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The morphology of aneurysmal bone cysts (ABC) in 10 children was studied by light and scanning electron microscopy. Angiodysplasia signs and disorder of bone remodeling occur in ABC areas leading to secondary hemodynamic disorders and abnormal bone remodeling with predominance of resorption in dynamics of remodeling.
PURPOSE OF THE STUDY: The aim of the study was to evaluate the long-term results of using the bioactive, glass-ceramic material BAS-0 for bone tissue replacement after removal of juvenile bone cysts by curettage. MATERIAL: Between 1990 and 2000, BAS-0 material was used to fill the cavity after removal of a juvenile bone cyst in 21 patients, 15 males and 6 females, with an average age of 15 years (range 4 to 44 years). Surgical treatment was indicated only in juvenile bone cysts meeting the following criteria: 1) subjective complaints, i. e., pain at activity; 2) X-ray findings of either a) thinning cortical layer with a potential for pathological fracture, particularly in the proximal femur, b) recurrent pathological fractures without apparent healing of the cyst or c) increase in cyst size by 25% within 6 months. In all patients, the diagnosis of a juvenile bone cyst was confirmed by histological examination. Cyst localization was as follows: eight in the humerus, eight in the femur, two in the fibula and one in the ulna, iliac bone and tibia each. METHODS: After careful curettage of a soft tissue lining from the inner surface of the cystic cavity, the space was filled completely with 2- to 4-mm BAS-0 granules in 15 patients; in the rest granules were applied in a mixture with cancellous bone graft, which was either autologous or allogenic. The former was implanted in one patient, the latter, taken from either the mother or father, was used in four and one patients, respectively. All patients were clinically and radiologically examined during the follow-up period of 3 to 12 years, with an average of 7 years. The clinical evaluation was based on subjective complaints, and on the state of soft tissues in the region of lesion, range of motion in the adjacent joints and the loading capacity of the limb treated. Radiological evaluation was based on standard X-ray images assessed according to the classification system of Neer. RESULTS: The clinical examination showed that 10 patients were free from subjective complaints, one patient had rest pain, three patients experienced pain when using the limb, four patients reported mild and intermittent pain, two patients were in pain when the whether changed and one patient complained of pain during pregnancy. Objectively, no inflammatory changes of soft tissues were found. Both passive and active motion of the adjacent joints was possible in the full range and the treated limb retained its complete function in all patients. X-ray examination showed excellent results, i. e., no residuum or cysts recurrence, in 16 patients. A residual lesion was present in one patient and cyst recurrence was recorded in four patients. DISCUSSION: The currently used methods of treatment include corticoid instillation in the cyst, injection of autologous bone marrow, multiple drilling and drainage of the cyst and removal of the cyst with subsequent filling of the cavity with bone graft. In our patients, the bioactive, glass-ceramic material BAS-0 was used to replace either autogenous or allogenic bone grafts. Complete healing of the cyst was achieved in 76% of our patients, which is the result comparable with the literature data. CONCLUSIONS: Although the therapy of juvenile bone cysts has changed from extensive surgical procedures to less invasive techniques, the curettage of a cyst with subsequent filling of the residual cavity still remains the method of choice in selected patients. Instead of autogenous cancellous bone grafts or allogenic grafts predominantly used for this procedure, the bioactive, glass-ceramic material BAS-0 can be recommended, particularly when the cavity to be filled is located in the metaphysis of a long bone, i. e., in the region subject to great compression.
An aneurysmal bone cyst is a benign solitary lesion of unknown etiology. A case report is presented of recurrence of an aneurysmal bone cyst in the foot that was treated with endoscopic curettage without bone grafting. Bone remodeling and bone formation were completed in the early stages postsurgically. At 2-year follow-up, the patient is asymptomatic with no radiographic evidence of recurrence.
Osteochondritis dissecans (OCD) and subchondral bone cysts (SBCs) occur commonly and at many different locations in equine limbs and can lead to secondary osteoarthritis when left untreated. Depending on the location and extent of the lesion, arthroscopic surgical debridement may be an effective treatment for returning a horse to athletic soundness. In many cases, however, additional techniques to improve the healing response in bone and cartilage are needed so as to preserve articular function. Methods for improving cartilage repair (ie, restoration of damaged cartilage)or regeneration (ie, reformation or recreation of new articular cartilage) in select cases of OCD and SBCs are discussed.
An aneurysmal bone cyst was diagnosed in the distal metaphysis of Mt3 in a 9-month-old-Quarter Horse colt. The lesion developed between the fifth and ninth month of life and clinically appeared as a non-painful swelling which did not cause a lameness. Radiographs of the lesion showed expansion of the cortex and incomplete septa of new bone extending from the cortex into surrounding soft tissue. Surgical intervention revealed a blood filled cavity. The animal died during the immediate post-surgical period. Histopathologic evaluation of the lesion was performed.
A 30 year-old female was admitted to our department because of an abnormal chest radiograph. The chest CT scan revealed a tumor expanding from the left first rib. The tumor was resected through a left posterolateral thoracotomy. Histological findings showed aneurysmal bone cyst. Aneurysmal bone cyst is an uncommon lesion, especially in the rib. The patient's postoperative course was uneventful and there has been no evidence of recurrence during the 15 months since operation.
