Bone eburnation in rheumatic diseases: a guiding trace in today's radiological diagnosis and in paleopathology.

Bone eburnation is a common anatomical trace of chronic arthropathy. However, its topographical analysis in rheumatic diseases can contribute to knowledge about the latter, by explaining today's diagnosis through radiology as well as by giving an historical perspective through paleopathology. After recalling that eburnated areas can also originate in infectious arthritis, the present analysis consists in a comparison between macroscopic and radiological observations of both osteoarthritis (OA) and rheumatoid arthritis (RA) at an advanced stage. It focuses on the human femoral head because of its demonstrative interest. Two main observations emerge from our study. The eburnated surface is less extensive in OA (where it appears to be essentially linked to the original structure of the hip) and more extensive in RA at an advanced stage (where an additional systemic factor is predominant). The size of the associated osteophytes appears to be inversely proportional to the extent of the corresponding eburnated area. In connection with the OA-RA comparison above, the contribution of the original joint structure to bone eburnation was also illustrated by acromiohumeral eburnation in shoulder OA and by the comparison with dog hip OA. It must also be noted that a femoral head bone remodeling similar on the whole to that of OA can occur in ochronotic arthropathies whose causal chondropathy is due to a genetic defect. Originating in an identified chondropathy, eburnation in ochronotic arthropathy gives us the opportunity to study an OA-type bone remodeling per se as in an experiment supplied by nature and involving a human hip. However, since RA and ochronotic arthropathy are due to a diffuse chondropathy, both may create a similar macroscopic (and thus radiological) eburnation topography.

Pseudomalignant myositis ossificans. A pathological study of eight cases.

Eight cases of pseudomalignant myositis ossificans are presented. There was a male predominance and four patients were under 20 years of age. There was no history of trauma, but there was evidence of mild local or general inflammation with positive roentgenograms in two cases. Histologically there was active fibroblastic proliferation, appearing to develop essentially in fibrin deposits with metaplasia leading to the formation of an unusual osteoid. The newly formed mass was surrounded by bone and compressed the surrounding muscle fibers, which were either atrophic or trapped therein. The histological criteria distinguishing this disorder from other forms of myositis ossificans are discussed, and comparisons are drawn with nodular fascitis and proliferative myositis. An association with the latter was observed in one case. This nontumourous growth must be distinguished from osteogenic sarcoma of soft tissue. The differential diagnosis is based on careful histological criteria, which must be supported by clinical and radiological data.

Rapidly progressive osteoarthrosis of ochronotic origin. A pathologic study.

A case of hip osteoarthrosis associated with ochronosis in a 65-year-old woman is reported. Characteristic features of both conditions were observed macroscopically and on light and electron microscopic examination. In the cartilage the pigment deposits were located on and between thick collagen fibrils. In the synovial membrane there were embedded packets of cartilage shards of which the collagen fibrils and pigment were phagocytosed, as well as calcified bone debris whose disaggregation might have explained the presence of some apatite deposits free of any underlying collagen structure. As also previously observed, the present case of ochronotic hip osteoarthrosis is remarkable for the minor osteophyte formation and for the inclusion of pigmented cartilage shards in the osteomedullar remodeled territory. It also demonstrates a collapse of the femoral head cortex presumably related to the rapid clinical and radiologic evolution. By the well-known origin of its chondropathy and by the pigment labeling of the cartilage, ochronotic arthropathy provides an almost experimental model for analyzing a broader problem, i.e., that of the various components of an osteoarthrotic remodeling.

Metastatic carcinoma of presumed prostatic origin in cremated bones from the first century A.D.

A cremated pelvis dating from the first century A.D. showed evidence of osteosclerotic metastasis, presumably secondary to prostate carcinoma. The case demonstrates the importance of microradiography in palaeopathology as well as some of the structural changes seen in cremated bone.

Synovial cyst and degeneration of the transverse ligament: an unusual cause of high cervical myelopathy. Case report.

A case of cystic degeneration of the transverse ligament located posteriorly to the dens and causing compression to the lower medulla and upper cervical spinal cord is reported. The clinical, pathological, and radiological findings are described and compared to the literature to characterize this syndrome more fully. The advantages of a posterolateral surgical approach are stressed.

Rapidly progressive hip osteoarthrosis--an unusual presentation of ochronosis.

A case of rapidly evolving osteoarthrosis of the right hip in a 65 year-old woman, as the presenting feature of ochronosis is described and literature reviewed. This unusual presentation may have been precipitated by an acute mechanical overload.

