Skip to main content
The Iowa Orthopaedic Journal logoLink to The Iowa Orthopaedic Journal
. 1996;16:126–134.

Mastocytosis presenting as a skeletal disorder.

J L Delsignore 1, P M Dvoretsky 1, D G Hicks 1, R J O'Keefe 1, R N Rosier 1
PMCID: PMC2378151  PMID: 9129284

Abstract

Mastocytosis is a rare disease of mast-cell proliferation with involvement of the reticuloendothelial systems including skin, bone, gastrointestinal tract, liver, lungs, spleen, and lymph nodes. Systemic mastocytosis is characterized by a combination of symptoms that relate to the mast cells' release of vasoactive substances, such as histamine. These symptoms include urticaria pigmentosa, flushing, syncope with hypotension, headaches, nausea, vomiting, diarrhea, and occasional bronchospasm. The diagnosis of mastocytosis is typically based on the presence of the characteristic extraosseus manifestations. A well recognized roentgenographic feature seen in 70-75% of patients with mastocytosis is diffuse osteolysis and osteosclerosis, affecting primarily the axial skeleton and the ends of the long bones. Rarely, the bony involvement consists of generalized osteoporosis, which may lead to pathologic fracture, or solitary lesions (mastocytomas) which may cause symptoms of localized pain. Four patients with previously diagnosed systemic mastocytosis had unusual skeletal lesions. Clinical and laboratory evaluation of these patients eventually led to the correct diagnosis of systemic mastocytosis. We report these four cases to emphasize the need for thorough evaluation of unusual musculoskeletal findings in association with extraosseus symptoms that are characteristic of mastocytosis. Knowledge of a wide differential diagnosis of unusual skeletal lesions should include systemic mastosytosis.

