Bone Proliferations Research Articles

Severe traumatic lesions in the Late Neolithic cattle from the site of At‐Vršac, Serbia

AbstractThis paper aims to assess the etiology and differential diagnosis of severe pathological lesions in wild and domestic cattle from the Late Neolithic site of At‐Vršac in the northeast part of the present‐day Serbia. Excavations of this multilayered site revealed the remains of a Late Neolithic settlement belonging to the Vinča culture network of the Central Balkans. An aurochs metacarpal bone, two domestic cattle fragments of fused ulna and radius and of tibia, all with massive bone proliferations were recovered during the archaeological excavations in 1976. Paleopathological study was undertaken using an interdisciplinary approach, including AMS dating, radiography, computed tomography (CT), and histopathology. The results show severe oblique healed fracture with secondary pronounced bone reaction in the aurochs metacarpal bone and in the domestic cattle ulna–radius, while traumatic alteration infected with disseminated osteomyelitis was found in the domestic cattle tibia. These pathologies of wild and domestic cattle are discussed to reveal the level of environmental and human influence on the origin and development of the lesions in the Late Neolithic cattle.

Ultrasound, magnetic resonance imaging and radiography of the finger joints in psoriatic arthritis patients.

To report the discrepancies and agreements between US, MRI and radiography of the hand in PsA, and to compare the sensitivity and specificity of US and radiography to MRI as the gold standard imaging study in PsA. All of the 100 prospectively recruited consecutive PsA patients underwent clinical assessment and concomitant radiographic, US and MRI studies of the MCP, PIP and DIP joints of one hand. Synovitis, flexor tenosynovitis, extensor paratenonitis, erosions and bone proliferations were identified and scored. All readers were blinded to clinical data, and agreement was calculated based on prevalence-adjusted bias-adjusted kappa (PABAK). The prevalence of synovitis, flexor tenosynovitis, extensor paratenonitis and erosions was similar for US and MRI, while that of bone proliferation was significantly increased in US and radiography compared with MRI (P < 0.001). The absolute agreement between US and MRI was good-to-very good for synovitis (85-96%, PABAK = 0.70-0.92), flexor tenosynovitis (93-98%, PABAK = 0.87-0.96) and extensor paratenonitis (95-98%, PABAK = 0.90-0.97). Agreement between US, MRI and radiography was 96-98% (PABAK = 0.92-0.97) for erosions and 71-93% (PABAK = 0.47-0.87) for bone proliferations. Sensitivity of US with MRI as gold standard was higher for synovitis (0.5-0.86) and extensor paratenonitis (0.63-0.85) than for flexor tenosynovitis (0.1-0.75), while the specificity was high for each pathology (0.89-0.98). There is very good agreement between US and MRI for the detection of inflammatory changes in finger joints in PsA. US, radiography and MRI have a good-to-very good agreement for destructive changes.

Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Background: Extradural synovial cysts (ESC) originate from an extrusion of the synovium in unstable or degenerated joints. In the spine, this condition can cause neurological signs such as hyperesthesia, proprioceptive ataxia and paresis. Since extradural presentations of synovial cysts are unusual in dogs, the aim of this manuscript is to report a case of extradural synovial cyst of the cervical spine, as well as the clinical findings, diagnosis, surgical treatment and clinical evolution after therapy.Case: A 3-year-old spayed Saint Bernard weighing 60 kg was presented to a Veterinary Medical Teaching Hospital with a history of acute paraparesis that evolved to non-ambulatory tetraparesis five days after the appearance of the first clinical signs. Neurological examination revealed non-ambulatory tetraparesis, normal muscle tone and segmental spinal reflexes in the thoracic and pelvic limbs, as well as cervical pain associated with limited neck movement. According to the neurological examination, the likely lesion location was the C1-C5 spinal cord segment. The differential diagnosis list included intervertebral disc disease, caudal cervical spondylomyelopathy, neoplasm, infectious or noninfectious inflammatory disease, and cystic diseases. Complete blood (cell) count and serum biochemistry tests were within reference limits. The cerebrospinal fluid analysis revealed 35 mg/dL of protein (&lt; 30 mg/dL) and 27 cells (up to 5 cells/mm3) with a predominance of lymphocytes. In plain radiography, bone proliferations of the C4 (caudal) C5 (cranial) articular processes were observed and, in myelography, extradural spinal cord compression was evident between C4-C5 on the right side. The animal underwent dorsal laminectomy for spinal cord decompression. An extradural synovial cyst and proliferated articular processes were removed. At 1,281 days after surgery, the dog was clinically normal and presented no neurological deficits.Discussion: The etiology of synovial cysts has not been well established. However, it is believed that osteoarthritic degeneration associated with joint mobility could cause a rupture in the articular capsule, leading to a synovial membrane protrusion, which would fill with synovial fluid and compress spinal structures. ESC in the cervical region have been reported, often associated with cervical neoplasm. The case we report had no evidence of bone or intervertebral disc compression in myelographic and radiographic exams, abnormalities that would appear in cervical neoplasm. The patient underwent dorsal laminectomy to confirm the presumptive diagnosis and decompress the spine. In the histopathological exam, the cystic material consisted of connective fibrous tissue with a synovial cell lining layer, compatible with synovial cysts. The fluid drained during surgery was also analyzed, showing similarities to synovial fluid drained from other conventional joints. Cerebrospinal fluid analysis revealed mononuclear pleocytosis, a common finding in ESC. The ESC should be included in the differential diagnosis of dogs with cervical myelopathy, especially in young animals and large breeds. A myelographic exam is an important but not definitive auxiliary tool for diagnosis and the therapeutic plan. Dorsal laminectomy is an effective technique for treating ESC.

Osteochondromatosis (multiple cartilaginous exostoses) in an immature killer whale Orcinus orca.

An immature killer whale Orcinus orca found dead on the southeastern Brazilian coast had multiple bone proliferations: on the skull, vertebrae, hemal arches, and ribs. The bony formations were characterized as multiple osteochondromas, as defined by osteochondromatosis. The diagnosis was based on macroscopic and radiographic observations. These benign osseocartilaginous tumors affect young individuals and grow until skeletal maturity is achieved. Case reports of this condition, besides humans, include other mammals, with most reports for pets and domestic mammals such as cattle, and a report in a fossil canid (Hesperocyon) from the Oligocene. The etiology, diagnosis, developmental characteristics, and occurrence of osteochondromas are distinct among different species. This report describes the first case of multiple osteochondromas in a wild cetacean.

Craniomandibular osteopathy in a golden jackal (Canisaureus)

Craniomandibular osteopathy is a rare disorder in dogs, characterised by subperiosteal and extraperiosteal new bone proliferations on the skull, on the mandibles in particular and occasionally on long bones. Data...

Manifestations of joint disease of domestic carnivores in X-ray view

Changes caused by joint diseases that are manifested in X-ray are very diverse. Some of them are present in all arthroparthies while some are specific to certain diseases. For all the arthropathies it is specific that the duration of a disease significantly influences the presence and intensity of radiological changes. In this paper there analyzed in detail some basic radiological joint diseases manifestations such as: distension of the joint capsule, change of size (width) of the joint space, change of position of corresponding bones within the joint, change in quality of subchondral bone, the appearance of intra-articular mineralization and calcified structures, as well as the presence of perichondral and periarticular bone proliferations. Beside that, there are described in detail arthropathies of different etiology.

