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Aneurysmal bone cyst. A review of 52 primary and 16 secondary cases
Abstract
Authors report on the results of treatment of 52 primary and 16 secondary aneurysmal bone cysts (ABC). ABC grow rapidly; 84% of them have already destroyed more than the half of the bone width at recognition. En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. Careful curettage and bone grafting still remains the surgical method of choice in the majority of cases, when the ABC is more destructive and affects the subchondral bone of the joints. Segmental resection is only indicated when removal of the affected bone does not influence the function of the extremity. Superselective embolization of the cyst was performed in seven cases with excellent results. This method is suggested for ABC in certain locations inaccessible to surgical intervention, e.g., the pelvis, or to avoid excessive bleeding in hypervascularized tumors. In one case, however, an incomplete rebuilding of the ABC could only be achieved by the administration of calcitonin. The 16 cases of secondary ABC were observed mostly in association with osteoblastomas, giant-cell tumors, and osteosarcomas. The incidence of the secondary ABC was 23% in the whole ABC group but not more than 2-4% among the osteosarcomas and giant-cell tumors. Secondary ABC may confuse the histological and clinical diagnoses and that, especially in cases of osteosarcoma, may have fatal consequences.
... [2][3][4][5][6] Lower recurrence rates can be achieved by marginal or wide resection, but are accompanied by loss of bone and the need for reconstruction. 2,7,8 Intralesional resection or curettage with effective adjuvant therapy to extend the surgical margin has been advocated. 5,9 Since 1969 we have used cryotherapy as an adjuvant after intralesional resection and we now evaluate our results. ...
... Aneurysmal bone cyst is common in adolescents and almost half of the patients are between 10 and 21 years of age. 2,6,8,[11][12][13][14][15] There is a slight predilection for females (Table I) pathological fracture. When located in the vertebral column neurological symptoms, as well as pain, are likely to be present. ...
... 2 Superselective embolisation with or without irradiation may be considered for aneurysmal bone cysts located in anatomical positions which are very difficult to treat surgically, like vertebral and sacral lesions. 2,8,14 No benefits in any form have been received or will be received form a commercial party related directly or indirectly to the subject of this article. ...
We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control, complications and functional outcome. The mean follow-up time was 47 months (19 to154). There was local recurrence in one patient. Two patients developed deep wound infections and one had a postoperative fracture.
We compared our results with previous reports in which several different methods of treatment had been used and concluded that curettage with adjuvant cryotherapy had similar results to those of marginal resection, and that no major bony reconstruction was required.
We recommend the use of cryotherapy as an adjuvant to the surgical treatment of aneurysmal bone cysts. It provides local tumour control. Combination with bone grafting achieved consolidation of the lesion in all our patients.
... From a clinical perspective, they are often causing pain and may reduce the range of motion and of the overall joint function. Bone cysts might result from external (trauma) or multiple internal etiologies such as osteoarthritis (OA), the major degenerative joint disease, [33][34][35][36] rheumatoid arthritis (RA), 37,38 intraosseous ganglia, [39][40][41] aneurysmal bone cysts (ABC), [42][43][44][45] and articular cartilage defects. [46][47][48] As such bone cysts alter the structural support for weightbearing, they potentially undermine the biomechanics of the joint, inducing degeneration of the overlying articular cartilage, subchondral collapse, and fracture, all leading to a possible extension into formerly unaffected areas in the form of OA. ...
... 43 They are characterized by a proliferation of connective tissue within blood-filled cavities. 42 Sometimes they are accompanied by potentially benign lesions such as chondroblastoma or giant cell tumors. 44 Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy, also termed Nasu-Hakola disease, refers to a rare combination of bilateral lytic lesions within the bones of extremities and presenile dementia. ...
Subchondral bone cysts represent an early postoperative sign associated with many articular cartilage repair procedures. They may be defined as an abnormal cavity within the subchondral bone in close proximity of a treated cartilage defect with a possible communication to the joint cavity in the absence of osteoarthritis. Two synergistic mechanisms of subchondral cyst formation, the theory of internal upregulation of local proinflammatory factors, and the external hydraulic theory, are proposed to explain their occurrence. This review describes subchondral bone cysts in the context of articular cartilage repair to improve investigations of these pathological changes. It summarizes their epidemiology in both preclinical and clinical settings with a focus on individual cartilage repair procedures, examines an algorithm for subchondral bone analysis, elaborates on the underlying mechanism of subchondral cyst formation, and condenses the clinical implications and perspectives on subchondral bone cyst formation in cartilage repair.
... Aneurysmal bone cyst, accounting for 10-15% of benign spinal tumors, is an expansible pseudotumoral lesion which is more prevalent than any other benign tumor in the spine Fig. 4 The intraoperative and postoperative radiological images of the patient showed in Fig. 1. a, b En bloc L4 corpectomy was conducted with related nerve roots identified. c, d The postoperative X-rays showed the fourth lumber spine was removed and replaced by artificial vertebral body with pedicle-screw instrumentation [1,4,19,20]. In our center, the mean age was 26.0 ± 15.0 (median 21, range 6-64) years, with a peak incidence in first two decades, which was conformed to the previous finding [1,4,21]. ...
... There were obvious differences between primary and secondary ABCs in DFS in our center. The theory of reactive vascular malformation may explain that based on osseous arteriovenous malformation initiated by the primary lesion, hemodynamic forces of the arteriovenous malformation thereby create secondary reactive lesion known as an ABC [7,20]. Secondary ABCs become more invasive, thus causing angiogenesis, representing as an aggressive lesion because of the compression of the spinal cord. ...
Purpose
The aim of the study was to report the long-term outcomes and analyze the potential prognostic factors that may contribute to symptomatic patients with aneurysmal bone cyst (ABC) of the spine undergoing surgical treatments.
Methods
A retrospective analysis of consecutive patients with ABCs of the spine was performed. The clinical features were reviewed, and the disease-free survival (DFS) and overall survival (OS) rates were estimated using the Kaplan–Meier method. Factors with p values ≤ 0.05 were subjected to multivariate analysis by Cox proportional hazards model to identify the independent prognostic contributors. p values < 0.05 were considered statistically significant.
Results
A total of 42 patients with ABCs of the spine were included in the study. All patients received surgical treatments. The mean follow-up period was 41.3 months (median 39.5, range 24–64). Local recurrence was detected in eight patients after surgery in our center, whereas death occurred in three patients. The estimated 5-year DFS and OS rate was 54.1% and 76.8%, respectively. The statistical analyses indicated that both en bloc resection and primary/secondary tumor status were independent prognostic factors for DFS.
Conclusions
Secondary ABC status may be associated with worse prognosis, and en bloc resection remains the treatment of choice for ABCs with neurologic deficits or spinal instability of the spine, which is correlated with better prognosis for local tumor control.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material. Open image in new window
... Optimal treatment of ABC is arguable. In spite of several techniques reported in literature, the recurrence rate of ABCs lies anywhere between 5% and 40%, sometimes greater than Shetty S, et al that [5]. Even though newer techniques such as sclerotherapy (that uses sclerosing substances) and synthetic bone grafts have come into play, still they remain less effective in comparison to the conventional curettage method [6]. ...
Introduction:
Aneurysmal bone cyst (ABC) is a benign, expansible, non-neoplastic tumor of usually long bones and is identified by blood vessels and spaces that are most often differentiated by fibrous septae. It is challenging to treat these rare, giant ABCs as they have a damaging effect on the bones and compress the nearby structures, especially in load-bearing bones of the body.
Case report:
We report a case of a giant ABC in the distal tibia one-third with soft tissue component of a 30-year-old male. The patient presented to our outpatient department with complaints of pain and swelling over left ankle for 1 year. The size of the swelling was 15 cm × 10 cm × 10 cm over medial aspect of ankle with 3 discharging sinuses which present over swelling. His blood parameters were suggestive of low hemoglobin count. X-rays showed cystic lesions over medial aspect of left ankle. Computed tomography scan and magnetic resonance imaging reports were suggestive of ABC.
