whereas KRAS gene mutation has only been reported in <2% of cases. CFC syndrome is characterized by cardiac abnormalities, distinctive craniofacial dysmorphism, and various cutaneous abnormalities. Musculoskeletal and orthopedic manifestations are also prevalent in patients with CFC syndrome, among which the most common are skeletal deformities and joint laxities. Dysplastic bone disorders, on the other hand, have not been reported in CFC syndrome before. We report on a case of symmetrical polyostotic fibrous dysplasia (FD) in a patient with CFC syndrome with the KRAS(NM_004985.5):c.57G>C; p.Leu19Phe variant. The FDs were incidentally picked up, and patient was conservatively managed and remained asymptomatic on follow-up. The same variant was reported previously in a patient with Oculoectodermal Syndrome (OES), who developed polyostotic non-ossifying fibroma (NOF). This case explores FD as a possible new clinical feature of CFC syndrome, and when linked to the historical case of OES, explores whether the KRAS(NM_004985.5):c.57G>C; p.Leu19Phe mutation may potentially contribute to the development of dysplastic bone lesions in patients with this particular mutation.
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Affiliation(s)
- Xiaoao Dong
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Nicholas C Y Png
- Department of Diagnostic and Interventional Radiology, KK Women's and Children's Hospital, Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Radiology, KK Women's and Children's Hospital, Singapore
| | - Jiin Ying Lim
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,SingHealth Duke-NUS Genomic Medicine Centre, Singapore
| | - Kenneth P L Wong
- Department of Paediatric Orthopaedics, KK Women's and Children's Hospital, Singapore
| | - Jonathan T L Choo
- Department of Cardiology, KK Women's and Children's Hospital, Singapore
| | - Ene Choo Tan
- KK Research Centre, KK Women's and Children's Hospital, Singapore
| | - Saumya Shekhar Jamuar
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Department of Diagnostic and Interventional Radiology, KK Women's and Children's Hospital, Singapore
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4
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Furtado ARR, Moris LM, Esmieu S, Cherubini GB, Mantis P. Low-field magnetic resonance imaging characteristics of multifocal vertebral lesions in dogs. Vet Rec 2021; 189:e78. [PMID: 34505679 DOI: 10.1002/vetr.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/10/2020] [Accepted: 12/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is a lack of information regarding magnetic resonance imaging (MRI) features of polyostotic vertebral lesions in dogs. The aim of this retrospective study was to identify and differenciate low-field MRI features of aggressive versus benign multifocal vertebral diseases in dogs. METHODS MRI examinations from 49 dogs with polyostotic vertebral lesions were reviewed. Images were evaluated for vertebral intensity changes, expansile lesions, new bone formation, cortical bone interruption, paravertebral musculature changes, lymphadenomegaly, spinal cord compression and spinal cord signal changes. RESULTS Twenty-nine dogs with non-aggressive bone lesions and 20 dogs with aggressive vertebral lesions were included. Non-aggressive lesions had variable T2-weighted fast spin-echo (T2W) signal intensity and the majority displayed low signal intensity on short tau inversion recovery (STIR). Aggressive lesions predominantly had high T2W and STIR signal intensity, with variable signal intensity on T1-weighted spin-echo and contrast enhancement. Aggressive lesions were associated with spinal pain (p < 0.01), new bone formation (p = 0.02), spinal cord compression (p < 0.01) and lymphadenomegaly (p < 0.01). Cortical interruption (p < 0.01) and paravertebral musculature changes (p < 0.01) were the strongest indicative imaging features for aggressive lesions. CONCLUSION Spinal pain, spinal cord compression, new bone formation, lymphadenomegaly and especially cortical interruption and paravertebral musculature signal intensity changes were the best discriminators for differentiating malignant from benign vertebral lesions.
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5
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Rahim AH, Hidajat NN, Ramdan A, Magetsari RMSN. Fibrous Dysplasia of the Spine-A Case Involving the Polyostotic Form Isolated to the Thoracolumbar Spine. Int J Spine Surg 2020; 14:S46-S51. [PMID: 33900944 DOI: 10.14444/7164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fibrous dysplasia of the spine in a polyostotic form is very rare, with fewer than 36 cases discussed in the literature and there is no such case in Indonesia that has been reported. The aim of this report is to present a case from Indonesia of polyostotic fibrous dysplasia isolated in the spine. We report a case of a 38-year-old Sundanese man with a 1-year history of progressive back pain and weakness of both lower extremities. There was no history leading to infection and no previous trauma. A physical examination revealed kyphoscoliotic deformity, a café au lait spot, tenderness at the thoracolumbar region, and neurological deficits. Laboratory studies were within normal ranges. Plain radiographs showed lytic lesion and kyphoscoliosis. Magnetic resonance imaging showed an endosteal scalloping, infiltrative process, expansion, and destruction in the vertebral bodies from T2 to L5. The findings of an aggressive destructive process was highly suspicious of a malignant process, relying on differential diagnosis and metastases, plasma cell myeloma, bone tumor and chronic infectious spondylitis. Histology revealed an irregularly oriented osteoid without osteoblastic rimming but surrounded by fibroblastic proliferation with a C-shaped sign. Investigations revealed a diagnosis of polyostotic fibrous dysplasia of the thoracolumbar spine in isolation. The patient underwent T5-S1 stabilization and bone grafting. At 1 year postoperative, the patient was asymptomatic; there was no recurrence and minimal neurological deficit with grade II on the modified McCormick scale. A case of the polyostotic form of fibrous dysplasia of the spine in isolation has never been reported in Indonesia. The extreme rarity of this type of presentation can pose a diagnostic dilemma, and in cases isolated to the spine, surgical treatment with posterior stabilization, decompression, and bone grafting gives a good functional outcome.
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Affiliation(s)
- Agus Hadian Rahim
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Nucki Nursjamsi Hidajat
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Ahmad Ramdan
- Head of Spine Division, Department of Orthopaedics and Traumatology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
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Jagtap KS, Patel NR, Hiray P, Wadhwa A. An unusual case of polyostotic fibrous dysplasia-A case report. Indian J Dent Res 2020; 31:640-643. [PMID: 33107470 DOI: 10.4103/ijdr.ijdr_409_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fibrous dysplasia (FD) is a fibro-osseous lesion where normal bone and marrow is replaced with fibrous tissue, resulting in formation of bone that is weak and prone to expansion. It is classified according to the number of affected bones, and its association to endocrine alterations, that is, monostotic (80-85%), polyostotic forms (20-30%), and Albright's disease. Involvement of two or more bones is termed as polyostotic FD, a relatively uncommon condition. Here we report a rare case of polyostotic FD involving facial bones, orbital bones, sphenoid bone, and spine in a 21-year-old male patient.
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Affiliation(s)
- Kiran Suresh Jagtap
- Department of Oral Pathology and Microbiology, SMBT Institute of Dental Sciences and Reserach, Dhamangoan, Nashik, Maharashtra, India
| | - Nikita Rajendrakumar Patel
- Department of Oral Pathology and Microbiology, SMBT Institute of Dental Sciences and Reserach, Dhamangoan, Nashik, Maharashtra, India
| | - Poonam Hiray
- Department of Oral Medicine of Dental Sciences and Research, SMBT Institute of Dental Sciences and Reserach, Dhamangoan, Nashik, Maharashtra, India
| | - Anjali Wadhwa
- Department of Oral and Maxillofacial Surgery, SMBT Institute of Dental Sciences and Reserach, Dhamangoan, Nashik, Maharashtra, India
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7
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Dheenadhayalan J, Avinash M, Lakhani A, Rajasekaran S. Shepherd's crook deformity: How to set it straight. A five-step surgical guide. J Orthop Surg (Hong Kong) 2020; 27:2309499019834362. [PMID: 30852946 DOI: 10.1177/2309499019834362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Fibrous dysplasia (FD) of the proximal femur can result in severe deformity and disability. The results of surgical management in such situations have been reported to be poor. We present a novel, five-step surgical treatment to correct proximal femoral deformity in FD. MATERIAL AND METHODS This study is a review of prospectively collected data of cases of proximal femur polyostotic FD managed at our institute from 2012 onward. We managed three patients with FD involving four femora (one patient had bilateral disease). Mean age at presentation was 16 years with an average follow-up of 46 months. All underwent five steps, that is, (1) curettage/excision of the lesion, (2) allograft in intramedullary region, (3) lateral closing wedge valgus osteotomy, (4) fixation with extramedullary implant, and (5) augmentation of osteotomy site with autograft. Functional outcome was assessed using Harris Hip Score preoperatively and at the final follow-up. RESULTS The neck shaft angle was corrected from an average of 91.7° to 152.1°, while the Harris Hip Score improved from an average of 59 to 95. There was no clinical or radiological evidence of recurrence of disease or deformity in any patient till the last follow-up. CONCLUSION This five-step technique ensures good functional and radiological outcomes in the management of proximal femur FD.
