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Anil, Kumar, Kumar Manoj, and Mishra Asim. "To Assess the Significance of Histopathology in the Diagnostic Process of Lytic Bone Lesions at a Tertiary Centre." International Journal of Pharmaceutical and Clinical Research 15, no. 10 (2023): 1340–47. https://doi.org/10.5281/zenodo.11294619.
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<strong>Background:</strong> The presence of lytic bone lesions is a common radiographic finding seen in patients seeking orthopaedic care. The histopathology’s plays a crucial role in providing guidance to orthopaedic surgeons in the management of patients with lytic lesions. <strong>Aims and Objectives:</strong> The purpose of this study is to assess the significance of histopathology in the diagnostic process of lytic bone lesions. <strong>Materials and Methods: </strong>The selection criteria for patients included those with radiologically evident bone disease. A total of 50 cases were identified, and radiographic diagnosis confirmed the presence of lytic bone lesions in all patients. Histopathological biopsies were conducted in all patients to diagnose lytic bone lesions. The biopsy procedure mostly included the use of the scraping technique as well as the incision and excision methods. In the laboratory, soft tissue samples were immersed in a solution of 10% formalin for fixation. As for bone samples, slices with a thickness ranging from 3 to 5 mm were prepared and then fixed in a 10% buffered formalin solution. Decalcification of the bone specimens was then performed by immersing them in a 5% nitric acid solution for duration of 2 days. <strong>Results: </strong>The findings of our investigation revealed that out of a total of 50 instances, there were 18 cases of inflammatory lesions, 22 cases of benign lesions, 3 cases of initial malignant lesions, and 7 cases of subsequent malignant lytic lesions. So, the most prevalent lytic lesion was a benign neoplastic lesion of bone. There were a total of 22 instances in the study. Out of a total of 18 inflammatory lytic lesions, 8 cases were of pyogenic osteomyelitis, and 10 cases were of tuberculous osteomyelitis. So, tuberculous osteomyelitis was slightly more common than pyogenic osteomyelitis in inflammatory lytic lesions. Out of a total of 22 lytic lesions classified as benign neoplastic, 14 instances were diagnosed as giant cell tumors, while 3 cases were identified as fibrous dysplasia. Giant cell tumors have a greater frequency of occurrence compared to other benign lytic lesions. <strong>Conclusion: </strong>It has been determined that the identification of lytic bone lesions is an often used radiological finding utilized by orthopaedic surgeons in the evaluation of several individuals. Histopathology serves as the definitive diagnostic method for a wide range of disorders that result in lytic lesions, establishing itself as the benchmark for accuracy and precision.
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Santos Sánchez, José Ángel, Almudena Blázquez Sáez, Luís R. Ramos Pascua, and M. Antonia Rebollo Alvarado. "Cranial lytic lesions." Medicina Clínica (English Edition) 146, no. 7 (2016): 334. http://dx.doi.org/10.1016/j.medcle.2016.05.036.
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Mendes, Gabriela Ribas, Fernando Swiech Bach, Luiz Fernando Cardoso Garcia, Saulo Henrique Weber, and José Ademar Villanova Junior. "A retrospective study of dogs with vertebral lytic lesions diagnosed tomografically: 28 cases (2012-2017)." Semina: Ciências Agrárias 40, no. 5Supl1 (2019): 2223. http://dx.doi.org/10.5433/1679-0359.2019v40n5supl1p2223.
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Lytic vertebral lesions cause significant pain and variable neurological deficits can cause sensory, motor and proprioceptive loss, and are causes of bones lysis such as discospondylitis, vertebral tumors, bone cysts and osteomyelitis. This study aimed to investigate the prevalence of vertebral lytic lesions in the canine population, from computed tomographic (CT) image analyses. A retrospective study, based on the descriptive findings from simple and contrast enhanced CT scans of dogs, between the years 2012 to 2017, was performed. The study consisted of the sequential analysis of 371 reports to identify vertebral lytic lesions, in areas with osteopenia and hypoattenuation, based on Hounsfield Unit scores. The Fisher’s exact test and descriptive statistics were used for statistical analyses. Twenty-eight cases (7.54%) of vertebral lytic lesion were observed; 46.42% of these had characteristics of discospondylitis, with a prevalence in males, in the cranial and caudal ends of the vertebrae. Vertebral tumors were identified in 37.71% of the cases, with a higher incidence in defined medium sized breeds, with unifocal lesions in the vertebral body. Single lesion bone cysts were observed in 10.71% of cases and osteomyelitis in 7.14% of cases. A significant association between the number of vertebrae and degree of impairment (unifocal or multifocal) was observed. CT imaging has become a useful tool for evaluating the architecture and vertebral bone density. This study provides perspectives for the analysis of vertebral lytic lesions. In addition to showing the prevalence of lytic lesions, this study emphasizes the importance of using advanced diagnostic imaging techniques, such as CT imaging, for observing and identifying such lesions, thus directing further examinations such as bone biopsy, culture, and antibiogram or histopathology. It can be concluded that lytic lesions have a considerable incidence, impair the architecture of the vertebra and CT imaging is an effective tool for diagnosing them. Prevalence was observed in male dogs, neutered, with defined breed, of medium size, with unifocal lesion and lytic lesions associated with the discspondylitis.
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Haque, Salina, Zulfia Zinat Chowdhury, Kazi Ishraque Ahmed, et al. "Spectrum of Bone Complications in Newly diagnosed Multiple Myeloma patients." Haematology Journal of Bangladesh 6, no. 02 (2022): 08–12. http://dx.doi.org/10.37545/haematoljbd202290.
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Abstract
 Multiple myeloma is a malignant disorder of plasma cells that seed throughout the bone marrow and usually produce a monoclonal immunoglobulin in the blood, urine, or both, cause lytic bone lesions. A total of 159 newly diagnosed multiple myeloma patients aged 24 to 85 were included in this study. The median age of 159 patients was 56 years. Highest incidence of multiple myeloma was found in 50-59 years age group and P value was statistically significant. Male patient was 103 (65%) and female patient was 56 (35%). The median age of male patients was 56 years and the female patients was 57 years. There was no statistically significant age difference between male and female patients. 76.1% patients had bone involvement. Lytic bone lesions were found in 45.9% cases. Among them 15.1% patient had single lytic lesion and 30.8% patient had multiple lytic lesions. Most common site of lytic lesion was skull (33.3%).Pelvis was the second most common site of lytic lesion (15.7%).The prevalence of fracture was 44.7%, among them vertebral fracture was in 37.1% cases, rib fracture was in 9.4% cases, humerus fracture was in 3.1%, femur fracture was in 3.8%, fracture of neck of femur in 0.6%. Nerve root compression found in 12.6% cases. Lytic lesion and fracture are most common features of bone involvement in multiple myeloma patients. MRI study instead of radiographic study may increase the detection of bone lesion especially in the thoraco-lumber spine, pelvis and proximal femurs. Further studies incorporating MRI study are necessary to determine skeletal changes of MM patients.
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Sreenivas, Kalyan Deepak, Sathyanarayanan Parthasarathy, and Akashdeep Ambikakumari Ajayakumar. "A Lytic Lesion in Proximal Phalanx of Hand: A Case Report and Diagnostic Approach." Case Reports in Orthopedic Research 4, no. 2 (2021): 145–51. http://dx.doi.org/10.1159/000516253.
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Lytic lesions arising in the hand can be confused with an enchondroma. Enchondroma is the most common tumor of the hand and can present with varied features. It often requires only observation. A dilemma arises when surgically treatable lesions like aneurysmal bone cyst (ABC) present in uncommon locations like the hand. To diagnose a lytic lesion in the hand, percutaneous biopsy is commonly done. But, percutaneous biopsy is unnecessary in enchondroma and may not be useful in conditions like simple bone cyst and ABC. In such situations, magnetic resonance imaging (MRI) can differentiate between the most frequent benign lesions of the hand thereby reducing the need for invasive procedures. We present a 25-year-old lady who presented with a painless right index finger swelling for the past 6 months. Radiographs revealed a lytic expansile lesion in the proximal phalanx of the hand. MRI showed multiple fluid-fluid levels. Curettage and autologous iliac crest bone grafting was done. Histopathology confirmed the diagnosis of an ABC. The patient was followed up for 12 months without any recurrence. We briefly review the paucity of literature on the diagnostic approach to benign lytic lesions of the hand.
