Observations on Massive Osteolysis

Osteolysis, OR dissolution of bone, is a nonspecific and relatively common abnormality produced by any decalcifying process of magnitude sufficient to diminish or destroy the roentgenographic image of a bone. A host of diseases may cause osteolysis; the commoner of these are infection, tumor, trauma (Sudeck's atrophy), various diseases of the nervous system, gout, the reticuloses, and scleroderma. The term “massive osteolysis” has recently been introduced to identify a rare and specific type of bone dissolution, associated with a benign, noncystic osseous angiomatosis and characterized by a progressive localized resorption of bone. For over a century scattered case reports have described patients with “phantom bone,” “vanishing bone,” “cryptogenic osteolysis,” “spontaneous resorption of bone,” “disappearing bone,” “essential osteolysis,” and the like. These names are now recognized as synonyms for massive osteolysis. In 1954, one hundred and sixteen years after publication of the initial case of the disease, Gorham (10, 11) established massive osteolysis as a distinct clinical syndrome, and “Gorham's disease” has been proposed as an eponym for massive osteolysis (6, 13). One year later, Gorham and Stout showed that the pathological basis of the syndrome was an angiomatosis of bone (12). The purpose of this paper is to summarize current knowledge of this disease and to report the twelfth case of massive osteolysis associated histologically with an osseous angioma. Gorham and Stout included in their paper summaries of 24 cases of massive osteolysis. To these there may now be added 7 cases. Three of these are histologically proved to have been associated with an osseous angioma, namely those of Phemister (27),4 Gambier (8), and Hambach et al. (see page 43 of this issue of Radiology). The 4 remaining cases, typical clinically and radiologically but not proved, were reported by Henderson (14), Codet and Deluen (3), Milner (22, 23), and de Seze and Hubault (4). With the example reported here (see Appendix) the number of cases on record is brought to 32, of which 12 have been established histologically. It is likely that the number will grow more rapidly as familiarity with this unusual disease is gained. Clinical Findings Massive osteolysis is a rare chronic disease which begins insidiously and is characterized by a progressive regional loss of bone with resultant deformity. After a variable period of activity, it usually undergoes spontaneous arrest. Two cases, however, have terminated fatally after unremitting progression. The earliest reported case, attributed to Jackson (16), appeared in The Boston Medical & Surgical Journal in 1838, with a late follow-up in the same journal in 1872 (17). Since this case epitomizes many features of the disease, and is of historical significance, it is abstracted here: