Massive osteolysis : two cases displaying extreme clinical aspects

We have come across two cases of massive osteolysis showing completely opposite clinical aspects. The first case is a young man aged 28 showing osteolysis of the distal third of the right ulna. His disease was discovered after performing X-rays for minor trauma of the right forearm. He had never complained of his arm before and he only displayed a loss of 45° in pronation. We noted that osteolysis could already be seen on X-ray at plaster removal after 45 days of immobilisation, although the osteolysis was not noticed on the first X-rays.The second case concerns a 17-year-old man who was known to have a massive osteolysis of the pelvis ring and who had used a wheel-chair from the age of 8. While hospitalized for a severe infection of the testicles and scrotum, he developped a recurrent chylothorax that required surgical pleurodesis. This young man displayed no radiological evidence of this disease above the pelvis.A review of the literature allows us to clarify the still obscure pathogenic aspects of massive osteolysis, its classification, the different forms that may be encountered and the keys to diagnosis. The authors caution against aggressive treatment in certain areas where the disease remains benign.