scholarly journals Bone Breaking Triglycerides

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A307-A307
Author(s):  
Ellen Dauterive ◽  
Virginia Wright
Keyword(s):  
Bone Biopsy ◽  
Bone Lesion ◽  
Fragility Fractures ◽  
Bone Lesions ◽  
Insulin Regimen ◽  
African American Female ◽  
X Rays ◽  
Left Femur ◽  
Arm Pain ◽  
The Right

Abstract A 40 yo African American female with pmhx of T2DM, DLD was admitted for worsening leg and arm pain that started a year prior but had worsened in the last 6 months. Pain started in the right arm and progressed to include the right leg and left leg. She had presented to the ER 3 times in the last 3 weeks with no diagnosis and prescribed anti-inflammatories. On ROS she had unintended weight loss of 50 lbs. Pain was not relieved with anti-inflammatories or narcotics. She was diagnosed with diabetes in the previous 5 years and had not been compliant with her medications. Plain x-rays showed OA of the hip. An osseus survey showed multiple expansile, bubbly, and lucent intramedullary lesions consistent with polyostotic fibrous dysplasia versus multiple myeloma. CT showed a radiolucent lesion of the left femur with absence of normal bone trabeculae. Her labs showed normal calcium, phosphorous, renal function, PTH and no evidence of monoclonal gammopathy. Vitamin D was low at 8.2 ng/ml (6.6–49 ng/ml). CT CAP showed no concern for malignancy in other organs. A lipid profile was done and showed elevated fasting triglycerides of 2617 mg/dL (<150 mg/dl) and LDL direct 54 mg/dl (<100 mg/dl). A1c was 11.2% on admission. She denied any use of alcohol, estrogens, SSRI’s. No history of pancreatitis. On physical exam she did not have tendinous xanthomas, eruptive xanthomas, palmar xanthomas, or lipemia retinalis. Family history not significant for lipid disorders. Patient was fasted for 24 hours and then started on intensive insulin regimen as well as fenofibrate for hypertriglyceridemia. Triglycerides came down to less than 500 over 7 days. She was evaluated by ortho for her bone lesions and underwent bone lesion biopsy as well as prophylactic IMN of her bilateral femurs for prevention of impending fragility fractures. Bone biopsy was significant for xanthoma of the bone. Following discharge, she remained on fenofibrate and fish oil as well as a basal/bolus insulin regimen. Triglycerides remained controlled. She has not followed up outpatient for further workup. This case highlights an atypical presentation of triglyceride deposition in the setting of hypertriglyceridemia. It shows that hypertriglyceridemia should be included in the differential for lytic lesions when preliminary workup is negative. It also highlights that complications other than pancreatitis and cardiovascular disease can significantly alter a patient’s life if triglycerides go untreated.

scholarly journals Osteitis fibrosa cystica mimicking bone tumor, a case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maya L. Nasser ◽  
Serge Medawar ◽  
Tonine Younan ◽  
Halim Abboud ◽  
Viviane Trak-Smayra
Keyword(s):  
Bone Tumor ◽  
Metabolic Diseases ◽  
Clinical Symptoms ◽  
Bone Biopsy ◽  
Bone Lesion ◽  
Osteitis Fibrosa ◽  
Bone Lesions ◽  
Osteitis Fibrosa Cystica ◽  
Bone Trabeculae ◽  
The Right

Abstract Background We report a case of osteitis fibrosa cystica, a rare benign resorptive bone lesion caused by hyperparathyroidism, that presented on imaging as an aggressive bone tumor. Case presentation The patient is a 51-year-old male complaining of severe sustained pain of the right hip region. Imaging studies were suspicious for a malignant tumor of the right iliac bone. Biopsy under CT guidance was performed and showed remodeled bone trabeculae with numerous osteoclasts, excluding bone tumor and raising the possibility of osteitis fibrosa cystica. Complementary tests disclosed elevated blood level of parathyroid hormone and a partially cystic enlarged left inferior parathyroid gland consistent with adenoma. After parathyroidectomy, the clinical symptoms were relieved and the radiological findings were significantly improved, which confirmed the diagnosis. Conclusions Metabolic diseases-associated bone lesions should always be considered in the differential diagnosis of bone tumors, to avoid unnecessary surgeries and treatments.

Biomarkers and Imaging in Non-Malignant and Malignant Osteomalacia

2001 ◽  
Vol 16 (2) ◽  
pp. 136-141 ◽  
Author(s):  
D. Lüftner ◽  
M. Bollow ◽  
A. Stürzenbecher ◽  
O. Kaufmann ◽  
F. Priem ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Parathyroid Hormone ◽  
Light Exposure ◽  
Bone Biopsy ◽  
Imaging Techniques ◽  
Sun Exposure ◽  
Type I ◽  
X Rays ◽  
Left Femur ◽  
Bone Specific Alkaline Phosphatase

Deoxypyridinium (DPD) cross-links are a specific parameter for collagen type I degradation. We report the longitudinal tracking of DPD in relation to other bone markers and imaging techniques in a patient with osteomalacia and secondary hyperparathyroidism from reduced light exposure due to attire. This patient was first admitted for diffuse skeletal pain. X-rays showed general demineralization and Looser's transformation zones in the neck of the left femur. MRI examinations of the pelvis and the proximal femora demonstrated bilateral signs of acute sacroiliitis, as well as edema-like lesions in the femoral heads and necks bilaterally. The baseline parathyroid hormone level was 8 times higher than the normal upper limit, whereas 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were significantly reduced. A 7fold increase in free urinary DPD and a 17-fold increase in bone-specific alkaline phosphatase (bone-AP) were also measured. Percutaneous transiliac bone biopsy revealed markedly increased osteoidosis. Osteomalacia was diagnosed due to chronically reduced sun exposure caused by restrictive attire, and cholecalciferol substitution therapy was begun. After a follow-up of 28 weeks, non-specific parameters of bone turnover (parathyroid hormone, total alkaline phosphatase, serum calcium and serum phosphate) had normalized, while DPD, as a specific bone degradation marker, and bone-AP, as a bone formation parameter, both remained elevated. This example underlines the validity of DPD and bone-AP as indicators of increased bone metabolism: not only were they the parameters with the highest baseline deviation, but they were also the last to normalize.

scholarly journals Relationship Between rhTSH Administration and Thyroid Cancer Progression: A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A899-A899
Author(s):  
Maria G Mejia ◽  
Hospital San José de Bogotá, C ◽  
Luz Amaya Veronesi ◽  
Diana Carolina Concha
Keyword(s):  
Thyroid Cancer ◽  
Case Report ◽  
Cancer Progression ◽  
Case Reports ◽  
Bone Lesion ◽  
Thyroid Tumor ◽  
Parietal Bone ◽  
Bone Lesions ◽  
Neoplastic Progression ◽  
The Right

