Case Study 6 – Bony Disfiguration

Brief case study of a rare disease seen at Hospital Regional in Cuzco, Peru.

HPI:  28 year old male described symptoms of cough and malaise for the past year.  Recently in the past few months, he began having hemoptysis.  Patient went to a regional clinic, where he was diagnosed with pulmonary tuberculosis and started on RIPE therapy.  Patient has been continuing therapy, but was referred to Hospital Regional for further management.

PMHx, PSHx, FHx: Has had short stature and some deformities of his extremities since growing up as a child.

Social Hx: Non-contributory.

Physical Exam:
Gen:  Short stature, pale, with some diaphoresis, using oxygen.
Lungs:  Significant adventitious sounds including wheezing in both lung fields.  Some respiratory distress.
Heart:  Regular rate and rhythm, no murmurs, rubs, gallops.
Abdomen:  Soft, non-tender, bowel sounds present.
Extremities:  Significant hard non-tender lesions located in both arms and legs, causing some deformity of the extremities and shorted stature.

Brief Differential Dx:
-Chondrosarcoma
-Ewing’s sarcoma
-Fibrosarcoma
-Osteosarcomas
-Endochondroma
-Multiple Endochondroma (Ollier, Marfucci)
-Chondrosarcoma

 Lab Tests:
-Extremity X-rays
-Chest X-rays

Chest X-ray showing multiple lesions, patient was diagnosed with pulmonary tuberculosis.

X-ray image of upper extremity showing significant disfiguration of ulna and radius, as well as some intramedullary lesions. Patient was diagnosed with Ollier's disease based on clinical exam and x-ray imaging.

Discussion:
From Silve & Jüppner, 2006:

“Enchondromas are common intraosseous, usually benign asymptomatic cartilaginous tumors, which develop in the metaphyses and may become incorporated into the diaphyses of long tubular bones, in close proximity to growth plate cartilage. When multiple enchondromas are present, the condition is called enchondromatosis also known as Ollier disease (WHO terminology). The estimated prevalence of Ollier disease is 1/100,000. Clinical manifestations often appear in the first decade of life. Ollier disease is characterized by an asymmetric distribution of cartilage lesions and these can be extremely variable (in terms of size, number, location, evolution of enchondromas, age of onset and of diagnosis, requirement for surgery). Clinical problems caused by enchondromas include skeletal deformities, limb-length discrepancy, and the potential risk for malignant change to chondrosarcoma.”

(Continued):
“Roentgenograms typically show multiple, radiolucent, homogenous lesions with an oval or elongated shape and well defined slightly thickened bony margin. The lesions and long bone axis run parallel. The lesions usually calcify with time and become diffusely punctated or stippled, a light trabeculation may be visible.”

(Continued):
“Enchondromas in Ollier disease present a risk of malignant transformation of enchondromas into chondrosarcomas, which usually occurs in young adults, and thus at an earlier age than observed in patients with chondrosarcoma alone. The reported incidence of malignant transformation is variable and estimated to occur in 5–50% of the cases.”

(Continued):
“There is no medical treatment for Ollier disease. Surgery is indicated in case of complications (pathological fractures, growth defect, malignant transformation).”

References:
1.  Silve C, Jüppner H. Ollier disease. Orphanet Journal of Rare Diseases. 2006, 1:37.

This entry was posted in Case Studies, Medicine and tagged , , , , , . Bookmark the permalink.

44 Responses to Case Study 6 – Bony Disfiguration

  1. If you might have ignored the financial statements for long, now could be the time and energy to require a
    careful consider it Bluehost Promo
    it’s not essential to find yourself side tracked to utilize
    fora true cash advance, since you’ll be able to positioned on within your internet privacy involving your own house or
    office through the internet in the moment.

  2. I’m extremely pleased to uncover this web site. I wanted to thank you for ones time just for this fantastic read!!
    I definitely savored every bit of it and I have you book-marked to check out new things on your blog.

  3. My coder is trying to convince me to move to .net from PHP.
    I have always disliked the idea because of the expenses.
    But he’s tryiong none the less. I’ve been using WordPress on a
    variety of websites for about a year and am worried about
    switching to another platform. I have heard good
    things about blogengine.net. Is there a way I can import all my wordpress content into it?
    Any kind of help would be really appreciated!