No overall damage progression despite persistent inflammation in adalimumab-treated psoriatic arthritis patients: results from an investigator-initiated 48-week comparative magnetic resonance imaging, computed tomography and radiography trial

In a comparative conventional MRI, dynamic contrast-enhanced (DCE)-MRI, CT and radiography study, the authors aimed to monitor whether inflammation is reduced or even eliminated and damage halted in PsA patients receiving anti-TNF therapy. A 48-week prospective open-label investigator-initiated trial of 41 biologic-naive patients treated with 40 mg adalimumab every other week. Hand CT, MRI (according to the PsA MRI scoring system method) and radiography (Sharp-van der Heijde method) were obtained at weeks 0, 6 (only MRI), 24 and 48. Clinical response was assessed by the PsA Response Criteria (PsARC). In the 23 PsARC responders at week 48, significant decreases from baseline in MRI synovitis (mean -2.0, P < 0.05), bone marrow oedema (BMO) (-1.3, P < 0.05), flexor tenosynovitis (-2.1, P < 0.05) and total inflammation (-6.0, P < 0.005) were observed. However, MRI signs of inflammation remained present (week 48 total inflammation score median = 9). Several DCE-MRI parameters also decreased (P < 0.05) and were correlated (ρ = 0.62) with conventional MRI total inflammation score. No statistically significant changes in bone erosion or proliferation scores were observed. With CT as the standard reference for detecting bone erosions/proliferations, sensitivity, specificity and accuracy were 100%/40%, 83%/93% and 84%/86%, respectively, for MRI, whereas corresponding values for radiography were 17%/26%, 98%/96%, and 93%/87%, respectively. Erosive progression as assessed by CT was found in 6 of 480 joints and baseline BMO was predictive (relative risk 10, 95% CI 2.1, 49). MRI signs of inflammation decrease, but do not disappear, during anti-TNF-α therapy. No overall changes in bone erosions or proliferations were observed. On joint-level baseline MRI, BMO was related to subsequent erosive progression detected by CT. ClinicalTrials.gov, http://clinicaltrials.gov/, NCT01465438.

Pattern of bone erosion and bone proliferation in psoriatic arthritis hands: a high-resolution computed tomography and radiography follow-up study during adalimumab therapy

Objectives: To investigate the pattern and development of bone erosion and proliferation in patients with psoriatic arthritis (PsA) during treatment with adalimumab, using high-resolution computed tomography (CT) and conventional radiography.Method: Forty-one biologic-naïve PsA patients were initiated with adalimumab 40 mg subcutaneously every other week. CT and radiography of the 2nd–5th metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints were conducted at baseline (n = 41) and after 24 weeks (n = 32). Changes in bone erosion and proliferation are described and the imaging modalities compared.Results: Ninety percent of bone erosions detected by CT were located in the metacarpal heads, and most frequently in the 2nd-3rd MCP joints. Radial (37%) and ulnar (31%) surfaces were more frequently eroded than dorsal (10%) and palmar (22%) sites. Using CT, bone proliferations were located primarily on the sides of the distal part of the DIP joints (43% of all proliferations), but also proximally in DIP (17%) and MCP joints (27%). For bone erosions and proliferations, respectively, radiography showed a low sensitivity (17% and 26%), but a high specificity (98% and 95%) and accuracy (93% and 87%), with CT as the gold standard reference. Neither CT nor radiography revealed statistically significant changes in bone erosion or proliferation scores between baseline and follow-up.Conclusions: Patterns of bone erosion and proliferation in PsA hands were revealed in more detail by CT than by radiography. No overall progression or repair could be detected during adalimumab treatment with either of the methods.

Spondyloarthritis and Diffuse Idiopathic Skeletal Hyperostosis: Two Different Diseases That Continue to Intersect

