Presentation
Several years of left sided pelvic pain. Occasional heat sensation.
Patient Data
Coarse bony structure and increased density of the entire left hemipelvis including the iliac wing, adjacent left sacral massa lateralis, and femoral head. The irregular, dense trabecular structure involves spongeous as well as cortical bone.
A bone core cylinder from the iliac wing (cortex on the right) demonstrates irregular woven bone formations with excessive osteoid surfaces.
Intertrabecular fibrosis with high vascularity and focal lymphocyte accumulation. Higher magnifications shows deep resorption lacunae with multiple, large osteoclasts.
Case Discussion
The radiographic and histopathological image presentation in Paget disease of bone is pathognomonic.
Coarse bone structure is generally limited to one bone or one part of a bone, e.g. proximal femur or single vertebra. In the presented case, the bony changes are extensive and breach over joints, not typical for Paget disease.
Deep resorption lacunae and osteoclasts with >10 nuclei are characteristic signs of the focal osseous disease and relate to unbalanced bone remodeling.
Patients are generally older and often present with long standing deep and dull pain. Antiresorptive medication may ameliorate symptoms and reduce bone remodeling markers.