Conclusion:
Our case report is unique as it reminds us that when presented with a case of ABC, excision of fungating soft tissue with curettage followed by cementing can be a preferable and better treatment option. ABC was extensively curetted out, the formed cavity was packed with bone cement, and fixation with 3 cortico cancellous screws was carried out. At 4-month follow-up, the lesion had receded, and the patient was walking without pain and any deformity. We suggest that this method of treatment is beneficial for ABC at this site and at this age.
... Major surgery Marginal excision 6 Capanna et al. [19] Malghem [59] Papagelopoulos et al. [8] Huang [60] Brastianos et al. [18] Rao [61] 1986 1989 2001 2004 2009 2013 3 1 17 1 3 2 27 Wide excision 5 Papagelopoulos et al. [8] Honl et al. [37] Yu et al. [36] Puri [20] Sharifah et al. [22] [17] grouped the age of patients as<10, 10-20, >20 yrs. Therefore, these data were excluded when calculating the median age for each treatment group 13 Wallace et al. [31] Dick [60] Capanna et al. [19] Delloye et al. [23] Papagelopoulos et al. [8] Wathiong [61] Docquier and Delloye [24] Cottalorda et al. [10] Yildirim [64] Brastianos et al. [18] Novais et al. [9] Rossi [65] Syvanen [66] Cheah [67] Papagelopoulos et al. [8] Pogoda [68] Brastinos [18] van de Luijtgaarden [26] Sobeai [39] 1999 The Enneking staging divides benign bone tumors into three categories: latent (stage 1), active (stage 2), and aggressive (stage 3). ...
Aneurysmal bone cysts (ABCs) are rare benign, vascular, and osteolytic bone lesions. Pelvic ABCs account for 8–12% of these tumors and no clear guidelines for their treatment are available. To the best of our knowledge, this is the first systematic literature review regarding pelvic ABCs. Our objective was to identify treatment modalities and assess bone healing, measured as the degree of radiological ossification. Searches were conducted in PubMed, Cochrane Library, and Web of Science. Based on the scarcity of reports, inclusion criteria were kept broad and included primary or recurrent pelvic ABCs, with a minimum follow-up of 1 year and available information on radiological ossification. Data were extracted at the individual patient level and grouped according to treatment modality. Forty-nine studies reporting on 194 patients were included from the study. The level of evidence was low (29 case reports and 20 retrospective case series), and the reporting of outcomes was inconsistent. Five major treatment groups were identified and divided into 11 subgroups. The largest subgroup was curettage (23%), followed by selective arterial embolization (20%). Most ABCs were located in the ilium. Variations in mean tumor size (4.5–22.2 cm) and degree of ossification (60–100%) depended on the treatment modality. Overall, in 77% of the cases, the cyst ossified completely. Recurrence was reported in 22 patients (11%) and two patients (1%) died during the course of the treatment. This systematic review provides the first comprehensive overview of pelvic ABC treatment modalities and their radiological and clinical outcomes. Neoadjuvant scleroembolic treatments appear to be used most in recent years, but further comparative studies and better quality of reporting are needed to determine their effectiveness.
... Secondly, ABCs may arise de novo; those that arise without evidence of another lesion are classified as primary ABCs. Thirdly, ABCs may arise in an area of previous trauma as results of either arteriovenous fistulas, venous blockage or local hemorrhage that initiates the formation of reactive osteolytic tissue [4,10,11,12,13]. The third theory may explain the occurrence of ABC in our case. ...
... 23.150] with or without spine stabilization, radiation therapy (RT), intralesional injection of bone cement, intralesional injection of mesenchymal stem cells, bisphosphonates, and Denosumab. [14,15] SAE has been used in limited number of patients, mainly vertebral, pelvic, and/or extensive ABCs. [16] Enneking et al. [17,18] classified ABCs into three types: Stage 1 (latent), which remains static, or heals spontaneously; Stage 2 (active), progressive growth without cortical destruction; and Stage 3 (locally aggressive), progressive growth with significant cortical destruction. ...
Objective: To study the clinicoradiological characteristics and surgical outcomes in patients with aggressive aneurysmal bone cyst (ABC) of spine. Materials and Methods: In this retrospective study, data was collected from patients with aggressive ABC of spine managed between January 2007 and December 2016. Clinical findings, radiological, and histological characteristics were studied. Follow-up was done either in the outpatient clinic or through a telephonic interview. Results: Seven patients (mean age, 15.6 years, range, 6–23 years) diagnosed with Enneking stage III aneurysmal bone cyst of the spine were included in the study. Local pain with restriction of movement was the most common presenting complaint (100%). Four patients presented with myelopathy. Thoracic spine was the most common site of involvement (43%). Of the patients, 71% had involvement of all three columns. All patients underwent surgical management; gross total resection in four patients (57%) and subtotal in three patients (43%). Of the seven patients, six required instrumented fusion. None of the patients developed any perioperative complication except for one patient who developed transient hip flexion worsening. Two patients received conformal radiation therapy (RT) postoperatively. The follow-up ranged from 40 months to 108 months (mean follow-up was 4.5 years). There were no recurrences. At last follow-up, all patients were alive and had significant improvement. Conclusions: ABC of the spine is found predominantly in the pediatric population. Intralesional en bloc resection with instrumented stabilization provides effective and fast relief from pain, early mobility, good surgical, and long-term outcomes. Conformal RT following a planned subtotal excision prevents the progression of the disease.
... The distal femur, proximal tibia, proximal humerus followed by spine with its preference being metaphysis of long bones are most common sites of its occurence. Aneurysmal bone cyst itself accounts for less than 6% of all bone tumours and is 4 times more rarer than osteosarcoma [3] . The etiology of Aneurysmal bone cyst still remains uncertain however many anticipated that it may result from local circulatory interruption which leads to increased venous pressure and local hemorrhage production. ...
... Aneurysmal bone cysts (ABC), also known as "Jaffe-Lichtenstein disease" [1-3], are rare benign non-neoplastic vascular lytic lesions of the bone of unknown etiology [4,5]. The annual incidence of ABC in all bony locations has been reported as 0.14 per 100,000 people; with slight female preponderance[6]. ...
Background:
Aneurysmal bone cysts (ABC) are rare benign, vascular, osteolytic bone lesions. Pelvic ABCs account for 8 -12% of these tumors and no clear guidelines for their treatment are available. To our knowledge, this is the first systematic literature review regarding pelvic ABCs. Our primary objective was to identify treatment modalities and to assess the bone healing, measured as the degree of radiological ossification. Secondary objectives were to describe demographics, tumor characteristics, clinical and functional outcomes and recurrence.
Methods:
Searches were conducted in PubMed, Cochrane Library, and Web of Science. Based on the scarcity of reports, inclusion criteria were kept broad and comprised primary or recurrent pelvic ABCs, with a minimum follow up of one year and available information on radiological ossification. Data was extracted on the individual patient-level and grouped according to treatment modality.
Results:
Forty-nine studies reporting on 194 patients were included. The level of evidence was low (29 case reports and 20 retrospective case series) and the reporting of outcomes inconsistent. Patients had a median age of 15 years and 52% were male. Five major treatment groups were identified and divided into 11 subgroups. The largest subgroup was curettage (23%) followed by selective arterial embolization (20%). Most ABCs were located in the ilium. Variations in mean tumor size (4.5-22.2cm) and degree of ossification (60-100%) depended on the treatment modality. Overall, in 77% cases the cyst ossified completely. Recurrence was reported in 22 patients (11%) and 2 patients (1%) died during the course of the treatment.
Conclusion:
Despite the low quality of reporting, this systematic review provides the first comprehensive overview of pelvic ABC treatment modalities and their radiological and clinical outcomes. Neoadjuvant sclero-embolic treatments appear to be used most in recent years, but further comparative studies and better quality of reporting are needed to determine their effectiveness. Quality of reporting should be improved by following reporting guidelines.
Level of Evidence: IV
... Embolization is done with an aim to devascularize the tumor and can reduce the intra-and postoperative complications of open surgery. Sclerosing therapy is not indicated in cases where there is cortical break [6]. remodeling, but it is a rather technically demanding procedure [7]. ...
