Differential Diagnosis
- Single most likely diagnosis
- Osteopetrosis is unlikely given the patient's age and the presence of a mosaic pattern of lamellar bone. The most likely diagnosis is Paget's disease of bone, which is characterized by an abnormal breakdown and regrowth of bone tissue, resulting in deformity and potential neurological complications. The elevated serum alkaline phosphatase level, sclerotic and thickened cortical bone, and the microscopic appearance of a mosaic pattern of lamellar bone are all consistent with this diagnosis.
- Other Likely diagnoses
- Osteoarthritis: The narrowed joint space near the acetabulum could be indicative of osteoarthritis, which is a common condition in older adults. However, the sclerotic and thickened cortical bone, as well as the elevated alkaline phosphatase level, are not typical of osteoarthritis.
- Bone metastasis: The patient's age and the presence of hip and thigh pain could suggest bone metastasis, but the radiographic and microscopic findings are not typical of this condition.
- Do Not Miss
- Osteosarcoma: Although rare, osteosarcoma is a malignant bone tumor that can present with similar radiographic findings, including sclerotic and thickened cortical bone. It is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Multiple myeloma: This condition can also present with bone pain and elevated alkaline phosphatase levels, although the radiographic findings are typically more lytic than sclerotic.
- Rare diagnoses
- Fibrous dysplasia: This condition can cause bone pain and deformity, but the radiographic and microscopic findings are not typical of fibrous dysplasia.
- Chronic osteomyelitis: This condition can cause bone pain and elevated alkaline phosphatase levels, but the radiographic findings are typically more destructive than sclerotic.