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Fulltext Severe psoriatic acroosteolysis in the absence of psoriatic arthropathy

Sakthiswary R, Naicker AS, Htwe O, Shahrir MS, Sazliyana SS

BMJ Case Rep, 2011;2011.
PMID: 22669957 DOI: 10.1136/bcr.09.2011.4794
Matched MeSH terms: Acro-Osteolysis/etiology*; Acro-Osteolysis/pathology
Fulltext Disappearing bone disease: a case report

Kareem BA, Das PK, Saad R

Singapore Med J, 1994 Oct;35(5):527-8.
PMID: 7701379

Disappearing bone disease is a rare condition and usually affects young adults. Its aetiology is not known. A case of a 12-year-old female child, who had a fall and sustained a fracture mid shaft of femur and supracondylar region, is reported. On follow-up subsequent X-ray showed extensive osteolysis which was progressively affecting the other side of the pelvic girdle and femur. She was put on trial of calcitonin 50 IU by nasal spray for six months but there was no improvement. However, during the past three and half years the disease process had progressively extended to the other side of pelvic girdle and femur with fatal outcome. To the knowledge of the authors such progression in a short time has not been reported in any case so far.

Matched MeSH terms: Osteolysis, Essential/physiopathology*; Osteolysis, Essential/radiography; Osteolysis, Essential/therapy
Fulltext Pelvic aneurysmal bone cyst

Sharifah M, Nurhazla H, Suraya A, Tan S

Biomed Imaging Interv J, 2011 Oct;7(4):e24.
PMID: 22279501 MyJurnal DOI: 10.2349/biij.7.4.24

This paper describes an extremely rare case of a huge aneurysmal bone cyst (ABC) in the pelvis, occurring in the patient's 5(th) decade of life. The patient presented with a history of painless huge pelvic mass for 10 years. Plain radiograph and computed tomography showed huge expansile lytic lesion arising from the right iliac bone. A biopsy was performed and histology confirmed diagnosis of aneurysmal bone cyst. Unfortunately, the patient succumbed to profuse bleeding from the tumour.

Matched MeSH terms: Osteolysis
Fulltext Marjolin's ulcer--a near forgotten entity

Tan BC, Horton TC, Sara Ahmad T

Med J Malaysia, 2006 Feb;61 Suppl A:91-3.
PMID: 17042239

We report a case of a 55-year-old man who presented with a 6-month history of a fungating ulcer on the right hand at the site of a previously healed ulcer that had been present for 40 years. Histopathological examination of four-quadrant biopsy specimens showed a moderately differentiated squamous cell carcinoma (SCC). A transradiocarpal amputation with stump closure using radial flap was performed as it was not possible to achieve a functionally and cosmetically acceptable hand after a wide excision with 2 cm tumour-free margin. It is our intention to highlight this rare condition as reminder to consider this entity as a differential diagnosis of chronic non-healing skin ulcer.

Matched MeSH terms: Acro-Osteolysis/diagnosis; Acro-Osteolysis/etiology; Acro-Osteolysis/surgery
Fulltext Modified Harrington Procedure for Acetabular Insuficiency Due to Metastatic Malignant Disease

Faisham, W.I., Muslim, D.A.J., Bhavaraju, V.M.K., Nawaz, A.H., Zulmi, W.

Malays Orthop J, 2009;3(1):36-41.
MyJurnal

Extensive peri-acetabular osteolysis caused by malignant disease process is a major surgical challenge as conventional hip arthroplasty is not adequate. We describe a modified use of the Harrington procedure for acetabular insufficiency secondary to metastatic disease in twelve patients. The procedures include application of multiple threaded pins to bridge the acetabular columns, anti-protrusio cage and cemented acetabular cup. Eleven patients were able to walk pain free and achieved a mean Musculoskeletal Tumour Society Functional Score of 80 (range, 68 to 86).

Matched MeSH terms: Osteolysis
Fulltext A gluteal mass of langerhans cell histiocytosis mimicking malignancy in a two-year-old boy: a case report

Ibrahim ZA, Lung WS, Long PK

Malays J Med Sci, 2009 Jan;16(1):48-50.
PMID: 22589649 MyJurnal

Langerhans cell histiocytosis is a disease primarily affects the bone. More than 50 percent of the disease occurs between the age of 1 and 15. We reported a case of a 2 year old boy who presented with a gluteal mass. Radiographic imaging showed an osteolytic lesion suspicious of malignancy. However, the histological diagnosis was Langerhans cell histiocytosis.

