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Extra resources for ATLS: Advanced Trauma Life Support for Doctors (Student Course Manual), 8th Edition

Sample text

Although it has been assumed that the formation of pagetic bone is a coupled response to increased resorption, it should be emphasized that all pagetic bone is abnormal. The osteoblastic rate is high, the osteoblastic surface is increased, and the osteoblasts themselves are also probably not normal. The increase in osteoblast function could somehow result from contact of cell membranes of osteoclasts and osteoblasts or stromal cells or through release of some product of osteoclasts. Many of the remodeling events in Paget's disease have been interpreted as consistent with an increased "birth rate" of all of the bone cell populations.

The older the patient (60-70 years) and the greater the extent of skeletal involvement, the higher the risk of sarcomatous change. Smith and colleagues 14 at Memorial Hospital reported 85 pagetic sarcomas collected over 55 years (1927 -1982). Histologically, the majority of these tumors were osteosarcomas. 13. Skull of a 73-year-old man with extensive skeletal involvement in Paget's disease. Severaliarge destructive lesions in the calvaria proved to be benign giant cell tumors (arrows). He had at least six tumors in the skull that responded to radiation treatment.

Skeletal RadioI1983;1O:102-106. REFERENCES 19 17. Mirra JM: Pathogenesis of Paget's disease based on viral etiology. Clin Orthop 1987; 217:162-170. 18. Schajowicz F, Slullitel I: Giant-cell tumor associated with Paget's disease of bone. J Bone Joint Surg 1966;48A(7):1340-1349. 19. Jacobs T, Michelsen J, Polay J, et al: Giant cell tumor in Paget's disease of bone: Familial and geographic cluster. Cancer 1979;44:742-747. 20. Monson DK, Finn HA, Dawson PJ, Simon MA: Pseudosarcoma in Paget's disease of bone.

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