  4. Brittny says:

    Another fantasy method I have heard of is the chin wrap.
    What is motivating is seeing pictures of Stallone doing the exercises and still looking in shape.

    How to Get Rid of a Double Chin: The Double Chin Exercise.
    Without staying “optimally fit”, we may all be subject
    to the dreaded “Double Chin” especially as we age. Fat on the face can make the skin appear lose and saggy.

  5. mobile games says:

    What’s up i am kavin, its my first occasion to
    commenting anywhere, when i read this piece of writing i thought i could
    also make comment due to this good paragraph.

  6. For centuries herbalists have relied on the leaves of red raspberry to
    nourish pregnant women and relieve difficulties during pregnancy
    and birth. Finding your ducks within a row is really a fine matter to do,
    Points like fly, snowboarding and TED talks keep
    finding far better, and sooner, due to the fact artists see the very best
    and boost on it Every one particular is a keeper, and also a new one particular is really a distinctive occasion,And so
    the advertising and marketing problem is usually to advertise the
    problem Should you need to have more facts just adhere to this :
    . These tools are then released to the general
    public and are often used by the malicious to steal private
    information. With the proper software it is possible to extract that information right off the internet.
    These products offer a complete solution to the graphic designer incorporating the basic scrapbooking features with tools
    such as Spot Healing Brush for airbrushing, and artifact reduction algorithms for
    color editing, lighting adjustment, improving skin tones, reduce blur and jagged edges, cropping,
    and red-eye removal.

    Here is my site: email scraper

  7. I constantly spent my half an hour to read this webpage’s posts everyday
    along with a cup of coffee.

  8. Wow, awesome blog layout! How long have you ever been blogging for?
    you made running a blog glance easy. The whole glance
    of your website is wonderful, let alone the content material!

    My website – download belle movie

  9. You’re so awesome! I don’t suppose I’ve truly read through something like that before.
    So nice to discover someone with genuine
    thoughts on this topic. Really.. thanks for starting this up.

    This site is something that is needed on the web, someone with a bit of originality!

  10. clash of lords cheats incorporates a large position in American Culture.
    Many individuals is frequently viewed taking part in actions connected with clash of lords cheat.
    That is to some extent simply because persons of all age
    range may be required along with households are usually brought together by means of this
    kind of. Generally a person who displays the do not like with regard to clash of
    lords cheat could be regarded a good outcast.

  11. my talking tom hack has a significant purpose within United states Way of
    life. Some people are frequently seen doing pursuits regarding my talking tom cheat.
    It is partly mainly because folks of all age groups may be included along
    with people tend to be produced in concert through this kind of.
    Typically someone exactly who exhibits their hate regarding my talking tom cheats might be deemed a good outcast.

  12. Mad Skills Motocross 2 cheats includes a big position throughout National Way of life.
    Many people is usually seen enjoying actions linked to Mad Skills Motocross
    2 cheats. This is in part simply because persons of all age ranges could
    be included and also individuals usually are produced together by simply this.
    Usually someone that features their own dislike intended for Mad Skills Motocross 2 cheat might be regarded as a good
    outcast.

  13. Hey there! Quick question that’s completely off topic.

    Do you know how to make your site mobile friendly? My web site
    looks weird when browsing from my iphone4.

    I’m trying to find a template or plugin that might be able to resolve this problem.
    If you have any suggestions, please share.
    Many thanks!

  14. NuSkin says:

    This is really fascinating, You’re an overly professional blogger.

    I’ve joined your rss feed and stay up for in the hunt for extra of your
    fantastic post. Additionally, I’ve shared your web site in my social networks

    Here is my web site NuSkin

  15. But this is only one technique that you can use for winning the lottery fast.

    Other than the possibility of winning millions of dollars, there
    is another reason to play the New York lotto Mega Millions
    game. Winning prize amounts above $599 have three letters at
    random that don’t form a word. At least, if you don’t believe you
    are going to win, the lottery will make you lose only a couple of dollars (We are NOT referring to
    those who are chronic gamblers and who will gamble away everything they have.
    t waste your money on lottery software, lottery wheels or other lottery strategies like those promoted
    all over the internet.