Matched MeSH terms: Osteolysis
Fulltext Multicentric Disappearing Bone Disease treated with Arthroplasty

Chan CK, Mohamed RM, Azlina AA, Azhar MM

Malays Orthop J, 2016 Nov;10(3):42-45.
PMID: 28553448 MyJurnal DOI: 10.5704/MOJ.1611.004

Multicentric disappearing bone disease, or Gorham disease, is a rare entity. A middle age woman, presented to us with left sided antalgic gait and severe bony deformity of her left knee. Radiograph revealed massive bone defect of the medial condyle of the left tibia with subluxation of the knee joint. She was scheduled for knee replacement in six months. However, she developed another lesion over the right hip that typically mimicked the disease progression of disappearing bone disease. The right femoral head vanished progressively within three months without significant history of infection or trauma. Subsequent bone biopsy of the right femoral head and left tibia condyle confirmed the diagnosis. Total knee replacement was carried out for her left knee. She remained pain free on her left knee. A year later, after confirming by sequential radiographs that the osteolysis had stopped, total right hip replacement was performed. Five years later, she remained pain free and both the arthroplasties were stable.

Matched MeSH terms: Osteolysis; Osteolysis/pathology; Osteolysis, Essential
Fulltext Osteoimmunology: Major and Costimulatory Pathway Expression Associated with Chronic Inflammatory Induced Bone Loss

Crotti TN, Dharmapatni AA, Alias E, Haynes DR

J Immunol Res, 2015;2015:281287.
PMID: 26064999 DOI: 10.1155/2015/281287

The field of osteoimmunology has emerged in response to the range of evidences demonstrating the close interrelationship between the immune system and bone metabolism. This is pertinent to immune-mediated diseases, such as rheumatoid arthritis and periodontal disease, where there are chronic inflammation and local bone erosion. Periprosthetic osteolysis is another example of chronic inflammation with associated osteolysis. This may also involve immune mediation when occurring in a patient with rheumatoid arthritis (RA). Similarities in the regulation and mechanisms of bone loss are likely to be related to the inflammatory cytokines expressed in these diseases. This review highlights the role of immune-related factors influencing bone loss particularly in diseases of chronic inflammation where there is associated localized bone loss. The importance of the balance of the RANKL-RANK-OPG axis is discussed as well as the more recently appreciated role that receptors and adaptor proteins involved in the immunoreceptor tyrosine-based activation motif (ITAM) signaling pathway play. Although animal models are briefly discussed, the focus of this review is on the expression of ITAM associated molecules in relation to inflammation induced localized bone loss in RA, chronic periodontitis, and periprosthetic osteolysis, with an emphasis on the soluble and membrane bound factor osteoclast-associated receptor (OSCAR).

Matched MeSH terms: Osteolysis/metabolism*
Fulltext Midterm Results of Conversion from Failed Bipolar Hemiarthroplasty to Total Hip Arthroplasty

Park KS, Chan CK, Lee DH, Yoon TR

Indian J Orthop, 2018 8 7;52(4):369-373.
PMID: 30078894 DOI: 10.4103/ortho.IJOrtho_494_16

Background: Conversion from failed bipolar hemiarthroplasty (HA) to total hip arthroplasty (THA) presents a great challenge to orthopedic surgeons for bipolar head removal and cup placement with or without change of femoral stem. Conversion THA after failed bipolar arthroplasty is known to offer both symptomatic and functional improvement. This study evaluates the midterm functional outcome and complications, especially dislocation associated with femoral head diameter, after conversion THA.
Materials and Methods: Forty eight hips with the conversion of bipolar HA to THA were followed up for an average 6.2 years (range 2.0-11.5 years). Twenty one hips had conversion surgery to THA using metal-on-metal articulation (28 or 32 mm head). Nine hips used ceramic-on-ceramic (28-40 mm) and eighteen hips used large head metal-on-metal bearing (>40 mm). Outcome was evaluated using Harris Hip Score (HHS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score. The radiographs were analyzed for evidence of osteolysis and/or loosening. The complications were evaluated, especially dislocation with different femoral head diameter.
Results: Average HHS significantly improved from 42 preoperatively to 86 postoperatively and the average WOMAC score also significantly improved from 47 to 22 postoperatively. Radiological evaluation showed all the femoral components were stable. There was one acetabular component loosening, which required revision 9 years after conversion to THA. One dislocation and one recurrent dislocation were recorded in isolated acetabular revision hip; whereas one dislocation, one recurrent dislocation, and one trochanteric nonunion occurred in the hips with revision of both components. All dislocations occurred in hips with a femoral head size of 28 mm (P = 0.052). The cup and femoral head interval length was the most significant factor contributing to dislocation (P = 0.013).
Conclusions: Conversion THA after failed bipolar HA offers a reliable pain relief and functional improvement. To prevent dislocation, it is highly recommended to use a larger diameter femoral head, especially where the cup size is big.

Matched MeSH terms: Osteolysis
Fulltext Two-Year Outcome of Synthetic Annular Ligament Reconstruction in the Elbow: A Case Report

Kesu Belani L, Abdullah S, Harun MH, Narin Singh PSG, Sapuan J

Cureus, 2020 Nov 19;12(11):e11564.
PMID: 33364091 DOI: 10.7759/cureus.11564

Monteggia fracture is commonly treated with open anatomical reduction and fixation of the ulna fracture. The radial head will be automatically reduced once anatomical fixation of the ulna is achieved. However, it is occasionally associated with an irreducible radial head dislocation requiring an open reduction and reconstruction of the torn annular ligament. We describe a case of traumatic Monteggia fracture which underwent initial plating, however post-operative radiograph denoted an irreducible radial head secondary to a ruptured annular ligament. We reconstructed the annular ligament with a synthetic graft sling around the radial neck with an anchor suture. The radial head was stable in all directions after annular ligament reconstruction. A two-year follow-up shows full range of motion of the elbow joint with osteolysis of the radial head, no other operative morbidity was observed.

Matched MeSH terms: Osteolysis
Fulltext Metastatic cervical carcinoma presenting as psoas abscess and osteoblastic and lytic bony metastases

George J, Lai FM

Singapore Med J, 1995 Apr;36(2):224-7.
PMID: 7676275

A 60-year-old Chinese lady presented with a left flank mass and weight loss. Plain films showed a sclerotic L1 vertebral body, osteopenic L2 and L3 vertebral bodies and loss of left psoas outline. However initially unrevealed history of previous carcinoma of the cervix caused confusion as to the aetiology of a sclerotic vertebral body associated with an left flank collection. Psoas abscess with adjacent bony osteomyelitis was initially suspected. The left flank mass turned out to be an infected necrotic large metastatic lymph node compressing the lower pole of the left kidney. The sclerotic and osteopenic vertebral bodies represented an unusual presentation of bony cervical carcinoma metastases.

Matched MeSH terms: Osteolysis/diagnosis*
Fulltext Non Secretory Multiple Myeloma With Extensive Extramedullary Plasmacytoma: A Diagnostic Dilemma

Low SF, Mohd Tap NH, Kew TY, Ngiu CS, Sridharan R

Iran J Radiol, 2015 Jul;12(3):e11760.
PMID: 26528383 DOI: 10.5812/iranjradiol.11760v2

Multiple myeloma (MM) is characterized by progressive proliferation of malignant plasma cells, usually initiating in the bone marrow. MM can affect any organ; a total of 7 - 18% of patients with MM demonstrate extramedullary involvement at diagnosis. Non-secretory multiple myeloma (NSMM) is a rare variant that accounts for 1 - 5% of all cases of multiple myeloma. The disease is characterized by the absence of monoclonal gammopathy in serum and urine electrophoresis. Our case report highlights the diagnostic challenge of a case of NSMM with extensive extramedullary involvement in a young female patient who initially presented with right shoulder pain and bilateral breasts lumps. Skeletal survey showed multiple lytic bony lesions. The initial diagnosis was primary breast carcinoma with osseous metastases. No monoclonal gammopathy was found in the serum or urine electrophoresis. Bone marrow and breast biopsies revealed marked plasmacytosis. The diagnosis was delayed for a month in view of the lack of clinical suspicion of multiple myeloma in a young patient and scant biochemical expression of non-secretory type of multiple myeloma.

