Phosphoglyceride Crystal Deposition Disease in the Spine

Abstract

The authors report phosphoglyceride crystal deposition disease in the spine after a lumbar anesthetic given at the time of appendectomy. A 76-year-old Japanese woman with increasing lumbar pain was transported to our hospital in an ambulance. She had tumor-like lesions that had repeatedly appeared in injured soft tissues for >20 years. Osteolytic changes were detected by x-ray in the 12th thoracic vertebra and the 4th lumbar vertebra. Compression of the left L4 nerve root was detected by myelography, and a tumor corresponding to the left L3-L4 intervertebral foramen was determined by computed tomography. An operation to achieve posterior decompression and fusion was performed. The histopathologic tests on this coarse matter revealed a radial deposition of needle crystals and a strong foreign matter reaction in the periphery. Based on the above analyses, the deposited crystals were regarded as phosphoglyceride. Phosphoglyceride crystal deposition disease is characterized by the deposition of crystals of the phospholipid called phosphoglyceride in sites especially susceptible to invasion, such as surgical sites. To our best knowledge, only three cases of phosphoglyceride crystal deposition disease, including this one, have been reported.

Phosphoglyceride crystal deposition disease mimicking a malignant tumor

“…The clinical features and imaging findings for phosphoglyceride crystal deposition disease are shown in Table 1 . In all cases, phosphoglyceride crystal deposition disease occurred at sites susceptible to invasion due to a previous injury [ [1] , [2] , [3] , [4] , [5] , [6] , [7] ]. Phosphoglyceride crystal deposition disease sometimes forms large masses, which could be misdiagnosed as malignant tumors.…”

“…2–1 Miura [ 1 ] 62/F dental treatment 32 right mandible NS lobulate heterogenously enhanced in the periphery, low-density area in the center low intensity on T1WI NS appendectomy 32 laparotomy scar 1–11 × 6 intramuscular injection 32 bilateral brachial muscle NS No. 2–2 Nishimura [ 6 ] 76/F lumbar anesthetic 32 vertebral bodies (Th12, L4) NS irregular osteolytic changes low intensity on T1WI NS high intensity on T2WI No. 3 Yamada [ 3 ] 50/F cesarean delivery 24 pelvic 10 lobulate NS contained a hemorrhagic component; central solid part exhibited a low intensity on T2WI NS No.…”

A Case of Phosphoglyceride Crystal Deposition Disease in the Pelvic Soft Tissues Recurring after Initial Surgery

“…No sex predilection, congenital abnormalities, or family history of metabolic disorders has been noted in connection with this disease entity. Deposition sites were characteristically intramuscular injection sites or postoperative sites including the buttock muscle [ 3 ], brachial muscle, spine [ 4 ], and abdominal soft tissue [ 5 ]. The masses gradually increased in size over more than 10 years in the soft tissue at the postoperative locus and were detected by routine check-up or subsequent to the appearance of symptoms.…”

Phosphoglyceride crystal deposition disease originating from the myocardium

“…PCDD is a rare disease in which phosphohglyceride crystals are deposited, simulating a neoplasm in a scar of the soft tissue or bone. [1][2][3][4][5] In this case a myocardial scar where the PCDD was located had probably been made susceptible to this kind of disease. However, to the best of our knowledge, this is the first case arising from the internal organs.…”

“…The sites of deposition were characteristically intramuscular injection sites or postoperative sites, such as buttock muscle, brachial muscle, spine, gingival soft tissue, and skin incisions of the abdominal wall. [1][2][3][4][5] The histologic findings of the PCDD are characterized by the aggregation of macrophages around the crystals and the formation of foreign body granulomas. On polarized microscopy, the fibrillar crystals appear refractive.…”