Differential Diagnosis Of Lytic Lesions Research Articles

A rare case of tertiary syphilis spondylodiscitis of the upper cervical spine: Diagnostic and therapeutic complexity, review of literature.

Syphilis is a sexually transmitted disease caused by the spirochetes Treponema pallidum. Syphilitic spinal lesions present as erosive bone lesions often simulating spondylodiscitis or cancer. In this article we describe a rare case of cervical osteolytic lesion from tertiary syphilis. A 45-year-old male with axial neck pain, without fever presented with an isolated osteolytic lesion at C3. Tuberculous spondylitis was initially suspected. A new CT and contrast enhanced MRI of the cervical spine and of the neck showed an extention of the bone lesion at C3 with bilateral lymphadenomegaly. To confirm the diagnosis of tertiary syphilis, US-guided biopsy of the lymph nodes was performed. The patient was treated with i.m. benzylpenicillin 2.4 MIU and the follow-up showed clinical and radiological resolution of the condition. The aim of this case report is to raise awareness of tertiary syphilis in the differential diagnosis of lytic lesions of the spine among the spinal community.

Primary Adenocarcinoma of middle ear with intracranial and parotid extension A rare case and literature review

Adenocarcinoma of middle ear is a rare tumor, few cases were reported in literature. Primary middle ear adenocarcinoma is locally invasive neoplasm arises from middle ear mucosa. These tumors may or may not be associated with Chronic Suppurative Otitis media. These tumors tend to have slow growth pattern and have an infrequent incidence of distant metastasis, recurrence is also a common problem. . They should be considered in the differential diagnosis of lytic lesions of the temporal bone on imaging. We reported a histologically proven case of adenocarcinoma of middle ear with intracranial and parotid extension in 24yr old female patient that was successfully managed. If managed early they have a very god prognosis with a 5-year survival of 70% has been reported for low-grade adenocarcinomas. Keywords: Adenocarcinoma, middle ear, invasive neoplasm.

Monostotic Paget Disease of the Lumbar Vertebrae: A Pathological Mimicker.

Paget disease is a metabolic disorder involving abnormal bone turnover that consists of 3 phases: the initial lytic phase, the intermediate mixed phase, and the chronic sclerotic phase. Paget disease mostly presents as polyostotic or monostotic lesions of the spine, and is rare on the Indian subcontinent. We present a case of isolated Paget disease of the lumbar third vertebra, which was confirmed only at biopsy. The patient presented with chronic low backache with a developing neurological deficit. We managed the patient with posterior spinal stabilisation, using pedicular screws and vertebroplasty of the collapsed vertebrae to regain the height. Upon the diagnosis of Paget disease, the patient was treated with calcitonin and bisphosphonates for 3 months, along with regular monitoring of alkaline phosphatase levels. Through this case, we hope to emphasize that Paget disease should be considered in the differential diagnosis of lytic lesions. Additionally, the alkaline phosphatase level in this patient was high-normal, which was an aspect of the role of Paget disease as a mimicker. Confirmatory biopsy is mandatory in all lesions.

The chordoma arised from ilium: A rare case report

Chordomas are malignant tumors that originate in embryonic notochordal remnants. The sacrum and skull are the most common sites; the mobile spine and other bones are extremely rare sites. We describe a 45-year-old man who presented with a lytic lesion in his left ilium. Imaging and pathology of a biopsy specimen suggested a malignant bone tumor; wide resection was accordingly performed. The morphology and immunohistochemistry of the operative specimen showed obvious characteristics of classic chordoma. To our knowledge, this is the first reported case of a chordoma originating in the ilium. Chordoma should therefore be considered in the differential diagnosis of lytic lesions in the ilium.

English

We report a rare case of osteogenic sarcoma of zygomatic arch presenting in a 20 year old male patient and a review of world literature on incidence and imaging. Craniofacial osteosarcomas are rare primary malignant bone tumours. This paper presents a case of osteogenic sarcoma of left zygomatic arch, showing erosion of middle aspect of left zygomatic arch with sun-ray spicules noted perpendicular to the cortex with multiple conglomerated new bone formation and associated soft tissue swelling extending inferiorly into the left infratemporal fossa and later diagnosed as osteosarcoma with chondroblastic differentiation. In head and neck, the most common sites of origin are the mandible, maxilla, nasal septum, hard palate and skull vault. More than 50% of craniofascial osteosarcomas arise in the jaw. Mandible is more commonly affected than maxilla. Zygomatic arch is a very rare site of involvement. Osteosarcoma should be considered in the differential diagnosis of lytic lesions with associated soft tissue swelling of zygomatic arch. Only four cases of primary osteogenic sarcoma of zygomatic arch have been reported in the English- language

Early adult-onset orbital apex Langerhans cell histiocytosis histologically confirmed during “truly spontaneous” regression