Abstract Introduction: The relationship between the administration of recombinant TSH (rhTSH) and the progression of thyroid cancer has been described in some case reports (1). There are scant data suggesting that rhTSH acts as a growth factor that stimulates metastatic tumor expansion. Case Report: A 55 year old male patient who 3 years ago reported an evident mass at cervical level. The ultrasound documented a large thyroid mass with an endothoracic component. The FNA reported BETHESDA IV, suspicious for follicular neoplasia. Extension studies showed lytic left parietal bone lesion and liver metastatic compromise. The pathology of the total thyroidectomy showed a follicular carcinoma with a micronodular pattern and capsular invasion, of 19x9x7 cm, vascular and esophageal involvement T4BN0M1. He was sent to radioiodine therapy with 100 MCI with previous suspension of LT4 (Preablative TGL> 300 ng / ml (<50 ng / ml) Abs-TGL 2 IU / ml (<2 IU / ml) TSH 31.3 mIU / L (0.37-4.7 mIU / L) and body scan documenting uptake of the radiotracer at the left parietal, the anterior costal grating, and liver. A second dose of iodine was applied, with 150 MCI after stimulation with thyrotropin (Preablative TGL> 300 ng / ml, Abs-TGL 1.76 IU / ml, TSH 83 mIU / L) Immediately after the administration of rhTSH, the patient described the appearance of alopecic plaques on the scalp, sensation of mass at the right upper quadrant of the abdomen and bone pain in the right rib cage and at the right hip, which progressively worsened the following days until they were incapacitating. The scan report showed a new uptake in dorsal vertebrae, the MRI showed new bone injury at the innominate bone, as well as increase in the sum of its maximum dimensions by 22%, indicative of progression. The cerebral angio-MRI showed hypervascularized metastasis at the left parietal level. Bone scintigraphy documented foci of hyper uptake in both parietals, manubrium and sternal body, 5-8 right anterior costal arches, right scapula, both humeral heads, vertebral bodies T3-T5-T7L4, right acetabulum, left proximal femur and the entire length of the right femur. The clinical and imaging worsening of the bone lesions after the application of rhTSH was striking, for this reason radiotherapy and embolization of the liver lesion was performed. The patient was not a candidate for neurosurgical management due to the vascular component of the cranial lesions. Conclusion: rhTSH is a very well-tolerated method that avoids symptoms associated with severe hypothyroidism. However, it has been associated with neoplastic progression. This is one of the few cases documented in the literature where there is a direct association between the administration of rhTSH and the progression of bone metastases. References: (1)Braga M. Ringel M. Cooper DS. Sudden Enlargement of Local Recurrent Thyroid Tumor after Recombinant Human TSH Administration. J Clin Endocrinol Metab. 2001; 86(11):5148–51.

scholarly journals Ultrasound-guided bone lesions biopsies - a systematic review

2017 ◽  
Vol 19 (3) ◽  
pp. 302 ◽  
Author(s):  
Romeo Ioan Chira ◽  
Alexandra Chira ◽  
Roberta Maria Manzat-Saplacan ◽  
Georgiana Nagy ◽  
Adriana Bintintan ◽  
...  
Keyword(s):  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Bone Biopsy ◽  
Bone Lesion ◽  
Final Analysis ◽  
Needle Aspiration ◽  
Bone Lesions ◽  
Ultrasound Guided ◽  
The Us ◽  
Cutting Needle

Aims: Ultrasound (US) is a highly valuable imagistic tool used to guide numerous interventional procedures. The US guided bone lesions biopsy has not yet received a consensus or a guideline. We aimed to evaluate the evidence to support the US role in guiding bone lesions biopsies.Material and methods: A computer literature search of PubMed was conducted using the keywords “ultrasound” and “bone biopsy”, in order to detect relevant studies regarding the aim of our analysis. Records were screened for eligible studies and data were extracted and analyzed.Results: We included 23 studies (n=610 patients) in the final analysis. The specificity and diagnostic yield of US guided biopsy were very good (between 78-100%), depending on the type and dimensions of the bone lesions. The type of the biopsy – aspiration or cutting – influenced theresults. The studies which included larger groups showed a better  performance for cutting needles (83.3-100% vs 50-80.5% for aspiration). The size of the bone lesion influences the diagnostic yield of the US guided bone biopsy. Most of the studies reported nil post-procedural complications.Conclusion: Core needle biopsy provided better diagnostic yield compared to fine needle aspiration. The number of the passages of the cutting needle biopsies in order to achieve the best diagnostic yield wasthree. Further studies are needed in order to standardize US-guided bone lesions biopsy and increase its role in the diagnosis algorithm of the bone lesions.

