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A recurrent aneurysmal bone cyst of the proximal phalanx treated with curettage, cryosurgery, and bone grafting is presented. There is no evidence of recurrence after 5 years. Although cryosurgery is commonly used as an adjuvant for intralesional treatment for aneurysmal bone cyst, there have been no reports of its use for the treatment of a lesion arising in the hand.
The calcaneus is not a common site for a unicameral solitary bone cyst. Little is known about the etiology and natural history of these lesions. The author reports an adult man with a solitary bone cyst of the os calcis which was confirmed radiologically and histologically and successfully treated with curretage and bone grafting.
PURPOSE: To define MR imaging characteristics of primary aneurysmal bone cyst. MATERIALS AND METHODS: MR imaging studies of 38 patients with histologically proven primary aneurysmal bone cyst were reviewed with reference to morphological features, signal characteristics, and patterns of contrast-enhancement. RESULT: Most lesions were well marginated towards bone and soft tissues (95%), either surrounded by a complete (84%) or incomplete (16%) rim of low signal intensity on images of all pulse sequences. Frequent features were polycyclic margins (84%), cortical expansion (87%), cystic spaces (100%), contrast-enhancing cyst walls (100%), internal septations (89%), fluid levels (71%) and diverticula-like projections of cyst walls (68%). Solid tissue components could be identified by MR imaging in all lesions which, on pathological examination, contained larger portions of solid material (18%). Edema of surrounding soft-tissues was observed in 29% of the cases. CONCLUSIONS: Primary aneurysmal bone cysts demonstrate a relatively uniform MR imaging appearance, which reflects the patho-anatomic composition of the lesion.
Official U.S. Navy diving records for enlisted divers who were 35 years of age and older were examined for differences in diving experience between those who were classified as positive or negative for bone cysts. One-third of the divers (n = 31) were classified as positive, and two-thirds (n = 62) as negative, for bone cysts. Diving experience factors included total years of diving experience, frequency of dives between 15 and 31 m, frequency of dives deeper than 31 m, number of saturation dives, number of dives involving decompression, and number of cases of decompression sickness. None of these factors differed significantly between the two groups. While previous findings showed that bone cysts are twice as prevalent among divers as among a comparison group of Navy enlisted men matched to divers for age, rank, and occupational specialty, these results indicate that this high prevalence rate does not appear to be related to specific types of diving exposure. Other environmental factors such as long-bone injury, disease, or exposure to hazardous or toxic substances may account for differences in the prevalence of bone cysts between the two groups.
STUDY DESIGN: An aneurysmal bone cyst in the neural arch of the fourth cervical vertebra of a 10-year-old girl is reported, along with a brief review of the literature on the topic. OBJECTIVE: To report the presentation and diagnosis of this disorder along with a discussion of the major pitfalls of treatment. SUMMARY OF BACKGROUND DATA: An aneurysmal bone cyst occurs commonly in the second decade, with a predilection for the lumbar spine. With occurrence in the neural arch of a cervical vertebra, the potential for instability following surgical excision is high. METHODS: A 10-year-old white female presented with neck pain of 3 months' duration. Diagnostic imaging revealed an expansile lytic lesion in the spinous process and lamina of the fourth cervical vertebra. Surgical treatment consisted of excisional biopsy and a segmental instrumented posterior fusion from C3-C5. The histopathology was consistent with an aneurysmal bone cyst. RESULTS: Surgical excision consisting of laminectomy and instrumented segmental fusion provided a good clinical result, and minimized the risk and degree of the 2 most common complications: recurrence of the tumor; and postlaminectomy kyphosis, a frequent occurrence in the pediatric population. CONCLUSIONS: In pediatric patients who develop a bone tumor of the posterior elements of the cervical spine, careful clinical and radiologic evaluation is necessary to narrow the differential diagnosis. In most cases, a complete excision should be performed if possible. The risk of postlaminectomy kyphosis is high in the pediatric age population. As such, a fusion should be considered whenever a laminectomy is performed in the immature cervical spine. Risk factors for kyphosis include a high cervical level, multiple laminectomy levels, and postoperative irradiation.
A large aneurysmal bone cyst of the upper tibia in a 17-year-old patient was treated by superselective embolization with excellent clinical and radiological results. Extensive curettage and detailed pathologic analysis performed 2 years following embolization revealed only healing bone. The presented case and reviewed cases in the literature indicate that embolization is a promising method for definitive therapy of the aneurysmal bone cyst.
