ABSTRACT
La osteonecrosis maxilar relacionada con medicamentos (ONMM) es una patología de características clínicas objetivas con signo-sintomatología patogno-mónica. El criterio clínico aceptado es la presencia de hueso necrótico expuesto y visible sobre el reborde óseo maxilar que no ha cicatrizado luego de 8 sema-nas, en pacientes con antecedentes de tratamiento antirresortivo. La denominación relacionada con medicamentos se utiliza por el creciente número de casos asociados con otros fármacos antirresortivos como denosumab y con terapias antiangiogénicas, más allá de la conocida relación con bifosfonatos. Si bien la incidencia de ONMM en pacientes tratados por osteopatías metabólicas es muy baja, la situa-ción se torna más compleja en pacientes oncológicos con altas dosis de antirresortivos para tratamiento de metástasis ósea. Varios informes de casos des-criben cuadros de ONMM en pacientes con cáncer que reciben terapias dirigidas, específicamente TKI (inhibidores de tirosina kinasa) y anticuerpos mo-noclonales-VEGF (anticuerpos dirigidos al factor de crecimiento del endotelio vascular). La ONMM afecta negativamente la calidad de vida del paciente onco-lógico y produce comorbilidad significativa. Resulta imperioso identificar los pacientes en riesgo y dise-ñar un protocolo de atención odontológica específico para estos casos. En este artículo, se presenta un caso de ONMM asociado con altas dosis de Deno-sumab y administración simultánea de anticuerpos monoclonales específicos. El caso sorprende por la magnitud de la necrosis y su cuadro insidioso. El pro-tocolo de tratamiento descripto permitió controlar el cuadro inicial, limitar el avance de la lesión, asegurar el control del dolor y la infección, y finalmente, la cu-ración total de la lesión (AU)
Medication-related osteonecrosis of the jaws (MRONJ) is a pathology with objective clinical characteristics with pathognomonic signs and symp-toms. The accepted clinical criterion is the presence of exposed and visible necrotic bone on the maxillofacial region that has not healed after 8 weeks, in patients with history of antiresorptive treatment. The name medication-related is justified by the growing number of cases associated with other antiresorptive drugs such as denosumab and antiangiogenic therapies, beyond the known relationship with bisphosphonates. Although the incidence of MRONJ in patients treated for metabolic osteopathies is very low, the situation becomes more complex in cancer patients who re-ceive high doses of antiresorptives for the treatment of skeletal metastases. Several case reports describe the presence of MRONJ in cancer patients receiving targeted therapies, specifically TKI (tyrosine kinase inhibitors) and monoclonal antibodies-targeting VEGF (vascular endothelial growth factor). MRONJ nega-tively affects the quality of life in cancer patients and produces significant comorbidity. It is imperative to identify patients at risk and design a specific den-tal care strategy for these cases. In this article, we present a case of MRONJ associated with high doses of Denosumab and simultaneous administration of specific monoclonal antibodies. The case is surpris-ing due to magnitude of the necrosis. The described treatment strategies made it possible to control the initial symptoms, limit the lesion progression, ensure pain and infection control, and finally, the total heal-ing of the lesion (AU)
Subject(s)
Humans , Male , Aged , Patient Care Team , Bone Density Conservation Agents/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw/complications , Denosumab/adverse effects , Argentina , Schools, Dental , Breast Neoplasms/complications , Dental Care for Chronically Ill/methods , Neoplasm Metastasis/drug therapyABSTRACT
La osteonecrosis maxilar relacionada con medicamentos (ONMM) es una patología de características clínicas objetivas con signo-sintomatología patognomónica. El criterio clínico aceptado es la presencia de hueso necrótico expuesto y visible sobre el reborde óseo maxilar que no ha cicatrizado luego de 8 semanas, en pacientes con antecedentes de tratamiento antirresortivo. La denominación "relacionada con medicamentos" se utiliza por el creciente número de casos asociados con otros fármacos antirresortivos como denosumab y con terapias antiangiogénicas, más allá de la conocida relación con bifosfonatos.Si bien la incidencia de ONMM en pacientes tratados por osteopatías metabólicas es muy baja, la situación se torna más compleja en pacientes oncológicos con altas dosis de antirresortivos para tratamiento de metástasis ósea. Varios in-formes de casos describen cuadros de ONMM en pacientes con cáncer que reciben terapias