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The radiological features of "solid" aneurysmal bone cysts.

The radiological features of nine solid aneurysmal bone cysts (ABC) have been reviewed. The appearances form a spectrum ranging from lesions indistinguishable from the classical ABC, to an osteolytic lesion with a wide zone of transition, cortical destruction and soft tissue extension. Over half the lesions reviewed fell into the latter category and all were situated in the axial skeleton. Discrimination between the more aggressive solid ABC, giant cell tumour and malignancy may be difficult. Demonstration of an expanded partial cortical rim by either conventional or computerised tomography suggests the diagnosis of solid aneurysmal bone cyst.

Adolescent↗

[Chemical embolization using estrogen for aneurysmal bone cyst of the skull: case report].

A case of aneurysmal bone cyst of the fronto-parietal bone was reported. The patient was a 48-year-old female with the complaints of conjunctival hyperemia and exophthalmus of the right side. Right selective externography revealed both arteriovenous fistula between right middle meningeal artery and diploic vein, and abnormal venous pooling draining into right superior ophthalmic vein. These symptoms probably caused by the increased intraorbital venous pressure in the right side. Skull plain film and CT scan showed blow-out appearance of right fronto-parietal bone in accordance with the enlargement of diploic space. The bulged area and the rest of the affected part of the bone presented faintly coarse "soap bubble" pattern. And the affected bone, being radiolucent, had well demarcated borders which are distinct and smooth, with faint sclerosis. Both arteriovenous fistula and clinical symptom have disappeared completely by the continuous injection of conjugated estrogen into the right external carotid artery. This is the first case that proved chemical embolization using estrogen will effect a cure in the treatment of aneurysmal bone cyst.

Bone Cysts↗

An angiostatic agent in treatment of a recurrent aneurysmal bone cyst.

Healing of an aggressive recurrent aneurysmal bone cyst of the distal humerus was induced by oral dexamethasone, an angiostatic agent. The severe pain and tenderness resolved rapidly. The soft tissue swelling subsided, and a thick layer of bone formed around the cyst. Complete healing followed saucerization and curettage of the remaining vascular tissue in the center of the cyst. We suggest that angiostatic agents be included in the nonoperative methods of treatment of aggressive aneurysmal bone cysts.

Bone Cysts↗

Aneurysmal bone cyst of the mobile spine: report on 41 cases.

STUDY DESIGN: Forty-one cases of aneurysmal bone cyst of the mobile spine were retrospectively reviewed. OBJECTIVES: To evaluate the role of surgical and nonsurgical treatment of aneurysmal bone cyst of the spine. SUMMARY OF BACKGROUND DATA: Ten to 30% of aneurysmal bone cysts arise from the mobile spine, frequently occurring in pediatric patients. The course of the disease depends on the aggressiveness of the tumor, as well as the treatment. Intralesional surgery seems to be an effective treatment, as well as radiotherapy and embolization. METHODS: All charts, radiographs, and images were reviewed. The composite information provided by this review allowed for oncologic and surgical staging of these cases. Thirty-two patients underwent curettage (14 of them followed by radiotherapy), four were submitted to selective arterial embolization, three received radiotherapy alone, and two underwent en bloc-excision. RESULTS: All patients were found alive and disease free at final follow-up evaluation. Two recurrences followed one incomplete curettage and one embolization. The combination of curettage and radiotherapy, although effective, showed the greatest incidence of late axial deformity. Selective arterial embolization was curative in three of four cases and did not affect the possibility of surgery in case of local recurrence. CONCLUSIONS: If confirmed on larger series, selective arterial embolization seems to be the first treatment option for spine aneurysmal bone cyst, because of the low cost-to-benefit ratio. Diagnosis must be certain, based on pathognomonic radiographic pattern or on histologic study.- In case of neurologic involvement, pathologic fracture, technical impossibility of performing embolization, or local recurrence after at least two embolization procedures, complete intralesional excision would be the therapy of choice.

Adolescent↗

Immunocytochemical markers (endothelial and histiocytic) and ultrastructure of primary aneurysmal bone cysts.

Since the first description of an aneurysmal bone cyst in 1942, the pathogenesis of this tumor-like lesion has been controversial. Aspects of interest for elucidating the nature of this lesion include the cellular linings of the aneurysmal cavity systems as well as the character and cellular composition of the stromal septa. To clarify these features, seven aneurysmal bone cysts were studied electron microscopically and immunocytochemically with endothelial (Factor VIII-related antigen, monoclonal endothelial marker) and histiocytic (alpha 1-antitrypsin, alpha 1-antichymotrypsin, lysozyme, acid phosphatase) markers. Both immunocytochemical and electron microscopic examination revealed that the aneurysmal cavernous spaces have no endothelial lining but are delimited by fibroblasts and histiocytic cell forms at varying stages of differentiation. These cell forms are also the main component of the mononuclear stroma cells of the septa between the aneurysmal cavities. From these findings it is concluded that the aneurysmal cavities are not vascular. The sinusoidal septal capillaries might play a special role in their pathogenesis. Due to the lack of basal membrane structures, rupture of the wall gives rise to erythrocyte extravasates, which can undergo secondary transformation into cysts.