Dear Editor, There are few reports addressing the appearance of Langerhans cell histiocytosis (LCH) in the sphenoid sinus and superior orbital fissure region [8], despite many reports of fronto-orbital LCH. We present an early adult case of left orbital apex LCH that was histologically confirmed during spontaneous regression. In the present case, regression was observed before any therapeutic intervention so that the regression in this case can be described for certain as “truly spontaneous” regression, not subsequent to any intervention. A 22-year-old man had an acute intermittent throbbing pain in the left temporal region that lasted for 2 days. After the pain subsided, he developed blurred vision of the left eye. The blurred vision of the left eye improved the following week. Magnetic resonance imaging (MRI) showed an enhanced left orbital apex lesion involving the sphenoid sinus (Fig. 1a). Despite gradual regression on follow-up MRI (Fig. 1f–j), optical coherence tomography revealed irreversible retinal damage of the left eye (Fig. 1b). For histological diagnosis to set the therapeutic strategy for the regressing orbital lesion, endoscopic endonasal biopsy confirmed the orbital lesion in the course of regression was LCH (Fig. 1d, e). Systemic work-up showed no further LCH lesions in other regions. This single-system, singlesite LCH has been kept under careful observation and follow-up. The orbital LCH shrank back to almost normal structure over 7 months after the regression occurred. While five reports of regressed orbital LCH are available [2–4, 6, 7], in each case, regression occurred after therapeutic interventions such as surgery or biopsy. Among them, our case is the first of adult LCH with spontaneous regression. We also have a paediatric case of regressed isolated neurohypophyseal LCH with diabetes insipidus [5], in which regression occurred after biopsy. Although “spontaneous regression” is often used in case reports of various fields, “truly spontaneous” regression is, in reality, extremely rare [9]. Differential diagnosis of lesions involving the orbital wall includes dermoid cysts, lymphangioma, mucocele, meningioma, tumours of the lachrymal gland, primary bone and soft tissue tumours, and metastases [10]. Adult onset LCH, though rare, should be included in the differential diagnosis of lytic lesions of the lateral orbital wall in an adult patient. Histopathological confirmation is crucial in fluctuating orbital lesions like in this case, because exclusion diagnosis from malignancies or from potentially recurrent lesions should be given. Spontaneous regression of cancer is well K. Satoh :Y. Yoneoka (*) Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan e-mail: yone@bri.niigata-u.ac.jp

Lymphangiomatosis: a differential diagnosis of lytic lesions of the temporal bone

We report a histologically proved case of lymphangiomatosis of the skull, involving the temporal bone and presenting as multiple lytic bone lesions. A case report and a review of the literature concerning lymphangiomatosis are presented. Lymphangiomatosis affecting bones is a rare disorder caused by a congenital malformation of the lymphatic system, resulting in diffuse proliferation of the lymphatic channels and involving bones, parenchymal organs and soft tissue. Involved bones show massive osteolysis and progressive, localised bone resorption. Lymphangiomatosis should be kept in mind in the differential diagnosis of lytic lesions of the skull.

LYMPHANGIOMA OF THE CLIVUS

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.

Adult onset Langerhans cell histiocytosis of the orbit - A case report

purpose To report an interesting case of adult onset Langerhans cell histiocytosis in a 41-year-old male with clinicopathological correlation. design Interventional case report. materials and methods A 41-year-old male presented with an ill-defined mass occupying the temporal quadrant of the left orbit. Computerized tomography revealed an ill-defined extraconal mass involving the superolateral aspect of the left orbit with areas of osteolysis involving the lateral and superior orbital walls. The mass excised at orbitotomy showed microscopic features consistent with Langerhans cell histiocytosis. Immunohistochemistry with CD-68 macrophage marker and S-100 was positive, confirming the diagnosis. Treatment included oral steroids and radiotherapy. At 6 months follow-up, he developed a punched-out lytic lesion in the left parietal calvarium. He again received external beam radiotherapy. At 14 months follow-up, he is doing well with no recurrences. conclusions Adult onset Langerhans cell histiocytosis, though rare, should be included in the differential diagnosis of lytic lesions of the lateral orbital wall in an adult patient.

Eosinophilic Granuloma of the Proximal Tibial Epiphysis

This is a 3-year follow-up report of an eosinophilic granuloma of bone occurring in a growing epiphysis. The lesion occurred in a 6-year-old boy and is only the third such case reported in the literature. Eosinophilic granuloma should be considered in the differential diagnosis of lytic lesions of the epiphysis in childhood.

Mediastinal Gastric Cyst

Staehelin-Burckhardt, 1 in 1909, first described the unusual finding of a gastric-lined cyst in the mediastinum. Since that time, many similar cases have been recorded in the literature. In only one instance, however, has this medical oddity been reported to involve the thoracic vertebrae. Mixter and Clifford 2 described such a patient in 1929. The following case, the second to be reported, is presented to emphasize this unusual area of involvement. It also represents a curable condition which should be considered in the differential diagnosis of lytic lesions in the thoracic spine. Report of Case A 42-month-old white boy was admitted to a military hospital with the chief complaint of severe episodic pain in the right hemithorax. It was located in the anterolateral chest at approximately the nipple level and had been intermittently present during the preceding 18 months. The pain appeared to come on without relationship to meals, exercise,