Search

Hyperostosis frontalis interna (HFI) is an idiopathic condition manifested by bone formation involving the endocranial surface of the frontal bone. A low androgen level seems to be an important correlating factor for the origin of the condition in males, while in females the correlation seems to be more complex. If hormonal imbalance was to be considered a probable cause of HFI occurrence, it would be expected that changes in hormonal levels would have some systemic effect, especially affecting the skeletal system. Aim: To compare macroscopic and microarchitectural morphology between male and female skulls with different types of HFI, whether frontal bone formation accompanies changes in bone structure in a systemic manner and could HFI be used as an additional criterion for sex and age estimation of the skeletal remains. Materials and methods: The first part was an observational, cross-sectional autopsy study where the sample was taken from human donor cadavers and divided into four groups: males with and without HFI and females with and without HFI. We analyzed age distribution, macroscopic appearance of HFI and morphological features (thickness of the frontal, temporal and occipital bones and longitudinal and frontal diameters of the skulls) of the male skulls with HFI and compared the results with female skulls with this condition. The second study was carried out on selected, age-matched subjects. The specimens of the frontal and femoral bones were collected and scanned using microcomputed tomography and dual energy x-ray absorptiometry (DXA). Parameters of hip structure analysis were calculated from data derived from DXA scans. Results: Males are younger at the time of HFI occurrence and show the same risk of having this condition as females less than 55 years of age. They most commonly have milder forms of HFI. Females have almost four times greater chances of developing the most severe HFI type. Bone formation is most pronounced on the frontal bone;however, Hiperostoza frontalne kosti (lat. hyperostosis frontalis interna – HFI) predstavlja zadebljanje unutrašnje ploče frontalne kosti čiji je uzrok nepoznat. Izgleda da je kod muškaraca nizak nivo androgena važan faktor u nastanku HFI, dok je kod žena hormonski uticaj složeniji. Ako HFI zaista nastaje usled hormonske neravnoteže, očekivano je da promene koncentracija hormona imaju uticaja i na drugim mestima u organizmu, što bi se posebno odrazilo na koštani sistem. Cilj: Uporediti makroskopsku morfologiju i mikroarhitekturu muških i ženskih lobanja sa različitim stadijumima HFI, utvrditi da li zadebljanje čeone kosti prati sistemska promena strukture kostiju i da li se HFI može koristiti kao dodatni kriterijum za procenu pola i starosti skeletnih ostataka. Materijal i metode: Prvi deo istraživanja je opservaciona, autopsijska studija preseka spovedena na kadaveričnom materijalu koji je podeljen u četiri grupe: muškaraci sa i bez HFI i žene sa i bez HFI. Analizirali smo starosnu distribuciju, makroskopske i morfološke karakteristike lobanja (debljinu frontalne, temporalne i okcipitalne kosti, uzdužni i poprečni dijametar) muškaraca sa HFI i upoređivali ih sa lobanjama žena sa HFI. Drugi deo istraživanja sproveden je na odbranim slučajevima iz prethodnog uzorka, koji su upareni po starosti. Uzimani su uzorci frontalne i butne kosti i analizirani korišćenjem mikrokompjuterizovane tomografije i dvoenergetske rendgenske apsorcimetrije (DXA). Parametri strukturne analize izračunati su iz podataka dobijenih DXA analizom. Rezultati: U momentu nastanka HFI, muškarci sa mlađi od žena, a njihov rizik da imaju ovo stanje je isti kao i kod žena mlađih od 55 godina. Muškarci najčešće imaju blaže stadijume HFI. Žene imaju skoro četiri puta veću šansu da ispolje najteži stadijum HFI. Koštano zadebljanje je najizraženije na frontalnoj kosti kod svih osoba sa HFI, međutim, ostale kosti lobanje su takođe zahvaćene procesom. Kod muškaraca, HFI ne utiče na zapreminu lobanjske duplje, dok je

Hyperostosis frontalis interna (HFI) presents irregular thickening of the frontal bone. Even though HFI is frequently seen during routine radiological imaging, it usually remains unrecorded owing to a common belief that it just represents an incidental finding or anatomical variant. Recent studies implied that HFI may be clinically relevant. Etiology of HFI is still debated, while presumptions are mainly based on altered sex steroids impact on skull bone growth. Some authors implied that frontal bone might be particularly affected by this condition due to specificity of its underlying dura. In this paper we present a 27-years old female patient with a treatment resistant headache. Head CT showed massive, irregular bony mass, with lobulated contours arising from the right frontal bone, but did not cross the fronto-parietal suture, spearing the superior sagittal sinus and skull midline. After surgery, histopathological analysis of the frontal bone sample in our patient showed thickening pattern similar to those described in micro-CT studies of HFI. Furthermore, in an attempt to test speculation of the possible role of estrogen in pathogenesis of HFI, we investigated the expression of a-estrogen receptors on dura of the frontal region. These analyses confirmed nuclear expression of estrogen on frontal region dural tissue, supporting previous speculation of the development mechanisms of HFI and contributing to a better understanding of this common condition of the frontal bone. Additionally, the presence of HFI may result in severe symptomatology, which could be misinterpreted and related to other disorders if HFI is not radiologicaly recognized and reported.