Adolescent↗

[Essential bone cyst of the calcaneus in children. Report of three cases].

OBJECTIVE: The purpose of this study was to analyze the properties of essential bone cyst of the calcaneus in childhood, as well as its evolution, and differences with regard to adults. PATIENTS AND METHODS: The cases of children with a diagnosis of essential bone cyst of calcaneus in last sixteen years in the pediatric orthopedic unit of San Carlos Clinic have been reviewed. We evaluated the information regarding the clinical history and the radiological and histological date as well as the therapy result with esteroid intracavity therapy and curettage and bone grafting. The radiologic score was done following Södergard criteria and the posttreatment follow-up with Neer's score. RESULTS: The mean age of the patients was 10.3 years. Two of the patients had recurrent heel pain for more than six months. Treatment consisted in intracavitary esteroid in two cases and curettage and bone grafting in all three cases, in two of the cases because of failure of esteroid therapy and in the other because of an atypical X-ray image. In all cases the histological stady identified the existence of a characteristic membrane conective tissue. The postsurgery follow-up a period of half four years has been satisfactory. CONCLUSIONS: The essential bone cyst of the calcaneous is exceptional localization in children, frequently symptomatic and resistant to the esteroid intracavitaria contrary to what happens with the essential bone cyst of other localizations and with the essential bone cyst of the calcaneus in the adults. The recurrent heel pain and atipical X-ray image are surgery indications.

Adolescent↗

Aneurysmal bone cyst associated with fibrous dysplasia.

We report the clinicopathologic features of a 22-year-old patient with aneurysmal bone cyst and fibrous dysplasia of the orbit. The patient was evaluated clinically with computed tomography of the orbit before surgery. An orbital biopsy specimen was examined histologically with conventional light microscopy. The lesion was treated with combined neurosurgical and orbital intervention. Clinical evaluation revealed axial and inferior displacement of the globe. Computed tomography revealed a cystic mass in the superotemporal left orbit with adjacent bone erosion. "Ground-glass" thickening of the adjacent frontal bone and sphenoid bone was observed. Microscopic examination showed fibrous stroma with giant cells and hemosiderin-laden macrophages with adjacent trabeculae of woven bone and osteoblast cells. A fronto-orbital craniotomy was performed, the cystic cavity was excised, and the hyperostotic bone was debulked. After treatment, the globe position and patient appearance have improved. There has been no sign of recurrence of the aneurysmal bone cyst. Aneurysmal bone cyst should be considered in patients with fibrous dysplasia that has a cystic component, or in patients with fibrous dysplasia who present with sudden expansion of their lesion.

Adult↗

Solid variant of an aneurysmal bone cyst (giant cell reparative granuloma) of the 3rd lumbar vertebra.

A 9-year-old girl with a solid variant of an aneurysmal bone cyst in the 3rd lumbar vertebra showed a good response to low-dose radiation as the only treatment. The solid variant of aneurysmal bone cyst is thought to be a reactive response to intraosseous hemorrhage and is also called giant cell reparative granuloma or giant cell reaction. These lesions in the jaw and the short tubular bones of the hands and feet frequently recur after surgery. Aneurysmal bone cysts of the spine also show a fairly high recurrence rate after incomplete resection or radiation therapy. However, 7 previous cases of the solid variant of aneurysmal bone cyst in the spine and this case did not show recurrence after a mean follow-up period of 45 months. This difference in behaviour suggests that the solid variant should be recognized before surgery as being distinct from conventional aneurysmal bone cysts, especially in the spine.

Bone Cysts, Aneurysmal↗

Imaging features of subperiosteal aneurysmal bone cyst.

PURPOSE: To analyze the imaging features of subperiosteal aneurysmal bone cyst. MATERIAL AND METHODS: The imaging material of 6 patients with biopsy-proved subperiosteal aneurysmal bone cyst was reviewed. Evaluation included patient demographics, lesion location and size, radiographic features, and intrinsic characteristics on CT and MR images. Review of histologic specimens was carried out by an experienced musculoskeletal pathologist. RESULTS: All lesions were located at the surface of long tubular bones (femur 3, tibia 2, humerus 1): 3 involved the diaphysis, 2 the dia/metaphysis, and 1 exclusively the metaphysis. Lesion size ranged from 2.5 to 6 cm in maximum diameter. Radiographs and CT images always showed a superficial bone defect, which on radiographs demonstrated irregular margins in 4 cases. All lesions caused an interrupted periosteal reaction (shell 3, trabeculated shell 1, Codman angle 2). MR images always showed a multicystic appearance with a hypointense rim, contrast-enhancing cyst walls, and fluid levels. Edema of adjacent soft tissues was present in all cases. CONCLUSION: Aneurysmal bone cyst in a subperiosteal location can demonstrate an aggressive radiographic appearance. MR imaging appears to be most valuable in the differential diagnosis, since it can demonstrate typical morphological features of the underlying process.

Adolescent↗

Minimal curettage, multiple drilling, and continuous decompression through a cannulated screw for treatment of calcaneal simple bone cysts in children.

This report concerns a series of 12 patients with simple bone cysts of the calcaneus, who were treated between 1988 and 2000 by a minimal surgical intervention of curettage, multiple drilling and continuous decompression through insertion of a cannulated screw. Inserted screws were made of titanium in 8 cases and ceramics in 4 cases. The mean operative time was 58.8 +/- 25.4 minutes, and complete healing was achieved in 11 cases after 9.2 +/- 6.4 months. One patient needed an additional surgery for replacement of a titanium screw. Final results were excellent after a mean follow up of 91 +/- 52.1 months. This series of patients represents one of the largest reported series of calcaneal simple bone cyst in conjunction with long-term follow-up. Our technique of minimal curettage, drilling and continuous decompression with a cannulated screw insertion is considered to be a good option for management of simple bone cysts of the calcaneus.

Adolescent↗

Rotational acetabular osteotomy for acetabular dysplasia of the hip with a giant acetabular bone cyst: a case report.

In acetabular dysplasia of the hip joint accompanied by a giant acetabular bone cyst, rotational acetabular osteotomy may cause serious complications, such as bone necrosis after surgery or fracture of the fragile acetabulum during the operation. In a patient with this condition, we performed a two-stage operation: first, autogenous bone grafting supplemented with hydroxyapatite filling, then rotational acetabular osteotomy (after new bone formation had been assured). Radiographs and CT scans showed favorable fusion of the grafted bone. Some 18 months after the second operation, arthrograms showed no inflow of contrast medium from the articular cavity into the bone cyst region, although this had been observed before treatment. Thus, an effective remodeling of bony congruency was indicated in the mobile acetabulum 5 years after the second operation. This two-stage operation appears to be useful for correcting acetabular dysplasia accompanied by a giant bone cyst and to carry a reduced risk of serious complications, such as deterioration of the articular surface of the acetabulum or necrosis of the translocated acetabulum.

Acetabulum↗

Selective arterial embolization in the treatment of an aneurysmal bone cyst of the pelvis.

This case report deals with an aggressive aneurysmal bone cyst of the pelvis in a 20-year-old man causing considerable destruction of the left ilium and the anterior column of the acetabulum, with extension into the pelvis. The treatment of large pelvic aneurysmal bone cysts is challenging because of local destruction of adjacent structures and because of the risk of severe intraoperative bleeding. Therefore selective preoperative embolization may be a valuable tool in the management of aneurysmal bone cysts.

Adult↗

Traumatic bone cyst.

A total of 161 cases of traumatic bone cyst, 94 from a review of the literature and 67 previously unreported ones, were analyzed for clinical and histologic features. No gender predilection was noted, and the history of prior trauma was equivalent to that described in the general population. The possibility of an association with florid osseous dysplasia is strengthened by the finding of a higher incidence of traumatic bone cyst in black females among the patients over the age of 30.

Adolescent↗

[Aneurysmal bone cysts in children. Study of 28 cases].

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.

Adolescent↗

Aneurysmal bone cyst of the hand: a report of four cases.

Aneurysmal bone cysts are benign lesions that rarely occur in the bones of the hand. Curettage and bone grafting are the most common treatment modalities performed considering the possible functional loss after total excision. Four cases of aneurysmal bone cyst of the hand were identified. Three out of four cases were treated initially with curettage and bone grafting alone without any other local therapy. One had total excision of the lesion. There were two recurrences in the curettage group. Both were treated with excision and followed up for a minimum of 12 months. Curettage alone was associated with high recurrence rates. Total excision of the lesion was the most successful procedure employed. In view of the high recurrence rates following curettage alone and non-neoplastic nature of the lesion, adjuvant treatment modalities such as cryosurgery, electric cauterisation should be considered for initial treatment of ABC. Resection should be preserved for recurrent cases.

Adolescent↗