Paget's disease of the bone. Differential diagnosis of osteolytic lesions.Report of one case

We report a 48 years old female with Paget's disease of the bone who consul ted for leg pain. After exhaustive examination a magnetic nuclear resonance revealed a 7 mm intradural schwannoma that was resected without improvemen t. Four years later, with generalized, progressive bone pains, several oste olytic rib lesions were detected. A bone scintigraphy showed extensive area s of hyperfixation of Tc99 DPM. Biochemical tests were normal with exceptio n of very high serum alkaline phosphatases. Looking for some neoplastic dis ease, a breast nodule was detected by mammography. Biopsy demonstrated beni gn disease. Finally, a rib lesion biopsy disclosed diagnosis of Paget's dis ease of the bone. Treatment with calcitonin, etidronate and vitamin D resul ted in partial clinical improvement, reduction of abnormal isotope hyperfix ation in bone scintigraphy and of serum alkaline phosphatase levels.