Mieloma múltiple con osteosclerosis difusa, diferente al síndrome de POEMS / Multiple myeloma with diffuse osteosclerosis: distinct from POEMS syndrome

Las lesiones osteoscleróticas difusas son una forma de presentación radiológica muy infrecuente en el mieloma múltiple. Afectan al esqueleto axial y apendicular proximal, y pueden acompañarse de lesiones osteolíticas en el curso evolutivo de la enfermedad. De hecho, ante una osteosclerosis difusa, el diagnóstico de mieloma múltiple es de exclusión, después de descartar otras enfermedades más comunes. Presentamos este caso por su excepcionalidad, y destacamos sus diferencias con el síndrome de POEMS (AU)

Diffuse osteosclerotic lesions are a very uncommon radiologic presentation in multiple myeloma. These lesions affect the axial skeleton and proximal limbs; they may be accompanied by osteolytic lesions in the course of the disease. In fact, in cases of diffuse osteosclerosis, the diagnosis of multiple myeloma is reached only after ruling out other, more common diseases. We present an exceptional case of multiple myeloma with diffuse osteosclerosis and highlight the differences between this entity and POEMS syndrome (AU)

[Multiple myeloma with diffuse osteosclerosis: distinct from POEMS syndrome]. / Mieloma múltiple con osteosclerosis difusa, diferente al síndrome de POEMS.

Diffuse osteosclerotic lesions are a very uncommon radiologic presentation in multiple myeloma. These lesions affect the axial skeleton and proximal limbs; they may be accompanied by osteolytic lesions in the course of the disease. In fact, in cases of diffuse osteosclerosis, the diagnosis of multiple myeloma is reached only after ruling out other, more common diseases. We present an exceptional case of multiple myeloma with diffuse osteosclerosis and highlight the differences between this entity and POEMS syndrome.

Tendinosis calcificante del pectoral mayor con migración intraósea / Calcifying tendinosis of the pectoralis major muscle with intraosseous migration

La tendinosis calcificante es una entidad caracterizada por el depósito macroscópico intratendinoso de hidroxiapatita. La mayoría de los casos afectan a los tendones del manguito rotador, fundamentalmente al supraespinoso, y con menor frecuencia a otros tendones prácticamente en cualquier localización. La erosión cortical con migración intraósea de los depósitos cálcicos es infrecuente. La localización atípica combinada con la afectación ósea hace que con frecuencia se confunda con otros procesos como una infección o un tumor maligno, lo que conduce a biopsias e intervenciones innecesarias. Presentamos el caso de un varón que consultó por dolor e impotencia funcional en el hombro. En la radiografía se observó una erosión de la cortical anteromedial de la diáfisis proximal del húmero con calcificaciones extra- e intraóseas que hicieron sospechar proceso infeccioso o maligno. Los hallazgos en la tomografía computarizada (TC), junto con la evolución clínico-radiológica, fueron claves para reconocer esta presentación atípica de tendinosis calcificante del pectoral mayor (AU)

Calcifying tendinosis is characterized by macroscopic deposits of hydroxyapatite within the tendon. Most cases involve the tendons of the rotator cuff, fundamentally the supraspinous tendon, and less frequently other tendons in practically any location. Cortical erosion with intraosseous migration of calcium deposits is rare. An atypical location combined with bone involvement can often lead to confusion with other processes like an infection or malignant tumor resulting in unnecessary biopsies or interventions. We present the case of a man who presented with pain and loss of function of the shoulder. Plain-film X-rays showed an erosion of the anteromedial cortex of the proximal diaphysis of the humerus with extra- and intra-osseous calcifications that made us suspect an infectious or malignant process. The findings at computed tomography, together with the clinical and radiological course, were key in enabling us to recognize this atypical presentation of calcifying tendinosis of the pectoralis major muscle (AU)

[Calcifying tendinosis of the pectoralis major muscle with intraosseous migration]. / Tendinosis calcificante del pectoral mayor con migración intraósea.

Calcifying tendinosis is characterized by macroscopic deposits of hydroxyapatite within the tendon. Most cases involve the tendons of the rotator cuff, fundamentally the supraspinous tendon, and less frequently other tendons in practically any location. Cortical erosion with intraosseous migration of calcium deposits is rare. An atypical location combined with bone involvement can often lead to confusion with other processes like an infection or malignant tumor resulting in unnecessary biopsies or interventions. We present the case of a man who presented with pain and loss of function of the shoulder. Plain-film X-rays showed an erosion of the anteromedial cortex of the proximal diaphysis of the humerus with extra- and intra-osseous calcifications that made us suspect an infectious or malignant process. The findings at computed tomography, together with the clinical and radiological course, were key in enabling us to recognize this atypical presentation of calcifying tendinosis of the pectoralis major muscle.