Introduction: Aneurysmal bone cyst (ABC) is typically a benign, expansile, and cystic lesion of the bone that can be locally aggressive characterized by vascular gaps separated by fibrous septae. Treatment modalities available are sclerosing agents, arterial embolization, surgical excision, curettage with or without bone grafting, and adjuvant radiotherapy.
Case Report: We report a rare case of ABC with pathologic fracture in the proximal femur in a 15-year-old female patient, treated with en blocexcision, bone grafting with non-vascularized fibular strut graft and stabilized with a 95°dynamiccondylar screw plate system. Follow-up at 24 months showed incorporation of the fibular graft and full union.
Conclusion: Structural support and autologous bone grafting in giant ABC in young individuals would yield adequate results.
Keywords: Aneurysmal bone cyst, Femur Tumorfibula strut graft, enbloc excision.
... The [2]. However, despite many treatment techniques, between 5 and 40% of relapses are described [3]. ...
... Intralesional injection of calcitonin-a suppressor of osteoclast activity and promotor of osteogenesis-was first described by Szendroi et al. 23 Recently, good results have been reported with percutaneous injection of calcitonin combined with methylprednisolone acetate-with angiostatic and fibroblastic inhibitory effects. [24][25][26][27] Some authors state that intralesional injection of calcitonin and methylprednisolone is efficacious and a less aggressive and invasive treatment for ABC. ...
Study Design
Retrospective study.
Objective
The aim of this study was to evaluate the clinical presentation, treatments, outcome, complications, and recurrence rate in the surgical and nonsurgical management of spinal aneurysmal bone cyst (ABC) in a series of 18 pediatric patients.
Methods
Between 1988 and 2014, we evaluated 18 pediatric patients diagnosed with ABC confirmed by pathology studies. We analyzed clinical and radiological features, non-surgical and surgical treatment, outcome, and complications.
Results
The series included 12 male and 6 female patients with a mean age of 10 years and 4 months, with a mean follow-up of 5 years. Location of the ABC was lumbar in 8, cervical in 7, thoracic in 2, and sacral in 1 case. Axial pain was the most common symptom followed by radicular involvement. Surgery was performed in the presence of spine instability or neurological involvement (tumor resection) and in the remaining, nonsurgical treatment (percutaneous intralesional injection of methylprednisolone and calcitonin). Recurrence was observed in 4 patients requiring reintervention. There were no procedure-related complications.
Conclusion
In patients without neurological involvement or spinal instability, nonsurgical treatment is the treatment of choice. Total or subtotal removal combined with posterior instrumented spinal fusion is recommended in cases with a neurological deficit. Both procedures have shown good long-term results.
... Adjuvant therapies are multiple and include electrocautery, cryotherapy, intra-lesional sclerotherapy, preoperative embolization, and medical therapy with denosumab as fracture prophylaxis [4][5]. Despite appropriate management, reports of tumor recurrence range considerably, with different treatment options from as low as 5% to more than 40% [6]. ...
Aneurysmal bone cysts (ABCs) are benign osteolytic vascular lesions that are capable of aggressive local expansion and bone destruction. These tumors are most common in adolescent patients and constitute approximately 9% of benign tumors. ABCs can present a diagnostic challenge, as they share several histological and radiographic characteristics with more aggressive lesions, including giant cell tumors and malignant telangiectatic osteosarcomas. The management of ABCs is diverse, but the most common approach includes lesion curettage with bone grafting. Here, we present the case of a large, central ABC of the distal femur in a young, previously healthy female who presented to the emergency room with a pathologic fracture.
... Aneurysmal bone cyst itself accounts for less than 6% of all bone tumours and is 4 times more rarer than osteosarcoma. 3 The etiology of Aneurysmal bone cyst still remains uncertain however many anticipated that it may result from local circulatory interruption which leads to increased venous pressure and local hemorrhage production. Lesions usually appear on x-rays films as expansile and lytic. ...
Aneurysmal bone cysts (ABCs) are benign but locally destructive, blood filled reactive lesions of the bone. Although a wider age group may be affected, most commonly they are seen in patients younger than 20 years of age, with a slight female preponderance. Most common sites include metaphysis of femur followed by tibia and then humerus. Vertebral lesions involving the posterior elements are common.Aneurysmal bone cyst of proximal fibula is a rare and uncommon. Here, we report a case of 13 year old female with classic histologic, clinical, and radiographic findings that was treated by en bloc resection. </p
... En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. Careful curettage and bone grafting still remains the surgical method of choice in the majority of cases, when the ABC is more destructive and affects the subchondral bone of the joints [11]. Despite this osteogenic characteristic, the clinical use of marrow as an osteogenic source has remained limited [12]. ...
... These symptoms can even have sudden onset caused by pathological fractures (which are uncommon for ABC in the extremities) [1]. Many treatment strategies have been proposed to manage ABC [6] but, being it a rare lesion, their efficacy is mostly based on the results of retrospective case series [17,[25][26][27][28][29][30][31][32] and only few prospective studies have been run [7]. ...
PurposeABC is a benign lesion with unpredictable behavior. Its treatment is challenging, especially in poorly accessible surgical areas, such as spine and pelvis. Currently, the first-line treatment of ABC is repeated selective arterial embolization (SAE) until healing. Other options have been used with variable success rates. We propose an alternative treatment for spine aneurysmal bone cyst (sABC) based on the injection of concentrated autologous bone marrow. Methods
We retrospectively report and analyze here two cases of patients, a 14-year-old girl and a 16-year-old boy, both affected by ABC in C2 vertebra which were impossible to treat by SAE. They were treated with single or repeated injection of concentrated autologous bone marrow into the lesion. Their follow-up period is 27 months for both patients. ResultsIn the two cases reported here we observed a progressive ossification of the lesion, which was slow in one case, requiring three subsequent injections of concentrated bone marrow, and fast in the other case, beginning 1 month after the procedure. In both cases, the healing of the lesion was associated with symptom relief and the clinical status of the patients remains stable after 2 years. Conclusions
Although SAE can still be considered the first line in the treatment of ABC in the axial skeleton, new promising therapeutic procedures involving the use of mesenchymal stem cells are developing.
... The optimal treatment for ABC's is debatable. In spite of the number of techniques reported in the literature, there remains a recurrence rate that ranges from 5% to greater than 40% [5]. Sclerosing substances and bone substitutes are less effective than conventional curettage [6]. ...
Aneurysmal bone cyst (ABC) is a benign, expansile, non-neoplastic lesion of the bone, characterized by channels of blood and spaces that are separated by fibrous septae. Giant ABC is an uncommon condition and can be difficult to handle because of the destructive effect of the cyst on the bones and the compressive effect on the nearby structures, especially in weight-bearing bones of the body. We report a case of a giant aneurysmal bone cyst in the proximal femur of a six-year-old child, which was treated with a sclerosing agent and ender's nail fixation first. There was recurrence after 13 months. It was then curetted out extensively, the cavity was filled with bone graft, and fixation with a dynamic hip screw (DHS) was done. At 19 months follow-up, the lesion had subsided and patient was walking pain-free without any deformity. We suggest this method of treatment to be worthwhile for ABC at this site and at this age.
... En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. Careful curettage and bone grafting still remains the surgical method of choice in the majority of cases, when the ABC is more destructive and affects the subchondral bone of the joints [11]. Despite this osteogenic characteristic, the clinical use of marrow as an osteogenic source has remained limited [12]. ...
Study design: Patients had Aneurysmal bone cyst lesion that underwent to be
treated by Injection of Autologous Bone Marrow Aspirates (ABM) and follow up
of this case for the final results.
