Pubic Osteolysis in an Elderly Masquerading as Malignancy: A Case Report and Review of Literature

Abstract

Introduction: A rapidly progressive destructive lesion characterizes pubic osteolysis (PO) in the pubic bone due to an inadequate fracture healing response. It may be seen in pelvic insufficiency fractures (IF) secondary to radiation therapy (RT) of pelvic malignancies, occurring even in the absence of significant trauma. Such a radiological picture may distract the clinician towards a malignant etiology and may affect the management. Case Report: A 79- year- old female, known case of carcinoma of the urinary bladder, underwent contrast-enhanced computed tomography (CT) (CECT) of the abdomen and pelvis as a routine follow- up and was found to have an osteolytic lesion in the right pubic bone, suggesting a malignant pathology. CT- guided biopsy did not reveal any malignant or infective etiology. The patient showed recovery with conservative management. Conclusion: Osteolytic lesions of the pubic bone can often occur following radiation for pelvic malignancies. It occurs due to impaired fracture reparative response by a bone afflicted by radiation therapy RT. It can be managed effectively with conservative analgesics, bisphosphonates, calcium, and Vitamin D supplementation. The radiographic picture can imitate malignant or infective lesions and provoke invasive testing for confirmation. The clinicians need to be conscious of this clinical entity to initiate proper treatment and avoid unnecessary investigations. Keywords: Pubic Osteolysis; Insufficiency Fracture; Radiation; Pelvis.

Post-Fracture Osteolysis of the Superior Pubic Ramus

“…There are only a few reports about it. The typical radiologic characteristics are similar to malignant bone tumors, which may lead to misdiagnosis and unnecessary invasive operations [ 4 , 6 ]. In addition to cases of pubic osteolysis, there are also a few cases of distal clavicle osteolysis, even post-traumatic spine or femoral neck osteolysis [ 7 - 10 ].…”

“…Imaging examination is helpful for the diagnosis of osteolysis. Osteoporosis, fracture, and separation of pubic symphysis can be seen on X-ray, but in the early stage, the fracture may not be found [ 4 , 6 ]. CT and MRI are both the keys to the diagnosis of post-fracture pubic osteolysis.…”

“…MRI can show soft tissue swelling, bone marrow edema, and bone fracture. Sometimes MRI will reveal a linear hyperintense line, which is helpful to distinguish between a benign pubic fracture and a malignant mass [ 4 ]. The lesion is mixed isointense and hyperintense on T2-weighted images and is hypointense or isointense on T1-weighted images [ 2 ].…”

“…The underlying mechanisms of this condition remain unclear. It is a benign lesion, and it mostly occurs in patients with osteoporosis or patients after pelvic radiotherapy [ 4 - 6 ]. We herein report a case of an old woman with post-fracture osteolysis of the pubic bone mimicking a malignancy.…”

Elbow calcific tendinosis initially detected by ultrasonography: a case report

“…Calcific tendinosis is a common condition caused by the pathologic deposition of hydroxyapatite crystals within the tendons [ 1 ]. It mostly affects the shoulder, with a 2.7% adult population incidence rate [ 2 , 3 ]. Although calcific tendinosis can appear in any tendinous insertion in the body [ 1 ], such as the hip, knee, wrist, finger, or elbow joints [ 3 , 4 ].…”