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Debnam, J. M., and D. Schellingerhout. "Focal Cement Accumulation in Lytic Metastatic Lesions: A New Sign in Vertebroplasty?" Interventional Neuroradiology 14, no. 4 (2008): 465–70. http://dx.doi.org/10.1177/159101990801400415.
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We describe a unique imaging appearance of focal cement accumulation inside lytic metastatic lesions in four patients with pathologic vertebral fractures undergoing vertebroplasty. This appearance differs from the normal, trabecular appearance of cement distribution in osteoporotic vertebrae. Two patients, in whom the lytic metastasis was completely filled with cement, had a complete pain response, and two patients, in whom the lytic metastasis could only be partially filled, had an incomplete response. Focal cement accumulation in a lytic lesion may be a predictor of favorable patient outcome in patients with lytic metastasis.
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Pandey, Vivek, Vishnu Senthil, and Kiran Acharya. "Rare Lytic Lesions of the Talus: A Diagnostic Challenge." Journal of Foot and Ankle Surgery (Asia Pacific) 4, no. 1 (2017): 49–52. http://dx.doi.org/10.5005/jp-journals-10040-1070.
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ABSTRACT Patients presenting with prolonged ankle pain following trivial trauma should be clinically and radiologically investigated. We present two young adults with incidentally diagnosed lytic lesion of talus. They underwent extended curettage and biopsy. Histopathological examination proved as aneurysmal and simple bone cyst and went for a secondary procedure of bone grafting. We want to emphasize the importance of differential diagnosis in the management of lytic lesions and complete removal of tumor. How to cite this article Senthil V, Pandey V, Acharya K. Rare Lytic Lesions of the Talus: A Diagnostic Challenge. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):49-52.
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Kaya, Serdar, Ahmet Colak, Murat Kutlay, and Atilla Gungor. "LYMPHANGIOMA OF THE CLIVUS." Neurosurgery 60, no. 4 (2007): E779. http://dx.doi.org/10.1227/01.neu.0000255351.79324.41.
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Abstract OBJECTIVE Different clival lesions have been reported in the literature previously. The lymphangioma reported in the present case seems to be the first lesion localized in the clivus. CLINICAL PRESENTATION The patient presented with a history of diplopia and headache. Imaging studies showed a lytic lesion at the cranial base. INTERVENTION Transsphenoidal excision of the lesion resulted in total resolution of the patient's complaints. CONCLUSION Lymphangioma must be kept in mind for the differential diagnosis of lytic lesions of the cranial base. Surgical removal leads to immediate improvement of the symptoms.
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Katz, Daniela, and Dvora Aharoni. "Lytic Lesions in Breast Cancer." New England Journal of Medicine 351, no. 27 (2004): 2850. http://dx.doi.org/10.1056/nejmicm040763.
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DUZOVA, A. "Phalangeal lytic lesions in sarcoidosis." Journal of the European Academy of Dermatology and Venereology 11 (September 1998): S256—S257. http://dx.doi.org/10.1016/s0926-9959(98)95547-7.
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Jajeh, Ahmad. "Plasmacytoid Transformation of Chronic Lymphocytic Leukemia CLL with Multiple Lytic Bony Lesions." Blood 120, no. 21 (2012): 4590. http://dx.doi.org/10.1182/blood.v120.21.4590.4590.
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Abstract Abstract 4590 Richter transformattion in patients with Chronic Lymphocytic Leukemia CLL can happen in 3%- 15%. This involve transformation of relatively indolent CLL cells into higher grade and aggressive form of Lymphoma. Plasmcytoid transformation of CLL with paraprotinemia, multiple lytic lesions and hypercalcemia can occur. This abstract will describe six patients with CLL who presented with hypercalcemia and lytic bony lesions in the course of their disease. Mean age is 72 years old. All were males, four whites and two blacks. One patient had solitary bony lesion with solitary small lung lesion that biopsy showed moderately differentiated adenocarcinoma. Bone scan was negative and monoclonal IgG lambda was present. The second patient had multiple lytic lesions with nephrotic range proteinuria of five grams; kappa light chain with bone marrow biopsy showing plasma more than 10%. Two patients has progressive adenopathy with elevated IgM level more than 2 grams with increased LDH. One patient progressed to PLL and developed renal failure that required hemodialysis with lambda light chain in urine. One patient with progressive bony lesion involving the scapula and close vertebrae with IgG spike. All patients expired in a short period less than six months with therapy. Biopsy was available for four patients which showed plasmacytoid or plasmablastic morphology. In conclusion: Plasmacytoid transformation in patient with CLL should be considered when hypercalcemia, lytic bony lesions and paraproteinemia is present. Disclosures: No relevant conflicts of interest to declare.
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TURGUTKAYA, Atakan, İrfan YAVAŞ, Tuğba ŞAHİN, Gokhan SARGIN, Gürhan KADIKÖYLÜ, and Ali BOLAMAN. "INVESTIGATION OF THE RADIOLOGICAL TECHNIQUES TO DETECT OSTEOLYTIC LESIONS, FRACTURES, AND OSTEOPOROSIS IN MULTIPLE MYELOMA PATIENTS." Ege Tıp Dergisi 62, no. 4 (2023): 536–41. http://dx.doi.org/10.19161/etd.1147765.
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Aim: Multiple myeloma is a malignancy of clonal plasmacytes. Osteolytic lesions represent a criterion for symptomatic myeloma and are associated with bone loss, pathological fractures, and osteoporosis. Skeletal surveys with other sophisticated techniques and dual-energy x-ray absorptiometry (DEXA) are used to screen lytic lesions, and bone mineral loss, respectively. Here, we aimed to investigate the rates of detection regarding osteolytic lesions and bone mineral loss by several imaging techniques.
 Materials and Methods: The study was carried out in Adnan Menderes University Hospital/Turkey, between the years 2004- 2020. Three-hundred and ten symptomatic myeloma patients were screened retrospectively. The results of radiological techniques were recorded. The detection rate of osteolytic lesions, fractures, and plasmacytomas by imaging techniques, as well as bone mineral loss with DEXA was recorded. Also, associations with gender, myeloma type, lytic lesions, and osteoporosis were investigated.
 Results: Skeletal survey and PET-CT detected lytic lesions in 71.3% and 81.2% of patients, respectively. PET-CT had a sensitivity of 96.1% and specificity of 90.6% to detect lytic lesions. MRI was only used for patients with suspicious fractures and detected them for all patients who underwent MRI. The osteoporosis rate was 83.1% for 113 patients who underwent DEXA. Any association between lytic lesions and gender/myeloma type was not detected. 
 Conclusion: Our study demonstrated that osteolytic lesions are not correlated with gender or myeloma type. PET-CT is a sensitive and specific method for detecting osteolytic lesions. Although DEXA is sensitive, its specificity is limited to detect osteoporosis in patients with lytic lesions.
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Gunalp, Bengul, Ali Ozan Oner, Semra Ince, Engin Alagoz, Aslı Ayan, and Nuri Arslan. "Evaluation of radiographic and metabolic changes in bone metastases in response to systemic therapy with 18FDG-PET/CT." Radiology and Oncology 49, no. 2 (2015): 115–20. http://dx.doi.org/10.1515/raon-2015-0012.
