Osteoporosis with vertebral fractures in young males, due to bone marrow mastocytosis: a report of two cases.

Male osteoporosis in young patients is an unusual condition, always worth investigating as a possible manifestation of secondary osteoporosis. Mastocytosis is a clonal disorder of mast cells with heterogeneous presentations; when pathologic cells accumulate only in the bone marrow, vertebral fractures and systemic osteoporosis may represent the sole clinical presentation at the onset of the disease. We report on two young male patients who came to our attention because of multiple dorsal and lumbar vertebral fractures, with no other signs of systemic mastocytosis (SM). Lumbar and femoral dual x-ray absorptiometry showed reduced bone mineral density values; biochemical investigations did not report significant anomalies, suggestive of secondary osteoporosis. One of the patients underwent iliac crest bone biopsy, which was not diagnostic. A vertebral intralesional CT-guided bone biopsy was performed in both patients, which allowed the diagnosis of SM. Our experience pointed out that bone biopsy still remains the gold standard for the diagnosis of SM. However, iliac crest biopsy can be not significant because of circumscribed bone marrow involvement: in these cases only intralesional bone biopsy could be diagnostic.

[Percutaneous radio-frequency ablation of osteoid osteoma: technique and preliminary results]. / Termocoagulazione percutanea degli osteomi osteoidi mediante radiofrequenza: tecnica e risultati preliminari.

PURPOSE: To report our personal experience with the percutaneous technique for in situ destruction of osteoid osteoma using radio-frequency ablation. MATERIAL AND METHODS: From January 2000 to January 2001 we performed 16 radio-frequency ablations in 15 patients. All candidates for treatment had previously undergone clinical and radiologic examinations to confirm features typical of osteoid osteoma. After administration of spinal anesthetic, procedures were performed with CT-guidance, using a Kirschner wire introduced into the localized lesion, and a guiding cannula. A hole was first cut into the bone with a cutter, then a few biopsy specimens were obtained with a Jamshidi needle. Finally, we introduced a small radio-frequency electrode into the bone, through the biopsy track. Sufficient current was used to heat the electrode tip to 85-90 degrees C with consequent thermal necrosis of the tissue. The healing was continued for 6 minutes. RESULTS: All patients well tolerated the percutaneous procedure and only 1 underwent a second, successful radio-frequency ablation. In all cases, pain relief was noted to occur very rapidly and all patients could bear full weight on the treated extremity within 24 hours after the procedure. No late complications attributable to the ablation were noted, except for a small eschar next to the puncture site. DISCUSSION AND CONCLUSIONS: The results of the present study suggest that percutaneous ablation is preferred to operative excision because it generally requires shorter hospital stay and is not associated with complications. Furthermore, in our experience, pain relief was noted to occur very rapidly in 100% of cases. In agreement with the literature data, our results show that CT-guided percutaneous radio-frequency ablation can actually replace operative excision in the treatment of osteoid osteoma as it achieves the same clinical outcomes with significantly lower costs.