Patients and Methods: Sixteen patients had had Aneurysmal bone cyst had been
treated by ABM injections. Study have 16 patients 11 females (68.75 %) and 5
male (31.25 %). Age ranged from 3-14 years with average age 7.5 years. Number
of injections for every patient ranged from 2-6 times with average 4.4 times. This
study including 5 cases (31.25 %) with proximal femoral cyst, 9 cases (56.25 %)
had tibial cyst (2 distal and 7 proximal tibiea) and 2 cases (12.5 %) had proximal
humeral cyst. All patients treated by injection of Autologous Bone Marrow
Aspirates which obtained from the iliac crest. The bone marrow aspirates was
obtained percutaneous by bone marrow aspiration needle, According to follow
up X-ray during injections we decide continuity of injections. Average size of the
defect was 2.3 cm. and average amount bone marrow/inj. Was 10.2 cc.
Results: Pain Score according to VAS ranged from 3-9 with average 5.7 which
was improved to average 1.5 at final follow up. Healing time ranged from 21 -
90 days with average 42.2 days. Motion of the arm as patients can move their
arm without pain was allowed. Weight bearing for the lower limbs also had
been allowed as patients felt pain subsided even there is no complete healing
radiological.
Conclusion: Aneurysmal Bone cyst has risk for fracture and recurrence after
various modalities of treatment. Bone marrow has the advantage of percutaneous
treatment (minimal Invasive) and has no recurrence reported for the current
study.
... Small lesions with minimal destruction or expansion of cortical bone can be treated with intralesional procedures with or without bone grafting; however, aggressive large-sized and expansible tumors should be treated through segmental or en bloc resection techniques and reconstruction with structural grafts [5]. En bloc resection has the additional advantage of allowing obtaining the lowest association with recurrence which is as low as 0% [6][7][8]. However, resection can be problematic, especially for the lesions located in functionally important segments, when the tumor is unusually large or in the presence of concomitant pathological fracture. ...
Aneurysmal bone cysts (ABCs) are benign, expansible, nonneoplastic lesions of the bone, characterized by channels of blood and spaces separated by fibrous septa, which occur in young patients and, occasionally, with aggressive behavior. Giant ABC is an uncommon pathological lesion and can be challenging because of the destructive effect of the cyst on the bones and the pressure on the nearby structures, especially on weight-bearing bones. In this scenario,
en bloc
resection is the mainstay treatment and often demands complex reconstructions. This paper reports a difficult case of an unusual giant aneurysmal bone cyst, which required extensive resection and a knee fusion like reconstruction with tibia allograft.
... La cisti ossea aneurismatica è una lesione benigna intraossea di natura osteolitica espansiva 2,5,6 costituita da cavità a contenuto ematico separate tra loro da setti fibrosi, contenenti cellule giganti multinucleate, fibroblasti, tessuto osteoide e depositi emosiderinici [5][6][7][8] . In relazione alla sede e all'estensione della lesione, sono stati descritti differenti approcci terapeutici, quali: a) il curettaggio semplice; b) l'enucleazione conservativa abbinata o meno a curettaggio del sito residuo; c) la resezione del distretto osseo interessato 4,[31][32][33] . A oggi, molteplici autori ritengono che il tratta to residuo potrebbe infatti impedire il loro sanguinamento e l'organizzazione di un coagulo all'interno del difetto stesso, interferendo con l'attivazione del processo di ri-ossificazione spontanea che normalmente si sviluppa durante le fasi di guarigione. ...
... The incidence of ABCs is slightly higher in females than in males, while the overall difference between men and women is not significant (3). An ABC is commonly observed at the metaphysis of a long tubular bone, although in certain cases, the cyst may be identified in short tubular bone, flat bone, the nasal cavity or sinuses (21). The type of case reported in the present study is rare, since the ABC occurred in the laryngeal cartilage ring. ...
An aneurysmal bone cyst (ABC) is a type of reactive reparative bone neoplasm that rarely occurs in the head and neck. To date, only a small number of cases have been previously reported. The present study reports the case of a 58yearold male who presented with a tumor in the laryngeal cricoid cartilage, a rare position for a tumor, who subsequently underwent treatment by surgical resection. Based on the observations of the present study and a literature review, it was concluded that an ABC of the larynx can be identified based on a combination of radiology and postoperative histopathology examinations. However, following a tracheotomy and excision, the difficulty of performing tracheal cannula removal is inevitable. The present study described in detail a rare disease, ABC, occurring in the larynx. More cases are required for follow-up studies.
... Second, the epidemiologic profile of our patients is slightly different from the literature. We have a relatively smaller population of young patients, with 35% (11 of 31) of patients in the first two decades of life, compared with the younger age profile more common in the literature [4,9,11,14,16,17]. Growth plates were still open at presentation in only nine patients, six of whom had cysts abutting the plates. ...
Background:
To decrease the recurrence rate after intralesional curettage for aneurysmal bone cysts, different adjuvant treatments have been recommended. Liquid nitrogen spray and argon beam coagulation have provided the lowest recurrence rates, but unlike the high-speed burr, these adjuvants are not always available in operating rooms.
Questions/purposes:
We asked: (1) Is high-speed burring alone sufficient as an adjuvant to curettage with respect to recurrence rates? (2) What is the complication rate from this technique? (3) What are the risk factors for local recurrence?
Methods:
A retrospective review of the database of the University Musculoskeletal Tumor Unit and the private files of the senior author (EHW) for a period of 19 years (1993-2011) was performed to identify all patients histologically diagnosed with primary aneurysmal bone cyst. During that period, patients with aneurysmal bone cysts were treated with intralesional curettage, burring, and bone grafting if the lesions showed an adequate cortical wall or a wall with thinned out portions which could be reconstructed with bone grafting. Based on those indications, we treated 54 patients for this condition. Of those, 18 were treated using approaches other than burring because they did not meet the defined indications, and an additional five patients were lost to followup before 2 years, leaving 31 patients for analysis, all of whom were followed up for at least 2 years (mean, 7 years; range, 2-18 years).
Results:
Of these 31 patients, one had a recurrence (3.2%). Complications using this approach occurred in three patients (9.7%), and included growth plate deformity (1) and genu varus (2) secondary to collapse of the reconstructed condyle. With only one recurrence, we cannot answer what the risk factors might be for recurrence; however, the one patient with recurrence presented with a large lesion and a pathologic fracture.
Conclusions:
Curettage, burring, and bone grafting compare favorably in the literature with other approaches for aneurysmal bone cysts, such as cryotherapy and argon-beam coagulation. We conclude that high-speed burring alone as an adjuvant to intralesional curettage is a reasonable approach to achieving a low recurrence rate for aneurysmal bone cysts.
Level of evidence:
Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
... Such an association with OF of the jaws has been previously reported in literature by Sun et al. [9]; where 64.7 % cases were associated with OF. In secondary ABCs involving long bones, giant cell lesions are the most common associated lesions accounting for 39 % of all secondary lesions [13]. Trabecular variety of juvenile ossifying fibroma is a well established aggressive type of juvenile ossifying fibroma in which ABC formation is relatively rare. ...
Aim
The aim of the present study was to analyze clinical, radiological and histopathological features of aneurysmal bone cysts (ABCs) of jaws.
Materials and Methods
Archival data from 2009 to 2012 present in the Oral Pathology Department was retrieved and clinicopathological features of all the cases which had been previously diagnosed as ABC were analyzed in detail.
Results
Seven cases ranging in age from 10 to 50 years were included, in which maximum (5/7) cases were below 20 years. Ratio of presentation of lesion in male to female and in maxilla to mandible was 3:6 and 1:6 respectively. Swelling and pain were the most common presenting features. Variable presentation of the lesion was observed radiographically; although multilocular, well defined, bone expansion and perforation were the most common observations. Histopathological analysis revealed association of one case with ossifying fibroma and two cases with trabecular variety of juvenile ossifying fibroma. Predominance of solid variety was noted and other features like stroma, giant cells, nature of blood vessels, bone destruction and perforation and presence of any osteoid or calcified material was also accounted for. The current study showed association of two cases with trabecular variety of juvenile ossifying fibroma, which is a rare finding.
Conclusion
ABCs of jaws, thus have varying patterns of presentation which are diagnostically challenging. A thorough examination of the incisional/excisional tissue is thus required to confirm the association with any other lesion which will affect the treatment plan for the patient.