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Abstract Background. The aim of the study was to retrospectively evaluate radiographic and metabolic changes in bone metastases in response to systemic therapy with 18FDG-PET/CT and determine their roles on the evaluation of therapy response. Patients and methods. We retrospectively evaluated radiographic and metabolic characteristics of bone metastases in 30 patients who were referred for the evaluation of response to systemic therapy with 18FDG-PET/CT. All patients underwent integrated 18FDG-PET/CT before and after treatment. Results. The baseline radiographic patterns of the target lesions in responders group were lytic, sclerotic, mixed and CT negative; after treatment the radiographic patterns of all target lesions changed to a sclerotic pattern and attenuation increased (p = 0.012) and metabolic activity decreased (p = 0.012). A correlation was found between decreasing metabolic activity and increasing attenuation of the target lesions (r = -0.55) (p = 0.026). Ho wever, in nonresponders group, the baseline radiologic patterns of the target lesions were lytic, blastic, mixed and CT negative; after treatment all lytic target lesions remained the same and one CT negative lesion turned to lytic pattern and the attenuation of the target lesions decreased (p ± 0.12) and metabolic activity increased (p = 0.012). A correlation was found between increasing metabolic activity and decreasing attenuation (r = -0.65) (p = 0.032). An exception of this rule was seen in baseline blastic metastases which progressed with increasing in size, metabolic activity and attenuation. Conclusions. This study shows that the metabolic activity of lesions is a more reliable parameter than the radiographic patterns for the evaluation of therapy response.
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Battikh, Naim G., Elrazi Awadelkarim Awadelkarim Hamid Ali, and Mohamed A. Yassin. "Osteolytic Bone Lesions in Patients with Primary Myelofibrosis: A Systematic Review." Blood 138, Supplement 1 (2021): 4624. http://dx.doi.org/10.1182/blood-2021-144449.
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Abstract Background: Philadelphia negative Myeloproliferative neoplasms classically characterized by excess production of terminal myeloid cells in the peripheral blood. Among this group, primary myelofibrosis is the least common and usually carries the worst prognosis. Bone involvement in primary myelofibrosis has many forms and tend to manifest as osteosclerotic lesions in vast majority of cases, however osteolytic lesions are reported in exceptional occasions. In this review, we tried to shed the light on this rare association. Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the English literature (Google scholar, PubMed, and SCOPUS) for studies, reviews, case series, and case reports about patient with myelofibrosis who develop lytic bone lesion. We used the terms in combination: "Myelofibrosis'" or "Primary myelofibrosis" OR "chronic idiopathic myelofibrosis" OR "agnogenic myeloid metaplasia" and "Osteolytic bone lesion", "Osteolytic lesion", "lytic bone lesion". The review included patients with primary myelofibrosis confirmed by biopsy. The reference lists of the included studies were scanned for any additional articles. The search included all articles published up to 10th April 2021. Two independent reviewers screened the titles and abstracts of the records independently and papers unrelated to our inclusion criteria were excluded. A total of 13 articles were included in the review. Results : Total of 13 patients were included in the review. 7 patients were males, male to female ratio almost of 1:1. The mean age at time of diagnosis was 57.69 year, only two cases were diagnosed at young age, however the majority have osteolytic bone lesion at age above 50 years (12/13) of cases. The mean time between the diagnosis of primary myelofibrosis until the osteolytic bone lesion capturing was approximately 8.8 years. 9 out of 13 patients have painful bone lesion, others were incidental finding during a scan for other reasons. All patients have significant splenomegaly. All patients had the lytic lesion detected on x ray, and 2 patients had confirmed findings on magnetic resonance imaging (MRI). The most common affected bones were the vertebrae, pelvis, ribs, humerus then the scapula, femur and skull and less frequently wrist bones and calcaneus. Only one case has reported involvement of the tibia and fibula. The shape, the extension and the numbers of lesion were variable, some showed cortical sparing and others come with cortical destruction. 10 out of 13 cases have confirmed the nature of the osteolytic lesion containing hematopoietic stem cells with or without fibrosis, 2 cases were positive for JAK2 mutation. 2 patients have received ruxolitinib, one of them preceded with bone marrow transplant, others received nonspecific therapies. Discussion: The hyperdynamic ineffective bone marrow can have a negative impact on the bone structure resulting in different types of bone pathology including lytic and sclerotic lesions. The exact mechanism beyond developing lytic lesions is not fully studied, observations revealed two possible causes: systemic inflammation and direct mechanical compression from para-osseus lymph nodes. Lesions prevalence was equal in both genders which can be attributable to a small sample size, in addition, most of the patients were in advanced stages when the lytic lesions discovered and this observation can be explained by the needed time to generate extramedullary hematopoiesis and its subsequent effect on bone structure. The variation in time between the diagnosis of PMF and development of osteolytic bone lesions could be due to the indolent phase of the disease, in which patients can survive for decades without symptoms. Until recently the treatment of myelofibrosis was supportive, but after establishing the JAK2-stat pathway role in myeloproliferative disorders the FDA approved ruxolitinib a JAK2 inhibitor which shows not only survival benefit but also has a significant impact on the resolution of the lytic bone lesions as well. conclusion Osteolytic bone lesions in patients with primary myelofibrosis is extremely rare finding, and noticed shortly after diagnosis in elderly and after longer duration in young patients. The lytic lesion seems to have a bad prognostic value as we can notice 11 out of 13 patients died within one year of detection. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Gülçin Bozbeyoğlu, Sabriye, and Ayse Nur Toksoz Yildirim. "Can we distinguish conventional osteosarcoma subtypes (osteoblastic and chondroblastic) based on their magnetic resonance signal intensities?" Srpski arhiv za celokupno lekarstvo, no. 00 (2023): 85. http://dx.doi.org/10.2298/sarh220920085g.
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Introduction/Objectives. Osteosarcoma (OS) is the most common primary malignant bone tumor in adolescents and young adults, with a tendency to produce variable amounts of osteoid, cartilage, and fibrous matrices. The objective of this study is to differentiate between osteosarcoma subtypes osteoblastic and chondroblastic according to their magnetic resonance (MR) signal intensities and X-ray findings. Methods. We performed a retrospective analysis for 21 pathologically proven osteosarcoma subtypes: osteoblastic (n = 14) and chondroblastic (n = 7). Conventional images of the bone of origin, periosteal reactions, lytic and sclerotic features, the presence of calcification, and pathological fractures were investigated with X-rays. We measured the mean ROI values for each lesion with MRI sequences. Results. Among the osteosarcoma lesions, 57% were localized at the knee. X-ray evaluations of the osteoblastic osteosarcomas revealed pure lytic lesions in 35.7% and pure sclerotic lesions in 35.7%. Chondroblastic osteosarcomas revealed pure lytic lesions in 14.3% and pure sclerotic lesions in 42.9%. Due to variable osteoblastic, chondroblastic, and fibroblastic areas and proportions of the ossified matrix, osteosarcoma lesions have a heterogeneous MR signal. However, no statistically significant value was detected. Conclusion. According to our results, MRI signal characteristics and X-ray findings may not be able to distinguish osteosarcoma subtypes, so prospective studies with larger patient cohorts are needed.
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Agarwal, Anil, Kumar Shashi Kant, Anubrat Kumar, Abbas Shaharyar, Indreshwar Verma, and Tarun Suri. "LYTIC LESIONS OF DISTAL RADIUS IN CHILDREN: A RARE TUBERCULAR PRESENTATION." Hand Surgery 19, no. 03 (2014): 369–74. http://dx.doi.org/10.1142/s0218810414500294.
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Introduction: We report the presentation, management, and outcome in five children with osteoarticular tuberculosis of distal radius. Patients: Patients were recruited in a prospective study. All patients underwent an open biopsy, curettage and diagnosis confirmed by histopathological/microbiological examination. In cavitary lytic lesions, bone grafting was also undertaken. The multidrug anti-tubercular chemotherapy was given for one year. Observations: Five patients were included in the study. The average follow-up post-completion chemotherapy was 34.8 months. Bony lesions presented as a poorly defined radiolucent lytic area in metaphysis, cavitary lytic lesions with or without sequestrum or spanned the physeal plate. At final follow-up, except for one case, a full pain free range of movements was achieved in all cases. Fibular graft was used in two cases with cavitary lesions and incorporated well in both cases. Conclusions: Tuberculosis can involve the adjacent physis and can be multifocal. The presentation is usually lytic with minimal sclerosis. For smaller ill defined lesions, curettage and multidrug anti-tubercular chemotherapy results in excellent outcome. Cavitary lytic lesions should be bone grafted as there is a risk of pathological fractures.
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Finkelstein, Samuel, Srinivas Raman, Joanne Van Der Velden, et al. "Changes in Volume and Density Parameters Measured on Computed Tomography Images Following Stereotactic Body Radiation Therapy of Nonspine Bone Metastases." Technology in Cancer Research & Treatment 18 (January 1, 2019): 153303381985353. http://dx.doi.org/10.1177/1533033819853532.
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Introduction: Volumetric and density parameters measured from computed tomography scans were investigated for evaluating treatment response of nonspine bone lesions following stereotactic body radiation therapy. Methods: Twenty-three patients treated with stereotactic body radiation therapy to nonspine bone metastases with pre- and post-treatment radiological follow-up with computed tomography imaging were identified in a retrospective review. An expert radiologist classified 26 lesions by type (lytic, sclerotic) and by response. Two independent radiation oncologists created separate contours of the bone and soft tissue lesion volumes. Density and volume were assessed relative to baseline values. Results: For bone-only lesions, all lesions designated as local control decreased in volume or remained within 20% of baseline volumes. Lytic lesions classified as progressive disease exhibited much larger volume increases. Lytic bone lesions showed indications of remineralization with some exhibiting immediate increases in density (1-6 months) and others decreasing initially then increasing back toward baseline between 7 and 12 months. The majority of sclerotic lesions, all classified as local control, decreased slightly in both volume and density. Lesions with both soft tissue and boney involvement resulted in contradictory results when employing both radiological and size parameters for assessing treatment response. Classification was dominated by changes in soft tissue volume, despite associated volume or density changes in the corresponding boney lesion. In contrast, when soft tissue volume changes were minimal (<20% increase), classification appeared to be related primarily to density changes and not bone volume. Conclusions: Volume and density changes show promise as quantitative parameters for classifying treatment responses of nonspine osseous lesions. Further work is required for clarifying how these metrics can be applied to lesions with both boney and soft tissue components.
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Mulligan, Michael. "Imaging of myeloma: beyond lytic lesions." International Journal of Hematologic Oncology 2, no. 6 (2013): 497–507. http://dx.doi.org/10.2217/ijh.13.61.
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GAFFNEY, Elizabeth K., and Gregory SUMMERS. "Non-malignant lytic lesions of bone." International Journal of Rheumatic Diseases 15, no. 1 (2011): e10-e11. http://dx.doi.org/10.1111/j.1756-185x.2011.01667.x.
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Capalbo, Silvana, and Vito Mascolo. "Phalangeal Lytic Lesions in Multiple Myeloma." Clinical Lymphoma and Myeloma 7, no. 9 (2007): 597. http://dx.doi.org/10.1016/s1557-9190(11)70113-5.
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Jung, Sung-Hoon, Jae-Sook Ahn, Deok-Hwan Yang, Yeo-Kyeoung Kim, Hyeoung-Joon Kim, and Je-Jung Lee. "Effect Of Advanced Lytic Bone Lesions On Peripheral Stem Cell Mobilization In Patients With Multiple Myeloma." Blood 122, no. 21 (2013): 3276. http://dx.doi.org/10.1182/blood.v122.21.3276.3276.
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Abstract The purpose of this study was to identify incidence and predictive factors of peripheral blood stem cell (PBSC) mobilization failure in patients with multiple myeloma (MM). Retrospective data of 104 patients who received cyclophosphamide plus G-CSF or G-CSF alone mobilization were analyzed. The rate of mobilization failure using two definitions of failure < 2 and < 4 ´ 106 CD34+ cells/kg following the first collection attempt was 16.3% and 33.7%, respectively. Predictors of mobilization failure were evaluated using logistic regression analysis including age, advanced osteolytic lesions, bone marrow cellularity before mobilization, platelet count, body mass index before mobilization, and mobilization method. Lytic bone lesion was assessed by conventional skeletal survey, and advanced osteolytic lesions were defined by lytic lesions more than three skeletal sites regardless of number of lytic lesions. By multivariate analysis, advanced osteolytic lesions (odds ratio mORn= 10.956, P = 0.001) and age ≥ 60 years (OR = 5.454, P = 0.017) were associated with PBSC yield lower than 2 ´ 106 CD34+ cells/kg, and advanced osteolytic lesions (OR = 5.088, P = 0.006), WBC ≤ 4,000/mL before mobilization (OR = 4.724, P = 0.005), and G-CSF only mobilization (OR 10.526, P = <0.001) were associated with PBSC yield lower than 4 ´ 106 CD34+ cells/kg. This data suggests that multiple osteolytic lesions as well as advanced age, WBC count, and mobilization method is a significant predictor of mobilization failure in MM patients. Disclosures: No relevant conflicts of interest to declare.
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Fallon, Keelin, Ali Akalin, Peggy Wu, and Aaron K. Remenschneider. "Primary Sarcoidosis of the Temporal Bone a Clinical Pathologic Correlation." Otology & Neurotology Open 3, no. 3 (2023): e039. http://dx.doi.org/10.1097/ono.0000000000000039.
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Objective: This report describes a case of sarcoidosis that presented as a lytic bone lesion in the squamous part of the temporal bone. Patients: A 64-year-old woman presented with right-sided aural fullness, pulsatile tinnitus, and intermittent otalgia. Interventions: CT and MRI were performed without contrast and suggested an osseodestructive, lytic bone lesion. An excisional biopsy was performed, showing granulomatous infiltration suggestive of osseous sarcoidosis. Main Outcome Measures: Removal of mass and resolution of symptoms. Results: Initial findings from patient imaging suggested a lytic bone lesion. An excisional biopsy was required for diagnosis and was performed with little patient morbidity. Biopsy findings showed granulomatous infiltration suggestive of osseous sarcoidosis. Osseous involvement of sarcoidosis is a rare manifestation and typically occurs secondary to other disease manifestations. After the removal of the mass and a short unrelated course of steroids, the patient’s symptoms resolved. Conclusions: Sarcoidosis should be added to the differential diagnosis of lytic bone lesions in the temporal bone.
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Chen, Bangzheng J., Huixiao Hong, Weigong Ge, et al. "Surface Chemistry Proteomics and Biomarker Discovery in Multiple Myeloma." Blood 106, no. 11 (2005): 2493. http://dx.doi.org/10.1182/blood.v106.11.2493.2493.
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Abstract Introduction: To further evaluate the utility of surface-enhanced laser desorption and ionization-time of flight mass spectroscopy (SELDI-TOF MS) proteomics in the diagnosis, prognosis, monitoring response to therapy, and follow up of patient with myeloma, we examined the ability of protein chips with 4 different surface chemistries to detect biomarkers of lytic bone disease. Method: Sera from 47 untreated myeloma patients were collected and stored at −80°C for future analysis. 22 serum samples were from patients with 1–26 lytic bone lesions as identified on X-ray skeletal surveys and 25 serum samples were from patients without lytic lesions. The sera were analyzed by SELDI-TOF MS using Ciphergen’s ProteinChip Biology System II (PBS II), to identify protein patterns associated with lytic bone disease. Each sample was applied in 2 replicates to randomly assigned spots on protein chips with different surface chemistries: immobilized metal affinity capture (IMAC30) activated with Cu++, weak cathion exchange (CM10), reverse phase (H50), and strong anaion exchange (Q10), all under conditions of low stringency, using a Biomek2000 robot. The mass spectra of proteins, generated using an average of 66 laser shots, were calibrated using peptide standards and normalized to total ion current using CiphergenExpress 3.0 software. We randomly selected 80% of patients for developing classification models that separate patients with lytic bone lesions from those without lesions, using a stepwise logistic regression method; 76 calibrated and normalized spectra from randomly selected patients, 18 with lytic bone lesions and 20 without lytic lesions were used for model development. The other 18 spectra from 4 patients with lytic lesions and 5 without lesions were used as a test dataset. The same datasets were used for all 4 chip types. Protein peaks that were significantly different between the two groups were used for modeling. Results: All 4 chip types yielded models with fit accuracies of 71%–92%. The spectra produced by each chip were different, reflecting the differences in surface chemistries, and each model used different protein peaks from each of the chip types; the IMAC30-based model used 11 protein peaks ranging in size from 2903 to 8226 kilodaltons (KDa); H50 model used 7 peaks, 2802–18837 KDa in size; CM10 model used 5 peaks, 2805–23307 KDa; and Q10 used 3 peaks, 6975–37210 KDa. Prediction accuracy was 89% for CM10, 78% for IMAC30, 76% for Q10 and only 33% for H50. CM10 and IMAC30 based models correctly assigned all patients with no lytic bone lesions. Wrongly assigned patients were different for the two chip types. Conclusions: Since each model wrongly assigned different patients and used different protein peaks, it is likely that a model that combines information from several surface types (consensus approach) will prove to provide the most accurate predictions, as needed for making clinical decision.
