1
|
Xiang J, Zhong W. The molecular mechanism of Gorham syndrome: an update. Front Immunol 2023; 14:1165091. [PMID: 37215116 PMCID: PMC10196207 DOI: 10.3389/fimmu.2023.1165091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Gorham syndrome, also known as "vanishing osteopathy" and "invasive hemangiomatosis," is a rare clinical syndrome whose etiology is unknown and can invade the whole-body skeleton. At present, more than 300 cases have been reported at home and abroad, usually manifesting as spontaneous chronic osteolysis with no periosteal reaction at the lysis site and occult onset, often with fractures, scoliosis, chylothorax, etc. When waiting for medical treatment, the condition is serious, and the prognosis is poor. At present, there is no effective treatment. The main pathological manifestations of Gorham syndrome are the non-neoplastic abnormal proliferation of lymphatic vessels or blood vessels and osteolysis caused by osteoclast proliferation or increased activity. At present, there is no unified conclusion regarding Gorham syndrome's pathogenesis. This paper starts with the two most studied osteolysis methods at present, osteoclast osteolysis and osteolysis caused by vascular and lymphatic proliferation and summarizes the corresponding most possible molecular mechanisms in recent years to provide more ideas for Gorham syndrome treatment.
Collapse
Affiliation(s)
- Juqin Xiang
- Chongqing Medical University, Chongqing, China
| | - Weiyang Zhong
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
2
|
Gupta R, Biswas S, Das P, Gupta P, Gupta K, Gopinathan M, Gupta A, Neyaz Z, Ora M. When "milky fluid" was aspirated from the bone: Gorham-Stout syndrome-A report of a rare entity. Pediatr Blood Cancer 2023; 70:e29896. [PMID: 35899433 DOI: 10.1002/pbc.29896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Ruchi Gupta
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Seema Biswas
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Prateek Das
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Prakhar Gupta
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Kusum Gupta
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Mathiyazhagan Gopinathan
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Anshul Gupta
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Zafar Neyaz
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Manish Ora
- Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| |
Collapse
|
3
|
Hong PY, Zhang XB, Zeng HQ, Zhao YL, Huang MH. Gorham-Stout syndrome: A chylothorax disease with bony destruction: A case report. Medicine (Baltimore) 2022; 101:e32105. [PMID: 36550844 PMCID: PMC9771225 DOI: 10.1097/md.0000000000032105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Gorham-Stout syndrome is a sporadic condition characterized by a tumor-like lesion with extensive osteolysis, severe symptoms, and a poor prognosis. Poor prognostic indicators include osteolytic lesions of the spine and pleura effusion. PATIENT CONCERNS A 67-year-old Chinese man with five months history of chest tightness presented to our institution with aggravated shortness of breath. Ultrasonography demonstrated hydrothorax on the right side. The patient's imaging studies (computerized tomography [CT] scan, magnetic resonance imaging, and positron emission tomography [PET]/CT) revealed osteolytic lesions (the skull, several spines, several ribs, both shoulder blades, and the pelvis). DIAGNOSES Gorham-Stout syndrome. (4) Interventions: We advised the patient to follow a low-fat diet. On the patient, we performed a superior vena cava angiography. The injection of zoledronic acid was used to prevent bone loss. OUTCOMES We found resolution of chylothorax after a low-fat diet, superior vena cava angiography and injection of zoledronic acid. LESSONS The possibility of Gorham -Stout syndrome should be ruled out in patients with clinical chylothorax. The relief of chylothorax requires comprehensive treatment.
Collapse
Affiliation(s)
- Ping-Yang Hong
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; the Third Clinical Medical College of Fujian Medical University, Fujian, China
| | - Xiao-Bin Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; the Third Clinical Medical College of Fujian Medical University, Fujian, China
| | - Hui-Qing Zeng
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; the Third Clinical Medical College of Fujian Medical University, Fujian, China
| | - Yi-Lin Zhao
- Department of Oncology and Vascular Intervention, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; the Third Clinical Medical College of Fujian Medical University, Fujian, China
| | - Mao-Hong Huang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; the Third Clinical Medical College of Fujian Medical University, Fujian, China
- * Correspondence: Mao-Hong Huang, Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; the Third Clinical Medical College of Fujian Medical University, Fujian Provincal Clinical Key Speciality No.201, Hubin Nan Road, Siming District, Xiamen, Fujian Province, China (e-mail: )
| |
Collapse
|
4
|
Wojciechowska-Durczynska K, Zygmunt A, Mikulak M, Ludwisiak M, Lewinski A. Difficult Therapeutic Decisions in Gorham-Stout Disease-Case Report and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811692. [PMID: 36141975 PMCID: PMC9517245 DOI: 10.3390/ijerph191811692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 05/30/2023]
Abstract
Gorham-Stout disease (GSD) is a very rare, life-threatening condition characterized by the proliferation of lymphatic vessels and osteolysis. Unfortunately, no standard treatment has been determined for management of GSD. The available therapies are not equally effective and carry substantial side-effects. We report a 42-year-old female with GSD manifested in multifocal osteolysis and chronic chylothorax and ascites. The combined treatment with sirolimus and zoledronic acid due to its synergism of action was introduced. To our knowledge, this is the first Polish case report of adult patients with Gorham-Stout disease.
Collapse
Affiliation(s)
- Katarzyna Wojciechowska-Durczynska
- Department of Endocrinology and Metabolic Disease, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| | - Arkadiusz Zygmunt
- Department of Endocrinology and Metabolic Disease, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| | - Marta Mikulak
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| | - Marta Ludwisiak
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| | - Andrzej Lewinski
- Department of Endocrinology and Metabolic Disease, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland
| |
Collapse
|
5
|
Rossi M, Rana I, Buonuomo PS, Battafarano G, Mariani E, D'Agostini M, Porzio O, De Martino V, Minisola S, Macchiaiolo M, De Vito R, Vecchio D, Gonfiantini MV, Jenkner A, Bartuli A, Del Fattore A. Dysregulated miRNAs in bone cells of patients with Gorham-Stout disease. FASEB J 2021; 35:e21424. [PMID: 33609323 DOI: 10.1096/fj.202001904rr] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 12/31/2022]
Abstract
Gorham-Stout disease (GSD) is a very rare disease characterized by increased bone erosion with angiomatous proliferation. The mechanisms underlying this disorder have not been deeply investigated. Due to its rarity, no guidelines are currently available for treatment and management of GSD. We recently evaluated the cellular alterations of the bone remodeling in patients showing that osteoclast precursors displayed increased ability to differentiate into osteoclasts and that affected osteoclasts resorb bone more actively than control cells. Moreover, osteoblasts isolated from a patient showed a defective ability to form mineralized nodules. In this paper, we investigated the molecular pathways involved in the cellular defects of GSD bone cells. For this study, we recruited nine patients and performed miRNome analysis of bone cells. Between the 178 miRNAs robustly expressed in GSD osteoclasts, significant modulation of three miRNAs (miR-1246, miR-1-3p, and miR-137-3p) involved in the regulation of osteoclast formation and activity or in the angiomatous proliferation was found in patients' cells. Interestingly, miR-1246 was also up-regulated in serum exosomes from patients. Analysis of miRNAs from patient osteoblasts suggested alteration of miR-204a-5p, miR-615-3p and miR-378a-3p regulating osteoblast function and differentiation. The resulting miRNA pattern may help to understand better the mechanisms involved in GSD and to identify new potential therapeutic targets for this rare disease.
Collapse
Affiliation(s)
- Michela Rossi
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ippolita Rana
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Sabrina Buonuomo
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Battafarano
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eda Mariani
- Research Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matteo D'Agostini
- Clinical Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ottavia Porzio
- Clinical Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Viviana De Martino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Salvatore Minisola
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Marina Macchiaiolo
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita De Vito
- Department of Histopathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Vecchio
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Alessandro Jenkner
- Division of Immunology and Infectious Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Bartuli
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Del Fattore
- Bone Physiopathology Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
6
|
Toga A, Watanabe K, Suzuki S, Nori S, Tsuji O, Nagoshi N, Okada E, Yagi M, Fujita N, Nakamura M, Matsumoto M. Gorham-Stout Disease Resulting in Spinal Deformity Treated by Fusion Surgery Combined With Everolimus Therapy: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00038. [PMID: 33657060 DOI: 10.2106/jbjs.cc.20.00296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Gorham-Stout disease (GSD) is a rare disorder characterized by progressive localized osteolysis and lymphatic malformation. A 26-year-old woman with GSD presented to our hospital with a Cobb angle of 100° and a kyphosis angle of 88°. Everolimus therapy was initiated to control the disease prior to surgery. After halo-gravity traction for 4 weeks, we performed anterior and posterior spinal fusion. Postoperative computed tomography revealed satisfactory bone union and no significant loss of correction 1 year post-surgery. CONCLUSION This case suggests that anterior and posterior spinal fusion combined with everolimus therapy can be a therapeutic option for GSD.
Collapse
Affiliation(s)
- Akira Toga
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Gallant SC, Chewning RH, Orbach DB, Trenor CC, Cunningham MJ. Contemporary Management of Vascular Anomalies of the Head and Neck-Part 1: Vascular Malformations: A Review. JAMA Otolaryngol Head Neck Surg 2021; 147:197-206. [PMID: 33237296 DOI: 10.1001/jamaoto.2020.4353] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Vascular anomalies of the head and neck are relatively rare lesions. Management is challenging because of the high likelihood of involvement of functionally critical structures. Multiple modalities of treatment exist for vascular anomalies of the head and neck, including medical therapies, sclerotherapy and embolization procedures, and surgery. This review focuses on the accurate diagnosis and the relative roles of the various therapeutic options. Observations Vascular anomalies are classified by the International Society for the Study of Vascular Anomalies into 2 major groups: vascular tumors and vascular malformations. Vascular tumors encompass proliferative lesions ranging from infantile and congenital hemangiomas to kaposiform hemangioendothelioma. Alternatively, vascular malformations are embryologic errors in vasculogenesis. This article focuses on the management of vascular malformations. The 3 primary vascular malformation subclassifications are lymphatic, venous, and arteriovenous. The burden of disease, diagnosis, and current management options are discussed in detail for each subtype. Conclusions and Relevance Most vascular malformations of the head and neck require a multidisciplinary approach. Available medical, interventional radiologic, and surgical interventions are constantly evolving. Optimization of function and cosmesis must be balanced with minimization of treatment-associated morbidity. Otolaryngologists-head and neck surgeons must remain up to date regarding options for diagnosis and management of these lesions.
Collapse
Affiliation(s)
- Sara C Gallant
- Department of Otolaryngology and Communication Sciences, Boston Children's Hospital, Boston, Massachusetts.,Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts
| | - Rush H Chewning
- Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.,Division of Vascular and Interventional Radiology, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Darren B Orbach
- Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.,Division of Vascular and Interventional Radiology, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Cameron C Trenor
- Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Michael J Cunningham
- Department of Otolaryngology and Communication Sciences, Boston Children's Hospital, Boston, Massachusetts.,Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
8
|
Liang Y, Tian R, Wang J, Shan Y, Gao H, Xie C, Li J, Xu M, Gu S. Gorham-Stout disease successfully treated with sirolimus (rapamycin): a case report and review of the literature. BMC Musculoskelet Disord 2020; 21:577. [PMID: 32843029 PMCID: PMC7446191 DOI: 10.1186/s12891-020-03540-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gorham-Stout disease (GSD) is a rare disease characterized by bone lesions and osteolysis. Therapy usually involves surgical resection. Sirolimus (Rapamycin) is used in some patients with GSD but the efficacy and safety of Sirolimus remains unclear. We propose that Sirolimus may be a novel therapeutic for GSD and present a case and review of literature that supports this. CASE PRESENTATION We presented a 1-year-old boy with GSD involving osteolysis of the right humerus with fracture of the left femur complicated by an effusion in the right pleural cavity. X-rays showed osteolysis in the right clavicle. A large pleural effusion was observed on the right-side, and the left lung was significantly compressed. X-rays also showed a fracture of the left femur. A femoral biopsy was performed that showed necrotic tissue in the cortical bone and a large number of irregularly shaped capillaries that proliferated within the necrotic tissue. Dilated lymphatic vessels were seen adjacent to the cortex, with fibrous tissue hyperplasia. We prescribed sirolimus, which is an oral mTOR inhibitor, for two consecutive years. The boy recovered well without other progressive bone lesions and participates in normal daily activities. His growth and development are the same as that of his peers. DISCUSSION AND CONCLUSION Gorham-Stout disease is a rare and enigmatic disease characterized by the presentation of an intraosseous lymphatic anomaly (LM), which results in progressive bone resorption. Based on this case report and a literature review, we conclude that sirolimus may be an effective alternative medication for GSD.