MULTIPLE CYSTIC TUBERCULOSIS OF THE BONES

PEDIATRICS ◽  
1948 ◽  
Vol 1 (6) ◽  
pp. 767-770
Author(s):  
MCLEMORE BIRDSONG ◽  
CAMILLUS S. L'ENGLE
Keyword(s):  
Past History ◽  
White Male ◽  
Bone Lesions ◽  
Sufficient Information ◽  
X Rays ◽  
Intermittent Fever ◽  
Fourth Finger ◽  
Small Bones ◽  
The Right ◽  
Hands And Feet

MULTIPLE cystic tuberculous cranial lesions are uncommon. Meng and Wu have reported 40 cases involving the skull, and Gibson has described 32 cases involving multiple lesions over the skeletal system. These two reports point out that in countries where tuberculosis is prevalent, multiple tuberculous lesions of other bones are common. Jungling called attention to multiple cystic lesions in the bones in nine cases and chose to refer to the condition as osteitis tuberculosa multiplex cystica. The lesions he described were in the small bones of the hands and feet almost entirely, and occurred in adults. A large majority of the cases mentioned were not confirmed by recovery of the tubercle bacillus from the lesions. In recent years Lyford, Hsieh, et al, Stalmann, Kelly and Sailer, Law and Perham, Martin, Fox, Frost, and Martin and Fogel, have all reported cases of multiple tuberculous bone lesions. Most of these cases have sufficient information to confirm the diagnosis. However, since proven cases of multiple cystic tuberculosis are uncommon in pediatric literature, this being the fourteenth case reported, it seem worth while to record it. History: No. 222,524, T.B.E., a 13 months old white male child, was admitted with a complaint of subcutaneous swellings and fever for eight months' duration. Except for several episodes of diarrhea the child was well until he was five months of age. At that time it was noticed that he had swellings on both sides of the neck. During the eight months prior to admission swellings appeared in the axilla, in the groin, on the anterior surface of the right upper leg, on the fourth finger of the right hand, and on the right side of the head. Some of the swellings attained the size of 1.5 cm. They did not increase or decrease in size. They never suppurated nor drained. The swellings were quite tender. At times the nodes softened, only to harden again. After the eighth month of life the child neither gained nor lost weight though he ate fairly well. He ran an intermittent fever, and, for one month prior to admission here, he ran a daily fever as high as 38.8°C. The child had been treated elsewhere with penicillin and X-ray therapy. A biopsy specimen taken from a node on the right side of the neck was sent to this hospital, and was reported as tuberculous adenitis. Past history revealed no exposure to tuberculosis. The mother and father had had negative chest X-rays elsewhere. The child had always received raw cow's milk.

scholarly journals A Patient With Femoral Osteitis Fibrosa Cystica Due To Hyperparathyroidism: A Case Report

2022 ◽  
Author(s):  
Xiaolong Xu ◽  
Cuiping Yang ◽  
Shengjun Lu ◽  
Hong Pei ◽  
Shunguang Chen ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Metabolic Diseases ◽  
Clinical Symptoms ◽  
Serum Alkaline Phosphatase ◽  
Bone Lesion ◽  
Osteitis Fibrosa ◽  
Bone Lesions ◽  
Team Approach ◽  
Osteitis Fibrosa Cystica ◽  
The Right

Abstract Background: Osteitis fibrosa cystica is a rare benign, lytic bone lesion attributed to hyperparathyroidism. The high level of parathyroid hormone cause rapid bone loss.Case presentation: The patient is a 50-year-old male complaining of severe sustained pain of the right knee joint. Imaging studies were suspicious for a benign tumor of the right distal femur. Biopsy under CT guidance showed numerous osteoclast aggregation and hemosiderin deposition around the bone trabeculae. Blood tests disclosed significantly elevated parathyroid hormone, serum calcium, serum alkaline phosphatase. Parathyroid ultrasonography and CT scan showed a solid mass in front of the trachea at the thoracic entrance plane. After resection of the mass, the clinical symptoms were relieved and the radiological findings were significantly improved, which further confirmed the diagnosis.Conclusions: Metabolic diseases-associated bone lesions require a comprehensive diagnosis of multiple inspection items.An interprofessional team approach to the diagnosis and treatment of Osteitis fibrosa cystica will provide the best outcome.

