Multiple Lytic Lesions Research Articles

Langerhans' Cell Histiocytosis Masquerading as Metastatic Papillary Thyroid Cancer on F-18 FDG PET/CT: Diagnostic Dilemma Solved by PET/CT-Guided Biopsy.

We present a case of papillary thyroid cancer (post-thyroidectomy status) on regular treatment with suppressive Levothyroxine therapy. On follow-up at 6months after radioactive iodine ablation for remnant thyroid tissue, her thyroglobulin, and anti-thyroglobulin levels were 0.06ng/ml and 670IU/ml, respectively. Low-dose whole-body I-131 scan was negative. To look for the cause of isolated increased anti-thyroglobulin level, a whole-body 18F-FDG PET/CT was done which revealed multiple FDG-avid lytic skeletal lesions suggestive of metastases. For confirmation of diagnosis, 18F-FDG PET/CT-guided metabolic biopsy was done, which revealed Langerhans' cell histiocytosis on histopathological examination.

Maffucci Syndrome with Clival Enchondroma in Nasopharynx: A Case Report.

Maffucci syndrome is an extremely rare sporadic disease, characterized by multiple enchondromas and associated with multiple hemangiomas and/or lymphangiomas. First case was reported in 1881, and fewer than 200 case have been reported to date. Potential sarcomatous malignant transformation have been noticed in previous cases. This report describes the case of 21years-old male complain of right sided nasal obstruction for 10months, and right sided aural fullness. Examination revealed multiple asymptomatic nodules in both hands since childhood, that have not been investigated and a large nasopharyngeal mass. Computed tomography, showed a 36mm in 30mm diameter lesion extending from the inferior aspect of the clivus and basisphenoid into the nasopharynx, which did not seems to be highly vascular with angiogram. Incidental radiological findings of multiple bubbly lytic bony lesions. Endoscopic sinus surgery and clival lesion excision was performed. Pathology confirmed diagnosis of clival enchondroma with clinical and radiological features consistent with Maffucci syndrome. Clear etiology have not been established yet. Mutations in gene encoding parathyroid hormone receptor 1 found in 10% of enchondromatosis. Mutations in gene encoding isocitrate dehydrogenase 1 and 2 (IDH 1&2) occur in some enchondromas and spindle cell hemangiomas. Maffucci syndrome usually presents with asymmetrical distribution of multiple enchondromas. Malignant transformation is the most concerning potential sequel. Many studies have shown sarcomatous degeneration of enchondromas to chondrosarcomas in average of 25% of cases. Patient counselling and education are crucial in the management. Surgical excision usually for symptomatic patients and suspicious lesions. Nevertheless, all patient of Maffucci syndrome will require a long term follow up and surveillance for the lifelong risk of malignant transformation. Maffucci syndrome diagnosis based on clinical presentation, radiological and histopathological findings. Surgical excision offered for symptomatic patients and for suspicious lesions. Lifelong risk of sarcomatous malignant transformation necessitate a long term surveillance.

Clinical Picture: Madura Foot

Madura foot is a chronic infection of the skin and underlying tissues caused by both bacteria (actinomycotic mycetoma or actinomycetomas) and fungi (eumycetomas or mycotic mycetoma). Mycetoma occurs most often in people who work in rural areas, usually in farmers, hunter-gatherer populations, and field laborer. The disease was first described in the Indian town of Madura. Lower extremities involvement is more common. Our patient, 26-year-old agricultural worker, presented with 1-year history of recurrent swellings, itching, and chronic purulent discharge from his right foot. On examination, he had multiple small swellings of the right foot and indurations with sinus tracts discharging pus. The classic clinical triad of mycetoma is soft tissue swelling, sinus tracts, and characteristic macroscopic grains. Grains contain aggregates of the causative organisms that may be discharged onto the skin surface through multiple sinuses. Bone radiography may show cortical thinning, cortical hypertrophy, or multiple lytic lesions. Disuse osteoporosis may occur in late stages mycetoma. Medical therapy in a form of antibiotic or antifungal alone may be sufficient for actinomycetoma, but surgery is generally needed for eumycetoma. Madura foot is an uncommon entity in the west but still seen in the rural areas of India.

