A Case of an Idiopathic Massive Osteolysis with Skip Lesions
A 38-year-old man is initially presented with pain and decreased strength in the left arm. Laboratory results were normal including renal function tests (urea, creatinine), thyroid and parathyroid hormone (PTH) tests. There was no history of any trauma and family history of similar diseases.\nRadiography of upper left extremity showed no abnormalities during this time. The patient was treated with non-steroidal anti-inflammatory drugs but the pain was not relieved, the patient was referred for radiography 2 years later. During this time, radiography demonstrated almost complete non-contiguous osteolysis in the left elbow, proximal and distal radius, ulna, wrist, carpal bones, proximal and distal metacarpals and phalanges (). Static images from bone scintigraphy with 99 technecium methylene diphosphate (99mTc-MDP) showed increased activities in the osteolysed regions (). To define the extent of the osteolysis, CT examination was performed. CT confirmed the osteolysis and accompanying soft tissue masses in the affected regions. MRI demonstrated that the soft tissue masses and the affected bones were hypointense to isointense with muscle on T1-weighted imaging (TR/TE, 732/12) and were of heterogeneous signal intensity on T2-weighted imaging (TR/TE, 3986/99) (). The lesions showed contrasting enhancements on T1-weighted sequences after intravenous administration of gadopentate dimeglumine.\nMulti-site fine needle aspiration biopsy and tru-cut biopsy were undertaken; bone specimens were taken from proximal, distal radius and proximal ulna for pathological examinations. This revealed fibrous tissue containing proliferated vascular structures replaced with bone trabeculae and bone marrow (). The pathological specimen obtained at open biopsy of a lesion in the left proximal radius also confirmed such findings. The patient was referred for radiation therapy. Radiation therapy was utilized to control the tumors locally and to alleviate associated pains. Because of its solely palliative role, full disease resolution was never accomplished. After one year follow-up there was no radiologic change.