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Yalamanchi, Amulya, Adlyne Reena Asirvatham, Karthik Balachandran, Shriram Mahadevan, Sandhya Sundaram, and S. Rajendiran. "Erdheim Chester Disease – Unusual Presentation with Isolated Skeletal Lytic Lesions." Journal of Orthopaedic Case Reports 12, no. 1 (2022): 63–67. http://dx.doi.org/10.13107/jocr.2022.v12.i01.2620.
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Introduction:Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis (LCH) of unknown origin that was first described in 1930. Since then, almost 600 cases have been reported worldwide. Even though this disease primarily affects the bone, it has a varied clinical spectrum of presentation ranging from asymptomatic bone lesions to multisystem involvement. Owing to its protean manifestations ECD is often misdiagnosed or diagnosed late. Case Report:We present a 48-year-old female with a long long-standing history of recurrent bone lesion of the tibia and multiple trivial trauma fractures of long bones. Recently, she also developed a persistent headache and painful swelling of the right shoulder and left hip joint. Radiographs revealed multiple lytic and lytic sclerotic lesions. With the probable diagnosis of LCH, she underwent biopsy which revealed features characteristic of ECD. Conclusion:This case highlights the fact that histopathological confirmation is the key to distinguish various types of histiocytic neoplasms. Overlapping clinical and radiological features with atypical manifestations can occur in both LCH and ECD and does not rule out either of them. Keywords: Osteolytic lesions, osteosclerotic lesion, histiocytic neoplasm, erdheim chester disease, langerhans cell histiocytosis.
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Dean, Eric W., and Elad Ziv. "African-American Multiple Myeloma Patients Exhibit Less Bone Disease Compared to Other Racial/Ethnic Groups." Blood 116, no. 21 (2010): 4994. http://dx.doi.org/10.1182/blood.v116.21.4994.4994.
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Abstract Abstract 4994 Background: Bone destruction remains one of the major complications in Multiple Myeloma (MM) leading to morbidity and mortality. African-Americans have a higher incidence of MM but exhibit longer survivals compared to Caucasians. We analyzed bone involvement in a cohort of patients with MM to determine if non African American (non AA) vs. African American (AA) race predicts the presence and severity of bone disease at presentation. Methods: Clinical data was gathered on 197 (176 non AA and 21 AA) MM patients at the University of California, San Francisco. Each patient had a skeletal survey at diagnosis and identified as having 0 lytic lesions, 1–2 lytic lesions or 3 or more lytic lesions. The presence of compression fractures was also documented for each patient as was age and sex. Results: The presence of compression fractures strongly correlated with the number of lytic lesions in both the non AA and AA groups, with no compression fractures observed in the patients with zero lytic lesions (p<0.001). Among the AA group, there were fewer (6 of 15) patients with compression fractures compared with patients from the non AA group (92 of 161) (p=0.02). There was also a trend towards fewer lytic lesions among the AA group (p=0.053). No significant difference was observed between the extent of bone disease and age or sex between the two groups. Conclusions: Within this cohort of patients, there is a significantly lower rate of compression fractures among African-Americans. These data supports the idea that African-American patients present with less bone disease which confers a survival advantage compared to other racial/ethnic groups. Disclosures: No relevant conflicts of interest to declare.
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Hiremath, Rudresh, and Abhigna Moudgalya. "Case report: Brown tumor, a masquerader of malignancy." Indian Journal of Musculoskeletal Radiology 5 (June 29, 2023): 56–60. http://dx.doi.org/10.25259/ijmsr_23_2022.
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There are various causes of multiple lytic lesions in bone in adults, among which metastases and multiple myeloma top the list. Brown tumor is a rare cause of multiple lytic lesions in bone in the present era. This is due to the early diagnosis of hyperparathyroidism by serological investigations and effective treatment. Brown tumor is named after its gross pathological appearance and is focal reactive osteolysis secondary to elevated parathyroid hormone. We herein present a case of a 36-year-old female with multiple osteolytic lesions with high suspicion of metastases, but a methodical radiological investigation suggested a case of primary hyperparathyroidism with multiple brown tumors. Therefore, brown tumor should always be kept as a differential diagnosis in the case of multiple lytic lesions in bone in adult patients.
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Khurana, Jasvir S., Shuji Ogino, Ting Shen, et al. "Bone Morphogenetic Proteins Are Expressed by Both Bone-Forming and Non–Bone-Forming Lesions." Archives of Pathology & Laboratory Medicine 128, no. 11 (2004): 1267–69. http://dx.doi.org/10.5858/2004-128-1267-bmpaeb.
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Abstract Context.—Bone morphogenetic proteins (BMPs) are thought to be responsible for bone formation; they cause bone to form in soft tissues and are clinically used in helping fracture union or tumor reconstructions. Skeletal metastases from epithelial tumors may be either bone-forming (blastic) or non–bone-forming (lytic). Objective.—We studied the expression of BMPs in a variety of primary and secondary lesions of bone (both bone-forming and non–bone-forming) to determine if there was a consistent relationship between bone formation and BMP expression. Design.—We compared a bone-forming lesion (fibrous dysplasia) with a non–bone-forming lesion (desmoid tumor), using reverse transcription–polymerase chain reaction, Northern blot analysis, and immunohistochemistry to detect BMPs. We also studied a number of non–bone-forming secondary lesions (carcinomas that formed lytic metastases to the skeleton) and found BMP production in most of these tumors. Results.—We found that BMPs were expressed in both bone-forming and non–bone-forming benign musculoskeletal lesions. In the first part of the study, BMPs were found in both fibrous dysplasia and desmoid tumors. Bone morphogenetic proteins were also expressed by several tumors. In the next part of the study (paraffin-embedded tissue), BMPs were expressed by a variety of tumors, irrespective of the radiological nature (blastic or lytic) of their metastases. Conclusions.—We conclude that BMP production alone cannot explain bone formation, and other factors either alone or in combination may be responsible for blastic metastases to the skeleton and for bone formation by primary bone lesions, such as fibrous dysplasia.
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Hough, Bruce, Adam Brufsky, and Suzanne Lentzsch. "Metastatic Breast Cancer or Multiple Myeloma? Camouflage by Lytic Lesions." Journal of Oncology 2010 (2010): 1–3. http://dx.doi.org/10.1155/2010/509530.
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We report a case of a female with stage I infiltrating ductal carcinoma who received adjuvant therapy including trastuzumab. One year later she developed lytic lesions and was retreated with trastuzumab that was held after she developed symptomatic heart failure. Lytic lesions were attributed to relapse of breast cancer, and cardiac failure attributed to prior trastuzumab therapy. After complications necessitated multiple hospitalizations, a further workup revealed that the lytic lesions were not metastatic breast cancer but multiple myeloma. Her advanced multiple myeloma was associated with systemic amyloidosis involving gut and heart, which ultimately led to her demise. This report addresses the pitfalls of overlapping symptoms and the question of which patients with suspected metastatic disease should undergo a biopsy.
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Tagliafico, Alberto Stefano, Liliana Belgioia, Alessandro Bonsignore, et al. "Subspecialty Second-Opinion in Multiple Myeloma CT: Emphasis on Clinically Significant Lytic Lesions." Medicina 56, no. 4 (2020): 195. http://dx.doi.org/10.3390/medicina56040195.
