Revista de Osteoporosis y Metabolismo Mineral

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Category: Osteology images

Maxillary metastasis due to pulmonary myofibroblastic tumor detected in study [18-F] FDG PET/CT

We present the case of a 62-year-old woman with a history of a fibrohistiocytic variant of a pulmonary inflammatory myofibroblastic tumor treated by a lobectomy of the right lower lobe and lymphadenectomy of the intrapulmonary area and pulmonary ligament, and a history of tooth extraction 11 due to a vestibular fistula torpid.
In a control [18-F] FDG PET/CT study, a solitary hypermetabolic lesion suggestive of malignancy was observed in the gingival area of the upper jaw (Figure1 A-C) and 3D reconstruction (Figure 2).
Given the suspicion of malignancy, a partial maxillectomy of teeth 13-23 was carried out with placement of an obturator prosthesis. Analysis confirmed the metastatic etiology by observing hypercellular areas with a fasciculate pattern and broader sarcomatoid areas. Immunohistochemical analysis showed strong ALK expression, higher FLI1 expression, and lower CD10 and TLE1 expression. At present, the patient remains asymptomatic.

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Multidisciplinary approach to diagnostic imaging in melorheostosis

We present a 44-year-old man with a history of multiple trauma in childhood and trauma to the left hip eight months before the consultation, who consulted for pain of short duration (5 days) in the left hip, presenting limited range of movement on physical examination in the extreme degrees of the left hip, without signs of local infection or laboratory abnormalities. The x-ray of the hips (Figure 1A) showed periosteal hyperostosis along the inner cortex of the left femur (white arrows), giving rise to a characteristic image of “molten wax dripping down the side of a candle”. (Figure 1B) Cortical thickening appeared as hypointense in all image sequences (white arrows), in addition to showing bone edema of the femoral head related to degenerative joint disease (black arrow). A bone gamma scan study was requested.

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Unusual case of bone proliferation: Nora’s lesion

We present the case of a 43-year-old man who presents pain and functional impotence in the left wrist of one year of evolution. Upon examination, an indurated tumor adhered to deep planes is found in this location. Following findings on computerized axial tomography (CT) of images consistent with osteochondroma versus peripheral chondrosarcoma (Figure 1), a bone scan was requested. This bone scintigraphic study in three phases of the upper limbs and a subsequent full-body image (Figure 2), showed the early arrival of the tracer with an increase in the vascular pool of slight-moderate intensity in the distal portion of the left radius (arrow), which persisted with greater intensity in late images. No other diseased findings were observed in the rest of the skeleton. These findings revealed increased vascularity and osteoblastic activity at the distal end of the left radius.
A biopsy was carry out, with a pathological result of osteochondromatous proliferation compatible with Nora’s lesion, confirming this diagnosis after surgical resection.

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Fibrous dysplasia mimicking rib metastasis

We present the diagnostic images of a 30-year-old woman, an asymptomatic BRCA1 mutation carrier and undergoing clinical-radiological follow-up for bilateral mammary fibroadenomas. The control MRI (Figure 1) highlighted the appearance of a nodular lesion posterior to the right breast prosthesis, relatively well defined and with lobulated contours. Given the suspicion of metastatic bone disease, a positron emission tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) was carried out to assess its metabolic activity and extent of the disease. This was the only active lesion, with a 2.6 cm diameter and high metabolic activity, located in the fourth right costal arch (Figure 2). In this context, the lesion was excised to rule out neoplastic etiology. Pathology studies showed it was fibrous dysplasia, a benign and slowly progressive pseudotumoral disease, which represents less than 5% of bone tumors.

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Metastatic transverse vertebral fracture due to lung cancer

A 58-year-old patient with rheumatoid arthritis in remission with methotrexate at a dose of 10 mg/week. He goes to hospital emergencies several times for acute lower back pain over one month. In the lumbar X-ray, an L4 transverse fracture with posterior wall retropulsion (Figure 1) goes unnoticed. This lower back pain becomes disabling with loss of left leg function. Lumbar MRI is carried out on T2 and STIR sequence (Figures 2a and 2b), showing acute-subacute fracture of the L4 vertebral soma with pedicles edema and moderate intra-canal displacement of the lower half of the posterior wall that compresses the efferent nerve root. Left and partially takes up the side recess. With suspicion of tumor etiology, enter for study. In the thoracic CT scan, a large, right-lobed, upper-cavity tumor is reported with ipsilateral main bronchus associated with perilesional pneumonitis and bronchiectasis (Figure 3). The pulmonary lesion histology was of large cell lung carcinoma PD-L1 80% positive. Vertebroplasty was carried out. The patient underwent pembrolizumab treatment with good response to date. Rheumatoid arthritis is maintained in remission despite treatment with anti-PDL [1].

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Vitamin D and heart failure. Pathophysiology, prevalence, and prognostic association

Heart failure (HF) is a major public health problem characterized by high mortality, frequent hospitalizations and deterioration in the quality of life, with a prevalence and incidence that is increasing worldwide [1,2]. Although the prognosis has improved in recent decades thanks to the diagnostic and therapeutic improvement of cardiovascular diseases, the morbidity and mortality of these patients remains high [3]. All this implies that new objectives and treatment options are still needed.
Vitamin D had traditionally been associated only with bone health, accepting that vitamin D deficiency caused osteomalacia and osteoporosis in adults and rickets in children [4,5]. However, data obtained in recent years indicate that vitamin D is an important micronutrient for optimal function of many organs and tissues throughout the body, including the cardiovascular system [6,7]. It has been suggested that vitamin D deficiency may be an important factor both in the genesis of risk factors and cardiovascular disease [7] as a prognostic marker in HF. Pathophysiological data indicate that vitamin D deficiency may be very harmful for patients with HF and that vitamin D supplementation can be potentially beneficial, although all this is not without controversy [8].

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120211301-en
120211302-en
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920191101-en
Brief Original
Clinical Notes
Committees
Editorial
English
Index of Authors
Index of Communications
Letter to the Director
Letter to the Editor
Oral Communications
Original Articles
Osteology images
Position Paper
Poster Communications
Presentation
Reviews
SIBOMM News
Special Article
Special Documents

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