Sternocostoclavicular hyperostosis (SCCHO) with palmoplantar pustulosis (PPP).

Three cases of sternocostoclavicular hyperostosis (SCCHO) or pustulotic arthro-osteitis (PAO) associated with plantar pustulosis are presented. Two of them were associated with psoriasis vulgaris although the pustulosis was of a different histological type in each case. Anatomo-pathological study of two of these three cases shows that this hyperostosis is secondary to an inflammatory osteomedulloperiosteal remodelling suggesting an infectious origin which remains to be proven. The relationship of this syndrome with some seronegative spondylarthropathies cannot, however, be excluded.

Fibular lipoma with areas of bone infarct calcification.

An anatomico-radiological study of a painful intraosseous lipoma of the fibula is reported. A blown up cortex and a rearrangement of surrounding cancellous bone trabeculae were observed. The lipoma contained two small bone infarcts. A radiological differential diagnosis with calcified chondroma as well as the pathogenesis of the condition are discussed.

A case of intracortical tuberculosis of the femur.

This is the report of an anatomical-radiological study of a case of femoral intracortical tuberculosis observed at the autopsy of an 83-year-old woman presenting with diffuse miliary tuberculosis. Among the differential diagnoses, carcinoma metastasis is the main alternative to be discussed.

Multiple bone islands in a skeleton dating from the Neolithic period.

Multiple bone islands were observed in a skeleton dating from the Neolithic period (two in a femoral head, two in the lower epiphysis of a femur, one in a humeral head). Macroscopic and radiographical examination was complemented by microradiography in the femoral head.

Magnesium whitlockite, a calcium phosphate crystal of special interest in pathology.

Whitlockite (in fact magnesium whitlockite) is a calcium orthophosphate crystal in which, in biological conditions, magnesium is partly substituted for calcium. Identified in X-ray or electron diffraction patterns, it occurs in physiological or pathological conditions at extra or intratissular sites, mainly in tissues of non-epithelial origin. In a range of pathological calcifications investigated by X-ray diffraction, we noted that whitlockite appeared to be frequently associated with apatite, particularly in "dystrophic calcifications" of tuberculous origin. These personal observations could be correlated with documented data in oral pathology (dental calculus, salivary stones, and dental caries). Whitlockite deposits have also been reported in non-infectious conditions, such as in aortic media, cartilage, and bone tissue. Whereas the formation of both apatite and magnesium whitlockite appears to be caused by the binding of their constituting ions with proteolipids, magnesium inhibits apatite originating from amorphous calcium phosphate to the benefit of whitlockite formation. Possibly, the development of magnesium whitlockite may provide an interesting marker for magnesium metabolism. Further studies linking histology to crystallography might relate the crystal to issues, such as tuberculous calcifications or diseases of bone tissue, and might be useful for potential diagnostic orientation.

Sternocostoclavicular hyperostosis. Radiological and pathological study of a specimen with ununited clavicular fracture.

Anatomico-radiological study of a sternocostoclavicular mass taken post-mortem from a man whose clinical history had shown bilateral sternocostoclavicular hyperostosis (SCCH) with plantar pustulosis for 27 years. The clavicle showed an ununited fracture attributable to a trauma sustained five years earlier. Both clavicular segments showed active remodelling with intraosseous granulation tissue and periosteal metaplastic ossification. The sternocostoclavicular region was fused in a bony block in which there were no signs of remodelling activity. The first rib and the distal extremity of the clavicle were histologically normal. These observations support the conclusions of a previous study of another case of SCCH. The condition might be due to a bone infection caused by an--as yet--unknown germ. Bone remodelling would explain the periosteal hyperostosis and the fragility of the underlying bone. Furthermore, the possibility that the condition might also be a joint disease related to the group of rheumatic diseases called spondyloarthropathies should be considered.

An anatomicopathological approach to the study of articular aging.

Bone and joint aging results from the combined action of various metabolic and mechanical factors. Osteoarticular aging produces primary changes in bone (intrinsic rarefaction, but also extrinsic osteogenesis), cartilage, synovial membrane, and tendon. The association of these primary changes can result basically in three anatomicopathological entities: hyperostosis and osteophytes at tendon insertions, senile remodeling, and osteoarthritic remodeling. Some of these entities are asymptomatic. Others form part of nosologic entities such as osteoarthritis and various types of joint pain and stiffness. The standard methods of morbid anatomy provide a link between clinical findings and modern research methods. By separating nosology and morphology they permit a better analysis of the boundaries and transitions between articular "aging" and "disease". With advancing age, osteoarthritis becomes increasingly frequent but not inevitable.