To improve our understanding of hyperostosis frontalis interna (HFI), we investigated whether HFI was accompanied by changes in the postcranial skeleton. Based on head CT scan analyses, 103 postmenopausal women were divided into controls without HFI and those with HFI, in whom we measured the thickness of frontal, occipital, and parietal bones. Women in the study underwent dual energy x-ray absorptiometry to analyze the bone density of the hip and vertebral region and external geometry of the proximal femora. Additionally, all of the women completed a questionnaire about symptoms and conditions that could be related to HFI. Women with HFI had a significantly higher prevalence of headaches, neurological and psychiatric disorders, and a significantly lower prevalence of having given birth. Increased bone thickness and altered bone structure in women with HFI was localized only on the skull, particularly on the frontal bone, probably due to specific properties of its underlying dura. Bone loss in the postcranial skeleton showed the same pattern in postmenopausal women with HFI as in those without HFI. Recording of HFI in medical records can be helpful in distinguishing whether reported disorders occur as a consequence of HFI or are related to other diseases, but does not appear helpful in identifying women at risk of bone loss.

Although seen frequently during dissections and autopsies, Hyperostosis frontalis interna (HFI) - a morphological pattern of the frontal bone thickening - is often ignored and its nature and development are not yet understood sufficiently. Current macroscopic classification defines four grades/stages of HFI based on the morphological appearance and size of the affected area; however, it is unclear if these stages also depict the successive phases in the HFI development. Here we assessed 3D-microarchitecture of the frontal bone in women with various degrees of HFI expression and in an age- and sex-matched control group, hypothesizing that the bone microarchitecture bears imprints of the pathogenesis of HFI and may clarify the phases of its development. Frontal bone samples were collected during routine autopsies from 20 women with HFI (age: 69.9 +/- 11.1years) and 14 women without HFI (age: 74.1 +/- 9.7years). We classified the HFI samples into four groups, each group demonstrating different macroscopic type or stage of HFI. All samples were scanned by micro-computed tomography to evaluate 3D bone microarchitecture in the following regions of interest: total sample, outer table, diploe and inner table. Our results revealed that, compared to the control group, the women with HFI showed a significantly increased bone volume fraction in the region of diploe, along with significantly thicker and more plate-like shaped trabeculae and reduced trabecular separation and connectivity density. Moreover, the inner table of the frontal bone in women with HFI displayed significantly increased total porosity and mean pore diameter compared to controls. Microstructural reorganization of the frontal bone in women with HFI was also reflected in significantly higher porosity and lower bone volume fraction in the inner vs. outer table due to an increased number of pores larger than 100m. The individual comparisons between the control group and different macroscopic stages of HFI reveal

Hyperostosis frontalis interna (HFI) is the overgrowth of bony tissue on the inner plate of the frontal bone. Females manifest significantly higher prevalence of HFI compared to males, with the peak incidence in postmenopausal women. Etiopathogenesis of HFI is still ambigous. Different hormonal imbalances i.e. prolonged estrogen stimulation during reproductive period, or abnormal progesterone effect on the ovaries, or inadequate androgen stimulation are pointed out in the literature as the most probable causes of HFI, due to its high prevalence and severity in the females, as well as the fact that in males only those with hypogonadism manifest advanced stages of HFI. Several models have tried to provide an adequate explanation of HFI developement. The most recent is the „global model“ which states that neovascularization originating from dura, might be one of the key processes in its formation. Some studies suggested that women with HFI tend to develop more robust skull characteristics. However, there are no studies that investigated whether HFI is accompanied by changes in bone thickness or density in postcranial skeleton. Present macroscopical classification of HFI is based on morphological characteristics and extension of frontal bone involvement and includes four different types of HFI. Relatively low percentage of radiological recordings of HFI may ocure due to the fact that present macroscopical method of identification and classification encompasses multiplanar reconstruction of head CT scans, which makes it complicated for routine radiological practice. Additionally, it remains unclear whether different macroscopic stages of HFI can be regarded as successive phases in the process of HFI development..., Hyperostosis frontalis interna (HFI tj. ХФИ), представља нагомилавање коштаног ткива локализовано на унутрашњој површини фронталне кости. Чешће се јавља код особа женског пола са највишом инциденцом забележеном код жена у постменопаузи. Етипатогенеза ХФИ и даље није разјашњена. Различити хормонски дисбалaнси као што је пролонгирана естрогена стимулација током репродуктивног периода, поремећена продукција прогестерона од стране оваријума или неадекватна андоргена стимулација су у литератури наведени као највероватнији узрочници настанка ХФИ, имајући у виду високу преваленцу и израженију манифестацију ХФИ код жена, као и чињеницу да се само код мушкараца са хипогонадизмом јављају изражене форме ХФИ. Неколико модела је понуђено као могуће објашњење процеса настанка ХФИ. Најновији је “глобални модел“, по коме неоваскуларизација, пореклом из дуре, може бити један од кључних процеса у настанку ХФИ. У појединим студијама примећено је да жене са ХФИ могу развити робусније морфолошке карактеристике лобање у односу на оне без ХФИ. Међутим, не постоје студије које су испитивале да ли је ХФИ праћена променама у коштаној густини и спољашњој морфологији и у посткранијалном делу скелета. Постојећа макроскопска класификација ХФИ је базирана на морфолошким карактеристикама и обиму захваћености фронталне кости и обухвата четири различита типа ХФИ (А, Б, Ц и Д). Релативно низак проценат бележења ХФИ од стране радиолога, може се објаснити чињеницом да постојећи макроскопски метод класификације и идентификације ХФИ обухвата тродимензионалну реконструкцију прегледа главе начинјених методом компјутеризоване томографије (CT), и да је као такав, сувише компликован за рутинску радиолошку праксу. Такође, и даље није познато да ли различити макроскопски типови ХФИ могу бити посматрани као сукцесивне фазе у процесу настанка ХФИ...

Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was 40.9 +/- 18.8 years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive.