Osteonecrosis Secondary to Paget′s disease: Radiologic and Pathologic Features

Abstract

Paget's disease (PD) is a chronic progressive disease of the bone characterized by abnormal bone metabolism affecting either a single bone (monostotic) or many bones (polyostotic) with uncertain etiology. We report a case of PD in a 70-year-old male, which was initially identified as osteonecrosis of the maxilla. Non-drug induced osteonecrosis in PD is rare and very few cases have been reported in the literature.

Saber tibia

“…En el presente caso, al haber un cambio reciente en la lesión con componente de partes blandas, se incluiría además la malignización sarcomatoide, siendo menos probable la osteonecrosis al carecer de antecedentes de toma de bifosfonatos, antiangiogénicos ni radioterapia. Sin embargo, por las alteraciones vasculares y la cicatrización comprometida del hueso pagético, podría desencadenarse una osteonecrosis espontánea 20 . A pesar de que el paciente evolucionó desfavorablemente, ha sido demostrado que la asociación de CaP y EOP demora la progresión metastásica y aumenta la supervivencia global 21 .…”

Adenocarcinoma de próstata metastásico y enfermedad ósea de Paget mandibular

“…In the present case, as there was a recent change in the lesion with a soft-tissue component, sarcomatoid malignancy would also be included, with osteonecrosis being less likely due to the lack of a history of bisphosphonates, anti-angiogenesis and radiotherapy. However, due to the vascular alterations and the compromised scarring of the Pagetic bone, spontaneous osteonecrosis could be triggered 20 . Although the patient developed unfavorably, it has been shown that PC and PBD association delays metastatic progression and increases overall survival 21 .…”

Insights into the aetiologies of hypercementosis: A systematic review and a scoring system

“…Last, five publications argue for combined causes (e.g., periodontal disease and paramasticatory activities, e.g., Garralda et al, 2004). Among the papers concerned, some more general causes were identified and classified as systemic diseases (n = 18 publications), among which, Paget's disease (e.g., Lucas, 1955;Polisetti et al, 2014), Gardner's syndrome (e.g., Arendt et al, 1989), acromegalia (e.g., Gardner & Goldstein, 1931, arthritis (e.g., Leider andGarbarino, 1987) andhyperthyroidism (e.g., Kupfer, 1951).…”

“…Most studies or case reports mention a generalised affection of all the teeth within one of the dental arch, with a greater extent on the roots in the post-canine region (e.g., Venkatesh et al, 2011;Polisetti et al, 2014). However, Paget's disease can be differentiated from other systemic diseases because of the associated specific aspect of hypercementosis under histological investigation.…”