IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Paget disease of bone

Case contributed by Björn Jobke
Diagnosis certain

Presentation

Several years of left sided pelvic pain. Occasional heat sensation.

Patient Data

Age: 65 years
Gender: Female
x-ray

Coarse bony structure and increased density of the entire left hemipelvis including the iliac wing, adjacent left sacral massa lateralis, and femoral head. The irregular, dense trabecular structure involves spongeous as well as cortical bone.

pathology

A bone core cylinder  from the iliac wing (cortex on the right) demonstrates irregular woven bone formations with excessive osteoid surfaces.

Intertrabecular fibrosis with high vascularity and focal lymphocyte accumulation. Higher magnifications shows deep resorption lacunae with multiple, large osteoclasts.

Case Discussion

The radiographic and histopathological image presentation in Paget disease of bone is pathognomonic.

Coarse bone structure is generally limited to one bone or one part of a bone, e.g. proximal femur or single vertebra. In the presented case, the bony changes are extensive and breach over joints, not typical for Paget disease.

Deep resorption lacunae and osteoclasts with >10 nuclei are characteristic signs of the focal osseous disease and relate to unbalanced bone remodeling. 

Patients are generally older and often present with long standing deep and dull pain. Antiresorptive medication may ameliorate symptoms and reduce bone remodeling markers. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.