Spondyloarthritis (SpA) and diffuse idiopathic skeletal hyperostosis (DISH) are different diseases obliged to converge1. SpA is an inflammatory disease involving the axial skeleton and the peripheral entheses and joints and showing a wide clinical spectrum that encompasses ankylosing spondylitis (AS), reactive arthritis (ReA), psoriatic arthritis (PsA), arthritis related to inflammatory bowel disease (IBD), and forms that do not meet established criteria for these definite categories and are designated as undifferentiated SpA (uSpA)2,3. Recently, classification criteria have been suggested by ASAS (Assessment in Spondyloarthritis International Society) for axial and peripheral SpA4,5. In contrast, DISH is a degenerative condition characterized by calcification and ossification of ligaments and entheseal sites in the axial and the peripheral skeleton6. Classification criteria for DISH used so far require involvement of the spine6 although extravertebral bone proliferations are frequent and characteristic and may precede axial changes7,8. An international study for the development of new criteria is in progress8. At the beginning of the story, AS and DISH resembled each other only on radiographs because of the bony outgrowths they produce in the spine1. Clinically, they were considered very different diseases. Symptoms of AS begin at a young age, frequently in second and third decades, and consist of inflammatory back pain and buttock pain, reduced spinal movement, and progressive typical postural abnormalities known as “Bechterew stoop.” In contrast, DISH was considered a disease with an asymptomatic course or with mild dorsolumbar pain and/or some restriction of spinal motion. Radiographically, DISH is characterized by “flowing mantles” of ossifications occurring in the anterior longitudinal … Address correspondence to Dr. Olivieri, Rheumatology Department of Lucania-San Carlo Hospital, Contrada Macchia Romana, 85100-Potenza, Italy. E-mail: ignazioolivieri{at}tiscalinet.it

Clinical results of femoral shaft remodeling with tapered stems after total hip arthroplasty in the elderly patients

Objective To investigate periprosthetic femoral shaft remodeling with tapered femoral stems after total hip arthroplasty （THA） for elderly patients and evaluate the mid-term clinical outcomes.Methods The study involved 30 elderly （70-90 years） patients （34 hips） treated with femoral shaft remodeling with tapered stems after THA from January 2003 to January 2005. The postoperative X-ray images were collected and perioperative periprosthetic bone mineral density was analyzed by dual-energy X-ray absorptiometry （DEXA）. The Harris score was applied in follow-up observation, and Kaplan-Meier method was used to evaluate the working life of the femoral prosthesis. Results Four patients were died of lung cancer. The remaining 26 patients （ 30 hips） were followed up for 5-7 years （ mean, six years）. The postoperative X-ray measurements showed that total hip prosthesis subsidences were less than 1.5 mm within one year in 12 hips, with no prosthesis loosening observed. Bone proliferations were seen in Gruen zones 2, 3, 4, 5, 6, 11 and 12, and bone resorptions were seen in zones l and 7. DEXA showed that bone mineral density was increased in Gruen zones 2,3,4 and 5, but decreased mainly in Gruen zones 1,6 and 7. The increase of bone mineral density in zones 2 and 5 was faster compared to other sites six months after the operation （ P 〈 0.05 ） and the change of bone mineral density was prone to be stable in two years （ P 〉 0.05 ）. Within one year after initial implantation, periprosthetic bone mineral density was significantly decreased （ P 〈 0.05 ）. Two years after the operation, rare changes of periprosthetic bone mineral density were found （ P 〉 0.05 ）, with only regional redistribution of bone mass from the proximal to the distal femur. The Harris score of hip joint function was increased from preoperative 38.56 ± 8.21 to 86.32 ± 6. 01 at the final follow-up. The 6-year survival rate of the prosthesis was 100%. Conclusion Femoral shaft remodeling with tapered stems after total hip arthroplasty for the elderly patients shows good periprosthetic bone remodeling and satisfactory mid-term clinical results. Key words: Arthroplasty, replacement, hip; Hip prosthesis ; Bone remodeling

Heel Enthesopathy of Diffuse Idiopathic Skeletal Hyperostosis Resembling Enthesitis of Spondyloarthritis

Diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) are 2 clearly different disease entities having in common the involvement of the axial skeleton and the peripheral entheses1,2. Both diseases produce bone proliferation in the spine and at the extraspinal entheseal sites in the later phases of their course. Although the aspects of the bone proliferations of the 2 diseases are dissimilar, confusion …

Diffuse idiopathic skeletal hyperostosis: Differentiation from ankylosing spondylitis

Diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) share involvement of the axial skeleton and peripheral entheses. Both diseases produce bone proliferations in the later phases of their course. Although the aspect of these bone proliferations is dissimilar, confusion of radiologic differential diagnosis between the two diseases exists mostly as a consequence of a lack of awareness of their characteristic clinical and radiographic features. The confusion may extend to the clinical field because both advanced DISH and advanced AS may cause the same limitations of spinal mobility and postural abnormalities. However, the radiologic spinal findings are so different that changes due to each disease can be recognized even in patients in whom both diseases occur. This article reviews the clinical and radiologic characteristics that should help clinicians differentiate between the two diseases without much difficulty.

Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis

The aim of the present study was to assess ultrasonography (US) for the detection of inflammatory and destructive changes in finger and toe joints, tendons, and entheses in patients with psoriasis-associated arthritis (PsA) by comparison with magnetic resonance imaging (MRI), projection radiography (x-ray), and clinical findings. Fifteen patients with PsA, 5 with rheumatoid arthritis (RA), and 5 healthy control persons were examined by means of US, contrast-enhanced MRI, x-ray, and clinical assessment. Each joint of the 2nd–5th finger (metacarpophalangeal joints, proximal interphalangeal [PIP] joints, and distal interphalangeal [DIP] joints) and 1st–5th metatarsophalangeal joints of both hands and feet were assessed with US for the presence of synovitis, bone erosions, bone proliferations, and capsular/extracapsular power Doppler signal (only in the PIP joints). The 2nd–5th flexor and extensor tendons of the fingers were assessed for the presence of insertional changes and tenosynovitis. One hand was assessed by means of MRI for the aforementioned changes. X-rays of both hands and feet were assessed for bone erosions and proliferations. US was repeated in 8 persons by another ultrasonographer. US and MRI were more sensitive to inflammatory and destructive changes than x-ray and clinical examination, and US showed a good interobserver agreement for bone changes (median 96% absolute agreement) and lower interobserver agreement for inflammatory changes (median 92% absolute agreement). A high absolute agreement (85% to 100%) for all destructive changes and a more moderate absolute agreement (73% to 100%) for the inflammatory pathologies were found between US and MRI. US detected a higher frequency of DIP joint changes in the PsA patients compared with RA patients. In particular, bone changes were found exclusively in PsA DIP joints. Furthermore, bone proliferations were more common and tenosynovitis was less frequent in PsA than RA. For other pathologies, no disease-specific pattern was observed. US and MRI have major potential for improved examination of joints, tendons, and entheses in fingers and toes of patients with PsA.

Assessment of cytological criteria for diagnosing osteosarcoma in dogs

To evaluate the specific cytological criteria of osteosarcomas in dogs. Significant cytological characteristics of osteosarcoma and benign mesenchymal bone proliferations were determined from imprint smears of 25 dogs with osteosarcoma (group 1) and 20 dogs admitted for removal of surgical bone implants after uncomplicated healing of bone fractures (group 2). Mild to moderate cellular necrosis occurred frequently in patients with osteosarcoma. The cytoplasm of osteoblasts was pale blue to blue with a more pronounced basophilia in group 2. In 48 per cent of the patients in group 1, but none in group 2, osteoblasts showed a slight to moderate eosinophilic cytoplasmic granulation. In both groups, osteoblasts contained one red to pale blue nucleus with one or two grey-red to blue nucleoli in group 2. Forty-four per cent of animals in group 1 had osteoblasts with more than two nucleoli per nucleus. The median nuclear:cytoplasmic ratio was higher in group 1 (1:2.0) than in group 2 (1:3.5). Osteoblasts in group I were frequently seen to have a clumped chromatin pattern and showed significantly more criteria of malignancy (median six criteria per patient) than those in group 2 (median two criteria per patient). In group 1, mitoses of osteoblasts were detectable in 23 of 25 dogs, whereas only one dog in group 2 had evidence of mitotic osteoblasts. Cytological criteria can be helpful in the diagnosis of canine osteosarcoma.

Proliferative bone lesions in rats fed a diet containing glucocorticoid for up to two years.

A glucocorticoid was fed in the diet to 50 Sprague-Dawley rats/sex at 0, 0.03, 0.06, 0.12, 0.25, 0.50, and 1.0 mg/kg/day for up to 2 yr. A total of 1,400 rats were examined. Bone neoplasms (5 osteosarcomas and 2 osteomas), involving the head, occurred in 7 males that were fed the test compound at the highest dose (0.25 mg/kg) with long-term survivors. One osteoma and 1 hyperostotic lesion were seen in 2 males receiving lower doses (0.06 mg/kg and 0.12 mg/kg, respectively); 1 female rat that received the highest dose (1 mg/kg) had an osteosarcoma. The results suggest, but do not confirm, a relationship between glucocorticoid exposure and bone proliferations in male Sprague-Dawley rats. Other proliferative bone lesions included hyperostosis in a 0.12-mg/kg male, osteoma in a 0.06-mg/kg male, and osteosarcoma in 1 female at 1.0 mg/kg. The purpose of this report is to characterize the incidence and morphology of primary bone proliferative lesions found in rats of 1-yr glucocorticoid toxicity and 2-yr carcinogenicity studies conducted in our laboratory.

病的骨折を起こした低リン血症性ビタミンＤ抵抗性クル病未治療成人例の一例

A 52-year-old man was admitted with medial neck fracture of the right femur. This fracture occurred when he stood up from a sitting position. He had a peculiar short stature.: 140cm in height; 59kg in weight with bilateral bow legs. Laboratory examinations showed hypophosphatemia with normocalcemia, increased level of serum alkalinephosphatase and normal levels of PTH, 25(OH)D3, and 1, 25(OH)2D3. Radiological findings showed Looser's zone in the subtrochanteric region of the right femur, osteoarthritic changes in many joints and exostotic bone proliferations at the site of ligamentous and tendinous insertions.The architecture of cancellous bone was atrophic with a coarse trabecular pattern. Histological examination showed the increase of osteoid. Therefore he was diagnosed as an untreated adult case of hypophosphatemic vit. D resistant rickets. We guess that the cause of this pathological fracture is weakness of the bone and increase of the shearing force on the femoral neck due to varus deformity of the femur. Failure of intestinal phosphate absorption may play a role in hypophosphatemia in this case.

On the So-called "Isolated Bone Fragment" in the Maxillary Sinus Found in Jomon Skulls from Hokkaido

Unusual bone proliferations within both maxillary sinuses of two skulls (No.2-child and No. 6-adult) belonging to the Late Jomon period excavated from the shell-mound of the Mitsuya cave site in southern Hokkaido were described and discussed from the palaeopathological point of view.Smooth surfaced bone proliferation in the maxillary sinus was characterized by a large and ellipsoid bone mass which had many bone-bridges or foot-like processes combining with the original sinus wall which seems to be within normal conditions. Gross observation of an enlarged slab X-ray of the proliferated area revealed the normal bone structure, i, e., a fine mesh-work of spongy bone enclosed by the dense compact bone of the outer layer.Palaeopathological diagnosis of these conditions seems to indicate this bone mass to be a so-called "Isolated Bone Fragment (IBF)" which is often encountered in the clinical field of otorhinolaryngology. On the differential diagnosis of "IBF ", the following diseases, which may often produce similar changes in the gross or X-ray examination of the maxillary sinus, were discussed;1. Periostitis caused by chronic sinuitis (sinuitis chr. ossificans).2. Benign osteoma or ossifying fibroma in the paranasal cavity.3. Malignant bone proliferation in the sinus.4. Antrolith or calcareous body in the sinus.5. Abnormal growth of the tooth into the maxillary sinus.There still remain some important problems to be solved with regards to the " IBF ", e, g., the etiology, including essential differences between " IBF " and osteoma, frequency, and genetic background. In particular, the genetic factor or familial occurrence of " IBF ", which seems to have been suggested in the present investigation, is one of the most interresting problems.