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MR imaging of simple bone cysts in children: not so simple.

OBJECTIVE: The unicameral bone cyst (UBC) is a common cystic bone lesion seen in children. We review and summarize its MR findings, focusing on their appearance following contrast enhancement, and correlating them to known histologic features of UBC. SUBJECTS AND METHODS: A retrospective review of 20 cases (13 boys, 7 girls; age range, 1-17 years; mean age, 8.9) diagnosed as UBC was conducted. Clinical histories, radiographic and MR features, follow-up data, and available pathologic findings were noted. RESULTS: At initial presentation 18 (90 %) of the patients with UBC had a history of acute or remote pathologic fracture. Cysts with history of fracture displayed heterogeneous fluid signals on T1-(n = 9, 50%), and T2-weighted (n = 15, 83 %) MR images. Gadolinium-enhanced images were obtained in 15 of the 18 UBC cases with history of previous fracture. All showed enhancement with focal, thick peripheral, heterogeneous, or subcortical patterns. Focal nodules of homogeneous enhancement (diameter > 1 cm) within the UBC (n = 5) correlated with areas of ground-glass opacification on plain film. Other interesting MR features were fluid-fluid levels (n = 11), "fallen-leaf" sign (n = 1), soft-tissue changes (n = 2), and detection of septations not seen on plain film (n = 2). CONCLUSION: UBCs frequently appear complicated on MR imaging, with heterogeneous fluid signals and regions of nodular and thick peripheral enhancement related to previous pathologic fracture and early healing.

Adolescent↗

Giant cell tumor of the scapula associated with secondary aneurysmal bone cyst.

Giant cell tumors are distinctive neoplasms characterized by a profusion of multinucleate giant cells scattered throughout a stroma of mononuclear cells. Most giant cell tumors are found at the epiphyses of long bones, especially around the knee joint. Flat bone involvement is rare. However, a case of giant cell tumor with secondary aneurysmal bone cyst was encountered at the scapula of a 25-year-old man. Since the occurrence of a giant cell tumor with secondary aneurysmal bone cyst on flat bones (i.e., the scapula) is extremely rare, the above-mentioned case is worthy of reporting.

Adult↗

Acid and alkaline phosphatase activity in bone-cyst fluid.

The acid and alkaline phosphatase activity in fluid aspirated from solitary bone cysts in six patients was measured, and large increases in the concentration of acid phosphatase were found. In some cases this increase was reflected in venous blood concentrations. The significance of these findings for the pathogenesis and the management of solitary bone cyst is discussed.

Acid Phosphatase↗

Aneurysmal bone cyst of maxilla.

A case of aneurysmal bone cyst of the maxilla is reported. The clinical and radiological feautres, histopathology and treatment, are described in detail. Although the pathogenesis is still obscure, surgical excision is considered to be the treatment of choice.

Adolescent↗

Aneurysmal bone cyst of the hand.

Diagnosis of aneurysmal bone cyst in the hands is confused by rarity (2%) and overlapping characteristics of other lesions, especially benign osteoblastoma and giant-cell tumor. Pseudosinusoidal vascular channels create interfaces between liquid blood (maintained by fibrolysin) and connective tissue cells. The role of trauma is inexplicable.

Bone Cysts↗

Sclerotherapy in aneurysmal bone cysts in children: a review of 17 cases.

OBJECTIVE: To determine the efficacy of percutaneous sclerotherapy in the treatment of aneurysmal bone cysts. MATERIALS AND METHODS: Seventeen patients (7 girls, 10 boys) with aneurysmal bone cysts were treated by the percutaneous approach with Ethibloc ( n=14) and histoacryl glue ( n=3) in our institution between January 1994 and June 2000. The cysts were located in the extremities ( n=6), pelvis ( n=2), spine ( n=2), mandible ( n=5), rib ( n=1) and sphenoid bone ( n=1). Percutaneous sclerotherapy was performed with fluoroscopic and/or computed tomographic guidance under general anesthesia. Clinical and imaging follow-up lasted from 24 months to 9 years and 6 months (mean: 57.3 months). The results were quantified as: excellent (residual cyst less than 20% of the initial involvement), satisfactory (residual cyst 30-50%), unsatisfactory (residual cyst more than 50%). RESULTS: The age of the patients ranged from 4 years and 6 months to 15 years and 8 months (mean: 11 years and 2 months). In nine patients, the therapeutic procedure was repeated 2-5 times. Excellent regression was observed in 16 (94%), satisfactory results in 1 (6%). There was no failure (unsatisfactory result or no response to treatment) in this reported series. The complications were minor and included: local inflammatory reaction ( n=2), small blister ( n=1), and leakage ( n=1). Relief of symptoms was achieved in all patients. No recurrence was noted during follow-up. CONCLUSION: Percutaneous sclerotherapy of aneurysmal bone cysts with Ethibloc is safe and effective. It is an important alternative to surgery, especially when surgery is technically impossible or not recommended in high-risk patients.

Adolescent↗

Aneurysmal bone cyst of the femur in a child with celiac disease.

A case of aneurysmal bone cyst of the femur in a 2-year-old boy with celiac disease is described. The bone cyst presented with a pathological fracture while the boy was undergoing gluten challenge. The definite diagnosis of celiac disease according to the criteria formulated by the European Society for Paediatric Gastroenterology and Nutrition was established. A hypothetical association between the two disorders is discussed.

