Multifocal Osteolysis Research Articles

Computed tomography features of discospondylitis in dogs.

Computed tomography (CT) findings of dogs with discospondylitis have not been widely described despite increased availability of this imaging modality. Describe the CT features of discospondylitis in a population of clinically affected dogs with discospondylitis diagnosed by magnetic resonance imaging (MRI). Forty-one dogs (63 affected discs) with MRI-identified discospondylitis presented to a single referral hospital between 2012 and 2022. Retrospective, single center, descriptive case series with analysis of MRI-identified discospondylitis sites and concomitant CT imaging. Computed tomographic features of MRI-affected sites including intervertebral disc space (IVDS), endplates, vertebral body, epidural space and paraspinal tissues were described. The most frequently found changes were: (1) endplate involvement (87.3%) most frequently bilateral (94.5%), with erosion (61.9%) and multifocal osteolysis (67.3%); (2) periosteal proliferation adjacent to the IVDS (73%) and spondylosis (66.7%); and (3) vertebral body involvement (66.7%) involving one-third of the vertebra (85.7%) with multifocal osteolysis (73.5%). Other less prevalent features included an abnormal IVDS (narrowed or collapsed), sclerosis of the adjacent vertebral body or endplates, presence of disseminated idiopathic skeletal hyperostosis or vacuum artifact. We determined that bilateral endplate erosion and periosteal proliferation were very common in dogs with discospondylitis. Careful evaluation of CT in all 3 planes (dorsal, sagittal, transverse) is necessary to identify an affected IVDS. These described CT features can aid in the diagnosis of discospondylitis in dogs but equivocal cases might still require MRI.

Osteolysis and Lymphatic Anomalies: A Review of 54 Consecutive Cases

Progressive osteolysis caused by lympathic malformations is a rare condition that should be known by specialists involved in the study of lymphatic disorders because they are necessarily involved in the treatment. The purpose of the present study is to report on a large series of patients to illustrate the multiple clinical pictures and the wide range of therapeutic measures necessary for arresting bone destruction and lymphatic leak. Inclusion criteria were osteolysis associated with lymphatic malformation that required treatment. Diagnosis was based on history, plain X-rays, MRI, and demonstration of the lymphatic nature of the lesions with D2-40 immunohistochemistry. Treatment was based on resection of the bone lytic lesion or soft tissue lymphatic masses, control of chylothorax or chyloperitoneum, interferon, zoledronic acid, and radiotherapy. The study included 54 patients (25 females and 29 males) with a median age of 9 years (range 2 to 65). Eight patients had focal osteolysis without soft tissue lymphatic anomaly, 15 multifocal osteolysis without soft tissue lymphatic anomaly, 7 focal osteolysis associated with soft tissue lymphatic anomaly, and 24 multifocal osteolysis with soft tissue lymphatic anomaly. Among the wide variety of pharmacological therapies provided, only one protocol showed a consistent positive effect (end of ostelytic progression) in 17 patients who received a course of 6 to 15 months of interferon alpha-2B at 1.5 million units/m(2) body surface area/day in association with zoledronic acid at 0.05 mg/kg/month. Thirty-two patients underwent multiple surgical procedures in order to remove the soft tissue involved, correct orthopedic problems, or improve chylothorax, and three were treated with radiotherapy which was successful in one case. Osteolysis from lymphatic origin is a devastating surgical condition. Therapeutic options have to be considered separately if the disease is active or inactive and according to the targeted organ (skin, bone, or viscera). Total removal of the lymphatic anomaly is rarely possible, but its subtotal excision together with pharmacological antiangiogenic therapy in selected patients under surveillance of a multidisciplinary group familiarized with the disease, minimize the progression of both, lymphatic invasion, osteolysis, and their serious complications.

