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Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medrol) and a discussion of results achieved in other bone lesions.

Extremely favorable results are obtained with the use of microcrystals of methylprednisolone acetate for treatment of bone cysts. These results have led to a complete suspension of surgical treatment of bone cysts since 1974. On the basis of these results with corticosteroids, a surgical procedure that involves an incision at the fracture location and bone graft inserted is not indicated. Results following surgery indicate a recurrence rate of approximately 25% to 30%. Since we are as yet unable to explain the mechanism by which the local injection of MPA promotes bone replacement of the cyst, the present observations only reaffirm the hypothesis (presented in our early publications) that the corticosteroid exerts a destructive action on the pathological tissue of the lesion, thus favoring a progressive process of repair. We consider this explanation valid even for lesions, e.g., eosinophilic granulomas and nonossifying fibromas, in which this method of treatment has had varying degrees of success.

Adolescent↗

Cervical spondyloptosis caused by an aneurysmal bone cyst: a case report.

STUDY DESIGN: The case of an 11-year-old patient with an aneurysmal bone cyst at C7, cervical spondyloptosis, and scoliosis of the lumbar spine is reported. OBJECTIVE: To describe an unusual presentation of aneurysmal bone cyst causing painless cervical spondyloptosis. SUMMARY OF BACKGROUND DATA: Aneurysmal bone cysts of the cervical spine are rare. There has never been a reported case of cervical dislocation by an aneurysmal bone cyst. This case highlights the potentially devastating effects that can be caused by benign tumors in the vertebral column. METHODS: The history, clinical examination, imaging findings, and treatment are reviewed. RESULTS: The patient was treated with a single-stage combined posteroanteroposterior operation to resect the tumor, reduce the cervicothoracic dislocation, and create a three-column stabilization of the spine. The results were satisfactory, with an improvement in neurology. CONCLUSIONS: Aneurysmal bone cysts should be considered in the etiology of complicated scoliosis. Patients with a benign clinical history should be investigated at an early stage using appropriate imaging. Surgery is the treatment of choice when stability of the spine is compromised and neurologic signs are present.

Bone Cysts, Aneurysmal↗

Aneurysmal bone cyst of the vertebra with paraplegia.

Aneurysmal bone cyst, a benign lesion, is difficult to diagnose radiologically, particularly in the spine, but has a characteristic microscopic appearance. Treatment of spinal lesions consists of curettage, with or without bone grafting, together with irradiation at low doses (1000 to 2000 rads). The author reports a case of aneurysmal bone cyst of the neural arch associated with neurologic complication, which illustrates some typical features of such cysts of the spine. The condition should always be considered in patients with lytic lesions of the spine, and prompt surgical intervention is recommended.

Bone Cysts↗

Treatment of aneurysmal bone cysts in childhood.

Twenty-five aneurysmal bone cysts were treated by curettage, saucerization, or resection. Healing occurred in all cysts of the long bones that were treated by saucerization and bone grafting or by resection and bone grafting. However, healing occurred in only half of the cysts of the long bones that were treated by curettage and bone grafting. In contrast, removal of the soft tissue contents from cysts of the pelvis, without curettage of bone or bone grafting, was sufficient to initiate healing. Although there was an apparent difference in the behavior of cysts of the long bones and pelvis, it is likely that the essential component of treatment at both sites is to remove the vascular soft tissue from the cyst.

Adolescent↗

Aneurysmal bone cyst of the coronoid process of the mandible.

A rare case of aneurysmal bone cyst (ABC) located in the coronoid process of the mandible in a 12-year-old girl is presented. Treatment consisted of excision of the lesion through preauricular, submandibular and intraoral approach. An access osteotomy distal to second molar region was required to gain access to medial side of the coronoid process. To our knowledge, this is the third case of an aneurysmal bone cyst of the coronoid process of mandible. While examining a patient with a large expansile intrabony jaw cavity with thin peripheral bone, which is filled with blood without presence of bruit, thrills and pulse pressure, the diagnosis of aneurysmal bone cyst should be on top of the differential diagnosis list. Seventy-four to eighty-five percent of aneurysmal bone cysts of jaws occur in 10-20 years age group. Therefore, a pediatric dentist may be the first person to see such a lesion.

Bone Cysts, Aneurysmal↗

[Aneurysmal bone cysts of the spinal canal].