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Affiliation(s)
| | - M Avinash
- Department of Orthopaedics and Traumatology, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Azhar Lakhani
- Department of Orthopaedics and Traumatology, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Rajasekaran
- Department of Orthopaedics and Traumatology, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Sanogo S, Guindo AA, Diarra H, Koné S, Diarra I, Kéita C, Camara M, Sidibé H, Traoré A, Dembélé S, Konaré IB, Diarra P, Sidibe S. [Ct scan diagnosis of polyostotic fibrous dysplasia with maxillofacial dysmorphia: a case report]. Mali Med 2020; 35:70-73. [PMID: 37978733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
We report a rare case of polyostotic fibrous dysplasia with maxillofacial dysmorphia diagnosed in the radiology department at Hopital Sominé Dolo of Mopti. The aim was to describe the role of medical imaging including the CT scan in its diagnosis. He was a 42-year-old man of rural origin with poor socio-economic conditions. He was sent to us for a craniofacial CT scan for assessment of a maxillofacial mass. This CT scan showed a thickening of the diploid of the vault and the cranial base with osteocondensation and osteolytic lesions at the maxillofacial level. An extension assessment showed polyostotic involvement. His diagnosis is based on medical imaging and in particular CT scan. Three types of radiological aspects are evocative: a homogeneous or heterogeneous clarity, a smoke-like appearance and a slightly condensed appearance. Complications observed were deformities, fracture of the femoral neck and aesthetic damage.
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Affiliation(s)
- S Sanogo
- Service de radiologie Hôpital Sominé Dolo de Mopti, Mali
| | - A A Guindo
- Service de chirurgie Hôpital Sominé Dolo de Mopti, Mali
| | - H Diarra
- Service de radiologie Hôpital du Mali, Mali
| | - S Koné
- Centre Hospitalier Universitaire de Kati, Mali
| | - I Diarra
- Centre Hospitalier Universitaire de Kati, Mali
| | - Ctm Kéita
- Service de chirurgie Hôpital Sominé Dolo de Mopti, Mali
| | - M Camara
- Service de radiologie Hôpital de Ségou
| | - H Sidibé
- Service de radiologie Hôpital Sominé Dolo de Mopti, Mali
| | - A Traoré
- Service de radiologie Hôpital Sominé Dolo de Mopti, Mali
| | - S Dembélé
- Service de radiologie Hôpital Sominé Dolo de Mopti, Mali
| | - I B Konaré
- Service de radiologie Hôpital Sominé Dolo de Mopti, Mali
| | - P Diarra
- Service de radiologie Hôpital Sominé Dolo de Mopti, Mali
| | - S Sidibe
- Service de radiologie Centre Hospitalier Universitaire du Point G, Bamako, Mali
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9
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Abstract
Fibrous Dysplasia is a benign fibro-osseous lesion occurring throughout the skeletal system with a predilection for craniofacial bones, long bones, and ribs. Fibrous dysplasia develops during bone formation and growth with a variable natural evolution. It is considered a genetic nonheritable disease resulting from missense mutations that occur postzygotically in the GNAS1 gene. This mutation leads to a focal congenital failure of proper bone formation and arrest at the woven bone stage. In turn, this leads to a decreased mechanical strength, causing bone pain, pathological fractures, and skeletal deformities. Besides clinical examination, fibrous dysplasia is diagnosed based on the results of radiographic imaging and the microscopic histopathological findings. On CT scan, fibrous dysplasia shows the characteristic "Ground-glass" appearance with well-defined borders. On MRI, fibrous dysplasia has a low signal intensity on T1-weighted MRI and variable signal intensity on T2-weighted MRI. We hereby report a case of an unusual presentation of fibrous dysplasia in a 67-year-old female presenting to the emergency department with generalized malaise and lower limb pain. Fibrous dysplasia may present in the elderly population and can be difficult to differentiate from other malignant and benign lesions affecting the skeletal system.
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Affiliation(s)
- Ali Alkhaibary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali H Alassiri
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alsalman
- Department of Medical Imaging, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sabig Edrees
- Department of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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10
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Jalan D, Jain P. Mazabraud's Syndrome - A Diagnosis Commonly Missed. J Orthop Case Rep 2019; 9:26-29. [PMID: 31559221 PMCID: PMC6742871 DOI: 10.13107/jocr.2250-0685.1404] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Mazabraud’s syndrome is a rare benign disorder characterized by the association of single or multiple intramuscular myxomas with monostotic or polyostotic form of fibrous dysplasia. Around 80 cases have been described till date; however, a higher incidence may be expected due to silent nature of the disease and missed diagnosis. The authors report one such case of a missed diagnosis. Case Report: A 39-year-old lady presented with recurrent soft tissue myxomas in thigh. A thorough evaluation with radiographs and magnetic resonance imaging (MRI) and a clinical suspicion of this rare entity helped in making the diagnosis of Mazabraud’s syndrome. The patient was treated with wide excision of the recurrent thigh swelling and watchful observation of two other asymptomatic swelling detected on MRI examination. Bisphosphonate therapy was given for fibrous dysplasia. At latest follow-up after 2 years, the patient was asymptomatic with no recurrence. Conclusion: The report highlights the importance of a high degree of suspicion of this clinical entity in patients treated for recurrent soft tissue swelling as both myxomas and fibrous dysplasia behave differently than their isolated counterparts.
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Affiliation(s)
- Divesh Jalan
- Central Institute of Orthopaedics, Vardhmaan Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Princi Jain
- Department of Medicine, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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11
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Tao L, Sun J, Jain A, Ouyang J, Tambunan D. Polyostotic Fibrous Dysplasia Mimicking Osseous Metastases. Cureus 2019; 11:e3884. [PMID: 30899635 PMCID: PMC6420325 DOI: 10.7759/cureus.3884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Fibrous dysplasia (FD) is a benign bone disorder, in which normal bone structure is replaced by fibrous connective tissue. Polyostotic FD is also related to McCune-Albright syndrome with possible endocrine disorder and Cafe-au-lait macules. Although FD commonly presents as craniofacial bone abnormality, atypical presentation can be misleading and pose a difficulty in clinical diagnosis. Here we report a case of polyostotic FD, who presented as an accidental finding of multiple spinal osseous lesions, leading to clinic workup for metastatic cancer.
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Affiliation(s)
- Luwei Tao
- Internal Medicine, Florida Hospital, Orlando, USA
| | - Jingxin Sun
- Internal Medicine, Florida Hospital, Orlando, USA
| | - Akriti Jain
- Internal Medicine, Florida Hospital, Orlando, USA
| | - Jie Ouyang
- Pathology, Florida Hospital, Orlando, USA
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12
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Abstract
Fibrous dysplasia (FD) is a nonneoplastic hamartomatous developmental fibro-osseous lesion, with anomaly in bone-forming mesenchyme which manifests as a defect in osteoblastic differentiation and maturation leading to fibro-osseous tissue formation characterized by deformities in the bone, fractures, nerve compression, and bone pain. The clinical behavior and progression of FD make the management of this condition difficult. Here is a case report of a young male patient who was diagnosed as having craniomaxillofacial FD. The diagnosis was based on clinicoradiological and histopathological investigations. In this case, management of FD poses significant challenges to the surgeon.
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Affiliation(s)
- Chembolu Neelima
- Department of Oral and Maxillofacial Surgery, Malla Reddy Dental College for Women and Hospital, Hyderabad, Telangana, India
| | - Patlola Bal Reddy
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hyderabad, Telangana, India
| | - Chembolu Nirupama
- Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Endla Varun Kumar
- Department of Oral and Maxillofacial Surgery, Maharaja Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India
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13
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Abstract
Fibrous dysplasia is a benign fibro-osseous disease of the bone, which is most commonly associated with congenital mutations in cAMP regulating protein Gsα coded by GNAS-1 gene. Often it is seen involving the craniofacial skeleton and can range from an asymptomatic monostotic form to polyostotic variant involving almost all the bones of the skull, thereby leading to functional and esthetic problems. This requires a continuous monitoring of the involved region throughout the life of the patient, even after the surgical interventions. We are presenting two cases of craniofacial form of fibrous dysplasia. One case shows monostotic form, while the other case shows features of polyostotic form of disease. To the best of our knowledge, these are the first two cases of craniomaxillofacial fibrous dysplasia from Nepal, which will be reported and published.
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Affiliation(s)
- Neha Mishra
- Department of Oral and Maxillofacial Pathology and Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur-10, Chitwan, Nepal,
| | - Sourav Kumar Rout
- Department of Oral and Maxillofacial Surgery, Chitwan Medical College and Teaching Hospital, Bharatpur-10, Chitwan, Nepal
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14
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Utriainen P, Valta H, Björnsdottir S, Mäkitie O, Horemuzova E. Polyostotic Fibrous Dysplasia With and Without McCune-Albright Syndrome-Clinical Features in a Nordic Pediatric Cohort. Front Endocrinol (Lausanne) 2018; 9:96. [PMID: 29599748 PMCID: PMC5863549 DOI: 10.3389/fendo.2018.00096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/27/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Fibrous dysplasia (FD) presents as skeletal lesions in which normal bone is replaced by abnormal fibrous tissue due to mosaic GNAS mutation. McCune-Albright syndrome (MAS) refers to FD combined with skin (café-au-lait) and endocrine manifestations. This study describes the clinical childhood manifestations of polyostotic FD and MAS in a Nordic cohort. PATIENTS AND DESIGN We retrospectively reviewed a cohort of pediatric patients (n = 16) with polyostotic FD with or without MAS diagnosed and followed in two Nordic Pediatric tertiary clinics between 1996 and 2017. RESULTS Half of the 16 patients with polyostotic FD presented with MAS. All patients with MAS (n = 8) had café-au-lait spots, and either gonadotropin-independent precocious puberty (PP) (girls; n = 5) or abnormal testicle structure (boys, n = 3). None manifested hyperthyroidism or growth hormone excess. Mild hypophosphatemia was common (11/16), but none had signs of hypophosphatemic rickets. Craniofacial bone involvement was found in 12 patients (75%); in 5 of these, skeletal lesions were limited to craniofacial area. One child with craniofacial disease had lost vision due to optic nerve damage. Eleven (69%) patients had sustained a fracture at FD lesion, over half of them requiring surgical fixation of the fracture, most commonly in the proximal femur. The first symptoms leading to FD/MAS diagnosis included skull/facial asymmetry (n = 4), PP (n = 3), abnormal gait (n = 3), pathologic fracture (n = 3), wide-spread café-au-lait spots (n = 1), headache (n = 1), and vision loss (n = 1). CONCLUSION Polyostotic FD and MAS remain diagnostic and therapeutic challenges because of the broad clinical spectrum. Recurrent fractures, pain, and even vision loss may impair the quality of life in children with FD.
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Affiliation(s)
- Pauliina Utriainen
- Children’s Hospital, Helsinki University Central Hospital, Helsinki, Finland
- Children’s Hospital, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- *Correspondence: Pauliina Utriainen,
| | - Helena Valta
- Children’s Hospital, Helsinki University Central Hospital, Helsinki, Finland
- Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Outi Mäkitie
- Children’s Hospital, Helsinki University Central Hospital, Helsinki, Finland
- Children’s Hospital, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Horemuzova
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Pediatric Endocrinology Unit, Astrid Lindgren’s Children Hospital, Karolinska University Hospital, Stockholm, Sweden
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15
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Abstract
Polyostotic fibrous dysplasia in combination with caféau-lait macules and hyperfunctioning endocrinopathies consists of a rare clinical condition termed as McCune-Albright syndrome. Aneurysmal bone cysts are tumor-like cystic lesions, composed of blood-filled compartments. They may occur as primary lesions or secondary to other pathologies; most commonly giant cell tumors of bone. However, secondary aneurysmal bone cysts in McCune-Albright syndrome are exceptional. We present a 28-year-old female with McCune-Albright syndrome. She experienced precocious puberty at age 3 months. In childhood, she experienced multiple long bone fractures, facial deformity and progressive visual and hearing impairment. One year ago, she experienced a painful, gradually enlarging bone lesion involving the right ilium, pubic and ischial bone with groundglass appearance, septa, marginal sclerosis, endosteal scalloping and blow-out expansion resulting in localized thinning of the cortex. CT-guided needle biopsy of the pelvic lesion showed aneurysmal bone cyst. Selective arterial embolization was recommended, however, the patient and her relatives did not consent to proceed to treatment, and she remained in close surveillance thereafter.
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Affiliation(s)
- Symeon Tournis
- Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", National and Kapodistrian University of Athens, School of Medicine, KAT General Hospital, Athens, Greece
| | - Alexia Balanika
- Department of Radiology, Asklipion Voulas General Hospital, Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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16
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Penn DL, Tartarini RJ, Glass CH, De Girolami U, Zamani AA, Dunn IF. Natural history of cranial fibrous dysplasia revealed during long-term follow-up: Case report and literature review. Surg Neurol Int 2017; 8:209. [PMID: 28966816 PMCID: PMC5609397 DOI: 10.4103/sni.sni_7_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fibrous dysplasia (FD) is a rare developmental disease characterized by the replacement of bone marrow with proliferating fibro-osseous tissue. There exist three forms of FD-monostotic, polyostotic, and that associated with McCune-Albright syndrome. The disease can present in different locations and with a variety of symptoms. One of the more common locations of FD occurrence is the craniofacial region. Treatment of asymptomatic FD often involves conservative management with serial imaging. Medical management with bisphosphonates is an option, though long-term efficacy data are lacking. Surgical resection is usually reserved for very large or symptomatic lesions. CASE DESCRIPTION We discuss the most unusual case of a 52-year-old male found to have a left pterional mass while being worked up for sinus headaches. The patient elected to follow this lesion conservatively, and imaging several years later showed obvious growth which accelerated in the last 4 years during an 18-year observational period. He ultimately underwent successful resection of an extradural and intradural FD. CONCLUSIONS The significant growth potential of these lesions was revealed in this patient, in whom conservative management had been adopted. Despite optimal surgical resection and outcome in this case, the importance of surveillance imaging and perhaps earlier intervention cannot be underestimated when managing cranial FD.
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Affiliation(s)
- David L Penn
- Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard J Tartarini
- Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolyn H Glass
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Umberto De Girolami
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amir A Zamani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian F Dunn
- Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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17
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Kamaleshwaran KK, Joseph J, Kalarikal R, Shinto AS. Image Findings of Polyostotic Fibrous Dysplasia Mimicking Metastasis in F-18 FDG Positron Emission Tomography/Computed Tomography. Indian J Nucl Med 2017; 32:137-139. [PMID: 28533645 PMCID: PMC5439207 DOI: 10.4103/0972-3919.202237] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Fibrous dysplasia (FD) of the bone is characterized by the medullary cavity of bones becoming filled with fibrous tissue, and its etiology remains unknown. It is usually asymptomatic and found incidentally on imaging studies that are performed for other purposes. FD may closely mimic the appearance of bony metastatic disease on radiological examinations. We report the case of a 45-year-old female patient, which appeared to have multiple bone lesions on initial workup images. Subsequently, the bone lesions that showed increased FDG uptake on PET/CT in right femur and tibia were identified as FD. The present case is a useful addition to the current body of literature of false positive F-18 FDG PET/CT due to a benign skeletal pathology and underscores the importance of high index of suspicion and careful correlation, whenever one comes across such an unusual PET/CT finding.
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Affiliation(s)
| | - Jephy Joseph
- Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Center, Kovai Medical Center and Hospital Limited, Coimbatore, India
| | - Radhakrishnan Kalarikal
- Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Center, Kovai Medical Center and Hospital Limited, Coimbatore, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Center, Kovai Medical Center and Hospital Limited, Coimbatore, India
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18
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De Luca Bossa LM, Mennonna G, Meomartino L, Paciello O, Ciccarelli F, De Biase D, Raia P, Caputo V, Fioretti A, Dipineto L. Polyostotic Chondroblastic Osteosarcoma in a Kestrel ( Falco tinnunculus ). J Avian Med Surg 2016; 29:336-9. [PMID: 26771323 DOI: 10.1647/2014-052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report a case of polyostotic chondroblastic osteosarcoma in a kestrel ( Falco tinnunculus ) admitted to the Wildlife Rehabilitation and Rescue Center (Naples, Italy). A consolidated fracture of the left tibiotarsus bone and a deviation of the limb were evident. After radiographic, cytologic, and histopathologic examinations, a diagnosis of polyostotic chondroblastic osteosarcoma was made. To our knowledge, this is the first report on polyostotic chondroblastic osteosarcoma in a kestrel.
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19
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Kornder J, Platt SR, Eagleson J, Kent M, Holmes SP. IMAGING DIAGNOSIS-VERTEBRAL POLYOSTOTIC LYMPHOMA IN A GERIATRIC DOG. Vet Radiol Ultrasound 2015; 57:E42-5. [PMID: 26592800 DOI: 10.1111/vru.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 08/17/2015] [Indexed: 11/28/2022] Open
Abstract
A 9-year-old spayed female Scottish terrier presented with an 8-day history of progressive paraparesis. Neurological examination suggested a painful T3-L3 myelopathy. Multifocal uniform contrast-enhancing masses involving the vertebral bodies, pedicles, laminae, and spinous processes of two vertebrae and compressing the spinal cord were present on MRI. Fluoroscopic-guided fine needle aspiration of one of the vertebral lesions revealed a predominantly lymphoblastic population of cells compatible with a diagnosis of lymphoma. To the authors' knowledge, this represents the first published case of canine lymphoma with vertebral involvement, characterized with MRI.
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Affiliation(s)
- Julie Kornder
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
| | - Simon R Platt
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
| | - Joe Eagleson
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
| | - Marc Kent
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
| | - Shannon P Holmes
- Department of Veterinary Biosciences and Diagnostic Imaging, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
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20
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Abstract
Accurate and early diagnosis of benign fibroosseous lesions is important because the treatment and resulting outcomes of each differ. Juvenile ossifying fibromas typically occur in young patients and grow rapidly with a high recurrence rate. Their monostotic nature has previously differentiated these tumors from other fibroosseous lesions. We describe an interesting and extremely rare case of polyostotic juvenile ossifying fibromas in a 14-year-old boy with involvement of the maxilla and mandible. The available literature on juvenile ossifying fibromas is also briefly reviewed. When diagnosing a polyostotic fibroosseous lesion, it is important to not exclude the possibility of juvenile ossifying fibromas because this may warrant a different treatment.
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21
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Nishio J, Kuwabara Y, Nabeshima S, Iwasaki H, Naito M. PET-positive polyostotic fibrous dysplasia mimicking Ollier disease. In Vivo 2013; 27:821-826. [PMID: 24292588] [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: 06/02/2023]
Abstract
Fibrous dysplasia can be monostotic or, less commonly, polyostotic. The imaging features of polyostotic fibrous dysplasia may closely mimic those of metastatic bone disease, Paget disease, or enchondromatosis (Ollier disease). We present a unique case of polyostotic fibrous dysplasia in a 57-year-old female with a medical history of enchondromas involving the proximal phalanges of the left hand. The skeletal radiographs showed unilateral multiple bone lesions suggestive of polyostotic fibrous dysplasia. On magnetic resonance imaging, the lesions exhibited low-to-intermediate signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images. Contrast-enhanced fat-suppressed T1-weighted images demonstrated moderate heterogenous enhancement. Integrated positron-emission tomography (PET)/computed tomography scan demonstrated increased (18)F-fluorodeoxyglucose (FDG) uptake within several bones, including the humerus, ilium, femur, and fibula, all on the left side. The maximal standardized uptake value of these lesions ranged from 2.18 to 3.78. We performed an open biopsy of the left humerus and histological examination confirmed the diagnosis of fibrous dysplasia. To the best of our knowledge, this is the first case of biopsy-proven FDG PET-positive polyostotic fibrous dysplasia with enchondromas of the hand.
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Affiliation(s)
- Jun Nishio
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
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22
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Abstract
Objective: To highlight the clinical and radiologic features and management of craniofacial fibrous dysplasia with review of literature. Materials and Methods: A retrospective review of 6 patients who underwent surgical treatment in a tertiary healthcare centre was done using the parameters of patients' details, clinical features, radiological findings, management and postoperative review. Results: Of the six patients, 3 females and 2 males were in the 2nd decade of life and 1 male in the 1st decade of life. The disease was restricted to maxilla in 3 patients, involved the temporal and frontal bones in addition to maxilla in one, involved the frontal bone in one patient and involved frontal and parietal bones in one patient. The primary reason for seeking treatment in all the 6 cases was facial deformity. There was absence of pain in all 6 cases. For surgical treatment in all three cases involving the maxilla, the approach was intraoral while bicoronal approach was used for the other three cases. Treatment consisted of surgical contouring and reshaping the area. All cases were followed up over a period of 2 years with no signs of recurrence. Conclusion: Treatment of craniofacial fibro-osseous lesions is highly individualized. Most cases of craniofacial fibrous dysplasia manifest as swellings that cause facial deformity and surgical recontouring after cessation of growth seems to provide the best results.
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Affiliation(s)
- Suresh Menon
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bangalore, Karnataka, India
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