Treatment of Relapsed Myeloma in a Patient With Renal Insufficiency.

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 45-year-old man was diagnosed in March 2010 with stage III immunoglobulin G kappa multiple myeloma (MM) after presenting with bone pain as a result of multiple lytic bone lesions and T12 vertebral collapse. Laboratory work-up showed a serum M protein of 72 g/L and a 24-hour kappa light-chain urine protein excretion of 730 mg, hemoglobin of 10.2 g/dL, serum albumin of 49 g/L, serum β2-microglobulin of 6.4 mg/L, serum creatinine level of 1.6 mg/dL with an estimated glomerular filtration rate (eGFR) of 47 mL/min/1.73 m2, and normal serum calcium and lactate dehydrogenase (LDH) levels. His bone marrow contained 58% plasma cells, which showed the 17p deletion abnormality (Fig 1). He was treated with vertebroplasty and alternating chemotherapy with carmustine, vincristine, cyclophosphamide, melphalan, and prednisone and vincristine, carmustine, doxorubicin and dexamethasone. Because of progressive disease, salvage therapy with bortezomib and dexamethasone was administered with no response. The patient was then switched to lenalidomide and dexamethasone, which yielded minimal response. He underwent autologous stem-cell transplantation (ASCT) with melphalan 200 mg/m2 as high-dose therapy in February 2011, which led to a partial response, but in December 2011, progressive disease was documented, and the patient was enrolled in a clinical trial of carfilzomib monotherapy, with stable disease for 33 cycles. In October 2014 serum M protein rose to 38.6 g/L, with 24-hour kappa light-chain urine protein excretion of 840 mg, serum creatinine of 2.1 mg/dL, and an eGFR of 41 mL/min/1.73 m2. He presented to discuss ongoing treatment options.

Non Secretory Multiple Myeloma With HCV Infection: A Rare Case Entity

Multiple Myeloma is a neoplasm of B cell lineage characterized by excessive proliferation of abnormal plasma cells. It is characterized by a clinical pentad of 1) anemia, 2) a monoclonal protein in the serum or the urine or both, 3) bone leisons and or bone pain, 4) hypercalcemia>11.5g/dl and 5) renal insufficiency. Non secretory multiple myeloma is a rare variant of the classic form of multiple myeloma and accounts for 1% to 5 % of all cases of multiple myeloma. The clinical presentation and radiographic findings of non-secretory multiple myeloma and multiple myeloma are the same. The diagnosis of multiple myeloma requires the demonstration of monoclonal gammopathy in the serum or urine. In non-secretory multiple myeloma, however no such gammopathy can be demonstrated, making the diagnosis more difficult. We describe a 60 year old woman who initially presented with back pain which when further investigated by complete blood count revealed hemoglobin of 13g/dl, Total Leukocyte Count of 10,890 and platelet count of 1.5 lac/cmm. Viral markers revealed HCV positive. Hypercalcemia with a serum calcium level of 12.5g/dl was also demonstrated. MRI revealed multiple lytic bony lesions. No monoclonal gammopathy was found in the serum or urine and bone marrow biopsy showed marked plasmacytosis of > 45%. We present a case of Non Secretory multiple myeloma because of its illusive nature and rare entity.

Multicystic Lesion in Jaws: A Rare Case Report on Gorlin-Goltz Syndrome

Background and Objectives: Gorlin-Goltz syndrome is an uncommon autosomal dominant inherited disorder, which is characterized by multiple odontogenickeratocysts (OKC) and basal cell carcinomas, skeletal, dental, ophthalmic and neurological abnormalities.Material and Methods: Thirteen years old male patient came with swelling of left maxilla obliterating buccal vestibule with pus discharge for 1 month. The orthopantomograph and computed tomography scan demonstrated multiple lytic lesions in maxilla and mandible. Incisional biopsy was suggestive of odontogenickeratocyst (OKC). Besides multiple OKCs; bifid ribs, palmer pits and hypertelorism were present supporting for the diagnosis as Gorlin-Goltz Syndrome.Results: The classical treatment of KCOT with enucleation with curettage or resection would have resulted in significant morbidity. Therefore we first decompressed and then enucleated the cysts.Conclusion: Gorlin-Goltz syndrome is a rare entity and the multiple KCOT can be managed with decompression followed by enucleation.Janaki Medical College Journal of Medical Sciences (2017) Vol. 5(2): 46-50

