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Hagelstein-Rotman M, Appelman-Dijkstra NM, Boyce AM, Chapurlat R, Dur NBJ, Gensburger D, Majoor BCJ, van de Sande MAJ, Dijkstra PDS. Extent of Extraskeletal Manifestations of Fibrous Dysplasia/McCune-Albright Syndrome in Patients with Mazabraud's Syndrome. Calcif Tissue Int 2022; 110:334-340. [PMID: 34854944 DOI: 10.1007/s00223-021-00918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/20/2021] [Indexed: 11/27/2022]
Abstract
Mazabraud's syndrome (MZB) is a rare condition in which fibrous dysplasia of bone/the McCune-Albright syndrome (FD/MAS) co-exists with intramuscular myxomas. Both FD and the myxomas harbor the GNAS-mutation. Recent studies have shown that extraskeletal, GNAS-related features are associated with a more severe phenotype of FD/MAS. However, patients with MZB are often only seen by orthopedic surgeons. We therefore evaluated MZB patients seen in tertiary referral centers from the Netherlands (LUMC), USA (National Institutes of Health) and France (INSERM UMR 1033 (Lyos), Hôpital Edouard Herriot). All FD/MAS patients known in these centers with an additional diagnosis of a myxoma were included. Demographic information and data on disease extent and extraskeletal manifestations of FD/MAS such as precocious puberty (PP) or café-au-lait patches (CAL) were retrieved from patient's medical records. Thirty MZB patients were included: 20 women (67%) and 10 men (33%). Patients received a diagnosis of MZB (median 42 years, range 16-19) significantly later than the diagnosis of FD/MAS (median 30 years, range 0-60), p < 0.01. Twenty-six patients were diagnosed with polyostotic disease (87%). In 97% the myxoma was located near the skeletal FD lesion. The combination of MZB and MAS was made in 13 patients in whom PP (n = 7), CAL (n = 7), GH-excess (n = 3) and hyperthyroidism (n = 3) were present. Other extraskeletal features were (multinodular) goiter (n = 2) and thyroid cysts (n = 1). Furthermore, in this cohort of patients with MZB several (pre-)malignant tumors were observed; ductal carcinoma in situ of the breast in 3 patients (10%), breast cancer in 1 patient (3.3%), intra pancreatic mucinous neoplasms in 3 patients (10%) and liver adenomas in 2 patients (6.6%). A total of 47% of patients with MZB had an additional extraskeletal feature such as an endocrinopathy. In MZB, 87% of patients suffer from polyostotic FD, 43% of patients have extraskeletal GNAS-features such as an hyperfunctioning endocrinopathy and 30% (pre-)malignant tumors. We therefore advocate that MZB patients should undergo a complete screening and long-term follow-up for extent of bone disease, but also extraskeletal GNAS features of FD/MAS.
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Affiliation(s)
- M Hagelstein-Rotman
- Department of Medicine: Division of Endocrinology, Centre for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands.
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - N M Appelman-Dijkstra
- Department of Medicine: Division of Endocrinology, Centre for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| | - A M Boyce
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - R Chapurlat
- UMR 1033, INSERM, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - N B J Dur
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - D Gensburger
- UMR 1033, INSERM, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - B C J Majoor
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - M A J van de Sande
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - P D S Dijkstra
- Department of Orthopaedic Surgery, Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
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Pankratjevaite L, Christensen LF, Pranckevicius T, Razbadauskiene S. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac145. [PMID: 35422994 PMCID: PMC9004476 DOI: 10.1093/jscr/rjac145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Intramuscular myxoma (IM) is a rare benign tumour. It may occur at any age but most commonly occurs among older women. The preoperative diagnosis of IM is complicated. The diagnosis can only be definitively established by histopathological examination. The treatment of choice is radical surgical excision. We report a case of a 41-year-old woman with an IM of the biceps brachii muscle.
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Affiliation(s)
- Lina Pankratjevaite
- Department of Breast Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Louise Fischer Christensen
- Correspondence address. Department of Ophthalmology, Aalborg University Hospital, 9000 Aalborg, Denmark. Tel: +4526811447; E-mail:
| | - Tadas Pranckevicius
- Department of Surgery, Lithuanian University of Health Sciences Kaunas Hospital, Kaunas, Lithuania
| | - Sigita Razbadauskiene
- Department of Pathology, Lithuanian University of Health Sciences Kaunas Hospital, Kaunas, Lithuania
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Osteosarcomatous Transformation in the Setting of Mazabraud's Syndrome: A Case Report and Review of the Literature. Case Rep Orthop 2019; 2019:2638478. [PMID: 31275685 PMCID: PMC6558611 DOI: 10.1155/2019/2638478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/14/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Mazabraud's Syndrome is a rare condition that is defined by the presence of fibrous dysplasia lesions in the bone and intramuscular myxomas in the soft tissue. Malignant transformation, in the setting of Mazabraud's Syndrome, of the fibrous dysplasia lesions into a sarcomatous neoplasm occurs in less than 1% of cases-with only six previously reported cases. Case Presentation Here, we present a 62-year-old Caucasian female who developed an osteosarcoma in a fibrous dysplasia lesion of the proximal femur in the background of Mazabraud's Syndrome. The patient was treated with wide excision and endoprosthetic reconstruction. She declined adjuvant chemotherapy. She is alive without evidence of disease one-year postoperatively. Conclusion Patients with Mazabraud's Syndrome remain at low risk for malignant transformation. However, close monitoring of asymptomatic patients with this condition for radiographic changes in their lesions and/or clinical symptoms is recommended.
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