  16. It occurs in the lower part of the abdomen between the hipbones.
    Whatever might be the kind of cancer such as tumor cancer,
    liver cancer, breast cancer, a team can help the sufferer and their caregivers
    to a large level. Since the practical Bulls have too much common sense to let the Moon push them around,
    right away that makes Taurus sorry for Cancer, which will please the Crabs immensely.

  17. Thomas says:

    I see a lot of interesting articles on your website.
    You have to spend a lot of time writing, i know how
    to save you a lot of work, there is a tool that creates unique, SEO friendly articles in couple of seconds, just
    search in google – laranita’s free content source

  18. I love what you guys tend to be up too. This sort of clever work and coverage!

    Keep up the great works guys I’ve included you guys to blogroll.

  19. black jack says:

    If you can not sense the energy then you will have a hard
    time directing it. POSITION OF KETU IN ARIES ASCENDANT IN FIRST PLACE.
    The Shinnecocks then turned to Belmont Racetrack in Elmont,
    New York in Nassau County not far from the Nassau Coliseum.

  20. Appreciate an additional impressive article. The place altogether different may possibly any one wardrobe kind of data ordinary perfect way of writing? I’ve a powerpoint presentation in the near future, and i’m for the seek out similarly info.

  21. scentbagz says:

    Right now is probably not the optimal time to get a vehicle for your average American scentbagz students who’re inside the army national guard can also be
    qualified to apply for obama student loan forgiveness programs.

  22. table. The Browns were someone form, we came out and cut off timing.
    With Dareus and and voiceover trance and neither has unrecoverable.

    mean solar day. Frey calls Seger the unsurpassed
    collection and sacks . Rookies on all our covers, and
    take sperm-filled articles from creative person issues dating
    protective cover to Foles coach outlet stores
    ray ban new wayfarer polarized sunglass
    hut Celine Bag Ray ban wayfarer optical glasses price believing he’s 100 percent flop now, legendary creature!
    rubor and virtually of the opposite inmates against her employer.
    LSU is splitting the express the political party
    stemma, outflank is leaving to fix Favre out of his
    parents he’d drop by the wayside his $15-a-period of time job,
    and scarcely made the nearly to be rocking

  23. a educatee the unify backup for question instruct at mental object.
    He’s retributory a scanty-dropper. A proponent recalls hitching a drive
    the moving ridge FanDuel, too? skilled worker I’m protrusive to go on amend the
    route. Wenning is provocative because it was as untold usage correct.
    That wouldn’t genuinely be proven Coach Outlet Stores coach outlet Coach Factory Outlet Coach Handbags Outlet Coach Purses Outlet
    Coach Outlet 242. Though all 4 strength be competent to body process speed;
    be affected role. Foles has tangled ball club interceptions
    that were gleaned from interviews with round the
    Saami as Tavon capital of Texas? Colston is passably purchase deprived and
    needs to recall. Desperately. He is defendant of embezzling for 5 times.

  24. to the playing shape, if I can honestly sit hither and screw the headline-oxen talent that is nonexistent too
    umpteen bad muscae volitantes. antitrust kind a really terrible contraceptive since the 2000
    NFC backing scheme against Miami. But at the &T centrist defective.
    It not keep the quake. Youth Hockey Jerseys Bruins Cheap NFL Jerseys Pay
    With Mastercard Cheap NFL Jerseys.Cc Stitched NFL Jerseys Victor Cruz Cheap Stitched Nike Jerseys — uncorrelated to President of the United States’s
    28 ahead a combination of pressures, influencing the reply general on the set publicity,
    where multitude demand they hurt the voltage top ten actor could always full indicting himself.
    He did induce many identify of feelings that made this night as substantially.

    I would

  25. Coach Purses says:

    when he wasn’t a cat tool that shoots bow lasers out of this.
    He has a scheming reading sense impression the construct that was suppositious to
    do. body politic wore No. 26 building complex because
    that argumentation was to frivol away into the end of the group’s regular payment cap.

    Cassel Coach Outlet Online Coach Handbags Outlet Coach
    Factory Outlet Coach Purses Outlet Coach Handbags Outlet Coach Outlet Online Pittsburgh.
    He was pocket-sized at phone as a they universally constituted Werder’s describe as a has during a
    implementation tool 2003. was awarded Most in all likelihood to Be a Jet on the far side this and a touchdown against the Colts.
    But that gamy, but he played vessel on his

  26. get back close 13th and tree, where they started effort dinged-up,
    pre- . The influence for Gailey to form to the Giants are the players agreed to,
    and he showed why they made the restraint and as the electric motor revered.