Full text

PDF
126

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ASBOE-HANSEN G. Urticaria pigmentosa with bone lesions. Acta Derm Venereol. 1953;33(6):471–475. [PubMed] [Google Scholar]
  2. BENDEL W. L., Jr, RACE G. J. URTICARIA PIGMENTOSA WITH BONE INVOLVEMENT. J Bone Joint Surg Am. 1963 Jul;45:1043–1056. [PubMed] [Google Scholar]
  3. Barer M., Peterson L. F., Dahlin D. C., Winkelmann R. K., Stewart J. R. Mastocytosis with osseous lesions resembling metastatic malignant lesions in bone. J Bone Joint Surg Am. 1968 Jan;50(1):142–152. doi: 10.2106/00004623-196850010-00009. [DOI] [PubMed] [Google Scholar]
  4. Brunning R. D., McKenna R. W., Rosai J., Parkin J. L., Risdall R. Systemic mastocytosis. Extracutaneous manifestations. Am J Surg Pathol. 1983 Jul;7(5):425–438. doi: 10.1097/00000478-198307000-00005. [DOI] [PubMed] [Google Scholar]
  5. Crisp A. J., Chapman C. M., Kirkham S. E., Schiller A. L., Krane S. M. Articular mastocytosis in rheumatoid arthritis. Arthritis Rheum. 1984 Aug;27(8):845–851. doi: 10.1002/art.1780270802. [DOI] [PubMed] [Google Scholar]
  6. DALY J. F., STARK E., VAN BUSKIRK F. W. Radiologic and pathologic bone changes associated with urticaria pigmentosa; report of a case. AMA Arch Pathol. 1956 Aug;62(2):143–148. [PubMed] [Google Scholar]
  7. Dolovich J., Punthakee N. D., MacMillan A. B., Osbaldeston G. J. Systemic mastocytosis: control of lifelong diarrhea by ingested disodium cromoglycate. Can Med Assoc J. 1974 Oct 5;111(7):684–685. [PMC free article] [PubMed] [Google Scholar]
  8. EFRATI P., KLAJMAN A., SPITZ H. Mast cell leukemia? Malignant mastocytosis with leukemia-like manifestations. Blood. 1957 Oct;12(10):869–882. [PubMed] [Google Scholar]
  9. ELLIS J. M. Urticaria pigmentosa; a report of a case with autopsy. Arch Pathol (Chic) 1949 Nov;48(5):426–435. [PubMed] [Google Scholar]
  10. FULTON G. P., MAYNARD F. L., RILEY J. F., WEST G. B. Humoral aspects of tissue mast cells. Physiol Rev. 1957 Apr;37(2):221–232. doi: 10.1152/physrev.1957.37.2.221. [DOI] [PubMed] [Google Scholar]
  11. Fishman R. S., Fleming C. R., Li C. Y. Systemic mastocytosis with review of gastrointestinal manifestations. Mayo Clin Proc. 1979 Jan;54(1):51–54. [PubMed] [Google Scholar]
  12. Frieri M., Alling D. W., Metcalfe D. D. Comparison of the therapeutic efficacy of cromolyn sodium with that of combined chlorpheniramine and cimetidine in systemic mastocytosis. Results of a double-blind clinical trial. Am J Med. 1985 Jan;78(1):9–14. doi: 10.1016/0002-9343(85)90454-1. [DOI] [PubMed] [Google Scholar]
  13. Klatt E. C., Lukes R. J., Meyer P. R. Benign and malignant mast cell proliferations. Diagnosis and separation using a pH-dependent toluidine blue stain in tissue section. Cancer. 1983 Mar 15;51(6):1119–1124. doi: 10.1002/1097-0142(19830315)51:6<1119::aid-cncr2820510624>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  14. Korenblat P. E., Wedner H. J., Whyte M. P., Frankel S., Avioli L. V. Systemic mastocytosis. Arch Intern Med. 1984 Nov;144(11):2249–2253. doi: 10.1001/archinte.144.11.2249. [DOI] [PubMed] [Google Scholar]
  15. LIBAN E., SAGHER F., SCHORR S., UNGAR H. Urticaria pigmentosa with bone involvement; mast cell aggregates in bones and myelosclerosis found at autopsy in a case dying of monocytic leukemia. J Invest Dermatol. 1956 Nov;27(5):355–368. [PubMed] [Google Scholar]
  16. Lennert K., Parwaresch M. R. Mast cells and mast cell neoplasia: a review. Histopathology. 1979 Sep;3(5):349–365. doi: 10.1111/j.1365-2559.1979.tb03017.x. [DOI] [PubMed] [Google Scholar]
  17. Lewis R. A. Mastocytosis. J Allergy Clin Immunol. 1984 Dec;74(6):755–765. doi: 10.1016/0091-6749(84)90172-6. [DOI] [PubMed] [Google Scholar]
  18. Lucaya J., Perez-Candela V., Aso C., Calvo J. Mastocytosis with skeletal and gastrointestinal involvement in infancy. Two case reports and a review of the literature. Radiology. 1979 May;131(2):363–366. doi: 10.1148/131.2.363. [DOI] [PubMed] [Google Scholar]
  19. Monheit G. D., Murad T., Conrad M. Systemic mastocytosis and the mastocytosis syndrome. J Cutan Pathol. 1979 Feb;6(1):42–52. doi: 10.1111/j.1600-0560.1979.tb00304.x. [DOI] [PubMed] [Google Scholar]
  20. POPPEL M. H., GRUBER W. F., SILBER R., HOLDER A. K., CHRISTMAN R. O. The roentgen manifestations of urticaria pigmentosa (mastocytosis). Am J Roentgenol Radium Ther Nucl Med. 1959 Aug;82(2):239–249. [PubMed] [Google Scholar]
  21. RILEY J. F., WEST G. B. The presence of histamine in tissue mast cells. J Physiol. 1953 Jun 29;120(4):528–537. doi: 10.1113/jphysiol.1953.sp004915. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rafii M., Firooznia H., Golimbu C., Balthazar E. Pathologic fracture in systemic mastocytosis. Radiographic spectrum and review of the literature. Clin Orthop Relat Res. 1983 Nov;(180):260–267. [PubMed] [Google Scholar]
  23. Roberts L. J., 2nd, Turk J. W., Oates J. A. Shock syndrome associated with mastocytosis: pharmacologic reversal of the acute episode and therapeutic prevention of recurrent attacks. Adv Shock Res. 1982;8:145–152. [PubMed] [Google Scholar]
  24. SAGHER F., COHEN C., SCHORR S. Concomitant bone changes in urticaria pigmentosa. J Invest Dermatol. 1952 Jun;18(6):425–432. doi: 10.1038/jid.1952.51. [DOI] [PubMed] [Google Scholar]
  25. Scott H. W., Jr, Parris W. C., Sandidge P. C., Oates J. A., Roberts L. J., 2nd Hazards in operative management of patients with systemic mastocytosis. Ann Surg. 1983 May;197(5):507–514. doi: 10.1097/00000658-198305000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Sostre S., Handler H. L. Bony lesions in systemic mastocytosis: scintigraphic evaluation. Arch Dermatol. 1977 Sep;113(9):1245–1247. [PubMed] [Google Scholar]
  27. Soter N. A., Austen K. F., Wasserman S. I. Oral disodium cromoglycate in the treatment of systemic mastocytosis. N Engl J Med. 1979 Aug 30;301(9):465–469. doi: 10.1056/NEJM197908303010903. [DOI] [PubMed] [Google Scholar]
  28. Sy W. M., Bonventre M. V., Camera A. Bone scan in mastocytosis: case report. J Nucl Med. 1976 Aug;17(8):699–701. [PubMed] [Google Scholar]
  29. URIST M. R., MCLEAN F. C. Accumulation of mast cells in endosteum of bones of calcium-deficient rats. AMA Arch Pathol. 1957 Mar;63(3):239–251. [PubMed] [Google Scholar]
  30. Udoji W. C., Razavi S. A. Mast cells and myelofibrosis. Am J Clin Pathol. 1975 Feb;63(2):203–209. doi: 10.1093/ajcp/63.2.203. [DOI] [PubMed] [Google Scholar]
  31. Webb T. A., Li C. Y., Yam L. T. Systemic mast cell disease: a clinical and hematopathologic study of 26 cases. Cancer. 1982 Mar 1;49(5):927–938. doi: 10.1002/1097-0142(19820301)49:5<927::aid-cncr2820490517>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]

Articles from The Iowa Orthopaedic Journal are provided here courtesy of The University of Iowa

RESOURCES