scholarly journals Multiple Solitary Plasmacytoma: A Rare Presentation

2021 ◽  
pp. 1-3
Author(s):  
Aravind Reddy Kuchkuntla ◽  
◽  
Nitish Singh Nandu ◽  
Keyword(s):  
Plasma Cell ◽  
Soft Tissues ◽  
Plasma Cells ◽  
Bone Marrow Involvement ◽  
Axial Skeleton ◽  
Bone Lesions ◽  
Solitary Plasmacytoma ◽  
Rare Presentation ◽  
Left Femur ◽  
The Right

Plasmacytomas are localized tumors of monoclonal plasma cells, typically affecting the axial skeleton and present as solitary bone lesions known as solitary bone plasmacytomas (SBP). Another type of plasmacytomas are extramedullary plasmacytomas (EP) that are localized plasma cell neoplasms affecting the soft tissues such as skin, brain lymph nodes etc. These tumors are account for 5-10% of all plasma cell disorders and among these tumors a rare entity is a multiple solitary plasmacytoma (MSP). MSPs are rare and account for only 5% of all SBPs. MSP presents with multiple SBPs with or without EPs with no bone marrow involvement as multiple myeloma. Literature is limited on MSP as it is a rare diagnosis. Here, we present a case of a 64-year-old male who presented with shoulder pain after a fall, found to have an SBP of the right shoulder, SBP of left femur and a left hypopharyngeal EP. The tumors were excised and he was treated with 6 cycles of bortezomib and dexamethasone. After chemotherapy and radiation patient showed good response and remained in remission on follow up.

scholarly journals MON-356 Atypical Femur Fracture with Denosumab

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Faryal S Mirza ◽  
Ravali Nallu
Keyword(s):  
Past History ◽  
Systemic Disease ◽  
Hormone Replacement ◽  
Trochanteric Fracture ◽  
X Rays ◽  
Left Femur ◽  
T Score ◽  
Increased Risk ◽  
The Right

Abstract Background: Osteoporosis (OP) is a systemic disease that is associated with increased risk for fractures. Anti-resorptive medications (ARM) are an effective modality for treatment and prevention of fractures in OP. Long-term use of ARM like bisphosphonates (BP) is associated with increased risk of atypical femoral fractures (AFF). Denosumab (DM) is monoclonal antibody that targets receptor activator of nuclear factor KB ligand (RANKL). A few cases of AFF with DM have been reported in patients who have previously been on long term BP therapy. We present a case where the patient had only received two zoledronic acid (ZA) infusions, last one three years prior to being initiated on DM and experienced AFF. Case: 73-year-old postmenopausal woman presented to the emergency room with sudden onset pain in the right thigh. Patient was standing and reaching into her closet when she felt a snap in right thigh followed by inability to move the right leg or bear weight on it. X-ray of the right femur showed a displaced femoral shaft fracture with a short transverse fracture line and a spike, without comminution. History was significant for OP for which she received raloxifene for a couple of years followed by ZA in 2013 and 2015 by her primary care. Fracture history was significant for a wrist fracture in 2015, and T12 and L1 fractures in 2017 from coughing while on Medrol dospak for an acute episode of bronchitis. In 2017, bone density showed L1-L4 T score of -2.0, the left total hip T score was -1.8 and left femoral neck T score was -2.5 consistent with OP. Work up for secondary causes of OP was unremarkable. Due to recent T12 and L1 compression fractures, she was recommended DM. She received DM in June 2018 as she was undergoing a dental implant followed by December 2018 and June 2019 and presented with the right femoral fracture in November 2019. Past history was significant for idiopathic pulmonary fibrosis which had been relatively stable without need for long-term steroid therapy. History was negative for diabetes or kidney disease. Menarche was at age 14, menopause at 52 and she did not take any hormone replacement therapy. She underwent surgical fixation with intramedullary rod. Due to concern about ARM associated sub-trochanteric fracture in the right femur, left femur was imaged. She had cortical beaking in the distal third of the left femur, and underwent prophylactic medullary nailing of the left femur as well. Conclusion: AFF are an uncommon complication of ARM used for OP. Not many cases of AFF have been reported with the use of DM and most of the reported cases are associated with prolonged BP therapy. Our case is unusual in that AFF occurred in the absence of prolonged BP therapy and raises concern that a couple of ZA infusions in the past can also increase the risk of AFF. Clinicians need to have a high index of suspicion and may consider doing femur x-rays in patients who have previously been on BP prior to starting DM.