Background
Spinal aneurysmal bone cysts (ABCs) are rare, histologically benign tumors with aggressive behavior, which may cause bone and soft-tissue destruction, particularly affecting neural elements. Management of these tumors, including treatment modalities and follow-up protocols, remains challenging.
Case Description
A 7-year-old boy presented with chest wall pain persisting for two months before admission, accompanied by progressive mono paresis lasting ten days before admission. Myelopathy signs were evident during the examination. Imaging confirmed a multicystic lesion at the T6 level involving the posterior elements of the vertebra, with significant cord compression. Due to deteriorating neurological function, he underwent urgent laminectomy and neural decompression, followed by subtotal tumor resection. Postoperative histopathological examination confirmed the diagnosis of an ABC, and the patient experienced significant neurological recovery. However, after 21 days, the patient was readmitted to the emergency department with severe paraparesis. Magnetic resonance imaging revealed rapid growth of the residual tumor, leading to cord compression. He underwent aggressive total tumor resection, T6 vertebral body corpectomy, and fixation with pedicle screws and cage insertion. Following the second surgery, prompt neurological recovery occurred.
Conclusion
This rare case report emphasizes the importance of a close follow-up protocol for spinal ABCs in the pediatric population. It highlights the challenges in managing these tumors and the need for vigilant monitoring to detect and address rapid recurrences.
Background:
Fluid-fluid levels (FFLs) is found in 10%-16% of giant cell tumor of bone (GCTB), and the presence of FFLs raises the suspicion of GCTB with secondary aneurysmal bone cyst (ABC), which can lead to increased intraoperative bleeding and, blurring the operative field, be associated with a risk of local recurrence. The first objective of this study is to determine whether secondary ABC is associated with a higher risk of local recurrence after curettage in patients with GCTB of the extremities. The second objective of this study is to investigate the sensitivity, specificity, positive predictive value, and negative predictive value of the presence of FFLs detected on magnetic resonance imaging (MRI) to diagnose secondary ABC associated with GCTB.
Methods:
Two hundred and eighty patients with GCTB of the extremities who underwent curettage at the authors' institutions between 1980 and 2021 were included in this study.
Results:
Secondary ABC was found in 36 of 280 patients (12.9%) and local recurrence occurred in 66 of 280 patients (23.6%). Multivariate analysis showed no significant correlation between secondary ABC and local recurrence (hazard ratio [HR]: 1.87 (95% confidence interval [CI]: 1.00-3.53]; p = 0.051). Preoperative MRI revealed FFLs in 13 of 82 patients (15.9%). Sensitivity, specificity, positive predictive value, and negative predictive value of FFLs detected on preoperative MRI to diagnose secondary ABC were 36.8%, 90.5%, 53.8%, and 82.6%, respectively.
Conclusion:
The results of this study showed that secondary ABC does not increase the risk of local recurrence after curettage in patients with GCTB of the extremities. Although rare, FFLs were present in patients with GCTB and half of those with FFLs detected on preoperative MRI had secondary ABC.
Objective
The purpose of this retrospective study was to investigate and compare the clinical, radiographic, pathological, pathogenesis, and therapeutic features of simple bone cysts (SBCs) and aneurysmal bone cysts (ABCs) of the jaw.
Methods
35 patients with SBCs and 6 patients with ABCs who received treatment at the Department of Oral and Maxillofacial Surgery, Zhejiang University School of Medicine from 2017 to 2022 were followed up and reviewed retrospectively.
Results
The study included 41 patients, accounting for 2.14% of all jaw pathologies, with 35 patients having SBCs and 6 patients having ABCs; their average ages were 26.63 ± 13.62 years and 17.83 ± 7.88 years, respectively. The prevalence of SBC and ABC did not differ significantly by sex. The mandible was the most vulnerable area to be involved. Only 5.71% (2/35) of patients with SBCs and 16.7% (1/6) of patients with ABCs reported histories of previous trauma in the same region of the pseudocysts. A total of 42.86% (15/35) of SBC cases and 66.67% (4/6) of ABC cases had malocclusions. The radiographic features of pseudocysts varied in shape, were associated with the root, and unilocular or multilocular. All patients had curettage with or without bone graft or substitute implantation, and recurrences did not occur in 94.29% (33/35) of SBC patients and 100% (6/6) of ABC patients after a mean follow-up time of 26.23 ± 15.47 months and 21.67 ± 19.75 months, respectively.
Conclusions
Pseudocysts, including SBCs and ABCs, are benign osteolytic lesions without an epithelial lining that occur occasionally in the jaw, mostly in adolescents and young adults, and their incidence did not significantly differ by sex. The most vulnerable site of involvement is the mandible, and they are generally not overtly aggressive. Trauma has a less significant role in pseudocysts, but minor trauma, such as malocclusion, has the potential to influence pseudocyst development. The clinical presentation of pseudocysts lacks specificity, and most patients are asymptomatic and found incidentally during radiographs. Dental panoramic radiographs and CBCT cannot accurately distinguish between SBC and ABC, and the final diagnosis depends on pathological diagnosis. Curettage combined with bone grafting is currently the best treatment for both, with a 5.71% (2/35) recurrence rate for SBC and no recurrence found for ABC.
Resumen
El quiste óseo aneurismático (QOA) es un tumor benigno, por lo general solitario. Representa el 1% de los tumores benignos. El QOA es primario (70% de los casos) o secundario (30% de los casos), y se desarrolla sobre una lesión preexistente a la que puede enmascarar. Una translocación cromosómica específica, 17p11-13 o 16q22, es característica del QOA primario. Aunque es un tumor benigno, el QOA tiene un alto potencial de agresividad. La gran mayoría de los casos se producen entre los 10-20 años. La clínica está dominada por el dolor y una tumefacción. La fractura patológica es infrecuente en el QOA. Desde el punto de vista radiológico, el QOA es una lesión lítica metafisaria, redondeada, excéntrica y a menudo de gran tamaño. Esta lesión insufla y expande el periostio y erosiona el hueso cortical de forma progresiva. En la resonancia magnética (RM), una lesión ósea expansiva bien delimitada, una disminución de la señal T1 con un aumento de la señal T2, un ribete periférico de baja señal realzado por la inyección de contraste, numerosas celdillas y la presencia de niveles de líquido son altamente sugestivos de QOA. El estudio por imagen sigue ofreciendo un diagnóstico de probabilidad y debe confirmarse siempre con una biopsia. La resección quirúrgica en bloque y la resección intralesional (raspado o saucerización) ± uso de adyuvantes locales fueron durante mucho tiempo el tratamiento de elección. En los últimos años, los tratamientos menos invasivos (embolización arterial selectiva [EAS], escleroterapia) han primado sobre los tratamientos quirúrgicos. Son eficaces, tienen pocas complicaciones y mucha menos morbilidad que la cirugía.
Background
Spine aneurysmal bone cysts (ABCs) rarely occur in adults. Primary and secondary lesions may show some differences and require appropriate treatments.
Objective
To systematically review the literature on adult spine ABCs.
Methods
PubMed, EMBASE, Scopus, and Web-of-Science were searched. Clinical-radiological features, treatments, and outcomes were analyzed and compared between primary vs secondary adult spine ABCs.
Results
We included 80 studies comprising 220 patients. Primary spine ABCs were more frequent (76.4%). Main symptoms were lower-back-pain (42.8%) and motor deficits (31.2%). Tumors were mostly thoracic (31.4%) or cervical (26.8%), showing lytic (70.4%) and/or cystic (52.3%) appearances. Surgical resection (79.1%) was preferred over biopsy (20.9%). Most primary ABCs underwent curettage with bone grafting (62.1%) and laminectomy (39.1%) (P < 0.001), while most secondary ABCs underwent corpectomy (51%) and spine fixation (93.9%) (P < 0.001). Radiotherapy was delivered in 58 patients (26.4%), and embolization in 37 (16.8%). Symptomatic improvement was reported in 91.8% cases, with no differences based on etiology nor extent-of-resection. Median follow-up was 28.5 months, significantly superior in secondary ABCs. Secondary ABCs had significantly higher rates of tumor recurrence (19.2%; P = 0.011) and death (5.8%; P = 0.002).
