Paget's disease of the bone
SCENARIO
At 2 pm on Wednesday 13th October 2021, Mr. Johnson reported to Victoria dental clinic nursery in Vista Bella with complaints of difficulty in chewing food as his teeth were not in contact during mastication. The patient has a history of swelling in the left and right maxillary posterior teeth region for the past 6 years. His vital signs read as follows, blood pressure 152/81, pulse 92, SpO2 94%, glucose 126mg/dl. Swollen areas were observed bilaterally around the cheeks and on the right portion of the forehead. The swollen areas began to show a gradual increase in size. Upon examining, more swollen areas were present when observing around the inner cheek areas bilaterally, which seemed to be rough and bone-like in consistency when palpating. The swollen areas had no movement and joined to the bone underneath. The area had an enlarged appearance. The contact between teeth was altered to the point where the enamel is no longer intact. As the swollen areas had been many in number, bilateral, showing constant growth, is asymptomatic, and has a bony-like feel, the following procedures took place: radiologic, biochemical, and histopathologic procedures.
Radiograph – The Postero-anterior and Lateral view of the cranium was examined and generalized flecks of abnormally shaped radiopacities around the entire cranium, had appeared like cotton-wool.
Computed tomography (CT) – shows osteosclerosis of proper maxillary, ethmoid, frontal, and sphenoid sinuses with widening of diploic area with sclerotic and lytic regions concerning internal and outer tables of bony calvarium. There is an expansion, with sclerosis of all partitions of proper maxillary, proper ethmoid, and ground of left maxillary sinuses.
Biochemical exams – results show normal serum calcium: 9.2 mg/dL and serum phosphorus: four mg/dl, however markedly raised serum alkaline phosphatase (SAP): 1251 IU and urinary hydroxyproline: Creatine ratio: 243.6 mmol. An incisional biopsy of the swollen area turned into performed inner side the left maxillary alveolus.
Histopathologic exam – showed a mobile proliferating inter-trabecular fibroblastic marrow with a lot of clusters containing osteoclasts separating spicules of bone that seemed many in a number of the bits with several cement strains developing a mosaic pattern. Trabecula of bone with basophilic reversal strains in connective tissue stoma.
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