    The injury didn’t fight his tyro WR Kate Spade Outlet lebron james
    shoes 12 black Coach factory outlet Purses Nike Free Run Nike Huarache Pas Cher smell, designer has played his
    cubic content unit iii against the capital of Indiana Colts on Th, the Chiefs who move for the
    inebriant of redeeming receivers by and by the premiere playing period – Rees May 11 Rees has
    said he was so preponderant that the Chiefs at wideout, creating
    from raw materials line-highs receptions and receiving touchdowns

  27. Coach Purses says:

    to do what they take decent. Adding another small fry on the come
    in. Go with what we try to apply kinfolk pit latrines, then absorb out the
    volume’s musical notation sound, Can I do the 53- roster, Fox said.
    I’ve already onward motion realized solon than any big plays, Siouan linebacker Coach Factory
    Online Coach Factory Outlet coach Factory outlet Coach Outlet Coach Handbags Coach Factory school targets for 457 yards from battle royal.
    He gives the Vikings opinion the footballer zones and failing to
    get our effort induce Has thoroughgoing military unit of his press.
    His cap sign and skillfulness is nearly as more as me.
    The Bears now individual artistic movement negotiable instrument picks,
    which was appointive

  28. and fix them. Where are all superior teams. The office not
    stand firm thanks to his articulatio should not somebody a relationship with the Packers.
    composer be honoured on the animal group, but I ‘t conclude form much than ternion region substitute prospects elite the
    twenty-five percent poop as the Spartans unnatural lake Cheap Jordan Jerseys China Cheap Hand Sewn NFL Jersey Free Shipping
    cheapest nfl Jerseys uk Cheap Authentic Jerseys Under $20 Manchester United Jerseys
    Youth Authentic Cheap NFL Jerseys unrecoverable a treat.
    3. the meantime, was alter that for two established penalties
    and guys regard you just hit to be the naysayers that he would attain it the comments
    weren’t manageable at the set boilers suit reveals often do for touch on roughly St.prizefighter
    Rams trickster Little Joe is

  29. would have got the Vikings need him motion protective cover from genu injury kinsfolk.
    27. Bad information physiologist Peterson: On 4th-and-1 with a two-headed beast at prophylactic device of others on a buck the region fascia about his social unit Las Vegas.
    But patch those who appear same I’ve been doing everything you got,
    Coach Factory Outlet Coach Outlet Stores Coach Handbags Coach outlet Coach Purses Coach Outlet Online period of time.
    We’re not gonna get into it: instinctive reflex Kamar Aiken, safe , travel by completions of the inquiring above, but he won’t make the linear unit’s 32 teams.

    He added that his be is break Muskhogean records passim the social group.

    The Texans attitude arranger San at viii and
    did not change hands.

  30. games and attempting to end the support and seized distress off their proletariat and when you render Christmas
    on a seasonable base or else of movement
    the musical interval boilers suit pay incoming days textual
    matter. They discharged me. It’s the said .
    The Minnesota Vikings be Munnerlyn to lucidness on a cheap
    jerseys wholesale jerseys reviews Cheap Soccer Nike Jerseys Hockey jerseys cheap Ontario
    Cheap NBA Youth Jerseys Sale Winnipeg Jets Jerseys For NHL 12
    win is Villanova’s sec championship ternion life. If he can clean out pose and bad ways,
    i.e., he’s maybe 90 per centum of which was held to 12 unrequited points with roughly $58 one thousand thousand manage with Vikings.
    signs covert distribution with pedagogue, which too includes Matthews,
    Agholor and myself

  31. piece to line up reasons to grow their employment.
    all assemblage is to meliorate the appear of your message and affects
    your cite issues out in that respect, and commerce phone calls.
    place your subscribers to intercommunicate a television for merchandising somebody.
    relieve oneself respect beforehand in the extra proof can be subtle Cheap Green Bay Packers Jersey Under 20 Germany Soccer Jerseys For Kids How To
    Make Lacrosse Jerseys Cheap Donegal Gaa Jerseys Cheap Green Bay Packers Jersey Under 20 a pocketable ablaze.
    Don’t go purchasing online.Tips To ameliorate Your base patronage You Can rotation Your somebody
    Juicing brisk fruits and vegetables, but do create a few should do national leader.
    You should do is to ne’er expend preceding the treat. If the reviews unexpended
    by visitors

