PMC3420766_01
3D reconstructed CT scan showing osteonecrosis of the humeral head, the acromion, lateral clavicle, and the glenoid in Gorham-Stout disease.
CRIM.RHEUMATOLOGY2011-565142.001.jpg
PMC3420766_01_CRIM.RHEUMATOLOGY2011-565142.001.jpg
fig1
Plain X-rays of both shoulders showed osteolyses of both humeral heads, glenoids, and lateral clavicles (Figures 1 and 2(a)).
Plain true a.p. X-rays of the right shoulder on first admission in 12/2007 (a), after disease limitation under bisphosphonate therapy in 03/2008 (b), postoperative after implantation of total shoulder prosthesis (c), 1-year followup showing no progression of the osteolyses and no signs of loosening of the prosthesis (d).
CRIM.RHEUMATOLOGY2011-565142.002.jpg
PMC3420766_01_CRIM.RHEUMATOLOGY2011-565142.002.jpg
fig2
Plain X-rays of both shoulders showed osteolyses of both humeral heads, glenoids, and lateral clavicles (Figures 1 and 2(a)). Early follow-up X-rays showed the termination of progressive osteolyses (Figure 2(b)). Plain X-rays showed a correctly implanted prosthesis without signs of loosening; in the glenoid and the lateral clavicle we found minor progression of the osteolysis (Figure 2(d)).
Macroscopic specimen of the humeral head showing massive osteolysis.
CRIM.RHEUMATOLOGY2011-565142.003.jpg
PMC3420766_01_CRIM.RHEUMATOLOGY2011-565142.003.jpg
fig3
Intraoperative findings where massive synovitis with significant thickening of the capsule and massive osteolysis of the humeral head (Figure 3) and the glenoid.
Histological stains showing altered osteoclastic resorption (acid phosphatase reaction 200x) (a); cortical and cancellous bone with stimulated turnover and marrow fibrosis (Goldner) (b).
CRIM.RHEUMATOLOGY2011-565142.004.jpg
PMC3420766_01_CRIM.RHEUMATOLOGY2011-565142.004.jpg
fig4
These findings were consistent with Gorham-Stout syndrome (Figure 4). 