Conclusion
Surgical resection, radiotherapy, and embolization are effective in managing adult spine ABCs. Secondary tumors have worse prognoses requiring more aggressive treatments.
Purpose
We retrospectively analysed a cohort of patients treated at our Centre with bone marrow concentrated (BMC) injection for aneurysmal bone cyst (ABC) of the spine, in order to propose this treatment as a valid alternative for the management of ABCs.
Methods
Fourteen patients (6 male, 8 female) were treated between June 2014 to December 2019 with BMC injection for ABC of the spine. The mean age was 17.85 years. The mean follow up was 37.4 months (range 12- 60 months). The dimension of the cyst and the degree of ossification were measured by Computed Tomography (CT) scans before the treatment and during follow-up visits.
Results
Six patients received a single dose of BMC, five patients received two doses and in three patients three doses of BMC were administered. The mean ossification of the cyst (expressed in Hounsfield units) increased statistically from 43.48±2.36 HU to 161.71±23.48 HU during follow-up time and the ossification was associated to an improvement of the clinical outcomes. The mean ossification over time was significantly higher in patients treated with a single injection compared to patients treated with multiple injections. No significant difference in ossification was found between cervical and non-cervical localization of the cyst. Moreover, the initial size of the cyst was not statistically associated with the degree of ossification during follow-up
Conclusions
Results of this paper reinforce our previous evidence on the use of BMC as a valid alternative for spinal ABC management when SAE treatment is contraindicated or ineffective.
Background
The standard treatment of Aneurysmal bone cyst is curettage and grafting and is associated with high morbidity. Hence minimal invasive alternative treatment methods such as sclerotherapy are gaining much popularity. Though sclerotherapy has been attributed to reasonable cure rates, undetermined tissue diagnosis often impedes with initiation of treatment. This study examines if sclerotherapy with polidocanol based on clinic-radiological picture is comparable with the standard intralesional curettage and bone grafting. Attempting biopsy and treatment simultaneously based on the clinico-radiological presentation makes this study unique.
Methods
We divided 48 patients into two treatment groups. Group 1 treated with percutaneous sclerotherapy using polidocanol and group 2 those treated with extended curettage and bone grafting. We assessed time to healing and recurrence, pain relief, and radiological outcome using modified Neer's criteria for the radiological healing of the bone cysts. 31 patients from Group 1 and 17 from Group 2 were available for study. The minimum follow-up was 2 years.
Results
At last follow-up, 100% in Group 1 and 82% in Group 2 had achieved complete healing and there was no statistical difference in outcome at 24 months (p = 0.255). Complications in Group 1 were injection site necrosis, pain and hypopigmentation, all of which resolved spontaneously. In Group 2, three patients had recurrence. Despite similar healing rates, we found higher incidence of clinically pertinent complications, poor functional outcomes and increased cost of treatment associated with intralesional excision.
Three cases were excluded from sclerotherapy group as the final diagnosis turned up to be secondary ABC.
Conclusions
Percutaneous sclerotherapy using polidocanol is a highly effective, cost efficient and safe treatment option with good cosmesis and reduced morbidity. In this study, we found comparable outcomes for both treatment methods however this will require confirmation in larger studies.
Objective/hypothesis:
Aneurysmal bone cysts (ABCs) are benign, lytic bone lesions, which rarely present in the paranasal sinuses. There is no published consensus on the appropriate diagnostic or treatment approach. Our objective was to elucidate the clinical behavior, treatment, and outcomes for patients with ABCs of the paranasal sinuses (psABCs).
Study design:
Retrospective case series and system review of the literature.
Methods:
A retrospective chart review was performed to identify patients evaluated at the authors' institution with psABC and consolidated with literature reports of psABC.
Results:
Eighty-nine patients met inclusion criteria. The most common presenting symptom was painless facial swelling (n = 35, 39%). The ethmoid sinuses were the most common site involved (n = 55, 62%). Surgical approach was reported in 74 cases including 20 endoscopic and 54 with an open or combined approach. Fifty-nine patients (71%) underwent gross total resection. Follow up data was reported for 67 patients. Fifteen patients (22%) were found to have recurrence or progression at follow up; 10/15 (66%) patients within the first 12 months, 14/15 (93%) within the first 24 months, and 1/15 (7%) greater than 24 months after treatment. Patients were more likely to have recurrence/progression if they presented with nasal discharge (P = .05), proptosis (P = .01), or orbital involvement (P = .03).
Conclusions:
psABCs typically present with painless swelling or nasal obstruction. Orbital involvement is a negative prognostic indicator with these patients more likely to have recurrence after treatment. Recurrence or progression of disease is most likely to occur within 2 years after treatment. Therefore, patients should be monitored closely during this time.
Level of evidence:
4 Laryngoscope, 2021.
The aneurysmal bone cyst (ABC) is a benign, blood-filled bony lesion that notoriously affects the vertebral column and long bones of the body. Rarely, ABCs can manifest in the head and neck (HNABC). The purpose of this paper is to provide a comprehensive review of existing literature on HNABC. This review includes: case reports and case series on ABCs manifesting in the head and neck region published in the English language. All cases identified via PubMed were analyzed individually. Articles were included according to specified eligibility criteria. The total number of cases analyzed were 72 (39 case reports; 33 case series). The average age at the time of HNABC diagnosis was 19.1 years (range: 0.42-62 years). The ratio of prevalence by gender affected exhibited an even 1:1 male-to-female split. CT in combination with MRI proved to be the most prevalent imaging modality utilized (37.2%). HNABC was most commonly detected in the mandible (37.1%), followed by the sinus (14.3%) and cranium (11.4%). The most frequently employed single treatment modality was surgical excision (94.1%). 94.4% of patients were alive with no evidence of disease at follow-up, while 5.6% of patients exhibited disease at follow-up. The average follow-up period was 3.59 years (range: 0.17-17.0 years). Aneurysmal bone cyst of the head and neck region is a rare condition that should be considered in the differential diagnosis of bony, vascular lesions presenting in the aforementioned locations. Since aneurysmal bone cyst of the head and neck region can present as a rapidly growing, expansive and destructive lesion, it is crucial that clinicians are aware of this entity so that patients are accurately diagnosed and treated.
Aneurysmal Bone Cyst (ABC) is a Benign tumor, Also known as Giant Cell Repetative Granuloma, They are locally destructive hemorrhagic benign cystic legion. According to the definition of the WHO Aneurismal Bone Cyst is expanding osteolytic lesion consisting of blood-filled spaces of variable size and that are separated by connective tissue septae containing trabecula of bone or osteoid tissue and osteoclast giant cells. We report a case of a giant aneurysmal bone cyst in the Middle one-third of Right humerus of a 16 -year-old boy, which was treated with Allograft, Autograft and ender's nail fixation. At 6 Years of follow up Patient regain a pain-free complete Range of motion with radiographically subside of legion.
Aims:
The study was done to review the literature about the intriguing aspects of the aneurysmal bone cyst and to describe our experience with these cases.
Design:
Retrospective.
Material and method:
We reviewed the records of all patients with primary spinal tumours whom we managed over last 8 years. We selected the patients with biopsy proven aneurysmal bone cyst (ABC) for our study.
Results:
Four patients (two males and two females) were included. The age ranged from 15-18 years. Three of them had neurological deficits and one had only pain. All of them were operated and three required instrumentation for stabilization. Neurological deficits improved in all the cases. However we had to re- operate one of the cases for recurrence and that patient was administered adjuvant radiotherapy.
