# A novel entity of massive multifocal osteolyses in the elderly

## TL;DR

This paper describes a new and severe bone disorder in an elderly patient that does not fit existing classifications and causes widespread bone destruction.

## Contribution

The paper introduces a previously unclassified bone disease with aggressive osteolytic features in elderly patients.

## Key findings

- The disease involves myxoid stroma and granulomatous inflammation, destroying cortical and cancellous bone.
- Standard diagnostic methods failed to classify the condition within known bone disorders.
- Treatment options include radionuclide therapy, radiation, and surgery for fractures.

## Abstract

Osteolyses are common findings in elderly patients and most frequently represent malignant or locally aggressive bone tumors, infection, inflammatory and endocrine disorders, histiocytoses, and rare diseases such as Gorham-Stout syndrome. We here report on a novel entity of massive multifocal osteolyses in both shoulders, the right hip and left knee joint and the dens of an 83-year-old patient not relatable to any previously known etiopathology of bone disorders. The soft tissue mass is of myxoid stroma with an unspecific granulomatous inflammatory process, aggressively destroying extensive cortical and cancellous bone segments and encroaching on articulating bones in diarthrodial large joints. Radiological, nuclear medical, serological, histological, and immunohistochemical analyses were incapable of further classifying the disease pattern within the existing scheme of pathology. Quantitative polymerase chain reaction and next generation sequencing revealed that mutations are not suggestive of any known hereditary or acquired bone disease. Possible treatment options include radionuclide therapy for pain palliation and percutaneous radiation to arrest bone resorption while surgical treatment is inevitable for pathological fractures. This case study shall increase the awareness of the musculoskeletal community and motivate to collect further information on this rare but mutilating disorder.

•We report a novel entity aggressively devastating extensive bone segments.•This disease cannot be classified within the existing nosological scheme.•Treatment options include radiation and radionuclide therapy as well as surgery.•This shall increase the awareness for a rare but mutilating disorder.

We report a novel entity aggressively devastating extensive bone segments.

This disease cannot be classified within the existing nosological scheme.

Treatment options include radiation and radionuclide therapy as well as surgery.

This shall increase the awareness for a rare but mutilating disorder.