Bone Cysts↗

Transnasal endoscopic surgery for the treatment of fibrous dysplasia of maxillary sinus associated to aneurysmal bone cyst in a 5-year-old child.

Fibrous dysplasia (FD) and aneurysmal bone cyst involving the facial skeleton are rare but their synchronous association in other parts of the body is well-known. The most common treatment for these lesions has been based on surgical resection using an external approach. Only recently has the endonasal endoscopic approach been utilized for the partial or complete removal of these lesions. In this report, we attempt to outline the effectiveness of the endonasal endoscopic approach for the treatment of a 5-year-old child affected by a fibrous dysplasia associated with an aneurysmal bone cyst of the right maxillary.

Bone Cysts↗

Giant cell tumor and aneurysmal bone cyst of the talus: clinicopathological review and two case reports.

Two cases of giant cell tumor and aneurysmal bone cyst of the talus were analyzed with a review of eight cases from the literature. This anatomic setting represents a distinct clinical and roentgenographic entity with a less aggressive natural history than the more common sites. All lesions presented a characteristic radiographic involvement of the head and neck of the talus. Eight of ten lesions were treated by curettage, with or without bone grafting, and healed. Two underwent partial en bloc resection. None developed late fracture, recurrence, avascular necrosis, or metastases. We concluded that a giant cell tumor or aneurysmal bone cyst when located in the talus may be difficult to differentiate but tends to exhibit a less aggressive biological behavior and a more favorable prognosis than the more classical proximal lesion. Talectomy is not indicated in the primary treatment. Curettage with or without bone graft has a high success rate. Cryosurgery should be reserved for a recurrent lesion.

Adolescent↗

Unusually large solitary unicameral bone cyst: case report.

A 15-year-old boy presented with complaints of pain and swelling of the right leg. Radiography revealed a large lytic lesion involving the proximal half of the tibia. The patient was taken to surgery, where the cavity was curetted and packed with allogeneic bone graft. Tissue was sent for histopathological evaluation. The patient was kept in an above-knee cast for 4 months, after which partial weight-bearing was allowed. The histopathological diagnosis was a unicameral bone cyst. A radiograph at 1 year showed incorporation of the graft, but a small part of the cavity was still visible and there was a persistent discharge. The patient was again subjected to allogeneic bone grafting in the remaining cavity. At 3.5 years of follow-up now, the patient is walking unsupported, there is no pain, and the radiograph shows complete obliteration of the cavity. Unicameral bone cysts are usually a few centimeters in size. To the best of our knowledge, a unicameral bone cyst of such a large size has never been reported in the literature.

Adolescent↗

Extraosseous aneurysmal bone cyst in a 12-year-old girl.

A soft-tissue aneurysmal bone cyst located on the lateral aspect of the left thigh of a 12-year-old girl is described. Conventional radiography of the thigh was normal. Sonography showed a hypoechoic mass with a feeding vessel and intralesional vascularity. On MRI, it was of predominantly soft-tissue signal intensity with intense enhancement following administration of i.v. contrast medium. Histopathological examination diagnosed the lesion as a soft-tissue aneurysmal bone cyst. This is the fourth paediatric case of this very rare benign tumour.

Bone Cysts, Aneurysmal↗

[Sphenotemporal aneurysmal bone cyst. A new case and review of the literature].

Aneurysmal bone cysts (ABC) are benign tumors of the bones, formed by multiple cysts filled with blood and eroding the bone. They are rarely located at the skull. We report a case of a right temporal ABC in a 5-year-old girl. On admission, the physical examination showed a tough and fixed tumor, with no inflammatory signs nor vascular characteristics. The neurological examination was normal. Imaging studies showed an heterogeneous extracerebral mass, eroding the temporal bone and the greater wing of the sphenoid bone. The treatment consisted in an extensive tumor resection, associated with reconstructive surgery. The outcome was uneventful (follow-up 27 months). We underline the pathogenetic, diagnostic and therapeutic features of this condition.

Bone Cysts, Aneurysmal↗

[The differential diagnosis of aneurysmal bones cysts and non-ossifying fibromas (author's transl)].

With the help of intraosseous angiography, and bearing in mind the plain films and histopathological basis of the lesions, it is now possible to differentiate with certainty between a non-ossifying fibroma and an aneurysmal bone cyst. Since 20% of aneurysmal bone cysts recur after curretage or excision and most non-ossifying fibromas disappear spontaneously, intraosseous angiography has a valuable place in diagnosis.

Adolescent↗

Distal third fibular aneurysmal bone cyst: en bloc resection and proximal third fibular reconstruction.

Treatment of aneurysmal bone cysts (ABCs) located in the distal third fibula adjacent to the growth plate, can be problematic. The first choice of treatment for these lesions has been cyst curettage and bone graft. Complications include the high recurrence rate, possible growth-plate injury, and possible ankle instability associated with that treatment led to the development of other surgical options. We used en bloc resection and proximal third fibular bone reconstruction to treat an 8-year-old female patient with a distal third fibular ABC close to the growth plate. There was no recurrence, growth-plate injury, or ankle instability at 30-month follow-up.

Bone Cysts, Aneurysmal↗