Collapse
Affiliation(s)
- Yu Liang
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Ruicheng Tian
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Jing Wang
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Yuhua Shan
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Hongxiang Gao
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Chenjie Xie
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Jingjing Li
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Min Xu
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China.
| | - Song Gu
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China.
| |
Collapse
|
9
|
Schneider KN, Masthoff M, Gosheger G, Klingebiel S, Schorn D, Röder J, Vogler T, Wildgruber M, Andreou D. Gorham-Stout disease: good results of bisphosphonate treatment in 6 of 7 patients. Acta Orthop 2020; 91:209-214. [PMID: 31928107 PMCID: PMC7144312 DOI: 10.1080/17453674.2019.1709716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Gorham-Stout disease (GSD) is a rare mono- or polyostotic condition characterized by idiopathic intraosseous proliferation of angiomatous structures resulting in progressive destruction and resorption of bone. Little is known about the course of disease and no previous study has evaluated patients' quality of life (QoL).Patients and methods - This is a retrospective analysis of 7 consecutive patients (5 males) with a median age at diagnosis of 14 years and a median follow-up of 7 years who were diagnosed with GSD in our department between 1995 and 2018. Data regarding clinical, radiographic, and histopathological features, and treatment, as well as sequelae and their subsequent therapy, were obtained. QoL was assessed by Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), and Reintegration to Normal Living (RNL) Index.Results - 3 patients had a monoostotic and 4 patients a polyostotic disease. Besides a diagnostic biopsy, 4 of the 7 patients had to undergo 8 surgeries to treat evolving sequelae. Using an off-label therapy with bisphosphonates in 6 patients, a stable disease state was achieved in 5 patients after a median of 20 months. The median MSTS, TESS, and RNL Index at last follow-up was between 87% and 79%.Interpretation - Due to its rare occurrence, diagnosis and treatment of GSD remain challenging. Off-label treatment with bisphosphonates appears to lead to a stable disease state in the majority of patients. QoL varies depending on the individual manifestations but good to excellent results can be achieved even in complex polyostotic cases with a history of possibly life-threatening sequelae.
Collapse
Affiliation(s)
- Kristian Nikolaus Schneider
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Germany; ,Correspondence:
| | - Max Masthoff
- Institute of Clinical Radiology, University Hospital of Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Germany;
| | - Sebastian Klingebiel
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Germany;
| | - Dominik Schorn
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Germany;
| | - Julian Röder
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Germany;
| | - Tim Vogler
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Germany;
| | - Moritz Wildgruber
- Institute of Clinical Radiology, University Hospital of Münster, Germany
| | - Dimosthenis Andreou
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Germany;
| |
Collapse
|
10
|
Rossi M, Buonuomo PS, Battafarano G, Conforti A, Mariani E, Algeri M, Pelle S, D'Agostini M, Macchiaiolo M, De Vito R, Gonfiantini MV, Jenkner A, Rana I, Bartuli A, Del Fattore A. Dissecting the mechanisms of bone loss in Gorham-Stout disease. Bone 2020; 130:115068. [PMID: 31525474 DOI: 10.1016/j.bone.2019.115068] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 12/17/2022]
Abstract
Gorham-Stout disease (GSD) is a rare disorder characterized by progressive osteolysis and angiomatous proliferation. Since the mechanisms leading to bone loss in GSD are not completely understood, we performed histological, serum, cellular and molecular analyses of 7 patients. Increased vessels, osteoclast number and osteocyte lacunar area were revealed in patients' bone biopsies. Biochemical analysis of sera showed high levels of ICTP, Sclerostin, VEGF-A and IL-6. In vitro experiments revealed increased osteoclast differentiation and activity, and impaired mineralization ability of osteoblasts. To evaluate the involvement of systemic factors in GSD, control cells were treated with patients' sera and displayed an increase of osteoclastogenesis, bone resorption activity and a reduction of osteoblast function. Interestingly, GSD sera stimulated the vessel formation by endothelial cells EA.hy926. These results suggest that bone cell autonomous alterations with the cooperation of systemic factors are involved in massive bone loss and angiomatous proliferation observed in GSD patients.
