Paget disease of bone

Case contributed by Dr Björn Jobke

Presentation

Patient with pain in the left pelvis for several years. Occasional heat sensation.

Patient Data

Age: 66
Gender: Female
Modality: X-ray

Coarse bony structure and increased density of the entire left hemi-pelvis incl. iliac wing, adjacent left sacral massa lateralis and femoral head. 

Modality: Pathology

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

Case Discussion

The radiographic and histo-pathological image presentation in Paget disease of bone is pathognomonic.

Coarse bone structure, generally limited to one bone or one part of a bone, e.g. prox. femur or single vertebrae. In the presented case the bony changes are extensive and breach over joints, not seen frequently. 

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

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

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Case Information

rID: 39303
Case created: 30th Aug 2015
Last edited: 5th Oct 2015
Inclusion in quiz mode: Included

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