title: Osteolytic form of Paget's disease. Differential diagnosis and pathogenesis.
abstract: Of fourteen patients with Paget's disease for whom adequate roentgenograms and pathological material were available, six had lesions showing significant or predominant osteolysis. Based on a study of these six patients and a review of the literature, the following mechanisms were identified as causes of the so-called osteolytic type of the disease: (1) an "early" destructive Paget's lesion; (2) "advanced" Paget's disease with secondary degenerative changes; (3) "seeding" of an independent osteolytic lesion, particularly tumor in pre-existing Paget's disease; (4) sarcomatous transformation; and (5) immobilization after fracture. An osteolytic lesion in a patient without other bone disease may be due to Paget's disease, while an associated lytic lesion may be the result of a variety of conditions. Accurate pathological diagnosis is essential.
mesh_terms: D000328:Adult; D000368:Aged; D001862:Bone Resorption / Q000000981:diagnostic imaging*; D002471:Cell Transformation, Neoplastic / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D010001:Osteitis Deformans / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D010014:Osteolysis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D011859:Radiography; D012509:Sarcoma / Q000473:pathology