Paget disease of bone

Case contributed by Dr Björn Jobke

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 histo-pathological 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. prox. femur or single vertebrae. 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 reduced bone remodeling markers. 

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Case information

rID: 39303
Published: 31st Aug 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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