Multiple Lytic Lesions on F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography not Always Metastatic?

Multiple Lytic Lesions on F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography not Always Metastatic?

Multifocal Osseous Epithelioid Hemangioendothelioma Involving Extremities and Spine with Visceral Metastasis

AbstractEpithelioid hemangioendothelioma (EH) is a rare locally aggressive intermediate grade malignant vasoformative tumor. Bone is a rarer primary site accounting for less than 1% of all malignant bone tumors. Multicentricity and/or multifocality are a relatively frequent occurrence, most commonly clustered in the bones of lower extremities. The axial skeleton is less commonly affected, and concomitant visceral involvement is rarer. We report a unique case of a 20-year-old male who presented with multiple lytic lesions in the skull vault, vertebral bones, bilateral proximal femur, and both radii and humerii with metastasis to the lungs and liver. A final diagnosis of EH was established on biopsy from the right iliac bone. He initially received multiagent chemotherapy and is currently on antiangiogenic therapy. On follow-up positron emission tomography–computerized tomography done 6 months later, marked reduction in fluoro-D-glucose avidity of the hepatic and most skeletal lesions was noted.

A 6-month-old male infant refuses to move his left leg

Chronic granulomatous disease (CGD) is a rare, genetically heterogeneous condition that occur from mutations in NADPH oxidase, resulting in recurrent infections from catalase-positive organisms and granuloma formation. It is most commonly diagnosed within the first two years of life. We present a case of a six-month-old infant who presented with left tibial pain with initial concerns for child abuse and was found to have CGD. A skeletal survey revealed multiple lytic lesions, diffuse osteopenia, and opacities in the lungs. MRI revealed a tibial subperiosteal abscess and, after incision and drainage, cultures grew Serratia marcescens, an unusual catalase-positive organism. Targeted testing for immunodeficiency revealed 0% NADPH oxidase activity on nitro blue tetrazolium (NBT), confirming the diagnosis.

Metastatic Cancer in the Middle Age: The Possible Case of a Female Skeleton from Bormio (Italy)

AbstractSecondary signs of cancer are difficult to assess in the archaeological context, as other lesions may mimic metastases on dry bones. Furthermore, the low life expectancy, lower level of environmental cancer risk factors and pollution than the present times can contribute in limiting the frequency of signs of cancer in archaeological populations.This study focuses on a female adult skeleton from the necropolis of Bormio (North Italy), dating back to Middle Ages, which shows multiple lytic lesions on cranium, upper limbs, ribs and pelvis; lesions are oval in shape, with a diameter ranging from 1–2 to 80 mm. The lesions appearance and distribution at macroscopic and radiographic level, together with sex and age indications, suggest the diagnosis of metastatic cancer. Possible diagnostic hypotheses of the possible sites of original cancer were performed as well, based on modern epidemiological data. Copyright © 2017 John Wiley & Sons, Ltd.

Atypical radiographic features of multiple myeloma in a dog: a case report

A 12-year-old castrated male miniature pinscher dog presented with right forelimb lameness. An expansile osteolytic lesion of the right humerus was conspicuous on right forelimb radiographs. Thoracic and abdominal radiographs showed multiple lytic bone lesions on the right scapula, ribs, vertebrae, femurs and pelvis. Additionally, an expansile osteolytic lesion was observed in two thoracic vertebrae and two ribs. Many plasma cells were identified on fine-needle aspiration of the right humerus expansile osteolytic lesion, and monoclonal gammopathy consistent with multiple myeloma was confirmed on serum protein electrophoresis. The expansile osteolytic lesion, an extraordinary radiographic feature of multiple myeloma in dogs, should be considered as a possible radiographic finding of multiple myeloma.

