Cases reported "Osteitis Deformans"

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1/20. Paget's disease of the tibia.

    Paget's disease of the bone is perceived to be rare in asia. We report the first documented case of Paget's disease of the bones in taiwan. A 66-year-old native Taiwanese woman was admitted to hospital with a 10-year history of pain and a bowing deformity of her left leg. Laboratory data disclosed elevated serum calcium and alkaline phosphatase levels, but no leukocytosis. A plain x-ray film of the left leg showed a curved tibia with thickening of the tibial cortex, while a technetium 99m bone scan revealed abnormal uptake in the left tibia. Elevated serum levels of bone-specific alkaline phosphatase and urinary collagen N-telopeptide were also noted. Histologic examination of a biopsy specimen of the left tibia lesion confirmed the diagnosis of Paget's disease in the bone. The patient received treatment with sodium chlodronate, and the symptoms improved rapidly. Laboratory data then revealed decreased levels of serum calcium, bone-specific alkaline phosphatase, and urinary collagen N-telopeptide after treatment.
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2/20. Synchronous Paget's sarcoma of tibiae in which Paget's disease was limited to these bones.

    A 51-year-old native of Rio de Janeiro presented with bilateral synchronous Paget's sarcomas in the tibiae, which developed in the upper right tibia and in the distal third of the left tibia. There were no other areas of Paget's disease. The largest tumor spread to the right inguinal nodes and also soft tissue. The tumor in the left tibia spread dramatically in the soft tissues up the leg and only involved the medullary cavity in its inferior portion. The patient died, but there was no autopsy. Comments are made about the prevalence of Paget's disease in Rio de Janeiro.
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3/20. Early experience with total knee replacement.

    This paper presents a review of two years' experience with the geometric total knee replacement. The results of 23 arthroplasties in 22 patients are discussed. Relief of pain was consistent and dramatic, movement was increased postoperatively in only three patients, but imporvement in overall function occurred in 20 of the 22 patients. There was one failure requiring arthrodesis. In this patient, six months after surgery the medial tibial condyle collapsed and the polyethylene tibial component fractured. This complication has not been reported before. Early results are encouraging. Total knee joint replacement is a useful procedure in advanced arthritis when arthrodesis is the only alternative.
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ranking = 0.25
keywords = tibia
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4/20. Multifocal osteogenic sarcoma in Paget's disease.

    The most serious complication of Paget's disease is sarcomatous degeneration of pagetic bone. Multifocal sarcomatous degeneration occurs mainly in polyostotic Paget's disease. Multifocal Paget's sarcoma is uncommon and can arise in any site. We report two cases of synchronous multifocal sarcomatous degeneration. The two patients were elderly women (aged 77 and 86 years, respectively) who developed sarcomatous lesions concomitantly, in the first case report in left ilium, left tibia, and first lumbar vertebra and in the second case report in the skull, right ilium, and sacrum. Whether these cases are due to the simultaneous development of several primaries or to metastases from a single primary remains unclear.
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ranking = 0.125
keywords = tibia
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5/20. Realignment of tibial deformity in Paget's disease. A case report.

    Paget's disease of bone is a relatively common condition which usually is asymptomatic. Furthermore, there is limited experience in surgical procedures, especially in realignment of severe skeletal deformities. Likewise, there are often relapses in tibial deformities treated with plates. We report a case of a severe tibial deformity treated with multiple osteotomies and stabilized with an unreamed medullary nail.
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ranking = 0.75
keywords = tibia
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6/20. An estimate of the turnover rate of bone-derived plasma alkaline phosphatase in Paget's disease.

    A through-knee amputation for suspected osteogenic sarcoma was performed on a patient with Paget's disease of the tibia. plasma alkaline phosphatase (AP) activity fell to normal values, apparently as a single exponential function of time, with a half-life of 1.7 days. The daily turnover of bone-derived plasma AP was estimated to be approximately 200 I.U. from the Pagetic tibia and 20 I.U. from the rest of the skeleton.
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7/20. Central low-grade osteosarcoma with pagetoid bone formation: a potential diagnostic pitfall.

    Central low-grade osteosarcoma is an uncommon form of osteosarcoma, which is often difficult to distinguish from benign bone lesions. We reviewed the radiographic studies, the histologic material and the clinical records of two patients with central low-grade osteosarcoma that closely simulated the histologic appearance of Paget's disease of bone. The patients were two women aged 46 and 53 years. Radiologically, they presented a large ill-defined densely sclerotic lesion involving the proximal tibia. Both lesions only focally presented the conventional histologic appearance of central low-grade osteosarcoma, with a proliferation of fibroblast-like cells embedded in a dense collagenous stroma and irregular anastomosing tumor bone trabeculae. The most striking feature was the presence of extremely thickened irregular plates of bone with an irregular mosaic pattern of cement lines that closely resembled that of Paget's disease of bone. One patient, who had been initially treated for Paget's disease for 7 years, experienced disease progression. At resection of proximal tibia, there was evidence of dedifferentiation to high-grade osteosarcoma. After 2 months, she developed local recurrence that was treated with above-knee amputation, followed by chemotherapy. She died with multiple lung metastases 4 months later. The other patient is alive 9 months after wide tumor resection. These cases further expand the spectrum of central low-grade osteosarcoma, and underscore the diagnostic difficulties in separating central low-grade osteosarcoma from benign bone diseases, which may lead to delay in diagnosis, inadequate treatment, and eventually to dedifferentiation. Recognition of this variant of central low-grade osteosarcoma is based on the aggressive radiologic appearance and on adequate tumor sampling for histologic examination.
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ranking = 0.25
keywords = tibia
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8/20. Monostotic Paget's disease of the tibia in korea.

    The incidence of Paget's disease has been estimated to be about 3%, but it is extremely rare in asia, especially in korea. In addition, monostotic involvement seems to be far less frequent. In this report, we describe a case of monostotic Paget's disease localized in the right tibia.
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keywords = tibia
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9/20. Metastatic spread of osteosarcoma to the temporal bone in a patient with Paget's disease: a case report.

    Secondary tumors involving the temporal bone are comparatively rare. We report a case of secondary osteosarcoma presenting in the temporal bone which arose from a primary lesion in the tibia in a patient with Paget's disease. To our knowledge secondary osteosarcoma of the temporal bone has never previously been described.
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ranking = 0.125
keywords = tibia
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10/20. Total knee replacement in Paget's disease.

    Due to rapid bone turnover in Paget's disease, loosening of artificial joints might be expected to be a problem, especially if they are of the tissue ingrowth type. Two patients with Paget's disease, who had had knee replacement with this type of prosthesis and have been followed for two years, have both done well to date. It appears that ingrowth-type implants can be used in the presence of Paget's disease. Paget's disease, which was first described in 1877, is characterized by a rapid turnover of bone. The cause of Paget's disease has yet to be determined. The common sites attacked, at least in a Canadian population, are the pelvis (45.4%), vertebrae (22%), femur (10%), tibiae (3.6%), and patellae (0.2%). Paget's occasionally gives rise to arthritic changes in a joint adjacent to the lesion, although the precise mechanism is uncertain. Disturbance of the subchondral bone due to hyperemia and overload due to increasing deformity have been cited as possible reasons. There was and is concern that joint replacement with cemented components would result in rapid loosening due to increased bone turnover. However, it has yet to prove a major problem. So far no reports have appeared in the literature on the effects of Paget's disease on knee replacement, specifically the effects of the porous tissue ingrowth type components that are now in common use. Two patients with Paget's disease around the knee who had had a knee replacement of this type are presented, with over two years of follow-up.
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ranking = 0.125
keywords = tibia
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