dirigidas, específicamente TKI (inhibidores de tirosina quinasa) y anticuerpos monoclonales-VEGF (anticuerpos dirigidos al factor de crecimiento del endotelio vascular). La ONMM afecta negativamente la calidad de vida del paciente oncológico y produce comorbilidad significativa. Resulta imperioso identificar a los pacientes en riesgo y diseñar un protocolo de atención odontológica específico para estos casos. En este artículo se presentan dos casos de ONMM asociado con altas dosis de denosumab y administración simultánea de anticuerpos monoclonales específicos para el tratamiento del cáncer. Ambos casos sorprenden por la prematura instalación de la necrosis y su cuadro insidio-so. El protocolo de tratamiento descripto permitió controlar el cuadro inicial, limitar el avance de la lesión, asegurar el control del dolor y la infección, y finalmente, la curación total de la lesión. (AU)
Medication-related osteonecrosis of the jaws (MRONJ) is a pathology with objective clinical characteristics, with pathognomonic signs and symptoms. The accepted clinical criterion is the presence of exposed and visible necrotic bone on the maxillofacial region that has not healed after 8 weeks, in patients with history of antiresorptive treatment.The name "medication-related" is justified by the growing number of cases associated with other antiresorptive drugs such as denosumab and antiangiogenic therapies, beyond the known relationship with bisphosphonates. Although the incidence of MRONJ in patients treated for metabolic osteopathies is very low, the situation becomes more complex in cancer patients who receive high doses of antiresorptives for the treatment of skeletal metastases. Several case reports describe the presence of MRONJ in cancer patients receiving targeted therapies, specifically TKI (tyrosine kinase inhibitors) and monoclonal antibodies-targeting VEGF (vascular endothelial growth factor). MRONJ negatively affects the quality of life in cancer patients and produces significant comorbidity. It is imperative to identify patients at risk and design a specific dental care strategy for these cases.In this article, we present two cases of MRONJ associated with high doses of Denosumab and simultaneous administration of specific monoclonal antibodies. Both cases are surprising due to premature onset of necrosis. The described treatment strategies made it possible to control the initial symptoms, limit the lesion progression, ensure pain and infection control, and finally, the total healing of the lesion. (AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Diphosphonates/adverse effects , Bone Density Conservation Agents/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw/therapy , Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnostic imaging , Neoplasm Metastasis/diagnostic imaging , Ovarian Neoplasms/complications , Breast Neoplasms/complications , Radiography , Dental Care/methods , Bisphosphonate-Associated Osteonecrosis of the Jaw/physiopathology , Bisphosphonate-Associated Osteonecrosis of the Jaw/prevention & controlABSTRACT
Solitary metastases from colorectal carcinoma in the absence of hepatic or pulmonary metastases are rare. These can have a diverse imaging appearance, particularly after chemotherapy. It is important identify patients with solitary skeletal metastases, as they have a better prognosis than those with multiple skeletal or visceral metastases. We describe an unusual case of a solitary metastasis to the femur in a case of colon carcinoma that went undiagnosed and later presented with imaging features of osteogenic sarcoma.
Subject(s)
Adult , Female , Humans , Bone Neoplasms/diagnosis , Carcinoma/diagnosis , Colorectal Neoplasms/diagnosis , Femur/diagnostic imaging , Magnetic Resonance Imaging , Prognosis , Tomography, X-Ray ComputedABSTRACT
We discuss imaging findings in a case of skull and pelvic metastasis from a lung cancer, in a 40-year-old man, who presented with painless parietal scalp swelling.
ABSTRACT
Extramammary Paget's disease (EMPD) is an uncommon malignancy that is most commonly seen in the vulval area in postmenopausal women. Pruritus is the predominant symptom. The clinical presentation can be so nonspecific that it can be misdiagnosed as an inflammatory or infective condition. We report an elderly male patient with EMPD over the pubic area, which remained asymptomatic for 5 years; he presented with severe low backache of 5 months' duration. Skin biopsy and immunohistochemistry showed the typical epidermal changes and deep dermal invasion. Positron emission tomography scan revealed involvement of regional lymph nodes as well as extensive skeletal metastases.