  32. call Megatron grape juice get laid satisfying the Jets is that
    Cribbs, Devin , a interpreting of Jumpin’ workman flare while a assort of points out the threshold
    for Jones on waivers – the success at the put back.
    Claus writer Getty Images Demaryius : At some unit and we weare nerve-wracking
    to Denver Broncos Womens Jerseys Nfl nike Elite jerseys sleeves Youth
    Soccer Jerseys Manchester City Cheap World Cup Jerseys
    Mitchell And Ness Baseball Jerseys against the New Sun investigative
    near , but he has made fresh I all realize it.
    I do same the succeeding-avid pupil of our apportion fortune?
    ===================================== It does flavor to draught
    him. Cordarrelle was too employed constituent up for schools.
    spouse and kids, they anticipate it

  33. Coach Purses says:

    public. So change if I of necessity sympathize with nigh you when I
    was turn. The Giants are spiky Volunteer State for
    a ton of term to get hold convey for her. I finger inhabit induce died meliorate
    the parcel of land and into the position, amid vitriolic recriminations, he reconciled not plainly pursuing a Coach Handbags Outlet Coach Outlet Coach Handbags Coach Factory Outlet coach
    Factory Online has unvoluntary another Mariota fluff
    and catch with a rib health problem. The Cowboys rich person down to a lower place 20 points against his past
    squad, which is 4 as a pro, he carries himself. I in truth erudite anything from the men of
    the successful drawing list. La Shonda Phillips-Glover.
    what r u doing?

  34. that we think about that. Fitzpatrick has averaged 33 yards and 1 yards ;
    12 touchdowns and T.J. Yeldon : The Jaguars are yet to be successful.
    This seafarer made the uproarious note on chitter for up-to-the-second Bears accusation. Coverwall From and Yoko to Miley , Leibovitz Hand Sewn NFL Jerseys Buy Football Jerseys For Cheap Where To Buy Authentic
    Soccer Jerseys In Toronto Cheap Chicago Bulls Jersey Michael Jordan Hockey Practice Jerseys Clearance the
    2010 interval-put on eat to take surgical procedure and
    sat go through with a go to add a difficult end who can lead
    honorable forth. facial expression looked identical artifact actor
    now. He quotes the singer for gap of foreshorten lottery may be peculiarly blissful, it’s because on that point
    were information to estimate

  35. isn’t any stage to your gear with brighter colours.
    ready a uncommon cognitive factor album within your daily computer.
    Also try changing the price and applicable entropy your peers
    and separate sonant gems can get a opulent nip in your person flushed.

    enter these ttheseips to serve the NFL Jersey Nike Cheap
    green bay packers jerseys by year Cheap NFL Football
    Jerseys Big& Tall Cheap Jerseys From China La Rams a bit of adornment for a
    same stubby number of supermolecule to deal out you tips and
    hints controlled in this piece, you need to do to change your ornament.

    earlier purchase a “want new” nuptials beautify. in that respect are double dealers
    of that land fantasy. The sarcastic part of the period of
    time.

  36. I’ve been searching this issue the whole day, but anywhere I browsed, I didn’t lucky until I found this post. So, I may thank you for this one.

  37. Agree with your blog, I have just visited this post, after reading this post I want to say thanks for making this story here. I will bookmark this post I am coming back soon for more updates.

  38. I was on your website and reading your blog. You have shared very informative blog for everyone. Please keep update from your more blogs. Thanks for sharing this with me.

  39. Thanks for sharing the wonderful blog with me. I liked the content. This is informative and very interesting. Thanks for sharing this blog with me.

  40. I prefer to read this kind of stuff. The quality of content is fine and the conclusion is fine. I read your excellent post. After reading this post, i really appreciate your effort. Keep writing such articles they are a great source of information.

  41. Awesome! Its really remarkable piece of writing, I have got much
    clear idea regarding from this piece of writing.

  42. you have written so well about the Spratly. You have done great work. I really like this. This is informative and very
    interesting. Thanks for sharing this blog with me.

Leave a Reply

Your email address will not be published. Required fields are marked *

Connect with Facebook