Aneurysmal bone cysts (ABC) are rare bone tumors of controversial pathogenesis. In 15% of cases, they are localized in the vertebrae. Despite the absence of anaplasia, their volume and localization are often responsible for incomplete surgical resection. The authors present 5 cases of primary vertebral ABC, 4 females and one male, localized in cervical (3 cases), dorsal (1 case) and lumbar (1 case) spine. Symptoms included rachialgia and torticollis. Radiological and histopathological examination disclosed the typical features of ABC. Pre-operative embolization (in 3 cases) and surgery (complete exeresis in all cases except one) were the therapeutic procedures. During a 39 month median period of follow-up, there was one local recurrence. The only case of incomplete exeresis show not did any evidence of progression until 36 months after operation.

Adolescent↗

[Aneurismal bone cyst of clavicle: A case report].

Aneurismal bone cyst is a rare tumour. The authors report an exceptional case in its clavicle localization. They review the diagnosis circumstances and treatment modalities of this pathology. The occurrence of the cyst is linked to vascular homodynamic disturbance and its discovery in a post-traumatic context has been assessed by the histology exam. Although numerous therapeutic trials, radical removal versus conservatory methods avoid relapse. Finally, resection of the clavicle leading to few functional consequences should be recommended for the cure of evoluted aneurismal bone cyst.

Adult↗

Radiolucent bone cysts and the type of dialysis membrane used in patients undergoing long-term hemodialysis.

The relationship between the types of dialysis membrane used and the prevalence and severity of radiolucent bone cysts (which are a main radiological feature of dialysis amyloidosis) was studied in 30 patients on hemodialysis for more than 10 years. One of them was treated exclusively with cuprophane; the other 29 were dialyzed with cuprophane, and then treated with polyacrylonitrile AN 69. In 12 of the 30 patients, radiolucent bone cysts (at least 5 mm in diameter in the wrists and at least 10 mm in the shoulders or hips) were observed. The patients with bone cysts spent significantly more time on cuprophane dialysis and significantly less time on AN 69 dialysis than the group of patients without bone cysts. Nine of the 14 patients who had been treated with cuprophane for more than 8 years had bone cysts; whereas bone cysts were observed in only 2 of the 12 patients dialyzed for more than 8 years with AN 69. The frequency of bone cysts was significantly different for each of the two groups. There was, however, no significant difference in the total duration of dialysis between the two groups. The severity of the cystic bone lesions correlated positively with the duration of dialysis using cuprophane and negatively with the duration of dialysis using AN 69. These findings suggest that the development of osteoarticular amyloidosis may be related to the type of dialysis membrane used. Hemodialysis using AN 69 membranes may prevent, or at least postpone the development of dialysis amyloidosis.

Bone Diseases↗

Aneurysmal bone cyst secondary to other osseous lesions. Report of 57 cases.

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.

Adolescent↗

Aneurysmal bone cyst of the talus.

Aneurysmal bone cysts localized in the talus are extremely rare. Such a case is described and the histological findings are analysed in relation to those in aneurysmal cysts in general. The pathomechanism of the lesions is discussed.

Adult↗

[Simple bone cyst--pathophysiology and treatment].

Internal pressure of simple bone cyst was slightly higher than normal bone marrow pressure measured on contralateral side. Internal pressure of the cyst measured during drill-holing with Kirschner wire gradually decreased along with the increase in the number of drill-holes. Internal PO2 was markedly lower than PO2 of venous and arterial blood measured synchronously. Venous obstruction in bone may be an etiology of simple bone cyst. Follow up study showed that all cysts of six cases treated by the multiple drill-hole method were filled up with bony tissue within five months after the treatment, and the clinical result of the treatment was excellent. Multiple drill-hole method may be the first choice in the treatment of simple bone cyst in the younger patients, because the operative invasion of this method was minimum.

Adolescent↗

Exophthalmos from aneurysmal bone cyst of the orbital roof.

An aneurysmal bone cyst of the orbital roof, causing a monolateral exophthalmos in a 15-month-old child with no previous history of head injury, was operated upon and histologically misdiagnosed as a giant cell tumor. Radiation treatment in a dosage (3,740 rad) appropriate for the latter diagnosis apparently caused a massive calcification of the residual mass with persisting exophthalmos. At a second operation the lesion was removed completely and a radical change in the histopathological features was found. 12 years after surgery, there is no evidence of residuals upon roentgenographic and CT scan examinations and the exophthalmos has practically disappeared, while there is a normal visual function in the affected eye. Some points of histopathological and gross pathological differential diagnosis between aneurysmal bone cysts and giant cell ("myeloplaxis") tumors are discussed.

