A Discussion of Generalized Osteosclerosis, with a Report of an Unusual Case

Abstract

THE recognition of osteosclerosis per se does not present a serious problem roentgenographically Its differential diagnosis from the etiological standpoint, however, is sometimes very difficult and often may be impossible. It has long been realized that the skeleton may exhibit a generalized increase in density as the manifestation of its reaction to various disease processes, such as osteopetrosis (1), aleukemic myeloid leukemia (2, 3, 10), and chemical poisoning such as fluorosis (4). Though far less common, diffuse and widespread osteoblastic carcinomatous metastases may produce similar skeletal changes rather than the usual type of irregular bony condensation. Weber (5, 6) reports an example occurring in a man 45 years of age with a severe anemia and an atypical leukemia, which, on subsequent review of postmortem specimens by Harvey Cushing, was found due to carcinomatous metastases. The case presented “multiple hemangic-endotheliomatous dural lesions” that were shown by him to be carcinomatous metastases to the dura, and the diffuse osteoblastic endosteal reaction was the result of widely disseminated miliary metastases from a carcinomatous prostate gland which had appeared grossly normal at necropsy. Similarly, o'Crowley, Trubek, and Goldstein (7) report a more obvious case in a man 48 years of age, in whom widespread metastases from a moderately enlarged nodular prostate, highly suggestive of carcinoma even during life, brought about the same kind of skeletal response. The case reported herewith presents a similar appearance. Case Report Unit No. 432501, Pathology No. 12262, J. P., a male 36 years of age, an Italian woodworker by occupation, was first admitted to Presbyterian Hospital in October, 1935, complaining of increasing weakness, pain in the back, pallor, and anorexia of about one month's duration. His family history was irrelevant, and his general health until then had been good except for occasional headaches during the previous year attributed to eye strain. For six years he had worked as a wood-carver, and no dangerous chemicals had been used in his work. For two weeks he had drenching night-sweats. Increasing weakness compelled him to stop work. During the week prior to admission his gums bled almost continually. The night before he was admitted, his back pain had become intolerably severe. Physical examination disclosed nothing important except pallor, sallowness, and bleeding gums. No purpuric spots were present. The liver and spleen were not palpable. Blood pressure 130/70, pulse 90, respiration 21, and temperature 100°. Blood examination showed the hemoglobin to be 42 per cent; red blood cells, 2,290,000/c.mm.; reticulocytes, 14.6 der cent; nucleated red cells, 5/200; capillary and red blood cell fragility, within normal limits; and polychromatophilia and marked poikilo-aniso-cytosis with both macrocytes and microcytes.