Benign Bone Conditions Research Articles

MONOSTOTIC OSTEOFIBROUS DYSPLASIA OF THE TIBIA

An 11-year-old boy presented with painful swelling of leg following fracture of tibia. Osteo brous dysplasia (OFD) is an uncommon, benign, non-hereditary bone disorder in which brous tissue develops in place of normal bone that affects the young adults in their rst and second decade of life. Tc-99m MDP whole-body bone scintigraphy revealed increased tracer uptake in dense proximal tibia. On single-photon remission computed tomography-computed tomography (SPECT-CT), radiological features of cortical-based lesion superimposed on abnormal tracer uptake con rmed it to be a monostotic OFD. This case emphasises the role of SPECT-CT and magnetic resonance imaging in detecting osteo brous dysplasia and differentiating it from other benign bone conditions. Key words: Bone scintigraphy, magnetic resonance imaging, monostotic osteo brous dysplasia, single-photon emission computed tomography computed tomography, tibia

Fibrous Dysplasia Mimicking Bone Metastasis on Both Bone Scintigraphy and (18)F-FDG PET-CT: Diagnostic Dilemma in a Patient with Breast Cancer.

Bone is the most common distant site to which breast cancer metastasizes [1]. Commonly used imaging modalities for imaging bone metastasis are bone scintigraphy, plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) [1]. Although bone scintigraphy has high sensitivity for detecting bone metastasis, its specificity is low [2]. This is because of the fact that bone scintigraphy images secondary changes in bone rather than just tumor cells. 18F-fluorodeoxyglucose (18F-FDG) PET-CT, on the other hand, directly images the tumor cells’ glucose metabolism [3]. Unfortunately, similar to bone scintigraphy, benign bone conditions can also show increased 18F-FDG uptake on PET-CT, and PET-positive asymptomatic fibrous dysplasia can be misinterpreted as a metastasis [4]. Fibrous dysplasia of bone has wide skeletal distribution, with variability of 18F-FDG uptake and CT appearance [5, 6]. It is therefore important to recognize the characteristics of this skeletal dysplasia, to allow differentiation from skeletal metastasis [6, 7]. Bone lesions with 18F-FDG uptake need to be carefully interpreted when evaluating patients with known malignancy [8]. In doubtful cases, fibrous dysplasia should be given as a differential diagnosis and histopathological diagnosis may be warranted, as highlighted in the present case (Fig. 1). Fig. 1 A 62-year-old woman had undergone modified radical mastectomy, followed by chemotherapy, radiotherapy, and tamoxifen for medullary carcinoma of the left breast. She developed vague discomfort in the left side of the chest 5 years post surgery. ...

Clinical Usefulness of (18)F-fluoride Bone PET.

(18)F-fluoride bone positron emission tomography (PET) has been reported as a useful bone imaging modality. However, no clinical bone PET study had been performed previously in Korea. The authors investigated the usefulness of (18)F-fluoride bone PET in Korean patients with malignant or benign bone disease. Eighteen consecutive patients (eight women, ten men; mean age, 55 ± 12 years) who had undergone (18)F-fluoride bone PET for the evaluation of bone metastasis (n = 13) or benign bone lesions (n = 5) were included. The interpretation of bone lesions on (18)F-fluoride bone PET was determined by consensus of two nuclear medicine physicians, and final results were confirmed using combination of all imaging studies and/or clinical follow-up. The analysis was performed on the basis of lesion group. Thirteen patients with malignant disease had 15 lesion groups, among which seven were confirmed as metastatic bone lesions and eight were confirmed as non-metastatic lesions. (18)F-fluoride bone PET correctly identified six of seven metastatic lesions (sensitivity, 86%), and seven of eight non-metastatic lesions (specificity, 88%). On the other hand, five patients with benign conditions had five bone lesion groups; four were confirmed as benign bone diseases and the other one was confirmed as not a bone lesion. (18)F-fluoride bone PET showed correct results in all the five lesion groups. (18)F-fluoride bone PET showed promising potential for bone imaging in Korean patients with malignant diseases as well as with various benign bone conditions. Therefore, further studies are required on the diagnostic performance and cost-effectiveness of (18)F-fluoride bone PET.

Ibandronate in Benign Bone Disease

Ibandronate is a potent bisphosphonate which has been most thoroughly assessed in benign bone disease for use in the management of postmenopausal osteoporosis. Its use in corticosteroid-induced osteoporosis, Paget's disease and uncommon benign bone conditions such as localised transient osteoporosis (or bone marrow oedema syndrome) and sternocostoclavicular hyperostosis has also been explored. Recent randomised controlled trial evidence suggests that intermittent high dosage oral ibandronate may be as efficacious as a daily low dose regime for the treatment of post-menopausal osteoporosis, with only a mild increase in adverse events. Movement towards an extended gap between doses has implications for patient compliance and adherence and thus potential benefits for fracture prevention. This review aims to provide an overview of the evidence from randomised controlled trials in humans for the use of ibandronate in benign bone diseases. This includes a discussion of the development program and dosage regimens for the prevention and treatment of post-menopausal osteoporosis, as well as the use of ibandronate in corticosteroid induced osteoporosis, Paget's disease localised transient osteoporosis and sternoclavicular hyperostosis. Adverse effects and long-term safety data will also be reviewed.

On the treatment of enchondroma

We recommend simply removing an enchondroma without filling the cavity with cancellous bone or plaster-of-Paris. This method can also be applied to other benign bone conditions, such as aseptic necrosis.

On the Treatment of Enchondroma

We recommend simply removing an enchondroma without filling the cavity with cancellous bone or plaster-of-Paris. This method can also be applied to other benign bone conditions, such as aseptic necrosis.

Post-irradiation osteogenic sarcoma

Although osteogenic sarcoma is the most common primary malignant neoplasm of bone,lm6 excluding myeloma,7 and represents 21% of all such tumors,* it is considered quite rare in the jaws, where it comprises only 6.5 to 7.4% of cases.4,6,7,9,10.11 Even rarer is extraskeletal osteogenic sarcoma.12 Entities such as Paget’s disease of bone, fibrous dysplasia, osteogenesis imperfecta, and trauma have been considered predisposing factors to osteogenic sarcoma, but this relationship has not been extensively studied in the jaws.‘~5~7~‘3-‘5 However, the direct relationship between radiotherapy and osteogenic sarcoma of the jaws has been well established. *.I4 It has been estimated2 that 10% of jaw sarcomas arise in irradiated bone and that in 46% of cases, fibrous dysplasia was the initial lesion.‘,2*‘6 It has also been hypothesized that radiation-induced sarcomas are more frequent in the jaws than elsewhere9; although others’ believe the incidence to be low when the extent to which radiation has been used to treat jaw lesions is considered. The mechanism of post-irradiation carcinogenesis has not been clarified, although it has been thought to be the result of alterations induced in the genetic material or viral infection, the irradiated area providing a susceptible and favorable site for growth of the virus.2 Radiation therapy is presently contraindicated in the treatment of benign bone conditions.2 Despite the implication of radiation in sarcomatous transformation of benign lesions or in the initiation of primary malignancy, the number of supporting cases is rather scarce,” a fact that prompted the report of this case.