Tsutsumi Satoshi, Yasumoto Yukimasa, Ito Masanori
Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
Neurol Med Chir (Tokyo). 2008 Jun;48(6):275-8. doi: 10.2176/nmc.48.275.
An 82-year-old diabetic female had been aware of gradually enlarging, painless scalp depressions in the bilateral parietal regions for more than 6 years. She had no history of head injury, or inflammatory or malignant disease. Her family history was unremarkable for hereditary bone disease. She had diabetes mellitus which had been well controlled with orally administered drugs. Blood examination showed normal renal and liver functions with normal serum calcium, magnesium, and phosphorus concentrations, in addition to normal parathyroid hormone and calcitonin levels. Neuroimaging including skull radiography, head computed tomography, and magnetic resonance imaging demonstrated symmetric thinning in the bilateral parietal bones attributed to loss of diploe and thinning of the outer table. The inner table was intact without associated soft tissue mass or vascular lesions. Technetium-99m methylene diphosphate systemic bone scintigraphy showed mild hypoaccumulation in the affected calvarium on the left. No other pathological findings were found by systemic examination. She underwent open biopsy for histological verification which revealed homogeneous membranous bone tissue with regressed diploe, absence of osteoblasts, absence of osteoclastic appearance, and absence of findings of underlying malignancy. There was no markedly fibrovascular connective tissue typical of Gorham-Stout disease. Calvarial thinning in the present case may have been caused by an undetermined complex mechanism.
一位82岁的糖尿病女性患者，双侧顶叶区域逐渐增大的无痛性头皮凹陷已持续6年多。她没有头部受伤史，也没有炎症或恶性疾病史。她的家族史中无遗传性骨病。她患有糖尿病，口服药物控制良好。血液检查显示肾功能和肝功能正常，血清钙、镁、磷浓度正常，甲状旁腺激素和降钙素水平也正常。包括颅骨X线摄影、头部计算机断层扫描和磁共振成像在内的神经影像学检查显示，双侧顶骨对称变薄，原因是板障消失和外板变薄。内板完整，无相关软组织肿块或血管病变。锝-99m亚甲基二膦酸盐全身骨闪烁显像显示左侧受累颅骨轻度放射性摄取减低。全身检查未发现其他病理结果。她接受了开放活检以进行组织学验证，结果显示为均匀的膜性骨组织，板障退化，无成骨细胞，无破骨细胞表现，也无潜在恶性肿瘤的表现。没有典型的戈勒姆-斯托特病的明显纤维血管结缔组织。本例颅骨变薄可能是由一种未明的复杂机制引起的。
