Massive Osteolysis of the Humerus With Spontaneous Recovery

Abstract

An elderly woman presented with a pathological fracture of the right humerus. Progressive dissolution of the shaft of this bone took place over six months. No cause could be established and the patient refused biopsy. With only simple splintage for treatment the humeral shaft gradually reformed and re-ossified over a period of two years. The patient has been under review for four and a half years and no further pathology has come to light. The cause of the osteolysis remains obscure.

Gorham's Disease or Massive Osteolysis

“…17,45 Campbell and colleagues 17 of the right humerus. In this case, progressive dissolution of the shaft of humerus occurred over a period of six months.…”

“…The process may affect the appendicular or the axial skeleton. The shoulder 121,123,126,131 and the pelvis 48,61,95,103,118,145 are the most common sites of involvement, however, various locations such as the humerus, 5,17,63 90 Disease of the ribs, scapula, or thoracic vertebrae may lead to the development of chylothorax from direct extension of lymphangiectasia into the pleural cavity or via invasion of the thoracic duct. 85 Without surgical intervention, patients with Gorham's disease who develop chylothorax have a high rate of morbidity and mortality.…”

“…The degree of osseous destruction generally increases relentlessly over a period of years and may, eventually, stabilize spontaneously. Some reports of massive osteolysis describe spontaneous recovery of some of the lost osseous tissue 17 or clinical and radiographic improvement after radiation therapy. 39 Radioisotope bone scan may demonstrate increased vascularity on initial images and, subsequently, an area of decreased uptake corresponding to the site of diminished or absent osseous tissue.…”

Gorham Disease of the Spine: A Case Report and Treatment Strategies for This Enigmatic Bone Disease

“…The difficulty in choosing treatments arises from the possibility of spontaneous arrest in Gorham disease reported in some cases (Campbell et al 1975;Woodward et al 1981). For this reason, several authors described that conservative treatment should be recommended first or surgical treatment should be performed as late as possible (Bullough 1971;Hejgaard and Olsen 1987).…”

Use of Bisphosphonate to Manage Avulsion Fracture of Tibial Tuberosity with Underlying Angiomatosis: A Case Report

“…7 There are sporadic reports of treatment using radiotherapy, 8 but it is also known that the condition can be selflimiting. 9 The difficulty is knowing which cases will and which will not be self-limiting. Magnetic resonance image features, triple-phase radionuclide bone scan results, and thallium scan results have been reported by Livesley et al 10 However, they provide very little useful practical information, except perhaps to confirm the mono-ostotic nature of the disease.…”