Adolescent↗

Aneurysmal bone cyst with chromosomal changes involving 7q and 16p.

An aneurysmal bone cyst was submitted to cytogenetic analysis. The modal chromosome number was 46. The composite karyotype was 40 approximately 48,XY,-Y[4],-6[3],del(7)(q32)[3],-9[3],+12[2],+13[2], inv(16)(p13.1q24)[4],-17[3],-19[4],-20[3][cp13]. The clonal structural changes detected were del(7)(q32) and inv(16)(p13.1q24). The breakpoints involved affected areas to which important genes for cell cycle regulation have been mapped. There is only one report in the literature of three aneurysmal bone cysts presenting clonal karyotypic alterations. The cytogenetic study of the aneurysmal bone cyst reported here showed different results when compared to those previously described in the literature.

Adolescent↗

Stafne bone cyst. Revision of four cases, one of them with bilateral affectation.

Stafne bone cyst of the mandible is the only described destructive bone lesion that is highly localized, nonprogressive, but nonhealing. Such defects usually occur unilaterally, however, bilateral defects are occasionally reported. This paper reports 4 cases of Stafne's bone cyst, one of which showed bilateral presentation. Only four previous cases of bilateral Stafne bone cyst have been reported in the literature. The bibliography is reviewed with regard to the incidence, plausible etiologic factors and methods of diagnosis of such lesions.

Adult↗

"Solid" variant of aneurysmal bone cyst (extragnathic giant cell reparative granuloma) in the axial skeleton and long bones. A study of its morphologic spectrum and distinction from allied giant cell lesions.

BACKGROUND: Giant cell reparative granuloma is generally considered to be a benign tumor-like bone lesion. Its involvement of axial skeleton and long bones is rare. METHODS: Seven cases of extragnathic giant cell reparative granuloma (GCRG), which arose in the axial skeleton and long bones, were analyzed clinicopathologically and compared with allied lesions consisting of 31 cases of aneurysmal bone cyst (ABC) and 83 cases of giant cell tumor of bone (GCT). RESULTS: These occurred in patients ranging in age from 8-36 years; two were in the vertebrae; two, in the clavicles; one, in a rib; one, in the humerus; and one in the tibia. None of the patients with GCRG had a recurrence despite incomplete resection. Its skeletal distribution and average associated patient age were similar to those of ABC. Histologically, they were characterized by florid fibroblastic proliferation with osteoclast-like giant cell-rich areas, stromal hemorrhage, and newly formed bone or osteoid trabeculae. The histologic features could be found around either the characteristic aneurysmal cysts or sinuses, although they were lacking any large blood-filled spaces. CONCLUSIONS: The overlapping clinical and histologic features between GCRG and ABC and their similar biologic behavior represent related responses to an intraosseous hemorrhage. The authors prefer to use the term "solid variant of aneurysmal bone cyst" to describe this lesion.

Adolescent↗

[Aneurysmal bone cyst of the spine. Case report].

The aneurysmal bone cyst (ABC) is a fast-growing tumor of undefined neoplastic nature. It is occasionally an aggressive benign lesion whose treatment of choice is a complete resection, even though the risk of profuse transoperative bleeding exists. We present a female patient with thoracic spine deformity, with progressive paresthesias and muscle weakness of lower extremities that evolved to paralysis of both lower extremities and sphincter incontinence. Based on radiographic films, lytic lesions were identified at T7 to T9 vertebrae as well as medullary space invasion. In electrophysiologic tests, a complete somatosensorial pathway block was reported. Prior to resection of the neoplastic lesion and thoracolumbar stabilization, an incisional biopsy was performed. There was no postoperative medullary functional improvement. Morphological findings corresponded to an aneurysmal bone cyst at T8. This lesion is mainly located in the long bones and less frequently of the spine, where instability and medullary compression may occur. It is possible to confuse this neoplasia with other lesions. Hence, definite diagnosis with biopsy is necessary for determining an adequate therapeutic plan to eradicate recurrence risk or associated neurologic sequelae, as well as to gain proper stability at the involved vertebral segments.

Adolescent↗