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Monostotic Paget's disease of bone is an uncommon disease, reported in the hand in only a few instances. We have described an additional case involving a metacarpal bone in a 43-year-old man. We believe this disease should be considered in the radiological differential diagnosis of lytic expansile, subchondral lesions of the hand.

Fig. 1 A-C. Chronological radiographic sequences of the fight fifth metacarpal bone during the different stages of disease. A lyric and expansile lesion within the medullary canal is seen (A, C). After treatment, a sclerosing reparative pattern is present (B) of fracture or cortical interruption. A subchondral location was noted. Enchondroma was the clinical and radiographic diagnosis. Extensive curettage of the medullary canal was performed, after which the cavity was packed with a cancellous bone graft obtained f rom the right iliac crest. During the curettage a thick fluidlike material was observed, and the bone fragments obtained were submitted for histological analysis. A radiological study performed 3 months later revealed a trabecular, sclerosing reparative pat tern (Fig. 1 B). Three years later, in January 1992, a new roentgenogram disclosed an expansile lytic lesion in the same anatomical zone, very similar radiographically to the original lesion (Fig. 1 C). Curettage was performed at that time. Periodic skeletal surveys were unremarkable except for the findings in the hand.