scholarly journals Pubic and ischial sarcoidosis: a single bone lesion

2021 ◽  
Author(s):  
Kaoutar Imrani ◽  
Kawtar Znati ◽  
Ittimade Nassar ◽  
Nabil Moatassim Billah
Keyword(s):  
Bone Biopsy ◽  
Histological Study ◽  
Bone Lesion ◽  
Lymph Node Involvement ◽  
Lytic Lesion ◽  
Imaging Features ◽  
Pubic Ramus ◽  
Single Bone ◽  
The Right ◽  
Bone Sarcoidosis

Bone sarcoidosis is very rarely indicative of the disease. When bone lesion is associated with lung and lymph node involvement, diagnosis can be made based on clinical and imaging features. When bone lesion is isolated, it is difficult to differentiate it from bone metastases because they both have similar appearance in imaging : in this case, the diagnosis is made by bone biopsy with histological study. We report the case of a 61-year-old male with a lytic lesion of the right ischio pubic ramus which appears to be aggressive whose biopsy revealed bone sarcoidosis.

Renal Infarction and Pulmonary Embolism in Patient with Myelodysplastic

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Mounia Bendari ◽  
Nouama Bouanani ◽  
Mohamed Amine Khalfaoui ◽  
Maryam Ahnach ◽  
Aziza Laaraj ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Myeloproliferative Neoplasms ◽  
Bone Biopsy ◽  
Bone Marrow Aspiration ◽  
Myeloproliferative Disorders ◽  
Acute Onset ◽  
International Prognostic Scoring System ◽  
Renal Infarction ◽  
The Right ◽  
Enhanced Computed Tomography

The myelodysplastic syndrome-myeloproliferative neoplasms (MDS/MPNs) are defined by a group of heterogeneous hematological malignancies resulting from stem cell−driven clonal growth of pathological hematopoietic progenitors and ineffective hematopoiesis, they are characterized concomitant myelodysplastic and myeloproliferative signs. Myelodysplastic/myeloproliferative disorders have been considered to have a higher risk of thrombus formation.We report a rare case about a 64 years old Moroccan woman, experienced renal infarction (RI) associated with pulmonary embolism as a complication of a myelodysplastic/myeloproliferative disorder.The patient complained of acute-onset severe left flank pain, a contrast-enhanced computed tomography (CT) of the chest and abdomen revealed RI by a large wedge-shaped defect in the right kidney with pulmonary embolism.Biological exam showed deep anemia, the bone marrow aspiration found myelodysplasia.the bone biopsy showed signs of myeloproliferatif disease. The karyotype was normal, BCR-ABL, JAK2, CALR mutations were absents, and MPL mutation was positive. The International Prognostic Scoring System (IPSS-R) was 0, and the patient was included to the low risk group.Anticoagulation therapy was initiated with heparin to treat RI and pulmonary embolism. Three months later, pulmonary embolism had resolved without the appearance of additional peripheral infarction.This case emphasizes the need to consider myelodysplastic/myeloproliferative disorders as a cause of infraction renal and pulmonary embolism.

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