Paget's Disease of Bone. In the bone scan, we see intense uptake in the lower T-spine, the mid L-spine, sacrum, and the sacral wings. The "butterfly" pattern of vertebral involvement suggests Paget's Disease, which affects the entire vertebral body rather than metastatic disease, which predelicts the pedicles. Paget's Disease frequently, but not always, involves multiple bones.

Paget's disease of bone aka/or Osteitis deformans may cause or feature Miscellaneous syndromes Carcinogenesis Osteoporosis Pathological fracture Symptoms and Signs Angioid streaks Arthropathy Back pain Bone pain Conductive hearing loss Facies abnormality Genu varum Hypertension, systemic Kyphosis Peripheral neuropathy Sabre tibia Sensorineural hearing loss Skull bossing Biochemical abnormalities Acid phosphatase levels raised (plasma or serum) Alkaline phosphatase bone isoenzyme levels raised (plasma or serum) Hypercalciuria X-ray abnormalities Osteosclerosis Cardiac and vascular conditions Cardiac failure, high output Inflammatory conditions Osteitis may be a risk factor for osteosarcoma Paget's disease of bone: Definition(s) via UMLS Osteitis Deformans: "A disease marked by repeated episodes of increased bone resorption followed by excessive attempts at repair, resulting in weakened, deformed bones of increased mass. The resultant architecture of the bone assumes a mosaic pattern in which the fibers take on a haphazard pattern instead of the normal parallel symmetry." Source: Medical Subject Headings, 2007_2006_08_08 Osteitis Deformans: "disease marked by repeated episodes of increased bone resorption followed by excessive repair, resulting in weakened, deformed bones of increased mass." Source: CRISP Thesaurus, 2006 Osteitis Deformans: "Paget's Disease is a disease of bone that initially results in the excessive resorption of bone (by osteoclasts) followed by the replacement of normal bone marrow with vascular and fibrous tissue. (On-line Medical Dictionary)" Source: National Cancer Institute Thesaurus, 2006_03D

Paget’s disease, or osteitis deformans, is a common condition in the middle-aged and elder persons. The disease is present in approximately 10% of patients over the age of 80 years. It is more common in men than in women. Seventy-percent of Paget’s disease is discovered as an incidental finding, patients for the most part asymptomatic.

Authors: Joseph Lane, M.D. and Reuven B. Minkowitz, New York, NY The purpose of this chapter is to provide an overview of the pathophysiology, etiology, diagnosis, clinical manifestations and management of Paget's disease of bone. Outline - I. Introduction II. Historical Perspective III. Anatomic and Physciologic Considerations IV. Natural History and Classifications V. Diagnosis and Recognition VI. Treatment VII. Summary X. References XI. Patient Education Summary

ACR-code 338-84

Paget's disease Pre-test and tutorial Joseph M. Lane, MD Hospital for Special Surgery, New York, New York Thomas A. Einhorn, MD Boston University of Medical School, Boston, Massachusetts Frederick Kaplan, MD University of Pennsylvania, Philadelphia, Pennsylvania Section of Orthopedics Hyperguide

Paget's Disease of the Skull: Radiology teaching file

Authors: Joseph Lane, M.D. and Reuven B. Minkowitz, New York, NY The purpose of this chapter is to provide an overview of the anatomic considerations, natural history, clinical manifestations, diagnosis, prognosis and management of Paget's osteosarcoma.
Outline - I. Introduction II. Historical Perspective III. Anatomic and Physciologic Considerations IV. Natural History and Classifications V. Diagnosis and Recognition VII. Summary X. References XI. Patient Education Summary

Illustrated cases from the experience of Dr Vinod Naneria, Indore, MP, India
Cases include synovial chondromatosis, fibromatosis, haemangiomas, Osteochondritis dissecans, Multiple Myeloma, Osteoid Osteoma, Osteochondroma, Lipoma, Fibroma, Non-ossifying Fibroma, Fibrous cortical defects, Paget Disease, Osteogenesis Imperfecta, Osteopetrosis, Hyperparathyroidism, Neurofibromatosis, Neurilemoma

J Bone Joint Surg Br. 1983 May;65(3):299-307
Sarcoma complicating Paget's disease of bone. A clinicopathological study of 62 cases.Schajowicz F, Santini Araujo E, Berenstein M. Out of 21 900 cases filed at the Latin-American Registry of Bone Pathology between April 1940 and July 1981, there were 987 with Paget's disease (4.51 per cent); 62 of these (6.28 per cent) were complicated by sarcoma and two were associated with giant-cell tumours of bone (osteoclastoma) without signs of malignancy. There was a slight predominance of men and the ages ranged from 45 to 87 years, with an average of 66 years. The most frequent sites were the femur (23 cases), the humerus (nine), the pelvis (10), and the tibia (nine). The low incidence of vertebral involvement (five cases) is noteworthy and is in sharp contrast to uncomplicated Paget's disease. The most common tumour type was osteosarcoma (39 cases), followed by fibrosarcoma (15 cases); other varieties (chondrosarcoma, malignant fibrous histiocytoma and reticulum-cell sarcoma) were much rarer. Most of the sarcomata occurred when the Paget's disease was polyostotic. Tumours often developed simultaneously, or at short time intervals, in the same or different bones; these bones had, in all cases, been affected by Paget's disease. The histological features of the osteosarcomata were characteristic, with large numbers of osteoclast giant cells, alternating with atypical osteoblasts, thus exaggerating the anarchic remodelling process of Paget's disease. The neighbouring areas of the pagetic bone showed an increased number of osteoclasts. These facts suggest a possible pathogenetic relationship between sarcoma and Paget's disease; the possibility of both processes having a viral aetiology is discussed.