Conclusions:
ABC is not a tumour in real sense but due to destructive nature that are classified as tumours. The patients have an excellent outcome as the disease is benign and has very low recurrence rates if surgical excision is complete. Best treatment modality is complete excision. Aneurysmal bone cyst is one of the uncommon tumors of the spine, and many of its features continue to be unclear even today. There is ambiguity about the definition, etiopathogenesis, radiological characteristics, histopathology and treatment modalities. They are common in young age and etiology is not clear. The presentation is varied with pain being the common symptom and neurological deficit depends on extent of cord involvement. The best treatment is controversial although surgery is believed to be curative in the majority of cases. We here describe our experience with four such cases who had varied clinical presentation and outcome.
Purpose:
The epidemiology and clinicopathology of aneurysmal bone cysts (ABCs) secondary to giant cell tumors of bone (GCTBs) have been well documented in the previous literature. However, reports on whether secondary ABCs could affect the postoperative recurrence of GCTBs are rare. This study analyzed the effects of secondary ABCs and other relevant clinical factors on the postoperative recurrence of GCTBs of the extremities.
Methods:
We retrospectively analyzed 256 cases of GCTBs of the extremities that were treated surgically at our institution. Among them, there were 60 patients diagnosed with GCTBs combined with secondary ABCs and 196 patients diagnosed with simple GCTBs. Intralesional curettage and tumor resection were performed in 136 and 120 cases, respectively. Univariate analysis, Kaplan-Meier survival analysis, and multivariate regression analysis were used to assess the factors for postoperative recurrence. The follow-up period was at least 24 months.
Results:
The total postoperative recurrence rate was 32%. The recurrence rate in the secondary ABCs group was significantly higher than that in the simple GCTBs group (53.3% vs 25.5%, P < 0.05). Curettage was associated with a higher recurrence rate than tumor resection (42.5% vs 20%, P < 0.05). Kaplan-Meier survival analysis showed that patients with GCTBs combined with secondary ABCs and who were treated by intralesional curettage had a decreased disease-free survival rate. The hazard ratio was 2.18 (95% confidence interval [CI], 1.15-4.13) for the group of GCTB combined with ABCs ( P = 0.01) and 1.97 (95% CI, 1.22-7.50) for the curettage group ( P = 0.01), respectively. Multivariate regression analysis revealed that the presence of secondary ABCs and curettage were independent factors for recurrence of GCTBs.
Conclusion:
According to the results of this study, the presence of secondary ABCs is a potential risk factor for postoperative relapse of GCTBs.
Background Data: Aneurysmal bone cysts (ABCs) of the spine account for 12 to 30% of all ABC cases. They mostly occur in the lumbar vertebrae, followed by the thoracic, cervical, and sacral vertebrae. Despite being benign, they can be locally
expansive and destructive, and can result in pathological fractures of the vertebrae and neurological complications. Treatment modalities include surgical resection, radiotherapy, and embolization with reconstruction. Purpose: To report on a rare case of very large aneurysmal bone cyst originating from the body and the posterior arch of L3 vertebrae and extending from the paraspinal sub-cutaneous tissue posteriorly to the anterior abdominal wall anteriorly and pushing the kidney up and explaining the way of management of such cases. Study Design: Case report and review of literature.
Patient and Methods: An 18years old female patient presented with back pain, right lower limb numbness and partial foot drop together with a big abdominal mass. A thorough general and neurological examination proceeded by proper
history taking including family history and previous trauma were done. Radiological workup was done in the form of plain X-ray, CT scan, and MRI. Total excision and reconstruction was performed under general anesthesia through a posterior only approach. Results: Post operatively the patient recovered nicely without any neurological deficits within 2 weeks. Post operative CT showed total excision, adequate reconstruction and trans-pedicular screw fixation. This patient was followed up clinically for 8 months till now with very good neurological condition. Conclusion: Proper diagnosis and adequate surgical techniques are mandatory for proper surgical excision of such a very big ABC especially if highly vascular.
(2014ESJ083)
Modern traumatology is based on the needs of the children and parents and the prevailing social, economic, cultural and geographic circumstances.
Trauma history: Has trauma occurred? If so:
When did the trauma occur?
What was the patient doing (sport, playing, normal routine)?
Direct or indirect trauma?
Pain history: Where is the pain located (neck, upper thoracic spine, lower thoracic spine, lumbar spine, lumbosacral spine)? When does it occur? Is it related to loading or movement, or does it also occur at rest (e.g. while sitting) or even at night? If so, does the pain occur only while changing position, or does the pain cause the patient to wake up at night? Does the pain occur on bending down or straightening up again? Does the pain also radiate to the legs? Does the pain occur on coughing or sneezing ?
Sports history What sports does the patient practice outside school? If spondylolysis is suspected ask specifically about the following activities: gymnastics, figure skating, ballet, javelin-throwing. If Scheuermann disease is suspected ask specifically whether the patient is involved in cycle racing or rowing.
Neurological symptoms Is a leg weakness present and, if so, since when? Are there problems of micturition or defecation?
Frakturen sind im Wachstums alter häufiger als Kontusionen und harmlose Distorsionen ohne Instabilität. 10–20% aller Verletzungen im Wachstumsalter sind durch Verkehrsunfälle bedingt und diese haben in 80 % Polyblessuren zur Folge. Zwischen 20 % und 40 % werden durch den Sport verursacht und 40–50% durch Spiel und im Hause [2–5, 10, 12, 14, 20, 22, 23, 25–27]. Das Hauptaugenmerk gilt an erster Stelle den Verkehrsunfällen mit der Gefahr des Poly- und v. a. des Schädel-Hirn-Traumas. Erwachsene müssen ihre Schutzfunktionen gegenüber den Kindern wahren und diesen die Gefahren frühzeitig bewußt machen. Dies hilft, die Quote derartiger schwerwiegender und gefahrenträchtiger Verletzungen zu senken. Sportverletzungen haben in den letzten Jahren erheblich zugenommen. Außer bei gefährlichen Leistungssportarten (wie z. B. Skiabfahrtsrennen etc.) kommt es hierbei meist zu mehr oder weniger harmlosen Singulärver-letzungen [2, 4, 22, 25, 26].
Objectives
To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs). Materials and methodsOur study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015. ResultsTreatment success based on imaging was categorized as substantial (51–100 %), partial (1–50 %), or none (0 %) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7 female, 2 male; mean age 19 ± 5 (range 12–25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93 months (mean 16 ± 29 months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75 %) had complete symptomatic relief and 2 patients (25 %) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50 %). There was a partial imaging response in 2 patients (25 %) and no imaging response in 2 out of 8 patients (25 %), and all 4 of these patients had local recurrence. There were no complications. Conclusion
Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence.
In 1968 Ralph C. Marcove introduced cryosurgery into orthopedic oncology for the treatment of primary and metastatic bone tumors by repetitive freezing. He was awarded the first prize in scientific research at the 162nd annual convention of the Medical Society of the State of New York (1). Since then more orthopedic surgeons dealing with skeletal tumors have adopted the technique, and the clinical results and experimental data of cryosurgery with specific reference to the skeletal system have been published regularly.
ContextAneurysmal bone cysts are rare pseudocysts, commonly seen in long bones and vertebral column. Although a well described and reported lesion, many misconceptions still prevail regarding their etiopathogenesis. Many of the reported cases of jaw aneurysmal bone cysts (JABC) present with another bone pathology. AimsThe purpose of this review was to evaluate the incidence of neoplastic lesions occurring simultaneously with a JABC (in contrast to primary JABCs). Any pathogenetic and oncogenetic association between primary and secondary jaw ABCs has been reviewed and discussed. Settings and DesignA methodical narrative review of literature was performed, given the incidence of mostly case reports on this topic. Methods and MaterialA methodical electronic search of Pubmed, Pubmed Central, Medline and Cochrane databases was performed for reported cases of JABC. These articles were analysed and segregated into primary and secondary ABC and, if secondary, the lesion it concurrently occurred with. Another search was conducted to yield articles discussing the cytopathogenetic and oncogenetic origins of ABCs. Results and Conclusions
About 15% of the ABCs reported were of secondary nature. Amongst the associated lesions, cement-ossifying fibroma and ossifying fibroma were the most common, followed by fibrous dysplasia and central giant cell granuloma. No ABCs were associated with metastatic changes. The search for histopathogenesis pointed to a specific cytogenetic abnormality as the origin of primary ABCs, with USP6 as its main oncogene and spindle cell as the neoplastic cell, unlike with secondary ABCs, suggesting that they are distinct pathological processes.