Matched MeSH terms: Osteolysis
Fulltext Floating teeth appearance: A radiographic dilemma

Rahman NA, Harun MH, Rahman SA, Mohammad NSA

J Taibah Univ Med Sci, 2020 Apr;15(2):160-165.
PMID: 32368214 DOI: 10.1016/j.jtumed.2020.02.005

Gorham disease (GD) is an extremely rare disorder that is characterised by massive osteolysis of the affected bone with unknown aetiology and an unpredictable prognosis. Additionally, no standard treatment is available for GD. This article describes a case report of a 61-year-old Malay woman who was diagnosed with GD of the anterior mandible without a prior history of trauma. She presented with pain and mobility of the dentoalveolar segment for 3 months. The radiographic findings showed "floating teeth" with widening of the periodontal ligament space and localized area of bony destruction. Histopathologically, there was proliferation of numerous dilated endothelial-lined channels within the intertrabecular tissue. Some areas of bone were replaced by fibrous connective tissue giving rise to the appearance of a benign fibroosseous lesion. The patient was managed with simple removal of the affected bone segment under local anaesthesia, followed by prosthodontic rehabilitation. Healing of the surgical site was uneventful, and no recurrence was reported at the 3-year follow-up.

Matched MeSH terms: Osteolysis, Essential
Fulltext The immunologic properties of undifferentiated stem cells from human exfoliated deciduous teeth (SHED) and its potential application in bone regeneration

Nurul, A.A., Tan, S.J., Asiah, A.B., Norliana, G., Nor Shamsuria, O., Nurul, A.S.

International Medical Journal Malaysia, 2013;12(1):19-26.
MyJurnal

Introduction: Stem cells from human exfoliated deciduous teeth (SHED) are highly proliferative, clonogenic cells capable of differentiating into osteoblasts and inducing bone formation. It is a potential alternative for stem cell bone regeneration therapy. However, stem cell therapy carries the risk of immune rejection mediated by inflammatory cytokines of the human defense system. Objective: This preliminary research studies the interaction between SHED and the immune system by determining the inflammatory cytokines profile and osteogenic potential of SHED. Methods: Human fetal osteoblasts (hFOb) cell line and isolated SHED were cultured and total RNA was extracted, followed by reverse transcription cDNA synthesis. Semi-quantitative reverse transcription PCR and Multiplex PCR were performed to detect the expression levels of OPG/RANKL and TNF-α, IL-1β, IL-6, IL-8 and TGF-β in both cell types. Results: Analysis showed that SHED expressed significantly lower amounts of IL-1β, IL-6, and IL-8 compared to hFOB. IL-1β is a potent bone-resorbing factor, while IL-6 and IL-8 induce osteoclastogenesis and osteolysis respectively. SHED did not express TNF-α which stimulates osteoclastic activity. SHED demonstrated high OPG/RANKL ratio, in contrast with that of marrow stem cells described in previous studies. Our findings suggest that SHED may have improved immunomodulatory profile in terms of promoting relatively lower inflammatory reaction during transplant and enhancing bone regeneration. Conclusion: SHED has a potential to be a good source of osteoblasts for bone regeneration therapy. Further studies on the immunomodulatory properties of SHED-derived osteoblasts are necessary to enable stem cell therapy in immunocompetent hosts.

Matched MeSH terms: Osteolysis
Fulltext Melioidosis: a localised osteomyelitis in a cat

Lim, M.L., Ismail, S.S., Rahman, N., Watanabe, M.

Jurnal Veterinar Malaysia, 2015;27(1):24-26.
MyJurnal

Melioidosis is a zoonotic disease as a result of infection by Burkholderia pseudomallei. It is of significant public health
concern due to its ubiquitous nature with high morbidity and mortality in humans and animals. In cats, the disease is usually reported
with abscess formation in lung, liver and spleen, however, isolated articular melioidosis is rare. A 1-year-old, a female Domestic
Shorthair cat was presented to University Veterinary Hospital, Universiti Putra Malaysia (UVH-UPM) with swollen right elbow and
non weight bearing lameness of the right forelimb. Physical examination revealed pyrexia, soft tissue swelling and pain upon
palpation of the right elbow joint. Radiographs of the right forelimb revealed osteolysis at the distal third of the humerus and
proximal radius and ulna, cortical thinning at the olecranon and soft tissue swelling around the elbow joint. Bacterial culture of the
joint fluid revealed positive growth for Burkholderia pseudomallei. Unfortunately, the owner opted to euthanise the cat citing
personal reasons. Upon necropsy, there was presence of multiple caseous nodules within the right elbow joint cavity only and none
of the other limbs, lung, spleen and liver was affected. It is important for veterinarian to be aware of septic arthritis and osteomyelitis
form of melioidosis.

Matched MeSH terms: Osteolysis

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