Aneurysmal bone cysts are rare bone tumors which normally affect the vertebral region or long bones. Involvement of facial bones is uncommon. Although nonneoplastic, these lesions are expansile and may cause local destruction of bone and soft tissues. When making the diagnosis, it is imperative to consider the clinical, radiologic, and histologic features of the entity to avoid confusion with other possibly malignant giant cell tumors. We report an unusual case involving the orbit in a 2 1/2-year-old girl.
In 2-3 reviews 30 patients with non ossifying fibroma and 31 patients with a solitary bone cyst were examined to evaluate the prognosis of these diseases. It has been shown that the cure rate of non ossifying fibromas of 95% and solitary bone cysts of 70% is extraordinarily good and does not depend on the treatment that has been realized. For that reason, the indication for operative treatment must be differentiated: Non ossifying fibromas should be left to spontaneous healing. Solitary bone cysts in the upper limb should be treated by puncture only when they show great activity, otherwise they can be left to spontaneous healing, too. In the lower limb active cysts with or without fracture should be operated, while inactive cysts should to be cured by puncture only.
The traumatic bone cyst is usually successfully treated by surgical exploration and curettage of the walls of the bony cavity. This article presents a case of traumatic bone cyst which not only failed to respond to surgical curettage but also demonstrated a marked increase in size and a multilocular appearance on the radiograph. Injection of autogeneic blood into the bony cavity produced rapid bony filling and resolution of the lesion.
Aneurysmal bone cyst occurring within the calvarium is uncommon. We report a case presenting as an intracranial space-occupying lesion. Fluid levels within a lesion on CT is very suggestive but inconstant. The theory of a pre-existing lesion is noted.
Multiple aneurysmal bone cysts (ABCs) are previously unreported in horses. An ABC was diagnosed in the left 3rd metacarpal of a Thoroughbred foal, which partially resolved following surgical curettage. A 2nd ABC developed in the left tibia, 7 wk postoperatively, and the foal was euthanized.
Although simple bone cysts in children have been described by many authors, there has been only one previous report of more than one lesion in a single patient. We describe an 11-year-old boy with symptoms caused by a cyst in the proximal femur. Following steroid injection of the cyst, a pathological fracture occurred and was treated by immobilization in a cast. A year later, a pathological fracture occurred through a cyst in the proximal humerus. This was treated in a sling. Steroid injection of both lesions was performed when the cystic areas persisted, and both cysts subsequently healed. This case demonstrates that simple bone cysts are not always solitary lesions and that patients with these cysts should be carefully monitored for recurrence following treatment.
An aneurysmal bone cyst of the occipital bone, presenting as an intracranial space-occupying lesion, is reported. Clinical and neuroradiological findings are described in detail. The significance of angiographic and computerized tomographic findings is discussed.
Spinal aneurysmal bone cyst is sufficiently rare for the authors to report this case with rapid evolution and development of paraplegia. Total removal was achieved, and clinical recovery remained complete six months after operation. The pathogenic, clinical, radiological, histological and therapeutic aspects are briefly reviewed and discussed.
Two cases of traumatic bone cyst of the mandible are reported exhibiting a considerable variation in their presentation and pathogenesis. This spectrum of behaviour is discussed and comparison made with the solitary unicameral bone cyst.
Generally, aneurysmal bone cyst is considered to be a benign lesion that occurs rarely. Its etiology and treatment vary considerably, but curettage and grafting is the widely accepted treatment. Due to the nature of the disease recurrence is always expected. It rarely regresses and we report here a case that showed an improvement spontaneously after open biopsy. Follow-up for more than 4 years has shown no progression.
A patient presented with a large, multilocular, refractory traumatic bone cyst. The radiolucency had increased in dimension since her last recall. Over 11 years, therapy had included needle aspiration biopsies followed by simple curettage and closure, the most common therapy for traumatic bone cysts. However, all treatment had proved unsuccessful for this patient. It was decided to treat the patient with a slightly unique method. After curettage of the lesion, the traumatic bone cyst was packed with a mixture of autogenous blood, harvested autogenous bone chips, and hydroxyapatite.
The traumatic bone cyst (TBC) is commonly reported on in the dental and medical literature. The lesion is discovered most often, as an incidental finding during intraoral or panoramic radiographic examination. Conservative treatment in the form of needle aspiration or surgical exploration and curettage is generally considered curative as well as diagnostic for the TBC. Some authors suggest that the TBC is a self-limiting entity, as it is rarely seen in patients older than thirty-five years of age. There are very few reports in the literature documenting recurrent TBCs. The patient reported on had a TBC measuring 1.5 cm. treated by surgical curettage in July 1981. There was no clinical or radiographic follow-up for eight years. When the patient presented for an initial examination in July of 1989, the recurrent lesion increased in size to 7cm x 4cm. Retreatment by surgical curettage established a diagnosis consistent with a TBC, and also produced impressive radiographic healing 3.5 years postoperatively. Because of the ability of the TBC to recur, long clinical and radiographic follow-up is recommended.