A challenging case of anaplastic large-cell lymphoma with primary bony presentation

AbstractAnaplastic large-cell lymphoma (ALCL) is a distinct type of T-cell lymphoma showing varied clinicopathological features. The clinical entities identified are systemic and primary cutaneous types. ALK+ ALCL are more common in childhood with predominant nodal presentation. Extranodal involvement is commonly seen in the skin, bones, soft tissue, lung, liver, etc., Here, we present an intriguing case of ALK+ ALCL in an adult patient primarily presenting as multiple bony lytic lesions.

Acute Promyelocytic Leukaemia(APML) in an Adult Patient Presenting with Multiple Lytic Bony Lesions – The First of its Kind – A Case Report with Review of Literature

Acute Promyelocytic Leukaemia(APML) in an Adult Patient Presenting with Multiple Lytic Bony Lesions – The First of its Kind – A Case Report with Review of Literature

Unexpected Interference on Alere Triage B-Type Natriuretic Peptide Measurement.

A 75-year-old male who was recently diagnosed with multiple myeloma presented to the urgent care clinic with worsening swelling of legs, scrotum, and penis. Because of external pressure of the urethra (from the swelling), the patient experienced difficulty voiding urine. Radiology imaging showed multiple lytic lesions in the skull, ribs, and iliac bone. The patient had been treated with standard chemotherapy (cyclophosamide, bortezomib, and dexamethasone). The patient denied having local pain, fever, shortness of breath, headache, or diarrhea. He had a history of colorectal cancer and received chemotherapy, but had no evidence of colorectal cancer. Renal ultrasound and Doppler of the lower extremity was unremarkable for deep venous thrombosis. The patient's renal profile was suggestive of acute kidney injury (see chemistry and hematology results in Table 1). Magnesium, ammonia, potassium, carbon dioxide, chloride, calcium, bilirubin, alkaline phosphatase, aspartate transferase, alanine transferase, and anion gap were all within normal range. View this table: Table 1. Abnormal chemistry and hematology results. The possible causes for acute kidney injury include myeloma or hypoperfusion of kidney as a result of …

Aches and Pain in a child- An unusual cause

Precursor B-cell lymphoblastic lymphoma presenting with severe pain and extensive skeletal lesions as an initial presentation is very rare. We report a nine year old boy who presented with lower backache and difficulty in walking of 2 months duration. He neither had lymphadenopathy nor organomegaly. His peripheral blood picture and bone marrow examination were normal. MRI revealed multiple lytic lesions in the spine and PET scan revealed metabolically active lytic lesions in the axial skeletal system and bilateral femurs and humerus. Biopsy of the vertebra revealed the diagnosis of precursor B cell lymphoma. A diagnosis of malignancy should never be missed in a patient with musculoskeletal pain, having ruled out infectious and traumatic etiologies especially when they present with several skeletal radiolucencies.

Pulmonary Kaposi Sarcoma with Osseous Metastases in an Human Immunodeficiency Virus (HIV) Patient: A Remarkable Response to Highly Active Antiretroviral Therapy

Patient: Male, 34Final Diagnosis: Pulmonary Kaposi’s sarcoma with bony metastatsesSymptoms: Cough • weight lossMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Rare diseaseBackground:Kaposi sarcoma (KS) is known to involve the mucocutaneous tissues and the aero-digestive tracts. In acquired immune deficiency syndrome (AIDS) patients, KS has an aggressive course and carries poor prognosis. We present a case of pulmonary KS with osseous metastases as the first presentation of human immunodeficiency virus (HIV) infection in a young male. The lesions impressively decreased in size and numbers following initiation of highly active antiretroviral therapy (HAART).Case Report:A 34-year-old heterosexual male presented with a one month history of cough and 15–20 pound weight loss within six months. Examination revealed oral thrush, decreased breath sounds and crackles on the right lower lung base. Imaging showed a large right perihilar mass with multiple lytic lesions involving thoracic and lumber vertebrae, ribs, sternum, and clavicles. Blood and sputum cultures, smears for acid fast bacilli, and a QUANTIferon gold test were all negative. He tested positive for HIV and his CD4 count was 7 cells/uL. Bronchoscopy with biopsy was unrevealing. Pathology of the right hilar mass was diagnostic of KS. Following initiation of antiretroviral therapy his condition dramatically improved; repeat chest CT scan showed marked regression of the bony and pulmonary lesions.Conclusions:The dual action of HAART on the recovery of the immune system and against human herpes virus 8 (HHV-8) may essentially cause regression of KS lesions.

Progress of miR-214 and miR-135b in multiple myeloma bone disease

Multiple myeloma (MM) originates from malignant plasma cells, leading to multiple destructive lytic bone lesions that occur in more than 80 % of MM patients. MicroRNAs have been reported to be involved in the development of bone lesions in MM. However, it is still unclear that microRNAs can be considered as diagnostic and prognostic biomarkers for bone lesions. MiR-214 and miR-135b may participate in the pathogenesis of bone marrow, which has shown a certain guiding significance in its prognosis. This paper will introduce the relationship between miR-214, miR-135b and myeloma bone disease. Key words: Multiple myeloma bone disease; MiR-214; MiR-135b

Raised ?2-Microglobulin as a Surrogate Marker in Non-Secretory Multiple Myeloma

Multiple myeloma is a neoplasm of plasma cells in the bone marrow. It is characterised by lytic lesions in the bones, marrow plasmacytosis and presence of M protein in serum and/or urine. Serum ?2 microglobulin is also raised and can be used for classification and prognostication of the disease. In the absence of M protein, the disease is known as non-secretory myeloma. It is proposed that raised ?2 microglobulin can be used for diagnosis and therapeutic guidance in the absence of M protein. A rare case of nonsecretory myeloma with neurocognitive impairment along with review of literature is being presented. The patient had multiple lytic lesions in bones with marked increase in plasma cells in bone marrow. M protein was not detectable in serum or urine but serum ?2 microglobulin was much elevated.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.142-145

Aggressive primary hepatic epithelioid hemangioendothelioma: a case report and literature review.

A new case of epithelioid hemangioendothelioma is reported to have occurred to a 67-year-old patient who consulted for right-sided chest pain. The work-up showed multiple right pulmonary lesions associated with bilateral moderate pleural effusion and left-sided pleural thickening and three hypodense nodules in the right lobe of the liver, peritoneal thickening, ascites, and multiple vertebral lytic lesions. The diagnosis of an epithelioid hemangioendothelioma was concluded through a histological examination of a computed tomography scan guided biopsy of the liver. The patient received a primary mono-chemotherapy with Adriamycin (75 mg/m2 every three weeks) and intravenous bisphosphonates without response and general status impairment. The patient died after 16 months of follow-up.

Hypoglossal Nerve Mononeuropathy as the First Presenting Symptom of Progressing Multiple Myeloma

Multiple myeloma (MM) rarely presents with a primary neurological dysfunction, and if it does it is usually due to a plasmacytoma. This is the first case to discuss hypoglossal nerve dysfunction as the first sign of MM progression secondary to severe pathophysiologic bone lysis. A PubMed-based literature search was completed on April 17, 2016 for the terms “multiple myeloma” and “hypoglossal nerve neuropathy”. A 73-year-old woman with known MM who received little treatment for several years, presented secondary to dysarthria and at first was thought to have hyperviscosity syndrome. On further examination, it was found she had light chain disease and her symptoms were secondary to severe disease progression. Imaging revealed multiple lytic lesions in the skull on skeletal survey and brain MRI revealed boney lysis near the occipital condyle and clivus likely interfering with the coursing of the hypoglossal nerve. Advanced progressing MM can cause severe boney destruction which can interfere with cranial nerve canals and cause neuropathy as a presenting symptom.