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Background and objectives: In order to increase the accuracy of lytic lesion detection in multiple myeloma, a dedicated second-opinion interpretation of medical images performed by subspecialty musculoskeletal radiologists could increase accuracy. Therefore, the purpose of this study is to evaluate the added value (increased accuracy) of subspecialty second-opinion (SSO) consultations for Computed Tomography (CT) examinations in Multiple Myeloma (MM) patients undergoing stem cell transplantation on standard computed tomography with a focus on focal lesion detection. Materials and Methods: Approval from the institutional review board was obtained. This retrospective study included 70 MM consecutive patients (mean age, 62 years ± 11.3 (standard deviation); range, 35–88 years) admitted in the last six years. Pre-transplant total-body CT (reported by general radiologists) was the only inclusion criteria. Each of these CT examinations had a second-opinion interpretation by two experienced subspecialty musculoskeletal (MSK) radiologists (13 years of experience and 6 years of experience, mean: 9.5 years), experts in musculoskeletal radiology and bone image interpretation with a focus on lytic lesions. Results: Per lesion intra- and inter-observer agreement between the two radiologists was calculated with K statistics and the results were good (K = 0.67: Confidence Inteval (CI) 95%: 0.61–0.78). When the initial CT reports were compared with the re-interpretation reports, 46 (65%) of the 70 cases (95% CI: 37–75%) had no discrepancy. There was a discrepancy in detecting a clinically unimportant abnormality in 10/70 (14%) patients (95% CI: 7–25%) unlikely to alter patient care or irrelevant to further clinical management. A discrepancy in interpreting a clinically important abnormality was registered in 14/70 (21%) patients for focal lesions. The mean diameter of focal lesions was: 23 mm (95% CI: 5–57 mm). The mean number of focal lesions per patient was 3.4 (95% CI). Conclusions: subspecialty second-opinion consultations in multiple myeloma CT is more accurate to identify lesions, especially lytic lesions, amenable to influence patients’ care.
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AN, JASON W., and SARAH M. TROSTER. "Lytic Bone Lesions: Osteomyelitis or Intraosseous Gout?" Journal of Rheumatology 44, no. 9 (2017): 1410–11. http://dx.doi.org/10.3899/jrheum.170125.
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Alhaj Moustafa, Muhamad, Justin L. Seningen, and Hayan Jouni. "Hypercalcemia, Renal Failure, and Skull Lytic Lesions." Journal of Investigative Medicine High Impact Case Reports 1, no. 2 (2013): 232470961348635. http://dx.doi.org/10.1177/2324709613486356.
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Jacobs, Peter, Lucille Wood, and Hillel Goodman. "Lytic bone lesions in polycythaemia rubra vera." European Journal of Haematology 45, no. 5 (2009): 275–77. http://dx.doi.org/10.1111/j.1600-0609.1990.tb00476.x.
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Colley, Steven, and Karl Johnson. "Systemic hyalinosis with extensive lytic bone lesions." Pediatric Radiology 36, no. 9 (2006): 998. http://dx.doi.org/10.1007/s00247-006-0196-0.
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Sidhu, Gurinder, and Yamen Homsi. "Severe Lytic Bone Lesions in Multiple Myeloma." American Journal of the Medical Sciences 357, no. 4 (2019): e11-e12. http://dx.doi.org/10.1016/j.amjms.2018.12.006.
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Sacré, K., C. Aguilar, C. Deligny, et al. "Lytic bone lesions in lupus-associated myelofibrosis." Lupus 19, no. 3 (2009): 313–16. http://dx.doi.org/10.1177/0961203309349118.
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Suri, V., Abhijai Singh, Reena Das, et al. "Osseous sarcoid with lytic lesions in skull." Rheumatology International 34, no. 4 (2013): 579–82. http://dx.doi.org/10.1007/s00296-013-2752-x.
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Orzincolo, C., G. Castaldi, L. Bariani, F. Franceschini, S. Corcione, and P. N. Scutellari. "Circumscribed lytic lesions of the thalassaemic skull." Skeletal Radiology 17, no. 5 (1988): 344–47. http://dx.doi.org/10.1007/bf00367180.
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Sofman, Michael S., and Neil S. Prose. "Dermatoses associated with sterile lytic bone lesions." Journal of the American Academy of Dermatology 23, no. 3 (1990): 494–98. http://dx.doi.org/10.1016/0190-9622(90)70248-g.
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Deng, Zhong-Liang. "Percutaneous Vertebroplasty Combined with Percutaneous Pediculoplasty for Lytic Vertebral Body and Pedicle Lesions of Metastatic Tumors." May 2015 3;18, no. 3;5 (2015): E347—E353. http://dx.doi.org/10.36076/ppj.2015/18/e347.
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Background: Percutaneous pediculoplasty (PP) consists of the injection of Poly(methyl methacrylate) (PMMA) into the fractured pedicle or lytic vertebral pedicle lesions, as a technique derived from vertebroplasty. Objectives: To evaluate the short-term analgesic effect of percutaneous vertebroplasty (PV) and percutaneous pediculoplasty (PP) in patients with lytic vertebral body and pedicle lesions of metastatic tumors. Study Design: Single-center retrospective observational study. Setting: An interventional pain management practice, a medical center, major metropolitan city, China. Methods: Single-center retrospective observational study of all patients managed with PV and PP for painful vertebral body and pedicle metastatic tumors between 2007 and 2013. For each patient, symptom duration and pain intensity were recorded. PP was performed under local analgesia, in the prone position, with C-arm fluoroscopy guidance. The mixture of PMMA and Doxorubicin was delivered into the vertebral body with a non-beveled needle for the initial treatment followed by the mixture delivery into the lytic pedicle during needle withdrawal. Results: Nine patients (5 women, 4 men) were enrolled in the study with a mean age of 65.9 years (range 57 – 75). Technical success was defined as the ability to access the lesion using the approach. A positive clinical response for pain relief was achieved in these patients in whom vertebroplasty and pediculoplasty had been performed. Pain level was not significantly reduced in 3 patients in whom just vertebroplasty has been performed because the medial wall of the pedicle was destroyed by the metastatic lesion. Limitations: This study is limited by its sample size. Conclusions: PV and PP via the transpedicular approach for infiltrated vertebral bodies and infiltrated pedicles of metastatic tumors may be considered a valid therapeutic option. Key words: Percutaneous pediculoplasty, percutaneous vertebroplasty, lytic pedicular lesions, bone cement
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Nair, Ashwin, David A. Davis, Andrew Warner, Baktiar Karim, Ramya Ramaswami, and Robert Yarchoan. "The elevated expression of ORF75, a KSHV lytic gene, in Kaposi sarcoma lesions is driven by a GC-rich DNA cis element in its promoter region." PLOS Pathogens 21, no. 3 (2025): e1012984. https://doi.org/10.1371/journal.ppat.1012984.
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The spindle cells of Kaposi sarcoma (KS) lesions primarily express Kaposi sarcoma herpesvirus (KSHV) latent genes with minimal expression of lytic genes. However, recent transcriptome analyses of KS lesions have shown high expression of KSHV open reading frame (ORF) 75, which is considered a late lytic gene based on analyses in primary effusion lymphoma (PEL) lines. ORF75 encodes a pseudo-amidotransferase that is part of the viral tegument, acts as a suppressor of innate immunity, and is essential for viral lytic replication. We assessed a representative KS lesion by RNAscope and found that ORF75 RNA was expressed in the majority of latency-associated nuclear antigen (LANA)-expressing cells. Luciferase fusion reporter constructs of the ORF75 promoter were analyzed for factors potentially driving its expression in KS. The ORF75 promoter construct showed high basal transcriptional activity in vitro in endothelial cells, mediated by a proximal consensus specificity protein 1 (Sp1) (GGGGCGGGGC) element along with two distal CCAAT boxes. Sp proteins formed complexes with the proximal consensus Sp1 element to activate ORF75 promoter transcription. We also found evidence that a repressive factor or factors in B cells, but not endothelial or epithelial cells, interacted with more distal elements in the ORF75 promoter region to repress constitutive ORF75 expression in B cells. Alternate forms of Sp1 were found to accumulate during latency and showed substantial enrichment during viral lytic replication in PEL cells and infected endothelial cells, but their functional significance is unclear. We also found that ORF75 can in turn upregulate its own expression and that of other KSHV genes. Thus, while ORF75 acts primarily as a lytic gene in PEL cell lines, Sp proteins induce substantial constitutive ORF75 transcription in infected endothelial cells and this can account for its high expression in KS lesions.