A boy is reported with a relapsing aneurysmal bone cyst of the lumbosacral spine. The therapeutical problems are discussed. The radiation of relapsing aneurysmal bone cyst is being advocated.
The surface of the large cystic spaces and dilated blood vessels in seven cases of aneurysmal bone cysts was studied. The endothelium of the blood vessels was surrounded by a layer of collagen types IV and V, and the endothelial cells contained factor VIII related antigen demonstrated by the peroxidase anti-peroxidase technique. Some blood vessels were dilated resembling small aneurysmal spaces. The visible surfaces of the aneurysmal spaces were devoid of collagen types IV and V, and of factor VIII related antigen. Ultrastructural analysis of paraffin embedded sections did not show the characteristic fine structural features of endothelium covering the aneurysmal spaces. It is concluded that the large spaces in aneurysmal bone cysts are devoid of basement membranes and endothelial cells. The absence of endothelium may explain the abundance of haemorrhages in these lesions. Immunocytochemical demonstration of endothelial antigen provides a valuable tool for the differential diagnosis between aneurysmal bone cysts and vascular tumours.
We report a case of multiple, simple bone cysts in long tubular, short tubular, and flat bones. The internal pressure of the cysts and the oxygen tension of cyst fluid were measured simultaneously. These values were similar to those of typical solitary cysts in other patients. Curettage and bone graft onto the calcaneal cyst were effective, although steroid injection therapy into the metacarpal cyst had no effect. Piercing the ulnar and radial cysts a number of times was uniformly effective. These results may suggest that venous obstruction of the lesions play an important role in the etiology of multiple simple cysts, as shown in typical bone cysts. However, we could not exclude the possibility that simple bone cysts, solitary or multiple, represent some kind of secondary forms of other disorders, or that a simple bone cyst is a heterogeneous entity.
PURPOSE OF THE STUDY: Several methods are used to treat essential bone cysts in children: curettage with bone graft, simple drainage, steroid injection, intramedullary nailing. No one method is preferred by all. We compared two retrospective series of children with solitary bone cysts treated by steroid injection or intramedullary nailing. MATERIAL AND METHODS: Seventy-two cysts were treated by the same team: 54 by injection of methylprednisolone, and 18 by intramedullary nailing. Fifty cysts were disclosed by bone fracture. The others were revealed by pain or discovered fortuitously. Seventy-five percent of the patients were boys. The humerus was involved in two-thirds of the cases. Patient age ranged from 5 to 10 years. Intramedullary nailing was used for the femur in 10 cases and the humerus for 8. Steroid injections were given after cyst opacification using 160 mg per injection, total mean dose 800 mg (range 80-2400 mg). RESULTS: Cure was obtained at 4 years on the average, with no difference between the two series. Complications observed were transient or definitive and more severe in patients treated by steroid injections. Most of the complications were transient effects of steroid overdosage or limb length discrepancy: 7 shortenings (1-8 cm) for injected cysts (all in patients given > 100 mg methylprednisolone), compared with 2 shortenings<2 cm after intramedullary nailing. DISCUSSION: Steroid injections have been used for many years with variable results depending on the reported series. Cyst opacification before injection is recommended to identify anomalies which could compromise outcome. Strict compliance with the rules of steroid treatment is required to avoid complications, as observed in our patients, which are dose dependent. The percutaneous method is attractive but can be used with other products such as bone marrow or bone substitutes to optimize results. Intramedullary nailing has the advantage of providing immediate support of the damaged bone while allowing cyst drainage and evacuation of the lytic segments. This method should probably be preferred for weight-bearing segments whether the cyst is associated with fracture or not. For non-weight-bearing segments, the choice between percutaneous treatment, and the substance to use, and intramedullary nailing depends largely on bone quality.
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The problem of the juvenile bone cyst in the region of the coxal end of the femur is described on the basis of the case histories and references. Surgery is always mandatory, whereas the type of surgery depends on the dimensions and shape of the juvenile bone cyst.
