Korean J Radiol.  2013 Dec;14(6):946-950. 10.3348/kjr.2013.14.6.946.

A Case of an Idiopathic Massive Osteolysis with Skip Lesions

• Ozbayrak M
• Yilmaz MH
• Kantarci F
• Ozer H
• Harmanci K
• Babacan M
• Dervisoglu S

• KMID: 1711462
• DOI: http://doi.org/10.3348/kjr.2013.14.6.946

Abstract

A patient with a 2-year history of pain in the left arm, and decreased strengths unrelieved by non-steroidal anti-inflammatory therapy, was being referred for repeating radiography. The radiologic examinations have demonstrated a unique pattern of non-contiguous osteolysis in the left elbow, proximal and distal radius, ulna, wrist, carpal bones, proximal and distal metacarpals and phalanges. Multi-site biopsies were being performed and confirmed the diagnosis of massive osteolysis. To our knowledge, this is the first case in which multifocal, non-contiguous osteolysis with skip lesions without associated nephropathy and without a hereditary pattern is being described in one extremity.

Keyword

Idiopathic osteolysis; Gorham-Stout syndrome; Disappearing bone disease

MeSH Terms

Adult
Biopsy, Fine-Needle
Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Male
Osteolysis, Essential/*diagnosis
Tomography, X-Ray Computed/*methods
Ulna/*pathology/radiography

Figure

• 

  Fig. 1 Massive osteolysis with skip lesions in 38-year-old man. Plain radiography of upper left extremity demonstrate almost complete osteolysis of left elbow (A), proximal radius (B), distal radius and ulna, wrist and carpal bones (C), proximal and distal metacarpals and phalanges (D). Bone scintigraphy showed increased activities in osteolysed region: elbow (E), wrist and carpal bones and phalanges (F). Sagittal MR images demonstrated that soft tissue masses and affected bones were hypointense to isointense with muscle on T1-weighted imaging (G) and were of heterogenous signal intensity on T2-weighted imaging (H). (I) Photomicrograph (Hematoxylin and eosin, original magnification × 200) revealed fibrous tissue containing proliferated vascular structures replaced with bone trabeculae and bone marrow.

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