Anatomy and radiology of a bone island.

Anatomoradiological study, on an amputation specimen for osteosarcoma from a 13 year old girl, of a bone island in the distal femoral epiphysis. It consists of a mature bone core caused by localized remodeling of the spongeous trabeculae, old but still slightly active, clearly different from a bone infarct, a tumoral or infectious process. Discussed the interest of a precise radiological study for making the diagnosis (particularly xerography), the risks of error involved in scintigraphy and the utility of a block excision if a biopsy is performed.

Anatomico-radiological study of intraosseous epidermoid cysts.

Anatomico-radiological study of 8 cases of intraosseous epidermoid cysts (1 in the skull, 6 in distal phalanges of the hand, 1 in distal phalanx of the foot with invasion of the adjacent joint). The epithelium was malpighian with hyperkeratosis (therefore the scales filled the cavity), sometimes with parakeratosis and even dyskeratosis but without signs of malignancy. The adjacent connective tissue and bone reactions were more active in the phalanx than in the skull and this could explain the frequent pain in the phalanges. The bone remodelling explains the radiological pictures and sustains the differential diagnosis. In 5 out of the 8 cases (particularly in the skull) a history of previous local trauma was present. However, the etiological importance of trauma should be discussed with respect to that of dysembryoplasia.

Enthesopathic erosive lesions of patella and tibial tuberosity in juvenile ankylosing spondylitis. Anatomico-radiological study of a case with tibial bursitis.

The authors report the case of a 20-year-old joiner suffering from ankylosing spondylitis, with recurrent knee effusions from the age of 11 and radiological evidence of sacro-iliac involvement. The patient presented with pain and bone erosions localized to the sites of tendinous attachments in the upper pole of the left patella and in tibial tuberosities. On both sides an inflammation of deep infrapatellar bursa was observed on anatomical examination. These destructive lesions are considered as rare forms of the erosive enthesopathy which has been described in ankylosing spondylitis, particularly on spine and calcaneum. They could be considered as highly localized forms of algodystrophy.

Diffuse enthesopathic hyperostosis--anatomical and radiological study on a macerated skeleton.

Anatomico-radiological study of a macerated skeleton in a 43-year-old diabetic woman. An important spondylosis with hyperostosis of the cervical, thoracic and lumbar vertebrae was seen. There were associated changes of insertional hyperostosis at various levels, particularly at the iliac crests. Paget's disease of the left iliac crest was also noted in the corresponding hyperostosis. This case presentation offers an opportunity to discuss local mechanical factors (observed at the tendinous insertions) as well as generalized considerations on the "terrain" of diabetes and perhaps malnutrition. It also demonstrates the interest that an anatomico-radiological comparison on macerated specimens can have for certain osteoarticular research, teaching and paleopathology.

Lumbar erosive intervertebral osteochondrosis. Anatomico-radiological study of a case.

A radiological and anatomical case study of intervertebral osteochondrosis is presented. X-rays reveal its evolution from an isolated Schmorl's node to a more diffuse lumbar intervertebral osteochondrosis. Macroscopical and microscopical post-mortem examination shows various degrees of disc deterioration with cartilaginous plate flaw and localized or diffuse intravertebral disc herniation. A discussion on the origin of this cartilaginous plate weakness and on the respective significance of the X-ray and biopsy in the differential diagnosis between intervertebral osteochondrosis and infectious spondylitis follows.

A historic skeleton with osteomyelosclerosis.

A case of osteomyelosclerosis (ie, an advanced stage of the myeloproliferative disorder named myelofibrosis) was reported in an adult male skeleton dating from the 17th or 18th century. The diagnosis was founded on the presence of a newly formed microspongiosa and a thickening of the preexisting trabeculae. A subperiosteal thickening of the cortical bone was also noted.

Presumed calcified leiomyoma of the uterus. Morphologic and chemical studies of a calcified mass dating from the Neolithic period.

An isolated, calcified mass was found among human skeletal remains that were approximately 5,000 years old. A systematic study was undertaken that included histologic examination (stained sections, polarized light microscopy, microradiographs, and electron microscopy), x-ray diffraction, and concentrations of hydroxyproline and fluorine. The results allowed us to eliminate the diagnoses of bone tissue and intracavitary deposits such as bezoar and calculi. The mass consisted of calcified tissue, with a collagenous organic matrix and deposits of apatite, and it most probably was a calcified uterine leiomyoma.