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LETTER
Year : 2016  |  Volume : 62  |  Issue : 3  |  Page : 211-212

A case of monostotic Paget's disease


1 Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
3 Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication18-Jul-2016

Correspondence Address:
A Jena
Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.186396

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How to cite this article:
Patnayak R, Rajasekhar S, Chintam S, Kalawat T C, Jena A. A case of monostotic Paget's disease. J Postgrad Med 2016;62:211-2

How to cite this URL:
Patnayak R, Rajasekhar S, Chintam S, Kalawat T C, Jena A. A case of monostotic Paget's disease. J Postgrad Med [serial online] 2016 [cited 2019 May 20];62:211-2. Available from: http://www.jpgmonline.com/text.asp?2016/62/3/211/186396


Paget's disease of the bone is a chronic disorder. It is characterized by disturbance of bone turnover in the form of focal areas of excessive osteoclastic bone resorption accompanied by a secondary increase in osteoblastic bone formation. [1],[2] Paget's disease results in bone expansion and structural weakness. It can cause pain, fracture, and deformity, apart from other complications. Although many patients with Paget's disease of bone are asymptomatic, it depends on the population of the patients studied. [1],[2],[3] It is commonly seen in the aging population. It affects both genders with slight male predominance. The diagnosis of the disease is mostly based on radiological examination and biochemical markers of bone turnover. [1],[2],[3]

A 60-year-old diabetic male came with complaints of hematuria and right flank pain associated with fever and chills for 2 months. Thorough clinical examination did not reveal any abnormality. On imageology, dimercaptosuccinic acid scan cortical renography showed bilateral chronic pyelonephritis-related changes; spiral computed tomography of the abdomen and pelvis showed sclerotic and lytic foci in the right pubic bone with the possibilities of Paget's and metastasis [Figure 1]. Bone scan showed intense radiotracer uptake involving right pubic bone suggestive of monostotic Paget's disease [Figure 2] which was later confirmed by trephine biopsy which showed irregular bony trabeculae, cement lines, and areas of fibrosis [Figure 3].
Figure 1: (a) Sagittal computed tomography image, bone window showing cortical thickening and lytic lesions in the right pubic bone. (b) Topogram showing cortical thickening, bony expansion with mixed lytic and sclerotic lesions in the right pubic bone

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Figure 2: Technetium 99m-methylene diphosphonate whole body bone scintigraphy images (anterior and posterior images) shows diffuse increased radiotracer uptake in the right pubic bone

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Figure 3: (a) Trephine biopsy showing irregular bony trabeculae (H and E, ×40). (b) Bony trabeculae with cement lines and areas of fibrosis (H and E, ×100). (c) Prominent cement lines (H and E, ×400). (d) Bony trabeculae and adjacent multinucleated osteoclastic giant cells (H and E, ×400)

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Paget's disease was first described by Sir James Paget. Paget's disease can be unifocal or multifocal.

Any bone can be affected. The most commonly involved bones include pelvis, vertebrae, skull, femur, and tibia. Rarely, patients with Paget's disease develop sarcoma-like osteosarcoma.

Paget's disease can be diagnosed in patients by plain X-rays, radionuclide bone scanning, or biochemical testing of bone turnover parameters such as serum alkaline phosphatase. [1],[2],[3]

Paget's disease shows wide geographical variation. Earlier Paget's disease was thought to be uncommon in India. Recently, there are several case studies from South India. [4],[5] Palkar and Mohan have reported 0.66% prevalence of Paget's disease in diabetic patients. However, association between diabetes and Paget's disease remains unclear. [6] Our patient was a diabetic.

Paget's disease of the bone may be asymptomatic initially, and it can be diagnosed by its classic radiologic features. It is treated by bisphosphonates, a group of antiresorptive drugs, with resultant decrease in the associated morbidity and mortality. [7] Singer et al. have recommended a single 5 mg dose of intravenous zoledronate as the treatment of choice in patients who have no contraindication such as renal impairment. [3] Zoledronate has greater potency and ease of use as compared to other available drugs such as calcitonin, etidronate, and pamidronate. [3] An early diagnosis of Paget's disease of bone can help to prevent potential complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 :: References Top

1.
Walsh JP. Paget′s disease of bone. Med J Aust 2004;181:262-5.  Back to cited text no. 1
    
2.
Mithal A. Paget′s disease in India. J Assoc Physicians India 2006;54:521-2.  Back to cited text no. 2
    
3.
Singer FR, Bone HG 3 rd , Hosking DJ, Lyles KW, Murad MH, Reid IR, et al. Paget′s disease of bone: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014;99:4408-22.  Back to cited text no. 3
    
4.
Anjali, Thomas N, Rajaratnam S, Shanthly N, Oommen R, Seshadri MS. Paget′s disease of bone: Experience from a centre in Southern India. J Assoc Physicians India 2006;54:525-9.  Back to cited text no. 4
    
5.
Bhadada S, Bhansali A, Unnikrishnan AG, Khadgawat R, Singh SK, Mithal A, et al. Does Paget′s disease exist in India? A series of 21 patients. J Assoc Physicians India 2006;54:530-4.  Back to cited text no. 5
    
6.
Palkar S, Mohan V. Paget′s disease in diabetic subjects. J Assoc Physicians India 2006;54:585.  Back to cited text no. 6
    
7.
Trikha V, Mittal R, Kotwal PP. Paget′s disease: An unusual cause of backache in an adult male - A case report. Indian J Orthop 2006;39:193-4.  Back to cited text no. 7
    


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