Collapse
Affiliation(s)
- Michela Rossi
- Bone Physiopathology Group, Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Giulia Battafarano
- Bone Physiopathology Group, Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Conforti
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Eda Mariani
- Research Laboratories, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mattia Algeri
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Marina Macchiaiolo
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Rita De Vito
- Histopathology, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Alessandro Jenkner
- Division of Immunology and Infectious Diseases Department of Pediatrics, Bambino Gesù Children Hospital, Rome, Italy
| | - Ippolita Rana
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Bartuli
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Del Fattore
- Bone Physiopathology Group, Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital, Rome, Italy.
| |
Collapse
|
11
|
de Keyser CE, Saltzherr MS, Bos EM, Zillikens MC. A Large Skull Defect Due to Gorham-Stout Disease: Case Report and Literature Review on Pathogenesis, Diagnosis, and Treatment. Front Endocrinol (Lausanne) 2020; 11:37. [PMID: 32117063 PMCID: PMC7012895 DOI: 10.3389/fendo.2020.00037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/20/2020] [Indexed: 11/13/2022] Open
Abstract
A 24-year old man was referred to the Erasmus MC Bone Center because of an asymptomatic increasing skull defect of the left parietal bone. The defect was first noticed at the age of six, and gradually increased over the years. His medical history was unremarkable, without any known trauma and a negative family history for bone diseases. Laboratory tests showed a low vitamin D level without other abnormalities. Particularly, there was no increase in markers of inflammation or bone turnover. CT-scans of the skull showed an osteolytic region of the parietal skull bone, with a two-centimeter increase in diameter over 9 years. Contrast enhanced MRI showed lymphangiogenic invasion, which was compatible with our suspicion of Gorham-Stout disease. The patient was referred to the neurosurgeon for treatment with a bone graft while considering additional drug treatment. Gorham-Stout or vanishing bone disease is a rare entity characterized by progressive osteolysis with lymphangiogenic bone invasion. Although already reported in 1838, currently the diagnosis and treatment of Gorham-Stout disease is still challenging. The underlying pathophysiology is not clarified yet and several theories exist. The disease usually affects persons younger than 40 years and the majority present with bone disease of the maxillofacial region, the upper extremities or the torso. The clinical presentation includes most frequently pain, swelling, and functional impairment of the affected region, but the disease can also be asymptomatic. Laboratory investigations are usually normal, and diagnosis is based upon imaging and sometimes pathology examination of affected bone tissue. Treatment is experimental and there is no general consensus about the best option due to lack of randomized controlled trials. Case reports showed patients treated with bisphosphonates, interferon-alpha, anti-VEGF therapy, mTOR inhibitors, and radiotherapy. There are some reports of surgery with prosthetic or bone grafts but no long-term follow-up data exist. This paper describes a unique case of Gorham-Stout disease of the parietal skull bone and discusses the current state of knowledge about this rare bone disease.
Collapse
Affiliation(s)
- Catherine E. de Keyser
- Department of Internal Medicine, Bone Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Michael S. Saltzherr
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eelke M. Bos
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - M. Carola Zillikens
- Department of Internal Medicine, Bone Center, Erasmus University Medical Center, Rotterdam, Netherlands
- *Correspondence: M. Carola Zillikens
| |
Collapse
|
12
|
Matsumoto T, Naito M, Hirose J, Nakada I, Morikawa T, Tanaka S. Gorham-Stout Syndrome of the Shoulder Girdle Successfully Controlled by Antiresorptive Agents: A Report of 2 Cases. JBJS Case Connect 2019; 9:e0285. [PMID: 31211750 DOI: 10.2106/jbjs.cc.18.00285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CASE Gorham-Stout disease (GSD) is a rare disorder characterized by massive bone destruction. Consensus is lacking on the effective treatment strategies for GSD. This report presents 2 cases of GSD, a 47-year-old man and a 72-year-old woman, involving the shoulder girdle which were successfully controlled by antiresorptive agents including bisphosphonates and denosumab, the antireceptor activator of nuclear factor-κB ligand antibody. CONCLUSIONS These 2 cases suggest that antiresorptive agents targeting osteoclasts can be efficacious therapeutic options for GSD. This is the first case of GSD we are aware of which showed good response to denosumab treatment.
Collapse
Affiliation(s)
- Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masashi Naito
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Jun Hirose
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Izumi Nakada
- Department of Orthopaedic Surgery, Tokyo Metropolitan Bokuto General Hospital, Sumida-ku, Tokyo, Japan
| | - Teppei Morikawa
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
13
|
Blei F. Update December 2018. Lymphat Res Biol 2018. [DOI: 10.1089/lrb.2018.29054.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|