Elsevier

Human Pathology

Volume 12, Issue 9, September 1981, Pages 813-820
Human Pathology

Systemic mastocytosis associated with generalized osteopenia: Histopathological characterization of the skeletal lesion using undecalcified bone from two patients**

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Abstract

Although mast cell proliferation in the bone marrow frequently occurs in systemic mastocytosis and is often associated with radiographically detectable bone lesions, the pathologic correlates of the skeletal abnormalities are poorly characterized. We therefore examined three nondecalcified transiliac crest biopsy specimens from two patients with systemic mastocytosis and diffuse osteopenia with vertebral crush fractures. Marrow involvement included unusual mast cell aggregates, as revealed by metachromatic staining, that mimicked granulomas. Histomorphometric analysis of trabecular bone revealed accelerated bone remodeling or “turnover” characterized by osteoidosis, peritrabecular fibrosis, increased numbers of osteoblasts and osteoclasts, and an increase in osteoclastic resorbing surfaces.

Our observations and review of the literature suggest that with the recent development of techniques for assessing undecalcified bone biopsy specimens, mastocytosis will probably be shown to be a more common etiology in “osteoporosis” than previously recognized. Metachromatic staining of the biopsy specimen should be a routine procedure in the investigation of any patient who undergoes diagnostic bone biopsy.

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**

Study supported in part by NIH training grant AM-07033, CRC grant RR00036, NIH grant AM-11674, and a grantin-aid from the Shriners Hospitals for Crippled Children (St. Louis Unit).

Presented in part at the First Annual Scientific Meeting of the American Society for Bone and Mineral Research, Anaheim, California, June 11–12, 1979.

*

Instructor in Pathology, Washington University School of Medicine. Chief Resident, Department of Pathology, The Jewish Hospital of St. Louis, St. Louis, Missouri.

Assistant Professor of Medicine, Department of Medicine, Division of Bone and Mineral Metabolism, Washington University School of Medicine. Assistant Professor, Department of Medicine, The Jewish Hospital of St. Louis, St. Louis, Missouri.

Associated Professor of Pathology, Department of Pathology, Division of Bone and Mineral Metabolism, Washington University School of Medicine. Associate Pathologist, Department of Pathology, The Jewish Hospital of St. Louis, St. Louis, Missouri.

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