OBJECTIVE: To present the case of an intercollegiate field hockey player with an aneurysmal bone cyst of the femur and the clinical decision making necessary in the evaluation, management, surgical intervention, and positive outcome of this athlete. BACKGROUND: A 21-year-old field hockey player presented with signs and symptoms typical of a deep thigh contusion. She had no history of direct or indirect trauma, infection, or previous injury. DIFFERENTIAL DIAGNOSIS: Aneurysm, bone cyst, chondroma, giant cell tumor, osteochondroma, osteosarcoma, osteoid osteoma. TREATMENT: When her symptoms persisted beyond 6 months despite conservative care, she underwent radiographs, magnetic resonance imaging, and bone scan, which revealed a lesion in the right femur. At surgery, the lesion was diagnosed as an aneurysmal bone cyst, and it was excised by an incisional x-ray-guided biopsy followed by curettage and bone grafting. UNIQUENESS: The aneurysmal bone cyst presented as a typical thigh strain or deep contusion during the athlete's training and conditioning season. After all forms of conservative management proved ineffective, the athlete was referred to her physician. A detailed history and physical examination demonstrated no underlying musculoskeletal pathology coinciding with the athlete's symptoms. CONCLUSIONS: Increased clinical awareness is necessary when conservative management fails to resolve an athletic injury in an appropriate length of time. Proper diagnostic tools are essential in determining the pathology of the injury and whether surgical intervention is needed.
A simple bone cyst located in the spine is rare. In the current work, we have documented the first case of a simple bone cyst located in the pedicle of the lumbar vertebra. The patient was a 50-year-old woman with low back pain. Radiographs of the lumbar region of the spine showed a well circumscribed radiolucent lesion with surrounding bone sclerosis in the right pedicle of L3. Computed tomography (CT) showed that the right pedicle was completely occupied by the cyst and slightly expanded. The cystic lesion extended to both the vertebral body and the lamina. T1-weighted magnetic resonance imaging (MRI) showed uniform low intensity, and T2-weighted MRI showed uniform very high intensity. Signal enhancement by gadolinium diethylenetriaminepenta-acetic acid was not observed in the lesion. During the operation, the cavity of the cyst was filled with 2 mL of serosanguinous fluid. Subsequent histologic examination showed a thin layer of connective tissue in the inner surface of the cyst.
A case of aneurysmal bone cyst of the proximal phalanx in a young boy with unfused epiphysial plates is reported. Curettage failed, so diaphysectomy and cortical bone grafting were performed, sparing the epiphysial plate. This resulted in normal length and function, and the graft remodelled completely to a normal appearance of tubular bone.
PURPOSE: To assess the efficacy of percutaneous embolization with an alcoholic solution of zein in the treatment of aneurysmal bone cysts. MATERIALS AND METHODS: Eighteen patients with aneurysmal bone cysts were treated percutaneously with alcoholic zein. The cysts were in the lower limb (n = 7), upper limb (n = 5), pelvis (n = 3), cervical spine (n = 2), and mandible (n = 1). All patients were symptomatic, three had previously undergone surgery. Percutaneous embolization was performed with fluoroscopic or computed tomographic guidance with the patient under general anesthesia. Clinical and imaging follow-up lasted 18 months to 4 years. RESULTS: Percutaneous embolization was performed in 16 cases. In two cases, cystograms showed marked venous drainage and thus embolization was not attempted. Six patients underwent repeat embolization. Complications consisted of a local transitory inflammatory reaction (n = 5), aseptic osteitis (n = 1), and a small pulmonary infarct without sequelae (n = 1). Relief of symptoms was achieved in all patients except one, who underwent surgery. At imaging, improvement was total in 13 cases (87%) and partial in two cases (13%). No recurrence was noted during follow-up. CONCLUSION: Percutaneous embolization of aneurysmal bone cysts with alcoholic zein should be considered a reliable alternative to surgery, especially in cases with a difficult surgical approach or cases of postsurgical recurrence.
Reviews of the literature show that simple bone cysts of the jaws no longer can be considered rare. The clinical and radiographic appearances are mostly rather typical, but in some cases there are great variations. In this article an unusual case with both facial asymmetry and bilateral occurrence is described. The differential diagnosis between simple bone cysts, tumors, odontogenic cysts and vascular abnormalities is sometimes hard to establish. In those cases aspiration biopsy can be of great help.
In order to define the histogenesis of bone solitary cyst it was performed immunohistochemical study of surgical material obtained from 17 patients with the monoclonal antibodies against the following antigens: CD-31 (marker of endotheliocytes), IV type collagen (marker of blood vessel basal membrane), vimentin (marker of connective tissue) and Ki-67 (marker of mitotic cell). The results of the study showed, that solitary bone cyst shouldn't be attributed to the blood-vessel formations and because of its vimentin-positive peculiarity it has connective tissue genesis. At the same time bone cyst shouldn't be considered as tumoral process because it contains low quantity of mitotic cells' markers and the latter appears on the peripheral region of an active cyst, where the regeneration and intensive transformation of bone tissue take place. According to the above-mentioned the solitary cyst of bone should be considered as non-tumor connective-tissue pathology, histogenesis of which shouldn't be related to blood vessels.