A clinicopathological review of 105 cases of aneurysmal bone cyst is reported. Age and sex distribution and localization were in agreement with two previously reported large series. Recurrence occurred in 30.5% of all the cases and in 34.2% of those treated by curettage. Proved incompleteness of surgical removal was an important factor in recurrence (12 out of 17 cases or 70.6%). The recurrence rate was significantly (P2 less than 0.01) higher in cases with a mitotic index of seven or more per 50 fields (X 750) than in those with a lower mitotic index. In relation to the recurrence rate, no statistically significant differences were found between the age groups less than or equal to 15 and greater than 15 years, between the combination age and lesion size, or between four localization groups. The cyst wall and the septa consist of a superficial layer of cellular fibroblastic and histiocytic tissue in which multinuclear giant cells are present, covering a deeper situated zone of less cellular fibrous tissue. This typical layered architecture was found at one or more places in 93 (88.6%) out of 105 cases. However, layered architecture may also be found in cases of teleangiectatic osteosarcoma. It is suggested that the group with a high risk of recurrence be treated more radically, i.e., with cryosurgery.
Radiological findings in 75 cases of aneurysmal bone cyst were analyzed. Sixty-five per cent were primary or simple and 35% were secondary, the aneurysmal bone cyst being combined with other osseous lesions. A primary aneurysmal bone cyst can be diagnosed with a high degree of certainty, but only 20% of secondary forms had the radiological appearance of aneurysmal bone cyst; in the other 80% the associated lesion dominated the radiological picture, particularly when it was malignant. In the secondary form a small biopsy specimen may show the features of aneurysmal bone cyst only; without radiological assistance a concomitant malignant lesion may be missed. Therefore, there must be close collaboration between the radiologist and and the pathologist.
Levy, Walter M., Miller, Arthur S., Bonakdarpour, Akbar, and Aegerter, Ernest: Aneurysmal bone cyst secondary to other osseous lesions. Report of 57 cases. Am. J. Clin. Pathol. 63: 1–8, 1975. Fifty-seven aneurysmal bone cysts which were associated with or secondary to other lesions of bone are reported. The most common associations were with solitary or unicameral bone cyst, and with osteoclastoma. Other associated lesions included osteosarcoma, nonosteogenic fibroma, osteoblastoma, hemangioendothelioma, and hemangioma of bone. Five aneurysmal bone cysts were secondary to fracture or other bone trauma.
The authors treated 79 patients with osteosarcoma by surgery and chemotherapy 1975 through 1991. The appearance, localization and differential diagnosis are discussed. Attention is called to the doctor's delay. The effective pre- and postoperative chemotherapy decreased the incidence of the lung metastases and increased the survival rate (71% 3 years overall survival and 41% 5 years survival) and made the limb-sparing surgery possible. The development of the reconstructive surgical technique and new designs of tumor endoprostheses enabled us to perform limb-sparing surgery in more than one third of the cases at the same survival chance. The limb-sparing means a decisive change in the quality of the rehabilitation of the osteosarcoma patients.
A series of 7 cases of aneurysmal bone cysts (ABC), all but 1 located in the pelvic bones, which were treated by transcatheter embolization is presented. Five embolizations were performed for primary treatment, while in 2 patients they were performed preoperatively. In all patients a definite histological diagnosis was established by open biopsy, and plain radiographs as well as computerized tomography (CT) were applied for evaluation of the results. The embolizing materials were tissue adhesive for permanent, and Gelfoam for preoperative vessel occlusions. Of 5 lesions treated for the purpose of definitive embolization, 3 (all located in the superior pubic ramus) showed complete ossification; in one, partial remineralization and progression occurred. In a further patient with a secondary ABC, partial reconstitution was recorded. Both preoperative embolizations resulted in successful en bloc resection with minimal blood loss. Transcatheter embolization is the treatment of choice for the highly vascular ABC in unfavorable anatomical locations.
Aneurysmal bone cyst is a relatively uncommon bone tumor. Six children treated between February 1985 and May 1987 with an operative approach involving insertion of several Kirschner pins across the tumor area are reviewed. Postoperatively, pain relief and varied healing of the lesion was noted radiologically. We conclude that it is worthwhile to consider insertion of Kirschner pins as a first step in treatment.
Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications.
Authors describe, 64 cases of giant-cell tumour. 5 (9 per cent) was found in the latent, 32 (50 per cent) in the active and 27 (41 per cent) in the aggressive stage when first seen. The operative methods are described and these are determined first of all by the surgical stage of the giant-cell tumour, its size and localization, by the age of the patient and whether primary tumour or a recurrence is found. Based on their experiences, excochleation and filing is suggested in the latent and active stage of this tumour. In tumours in the agressive stage the so called wide resection in the healthy tissue is reasonable. In the rare malignant giant-cell tumour radical resection is suggested. Recurrence was found in 29 per cent after the first operation. Follow-up examinations show that 64 per cent of the patients is symptom free, in 33 per cent the main source of complaints is the consecutive arthrosis, 2 patients were lost in consequence of lung metastasis.
A group of 639 bone lesions was reviewed in order to study the features of the aneurysmal bone cyst and its association with other conditions. A diagnosis of primary aneurysmal bone cyst not associated with any other bone lesion was made in 87 patients. In 36 additional patients the gross and microscopic changes of aneurysmal bone cyst were identified as part of some other solid bone lesion. Fourteen of these additional cases were associated with giant cell tumor (96 cases studied), six with chondroblastoma (41 cases studied), three with chondromyxoid fibroma (45 cases studied), two with nonossifying fibroma (68 cases studied), four with osteoblastoma (61 cases studied), one with fibrosarcoma (50 cases studied), three with fibrous histiocytoma (45 cases studied), two with osteosarcoma (100 cases studied), and one with fibrous dysplasia (42 cases studied). The age, site, and sex distribution of the cases associated with another lesion compares closely with that of the solid lesion concerned, supporting the concept that the aneurysmal bone cyst component is secondary.
Twenty-eight aneurysmal bone cysts in children aged between 3 and 16 years, with a mean follow-up of five years, have been reviewed. The diagnosis in these uncommon lesions was straightforward in 22 cases, based on the clinical, radiological and macroscopic features. The histological characteristics confirmed the diagnosis. Apart from these typical lesions, there were some cases in which the diagnosis remained doubtful in spite of a review of the sections and a re-assessment of the radiological and clinical findings. For the surgeon, the diagnosis is primarily from a unicameral bone cyst, whose treatment is very different. For the pathologist, the diagnostic problem is not so much from benign dystrophies, which are often difficult to distinguish from them, but from rare lesions in children, such as telangiectatic sarcoma, which have a more serious prognosis. The high recurrence rate, in four cases out of eleven, after curettage led to a preference for more radical treatment whenever possible, such as excision or resection, which was performed in 14 cases and which limited the liability to recurrence. Aneurysmal bone cyst is a benign tumour whose severity depends on its site, especially in the spine, where there is a risk of neurological complications, on its size, which may render surgical removal difficult and on its proximity to the growth plate, which may result in disturbance to growth which not infrequently occurs.
Ten patients with giant cell tumor and/or aneurysmal bone cyst were treated by transcatheter arterial embolization using Gelfoam and coil. Pain relief was observed in seven patients and tumor healing with increased calcification in five patients. Six (60%) of the 10 patients responded to the treatment; five of them became asymptomatic for 14-55 months of follow-up. The complications included one patient with foot drop and one with foot numbness.
The treatment of three cases of aneurysmal bone cyst by selective arterial embolism is described. Two cases had involvement of the pelvis and one of the knee. The 2-year follow up has been promising. Radiologically the lesion has been arrested with increased density of the cyst wall and intra-cystic trabecular new bone formation. Pain relief has been complete and up to now no surgical treatment has been required.