Multiple myeloma in 16 cats: a retrospective study

Background: There is limited published information regarding feline multiple myeloma. Diagnostic criteria are derived from canine studies and to our knowledge, have not been critically reviewed for cats. Objective: To evaluate the clinical and laboratory findings in cats with multiple myeloma and appraise diagnostic criteria. Methods: Retrospective evaluation of medical records was performed. Inclusion required an antemortem diagnosis of multiple myeloma using 2 of 4 criteria: 1) ≥20% plasma cells in the bone marrow, or ≥10% if atypical plasma cells; 2) paraproteinemia; 3) radiographically‐evident osteolysis; 4) light chain proteinuria. Alternatively, a postmortem diagnosis was based on the findings of multiple plasma cell neoplasms, with marrow involvement. Results: Sixteen cats were diagnosed with multiple myeloma between 1996 and 2004, with a median age of 14.0 years; 9 of 16 (56%) were castrated males, and 7 of 16 (44%) were spayed females. Laboratory abnormalities included hyperglobulinemia (14/16, 87.5%), with 11/14 (78.5%) monoclonal and 3/14 (21.4%) biclonal gammopathies; hypoalbuminemia (4/16, 25%); light chain proteinuria, (4/9, 44.4%); hypocholesterolemia (11/16, 68.7%); hypercalcemia, (3/15, 20%); nonregenerative anemia, (11/16, 68.7%); regenerative anemia, (1/16, 6.2%); neutropenia (5/15, 33.3%); thrombocytopenia (8/16, 50%); and marrow plasmacytosis (14/15, 93.3%). Plasma cells were markedly immature, atypical, or both in 10 of 12 (83.3%) cats. Focal or multifocal osteolysis was noted in 6 of 12 (50%) cats for which radiographs were available for review; generalized osteopenia was found in 1 (8.3%) cat. Noncutaneous, extramedullary tumors were found in all cats assessed, 7/7 (100%), including spleen (6), liver (3), and lymph nodes (4). The disease in 1 of 2 cats with cutaneous tumors progressed to plasmacytic leukemia. Conclusions: Common findings in feline multiple myeloma include atypical plasma cell morphology, hypocholesterolemia, anemia, bone lesions, and multi‐organ involvement. Based on the results of this study, we advocate modifying diagnostic criteria in cats to include consideration of plasma cell morphology and visceral organ infiltration.

Hypercalcemia may indicate Richter's syndrome

Hypercalcemia has rarely been reported in patients with Richter's syndrome (RS). In this article, the authors report four cases with complementary pathophysiologic examinations. Four patients with hypercalcemia that indicated RS were admitted to the study unit between 1980 and 1994 with the following diagnoses: transformation of mixed follicular lymphoma, Waldenstrom's macroglobulinemia, and chronic lymphocytic leukemia, respectively, in 3 men ages 60 to 73 years, and chronic lymphocytic leukemia in a woman 73 years of age. Radiologic and histologic features were reported. Circulating levels of parathormone-related peptide (PTHrP), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) were measured. Radiologic skeletal abnormalities were found in three of three cases: osteopenia twice and multifocal osteolysis once. All four patients had large cell lymphoma (LCL). Bone resorption assessed histomorphometrically was elevated in two of two cases. Serum TNF-alpha and IL-6 levels were high in three of three and one of three cases, respectively. Elevated values were also found in four patients with LCL but without hypercalcemia. The serum PTHrP level was increased in the only hypercalcemic patient tested and values were normal in the three control patients. Hypercalcemia arising in a patient with a low grade lymphoproliferative disorder may indicate RS. Hypercalcemia is due to increased bone resorption, which may be caused by the secretion of osteoclast-stimulating factors by the LCL invading the bone marrow. Independently, TNF-alpha and/or IL-6 were unlikely causative factors of hypercalcemia in the patients in this study; however, synergism with PTHrP was suspected in one case.

Die Knochenlymphangiomatose im Kindesalter*

Lymphangiomatosis of bone is a very rare congenital malformation of lymph vessels. So far 60 patients have been described with this disease (43 children, 17 adults). Radiologically the lymphangiomatous skeletal changes usually consist of circumscribed areas of uni- or multi-focal osteolysis. They may remain asymptomatic for years; in a few cases intrathoracic chylous effusions or pathological fractures have occurred. The protean radiological appearances of bone lymphangiomatosis are illustrated by four children. The differential diagnosis is discussed in detail.

Multifocal osteolysis with nephropathy.

A patient with progressive osteolysis of the carpal and tarsal bones with glomerulonephritis of unusual severity is described. There was a notable absence of osteodystrophy in this and other reported cases who had chronic renal failure.