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"en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MR imaging where hyperintense focal bone lesions are identified. In sagittal planes STIR of skull vault (arrow 1) and sternum (arrow 3). Image in axial plane of T2 Med of the fifth posterior left costal arch (arrow 2).</p>"
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"textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Presentation of the clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 20-year-old male patient was referred for presentation of lytic lesions in an X-ray of the pelvis. He had had a history of chronic disabling lumbago since the age of 14, coinciding with a sport’s injury. He did not present with any family background of osteolysis. Physical examination reported ectomorpheus phenotype, lumbar rectification and painful palpation in the last lumbar vertebrae. There were no neurological changes. Nephropathy markers were negative.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The radiological bone series showed lytic lesions in the skull vault, sacrum, pelvis, femurs, costal arches, and vertebra L4 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Magnetic resonance confirmed the described osteolysis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, diffuse osteolysis in vertebral bodies and posterior elements of the cervical, dorsal and lumbar spine, multiple vertebral and dorsal flattening and secondary hyperkyphosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Computerised tomography demonstrated destruction of the cortical bone in vertebral bodies (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Imaging tests showed a left laterocervical lymphangioma (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>) and multicystic splenomegalia compatible with diagnosis of diffuse abdominal lymphangioma (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). The bone biopsy revealed discreet medullar lymphoid infiltration, with no signs of malignancy.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Based on clinical, radiological and histopathological findings a diagnosis of Gorham-Stout syndrome was made. The patient rejected radiotherapy and began oral treatment with alendronic acid (70<span class="elsevierStyleHsp" style=""></span>mg/week) and sirolimus (2<span class="elsevierStyleHsp" style=""></span>mg/day) until the next control visit.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion/comment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Gorham-Stout syndrome is a sporadic bone disease, 300 cases of which have been described,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> approximately 50 in the vertebral spine.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is characterized by a progressive osteolysis with no bone regeneration, with destruction of the cortical bone, triggered by non neoplasic lymphangiogenesis and hemangiogenesis at medullar level, which may infiltrate soft tissues and lead to fibrosis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Involvement is usually regional or multifocal,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> mostly in the axial skeleton.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The evolutional course of the disease is unpredictable, with up to 16% mortality.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Diagnosis is made by exclusion, ruling out lymphangiomatosis, which does not injure the cortical bone.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,7</span></a> Magnetic resonance with gadolium contrast agent is used to monitor patient evolution,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> showing lymphangiogenesis in the active lesions.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Multifocal location and extensive involvement of the spine makes this case exceptional.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>"
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