Co-existent Paget’s Disease of the Bone, Prostate Carcinoma Skeletal Metastases and Fracture on Skeletal Scintigraphy-Lessons to be Learned

Sonoda, Luke; Balan, Kottekkattu

doi:10.4274/mirt.135

Cited by 8 publications

(10 citation statements)

References 8 publications

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“…Pagetic bone can be hard to differentiate from metastases,[ 21 ] especially since Paget's disease of bone and osseous metastases often coexist. [ 22 ] This possibility must be considered to avoid mistaken diagnosis and ensure the correct staging and treatment of patients. The patients in this study demonstrated typical imaging findings: osteolytic areas, cortical thickening, loss of distinction between cortex and medulla, trabecular thickening, osteosclerosis, bone expansion, and bone deformity.…”

Section: Discussionmentioning

confidence: 99%

Paget's disease of bone in Tunisia: A study of 69 patients

Maatallah¹,

Rahmouni²,

Miladi

et al. 2020

Indian J Endocr Metab

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Context: Paget's disease of bone is a common bone disease with a striking variation in its incidence and characteristics in different parts of the world. It is uncommonly reported in African patients. Aims: Given the lack of studies describing the characteristics of patients with Paget's disease of bone in North Africa, we aimed to describe demographic, clinical, biochemical, and imaging characteristics, as well as treatment outcomes of Tunisian patients with Paget's disease of bone. Subjects and Methods: This bicentric and retrospective study included patients with Paget's disease of bone. Clinical, laboratory, radiological profile, and response to treatment were analyzed. Results: Sixty-nine patients were identified. The mean age was 64.9 ± 11.6 years and 52.2% were women. One patient reported a positive family history. Seven patients were asymptomatic. Bone pain was the most common presenting symptom. Eight patients had a history of malignancy. In three patients, Paget's disease of bone was diagnosed as part of a metastatic workup. Monostotic disease was found in half of the cases. The most commonly involved sites were pelvis (43.5%), femur (21.7%), and spine (21.7%). The mean serum alkaline phosphatase level at presentation was 591 U/L (68–8380). Two patients received salmon calcitonin (2.8%) and 47 patients (68.1%) received bisphosphonates. After a mean follow-up of 55 months (2–240 months), bone pain improved in 43.1% of patients and the serum alkaline phosphate levels had normalized in 22 of them (43.1%). During follow-up, there was no malignant transformation. Conclusions: In this series of Tunisian patients, Paget's disease of bone had a female predominance and was usually monostotic. The clinical and radiological presentations were similar to the European series.

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Section: Discussionmentioning

confidence: 99%

Paget's disease of bone in Tunisia: A study of 69 patients

Maatallah¹,

Rahmouni²,

Miladi

et al. 2020

Indian J Endocr Metab

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“…Among the previously published cases that reported coexistence of PDB and metastatic bone disease, the primary sites of malignancy were the breast, lung, and prostate. [18][19][20][21] In our patient, the final diagnosis of metastatic bone disease secondary to adenocarcinoma of the lung was found after PDB was diagnosed by bone biopsy. As illustrated in the case, three modalities, including radiography, bone biopsy and 18 F-FDG PET/CT were utilized in the diagnostic process.…”

Section: Discussionmentioning

confidence: 88%

Metastatic Bone Disease Secondary to Bronchial Adenocarcinoma in a Patient with Paget’s Disease of the Bone

Lim

Kok

Kamaruddin

2018

JAFES

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A 69-year-old female complained of intermittent left hip pain for the past 3 years. Biochemical tests revealed normal serum calcium and phosphorus with markedly raised alkaline phosphatase. MRI of the hip revealed extensive marrow signal abnormalities at the left pelvic bone, while CT of the thorax revealed a spiculated lung nodule at the left lower lung lobe. In order to diagnose either primary, metastatic bone tumour or Paget's disease of the bone (PDB), an open biopsy of the left iliac bone was performed. The histopathology of bone biopsy of the left iliac bone was consistent with PDB. A CT guided biopsy of the lung mass done later revealed adenocarcinoma of the lung. She had 18 F-FDG PET-CECT Scan for staging evaluation and result was suggestive of new bony metastases. Patient was started on IV Zoledronic acid for treatment of the PDB. In view of the stage 4 lung adenocarcinoma with bony metastases, patient was scheduled for palliative chemotherapy.

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“…[ 3 ] Paget’s disease also tends to preserve anatomic details while metastatic disease tends to obscure anatomy. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

Synchronous osseous metastasis, degenerative changes, and incidental multifocal Paget's disease in a case of newly diagnosed prostatic carcinoma

2020

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Tc-99m methylene diphosphonate bone scintigraphy (bone scan) is a highly sensitive technique for the evaluation of osseous pathology. However, the nonspecificity of the method can present diagnostic challenges in differentiating benign from malignant processes. Often, Paget’s disease and osseous metastasis can coexist in elderly patients. Therefore, it is important to accurately distinguish the two pathologies, as each has a different prognosis and impacts clinical management. Obtaining the appropriate clinical diagnosis often involves a combination of laboratory, radiographic, and clinical data. We present a case of newly diagnosed prostatic carcinoma presenting with synchronous osseous metastasis, degenerative changes, and incidental multifocal Paget’s disease.

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Co-existent Paget’s Disease of the Bone, Prostate Carcinoma Skeletal Metastases and Fracture on Skeletal Scintigraphy-Lessons to be Learned

Cited by 8 publications

References 8 publications

Paget's disease of bone in Tunisia: A study of 69 patients

Paget's disease of bone in Tunisia: A study of 69 patients

Metastatic Bone Disease Secondary to Bronchial Adenocarcinoma in a Patient with Paget’s Disease of the Bone

Synchronous osseous metastasis, degenerative changes, and incidental multifocal Paget's disease in a case of newly diagnosed prostatic carcinoma

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