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A.H, Chidiebere, and Songden Z.D. "Parathyroid Adenoma Presenting with Multiple Long Bone Lytic Lesions in An Adult Female: A Diagnostic Dilemma." SVOA Orthopaedics 4, no. 4 (2024): 67–72. http://dx.doi.org/10.58624/svoaor.2024.04.073.
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Lytic bone lesion is one of the manifestations of Parathyroid adenoma due to osteoclastic bone resorption. It is also referred to as Brown's tumor and it is characterized by elevated serum calcium and serum parathyroid hormone. Primary hyperparathyroidism is due to parathyroid adenoma in 80-85% of cases, hyperplasia in 10-15% of cases and carcinoma in 1-5% of cases. Our case is a 38year old female with multiple long bone lytic lesions resembling malignancies for which the primary source could not be identified from the clinical examination. A possible diagnosis of primary and secondary bone malignancies was made. Postoperative histological diagnosis gave a conflicting finding of fibrous dysplasia and non-ossifying fibroma. She was eventually found to have parathyroid adenoma for which she had partial parathyroidectomy with subsequent healing of the bone lesions.
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Rossi, Adriana C., Tomer M. Mark, Kevin Wood, et al. "PET/CT Evaluation As a Prognostic Indicator In Relapsed Or Refractory Multiple Myeloma." Blood 122, no. 21 (2013): 1878. http://dx.doi.org/10.1182/blood.v122.21.1878.1878.
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Abstract Background Conventional radiography remains the gold standard imaging modality for staging multiple myeloma (MM). Other imaging modalities have been evaluated in recent years, and been shown to provide additional information about disease burden and location. FDG-PET/CT has proven to be useful in the identification of extramedullary disease and in monitoring patients with non-secretory myeloma. In addition to diagnostic utility, FDG-PET/CT has also been shown to predict time to relapse in the setting of newly diagnosed MM. However, to our knowledge its utility as a prognostic indicator in relapsed or refractory disease has not been studied. Methods We conducted a retrospective analysis of 61 patients with relapsed or refractory multiple myeloma (RRMM) who underwent PET/CT imaging prior to receiving salvage chemotherapy on a therapeutic trial of ClaPD (clarithromycin, pomalidomide, dexamethasone). Patients were heavily pre-treated, having received a minimum of 3 prior lines of therapy (range 3-15). All imaging was performed on the same PET/CT system at a single institution. Each PET/CT was evaluated in blinded fashion by two independent nuclear medicine physicians, with attention to the number and type of lesion, maximum SUV, and presence or absence of extramedullary disease. Disease response evaluation was performed monthly, and measured according to the international uniform response criteria. Multivariate analysis was performed to assess relationships of the above variables to depth of response, progression free survival (PFS), and overall survival (OS). Results Of 61 evaluable patients, 23 (38%) had no lytic lesions, 12 (20%) had <5 lytic lesions, and 26 (42%) had >5 lytic lesions on FDG-PET/CT. It is worth noting that 10 patients (16%) were found to have extramedullary disease, 8 of whom had >5 lytic bone lesions. There was no correlation between FDG-PET/CT findings and depth of response or median PFS, however patients with >5 lytic lesions had a median OS of 5.8 months, while it has not yet been reached for the other groups. At a median follow up of 13.2 months, 17 patients (74%) with no lytic lesions and 7 (58%) of those with <5 lytic lesions are alive. Conclusions The presence of >5 lesions on PET/CT at time of relapse is associated with poor prognosis in our cohort of heavily pre-treated patients with relapsed or refractory multiple myeloma receiving salvage chemotherapy with ClaPD. The presence of extramedullary disease, seen mostly in patients with >5 lesions, may contribute to our findings. Further studies in patients with relapsed or refractory MM are needed to evaluate the prognostic utility of FDG-PET/CT in this setting, as well as to extend these findings to other salvage regimens. Disclosures: Rossi: Celgene: Speakers Bureau. Mark:Celgene: Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Millennium: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Onyx: Research Funding, Speakers Bureau. Zafar:Celgene: Speakers Bureau; Millennium: Speakers Bureau; Onyx: Speakers Bureau. Pekle:Celgene: Speakers Bureau; Millennium: Speakers Bureau. Niesvizky:Millennium: The Takeda Oncology Company: Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Onyx: Consultancy, Honoraria, Research Funding, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau.
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Østergaard, Brian, Julie R. Mortensen, Anne L. Nielsen, et al. "18F-FDG-PET/CT and Osteolytic Bone Disease in Multiple Myeloma." Blood 128, no. 22 (2016): 5622. http://dx.doi.org/10.1182/blood.v128.22.5622.5622.
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Abstract Introduction: FDG-PET/CT is a promising methodology for staging, prognostication, and response evaluation in multiple myeloma (MM). The number of focal FDG lesions and the intensity of FDG uptake (standard uptake value, SUV) at diagnosis are informative of disease aggressiveness. Osteolytic bone disease is a hallmark of MM. Hypothetically; increased focal metabolic activity will precede, induce and correlate to osteolytic lesions. We aimed to elucidate the association between focal FDG positive lesions and osteolytic bone disease in MM patients. Methods: Twenty-two newly diagnosed MM patients, 16 males and 6 females aged 53-81years, were prospectively enrolled and studied with a standardized baseline FDG-PET/CT at diagnosis. A nuclear medicine and a radiology specialist evaluated the PET and CT parts separately and independently. Focal FDG positive lesions were assessed by dedicated software (ROVER™, ABX, Germany) to yield volume and SUV measures. All osteolytic lesions identified on CT were noted by size and localization. Results: FDG-PET and CT together identified a total of 390 lesions. We found more osteolytic lesions on CT (335) than FDG-positive lesions (169); the concordance between the modalities was 30%. 34% (114/335) of lytic lesions were FDG-positive, whereas ⅔ (114/169) of focal FDG-PET positive lesions were lytic according to CT. We found a significant correlation between higher FDG uptake measured as SUVpeak and osteolytic lesions >10 mm, and focal lesions with high FDG uptake had more pronounced osteolysis than focal lesions with less FDG uptake. Still sparse follow-up data did not allow analysis of the predictive value of focal PET positivity and the risk of development of future osteolysis. More compulsive data will be presented at the meeting. Conclusion: FDG-PET/CT offers dual information including metabolic activity (FDG-avidity) and degree of lytic bone disease (low dose whole body CT) in MM. About ⅔ (221/335) of osteolytic lesions were FDG-negative, whereas ⅔ (114/169) of FDG-positive lesions had a lytic component. Disclosures Plesner: Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Oshin, Abimbola, Dominique Griffon, Karin Lemberger, James Naughton, and Anne Barger. "Patellar Blastomycosis in a Dog." Journal of the American Animal Hospital Association 45, no. 5 (2009): 239–44. http://dx.doi.org/10.5326/0450239.
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A 4-year-old, spayed female, mixed-breed dog was presented for evaluation of chronic left hind-limb lameness. Lytic lesions were observed in the left patella on radiographs of the stifle. A biopsy of the patella led to a histopathological diagnosis of blastomycosis. Surgical debridement followed by a 90-day course of itraconazole and physical rehabilitation resolved the clinical signs and stopped the progression of radiographic lesions. Blastomycosis should be considered as a differential diagnosis for stifle joint lameness with lytic lesions in the patella.
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Muehlschlegel, Paula, Roopinder Gillmore, and Sabine Pomplun. "Metastatic breast cancer and monoclonal gammopathy of undetermined significance resembling multiple myeloma." BMJ Case Reports 16, no. 6 (2023): e254016. http://dx.doi.org/10.1136/bcr-2022-254016.