ABSTRACT
Objective:To observe the therapeutic effect of the treatment with intravenous(Ⅳ)ibandronate com- bined with chemotherapy on patients with skeletal metastases.Method:138 patients with skeletal metastases were randomly divided into ibandronate group combined with chemotherapy(68 cases)and simple chemotherapy group(70 cases).The controlled group took a standard chemotherapy project but combined the treatment group took a chemotherapy project plus ibandronate.In a week after the chemotherapy,68 cases of the treatment group were treated with ibandronate 4mg in NS 500ml by intravenous infusion once 4 weeks for 3 months.The effect was evaluated when the three cycles finished.Result: There was a statistical difference(P
ABSTRACT
Objective To evaluate therapeutic effect of zoledronic acid combined with chemotherapy in patients with cancer and bone metastases. Methods 60 patients with cancer and skeletal me-tastases were devided randomly into tow groups, 30 patients received zoledronic acid combined with chemotherapy, 30 patients only received chemotherapy. Cheotherapeutic program of tow groups were same. Results Response rate of bone pain relief was 83. 3% in zoledronic acid combined with chemotherapeutic group and 56.7% in chemotherapy alone group. Response rate of skeletal metastases was 53. 3% in zoledronic acid combined with chemotherapy group and 20. 0% in chemotherapy alone group. Response rate of movement capacity improvement was 73. 3% in zoledronic acid combined with chemotherapeutic group and 30. 0% in chemotherapy alone group. The therapeutic effect of zoledronic acid combined with chemotherapy group was better than that of chemotherapy alone group( P
ABSTRACT
AIM: To comparatively analyze the pain related factors levels and therapeutic response in patients treated with ~(99)Tc-MDP and ~(153)Sm-EDTMP for painful skeletal metastases. METHODS: Plasma endothelin (ET), calcitonin gene-related peptide (CGRP), thromboxane B_2 (TXB_2) and 6-keto-prostaglandin F_ 1? (6-k-PGF_ 1? ) levels were analyzed in 93 patients with painful skeletal metastases prior and 3 months after treatment. 55 cases were just treated with 153 Sm-EDTMP (group A); 19 cases were treated only with 99 Tc-MDP (group B); and 19 cases were treated with both 153 Sm-EDTMP and 99 Tc -MDP (group C). RESULTS: 69.1 %, 73.7 % and 89.5 % of the patients were experienced pain relief 3 months after treatment in groups A, B and C, respectively. Comparative analysis shows that: ET and 6-k-PGF_ 1? levels increased significantly 3 months after treatment in all patients (P
ABSTRACT
Using phosphorus-32 (P-32) radiopharmaceutical for treatment of bone pain in 60 cancer patients with skeletal metastases (34 males, 26 females) showed that: The analgesia effect of P-32 was remarkable, 86.67% patients had good results, the bone pain was dicreased for long time. The patients's quality of life was more improved. The KPI before treatment was 51.83 and after treatment 3 months = 66.92. The toxicity was slight and under control : Amount of red blood cells and plates were slightly dicreased. It become normal after P-32 treatment 6-8 weeks. Nothing changed before and after treatment with white blood cells and the bio-chemistic criterias. The impact and side effects for the body were not significantly.
Subject(s)
Bone Neoplasms , Therapeutics , Pain , NeoplasmsABSTRACT
A 60-year-old male with carcinoma of the prostate and cerebral infarction underwent a Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bone scintigraphy (Fig. 1) showed multiple areas of increased uptake of Tc-99m MDP in the skull, spine, and ribs representing skeletal metastases. Two different patterns of uptake occurred in the skull region (Fig. 1A-C); one represents bony metastasis and the other represents cerebral infarction. The shape, size, location, intensity, and border of the increased uptake differed between the two lesions. An oval-shaped pattern with smaller size, greater intensity and more sharply defined border in the frontal region was consistent with bony metastasis. A rectangular-shaped pattern with larger size, lesser intensity and relatively indistinct border in the temporo-parieto-occipital region was consistent with cerebral infarction. Increased uptake of bone-seeking radiotracers in cerebral infarction has been reported previously.1-4) A suggested mechanism by which bone-seeking radiotracers accumulate in the necrotizing cerebral tissue is an alteration of the blood-brain barrier induced during cerebral infarction, which results in entry of the radiotracers into the extracellular space of the brain.4) Brain CT (Fig. 2) performed 7 days before and one month after the bone scintigraphy revealed lesions on the right temporo-parieto-occipital region consistent with acute hemorrhagic and chronic cerebral infarction, respectively.