[Baastrup syndrome of the lumbar spine in miners].
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PURPOSE: To describe the imaging features of POEMS, and to compare our experience of 8 cases to a review of literature. MATERIALS AND METHODS: This retrospective study included 8 patients (6 men, 2 women) with POEMS. Plain radiographs (8 patients), CT (6), MR (2) were performed. RESULTS: Topographic localizations of POEMS were pelvis (7 cases), spine (5), femur (1), humerus (1), rib cage (1). Focal bone lesions, multiple (5 cases) or solitary (3 cases), were sclerotic in 4 cases, mixed lytic-sclerotic (lytic center and sclerotic rim) in 3 cases and one patient had an osteolytic lesion with sclerotic margins associated with many osteosclerotic lesions. Profilerative osseous changes were seen in 4 cases (pelvis, spine, tibia). MR imaging was performed in 2 patients: in one patient MR imaging revealed areas of low signal intensity on spin echo T1- and T2-weighted images in vertebral bodies, the other showed a lesion of low signal intensity on spin echo T1-weighted and high signal intensity on T2-weighted images in the ilium and adjacent soft tissue. CONCLUSION: The imaging features commonly observed in POEMS syndrome are sclerotic and mixed lytic-sclerotic lesions, particularly in the pelvis and spine. Proliferative new bone formation is detected in 50%. MR imaging correlates with ostesclerotic or mixed lytic-sclerotic appearance.
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The aim of this review is to detail the pathophysiologic mechanisms occurring during bone metastases. osteolytic and osteosclerotic metastases are observed after migration of malignant cells coming from a primitive tumour which can localize and grow inside the hematopoietic bone marrow. Bone lesions observed during hematologic malignancies (lymphomas and myeloma) are not detailed here. The various cytokine networks that are occurring in bone metastases are detailed: in both cases there is a "vicious circle" between the the tumoral cells and bone cells responsible for the physiological remodeling of bone. The knowledge of these interferences permits to understand the use of anti-osteoclastic treatments (bisphosphonates) in osteolytic as well as osteosclerotic metastases.
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