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Radiological evidence of lytic bone lesions has a wide differential diagnosis including metastatic bone disease, multiple myeloma, primary bone cancers and infection. Here, we present the case of a woman in her 80s found to have lytic bone lesions associated with an IgA paraproteinaemia who was thus presumed to have a diagnosis of multiple myeloma. However, bone marrow biopsy results were indicative of monoclonal gammopathy of undetermined significance. She was subsequently referred to the ‘carcinoma of unknown primary (CUP) team’, and ultimately diagnosed with metastatic breast cancer following a repeat trephine biopsy. A range of conditions may present with lytic bone lesions and these differentials must be suitably investigated even in the presence of paraproteinaemia. Early CUP team involvement is pivotal to ensure appropriate clinical management and patient support.
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Wahezi, Sayed E. "Pain Relief with Percutaneous Trochanteroplasty in a Patient with Bilateral Trochanteric Myelomatous Lytic Lesions." Pain Physician 18;1, no. 1;1 (2015): E57—E63. http://dx.doi.org/10.36076/ppj/2015.18.e57.
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Multiple myeloma is a hematologic malignancy associated with destructive bone loss. Lytic lesions, a hallmark of this cancer, can result in significant morbidity because of associated pain and structural osseous compromise. Osteoplasty has demonstrated efficacy in the treatment of myelomatous pain within the axial skeleton; however, there is limited evidence supporting the utility of osteoplasty to treat extra-spinal lesions. We describe a 67 year-old woman with stable IgA lambda multiple myeloma with sentinel bilateral greater trochanteric lytic lesions that was referred to our interventional pain management clinic for evaluation of bilateral lateral hip pain. Conservative treatment options including physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), oral opiates, and local corticosteroid injections to bilateral trochanteric bursae failed to offer pain relief. The patient underwent minimally invasive percutaneous trochanteroplasty with concomitant core biopsy of her bilateral trochanteric lytic lesions. The intended goals of this novel procedure were to determine the cause of the suspected lytic lesions, provide pain relief, and offer structural stability by safely implanting bone cement as part of a fracture prevention strategy. At 12 month followup, the patient’s pain improved by 70% and she no longer required the use of pain medication. The patient also displayed a significant improvement in her day-to-day functioning and quality of life. Key words: Pain, osteoplasty, trochanteroplasty, multiple myeloma, greater trochanter, percutaneous
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Meinerz, Carolyn, Adam Wooldridge, and David King. "Bilateral Patellar Brown Tumors as Presenting Symptom of Hyperparathyroidism." JBJS Journal of Orthopaedics for Physician Assistants 12, no. 3 (2024): e24.00008. http://dx.doi.org/10.2106/jbjs.jopa.24.00008.
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Case: Osteolytic lesions have a broad differential. We present a 33-year-old man with bilateral patellar lytic lesions with unilateral pathologic fracture. Workup demonstrated hyperparathyroidism and isolated patellar lesions consistent with brown tumors. The patient underwent subtotal parathyroidectomy followed by curettage and cement augmentation with open reduction internal fixation of pathologic fracture and aspiration with injection of Pro-Dense to unfractured side. The patient is 2 years postoperatively and doing well. Conclusion: Multiple lytic lesions in bone should raise concern for possible metabolic derangements as the cause. Workup for brown tumors including hyperparathyroidism laboratory markers is an important differential diagnosis for orthopaedic surgeons.
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Papavasiliou, Kyriakos, Konstantinos Asteriadis, Sousana Panagiotidou, and Eleftherios Tsiridis. "Palliative Surgical Management of a Metastatic Lesion of the Tibia with Extension into the Popliteal Fossa Using Polytetrafluoroethylene Felt and Bone Cement." Case Reports in Orthopedics 2020 (November 12, 2020): 1–8. http://dx.doi.org/10.1155/2020/8845173.
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The treatment of metastatic bony lesions with the involvement of adjacent neurovascular structures presents a surgical challenge. We present—to the best of our knowledge—the first case of a patient suffering from a metastatic lytic lesion at the proximal tibia who underwent palliative treatment with the use of a polytetrafluoroethylene (PTFE) felt as a liner in order to preserve the adjacent vasculature and nerves. An 82-year-old female patient was diagnosed with multiple lytic bone metastases from renal cell carcinoma. One of these metastatic lesions was located at the proximal metaphysis of the left tibia. The lesion destructed the proximal metaphyseal part and the posterior cortex, and it was extending into the popliteal fossa. As a result, the patient was unable to bear weight. The patient was not fit to undergo radical operative treatment. As a means of palliative therapy, she underwent intralesional curettage and instillation of Poly-Methyl-Methacrylate (PMMA) bone cement using an alternative novel surgical technique with the use of a PTFE felt as a liner in order to protect the adjacent vasculature and nerves. This technique has proven to be successful in preventing cement leak into the popliteal cavity and efficient in allowing the patient to bear weight and walk independently until she demised 14 months later. The use of a PTFE felt as a liner, when treating lytic lesions, in order to protect the adjacent vasculature and nerves from PMMA leakage, is a helpful novel surgical option in cases when a radical treatment cannot be implemented.
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A., Aria Jyothi, and Lilarani Vijayaraghavan. "Lytic lesions of bone: a cytological and histopathological correlative study." International Journal of Advances in Medicine 8, no. 3 (2021): 382. http://dx.doi.org/10.18203/2349-3933.ijam20210480.
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Background: Lytic lesions of bone are easier to aspirate and fine needle aspiration cytology aids in an earlier diagnosis. The findings are correlated with radiological findings and subsequent histopathological diagnosis. Sensitivity, specificity, positive and negative predictive value of fine needle aspiration cytology of lytic lesions of bone evaluated.Methods: It was a descriptive study for 2 years. All types of lytic lesions of bone were aspirated with fine needle along with radiological assistance. The cytological diagnosis was correlated with histo pathological diagnosis.Results: A total number of 84 cases were studied with histopathological follow up in 51 cases. FNAC diagnosis was correct in 34 cases. In 8 cases, cytology diagnosis was malignant neoplasm, but correct typing was not possible. In 9 cases cytological diagnosis were inconclusive due to inadequate material. Sensitivity of the test was 70.83%, specificity was 50.12%, positive predictive value was 97.14%, negative predictive value was 6.67% and overall accuracy was 70 .01%.Conclusions: The role of FNAC in diagnosis of bone lesions is both promising and challenging. Because of simplicity, low morbidity and economical benefits, FNAC should be the first step in the diagnosis of bone lesions.
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Yaseen, M., Hussam Safa, and Dawod Saeed Hussam. "Comparison of the diagnostic value of low-dose computed tomography of the axial skeleton and skeletal radiography in patients with multiple myeloma." Archivos Venezolanos de Farmacología y Terapéutica V41, no. 7 (2022): 500–503. https://doi.org/10.5281/zenodo.7348901.
Full textAbstract:
Background: Multiple myeloma (MM) is a plasma cell neoplasm characterized by bone marrow infiltration and clonal proliferation of plasma cells. The detection of lytic bone lesions represents a criterion defining a symptomatic and treatment-requiring MM. Aim of the study: To compare the accuracy of whole body low dose CT (WBLDCT) versus skeletal radiographs in detecting myeloma lesions and to establish the feasibility of (WBLDCT) protocol as an alternative to conventional X-ray imaging. Patients and Methods: A cross sectional analytical study had been conducted in Al- Yarmouk teaching hospital in Baghdad. A total of 41 patients, their ages range between 40 – 82 years, diagnosed with multiple myeloma, underwent WBLDCT and digital radiography (DR). Re: There was weak agreement between WBLDCT and Xray in detection of lytic lesions in skull, spine and pelvic bones with (Kappa = 0.382, p = 0.007) for skull, (Kappa = 0.147, p=0.077) for spine, (Kappa = 0.223, p = 0.023) for pelvic bones. WBLDCT identified more osteolytic lesions than radiograph with total number of lesions detected with WBLDCT was 520 versus 152 for radiographs (p<0.001). Conclusion: Whole body Low-dose CT is superior to skeletal radiography with a comparable radiation dose for detection of lytic lesions of MM, with a fast scanning time and high resolution images.