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The authors report a familial case of primary aneurysmal bone cyst in father and son, affecting both at the same location at nearly the same age. This fact again raises the speculation of a genetic link as another factor in the pathogenesis of aneurysmal bone cyst.
The etiology of aneurysmal bone cyst is still unknown. Most theories of the histogenesis of this lesion assume a vascular origin and speculation has focused on the characteristic pseudoendothelial lining of the cyst walls. In the present study, this structure has been subjected to enzyme histochemical, electron microscopical, and immunohistochemical investigation. Of the enzymes tested only alkaline phosphatase was present in the cyst lining. Electron microscopy revealed fibroblast-like cells covering the walls of cystic cavities, but no genuine endothelium, basement membranes or pericytes were identified. For the immunohistochemical studies a panel of poly- and monoclonal antibodies against HLA-DR antigens, mature and immature macrophages/histiocytes, smooth muscle fibers and endothelial cells, as well as the lectin Ulex europaeus I agglutinin were used. None of these markers demonstrated the presupposed vascular characteristics in the cells constituting the pseudoendothelial lining of the cyst walls. Despite current theories to the contrary, it was concluded that aneurysmal bone cyst is unlikely to originate from the vascular system, and that a new concept of its pathogenesis must be sought.
The recurrence rate after excochleation and homogeneous bone grafting of juvenile and aneurysmal bone cysts is high. One of the reasons is the poor vascularisation of the wall of the cyst. En-bloc resection is recommended in cases of recurrence after curettage and bone grafting and in cases of prior conservative treatment after pathological fracture followed by a rapid growth of the cyst. Excellent results of en-bloc resection in 8 cases of humerus bone cyst are reported. Good vascularisation of the juvenile periosteum and the surrounding soft tissue is most important for new bone formation after homogeneous bone grafting.
The aneurysmal bone cyst occurs predominantly in the long bones and vertebral column although lesions have been seen in the clavicle, ribs, innominate bone, skull and bones of the hands and feet (Shafer et al., 1974). A case is reported of such a lesion presenting in the ascending ramus of the mandible.
A review of the literature suggests that traumatic bone cysts have been detected more frequently since the advent of panoramic radiography. Some authorities believe that these lesions may regress spontaneously without intervention within a period of time. Surgical exploration will enhance the bony repair of these cysts and is the usual recommended treatment. A case is reported in which complete regression of a traumatic bone cyst has occurred within 30 months of aspiration of its contents.
Strictly speaking, the aneurysmal bone cyst is not a true cyst. It is a lesion characterized by replacement of bone by fibro-osseous tissue containing blood-filled cavernous spaces. It is usually treated by surgical curettage, and access within the jaws may sometimes be difficult. We reviewed the world literature and found 63 cases of aneurysmal bone cysts involving the face, 22 reported in the maxilla, and 63 in the mandible. One was found in the zygomatic arch. Of the patients reported, 88% were younger than 30 years old; there was an equal sex distribution. Included in this report, are two cases of our own, one involving the maxilla and one the mandible.
We treated 23 simple bone cysts by the multiple drill-hole method and reviewed them a mean of 5 (2-10) years later. 11 cysts were located in the humerus, 9 in the femur, 2 in the tibia, and 1 in the pubis. The cysts recurred in 15 cases after the initial operation. 12 recurrent cysts were treated with reoperations. At the follow-up, good bone formation with no sign of recurrence was seen in 15 cases. A residual cyst was found in 8 cases, but further treatment was not considered necessary.
Aneurysmal bone cysts (ABCs) are relatively uncommon, benign lesions. Fully 50% occur in long bones and 20% in the vertebral column, mostly in patients under 20 years of age. We report a case of an ABC in the odontoid process of a 74-year-old who sought treatment for pain and myelopathy. This is the first case reported of an ABC of the odontoid process.
The etiology of the unicameral bone cyst remains undefined. Likewise, the treatment of the cyst has had proponents suggesting procedures ranging from decompression to diaphyseal resection. The use of intralesional steroids has gained popularity since its introduction in 1979 by Scaglietti. We present the results of aspirations of seven cysts, with serial measurements of prostaglandin levels in five cases, and suggest that the antiprostaglandin action of the steroid forms the rationale for treatment of the simple cyst.
The article describes the treatment of solitary bone cysts of the upper and lower limbs by means of elastic intramedullary nailing. In the 11 cases treated, bone rehabilitation was complete, probably due to the defluction of the intracystic fluid by means of the drainage caused by the nails.
Simple (unicameral or solitary) bone cysts are the only true cysts of primary intraosseous origin. These cysts involve the metaphysis of long tubular bones such as the proximal humerus and proximal femur and, occasionally, the proximal tibia, distal femur, patella, ilium, rib, and calcaneus. They are very rarely found in vertebrae, especially in the cervical vertebral spinous process and laminae. We report a 14-year-old boy with an expansile, bubbly cystic lesion in the spinous process and laminae of the seventh cervical vertebra. Histopathologic examination showed a cyst surrounded by thin fibrous or fibro-osseous wall without any lining epithelial cells, compatible with a simple bone cyst. As far as we know, this is the first case of simple bone cyst involving the spinous process and laminae of a cervical vertebra reported in Taiwan.
Twenty cases of aneurysmal bone cyst were reviewed, with an average follow-up of 10.3 years. Twelve patients still had open growth plates at diagnosis, but all of them were fully grown at follow-up. The treatments performed were: resection of the cyst or of the whole affected bone, curettage, and curettage and bone grafting. Radiation therapy was a complementary treatment in three cases. Two patients relapsed, one that had been treated by curettage alone and one by curettage and bone grafting. Five patients showed skeletal deformities at follow-up. Two had lesions of the growth plate, most likely caused by radiation therapy, whereas in the other three growth had probably been impaired by surgical trauma.
STUDY DESIGN: First published report of a child with an aneurysmal bone cyst (ABC) of the first cervical vertebrae treated successfully with intralesional injection of calcitonin and methylprednisolone. OBJECTIVES: To describe a safe and effective nonsurgical treatment method for an ABC of the first cervical vertebrae. SUMMARY OF BACKGROUND DATA: Aneurysmal bone cysts of the spine comprise from 3% to 20% of all such lesions. Upper cervical spine involvement is rare and these lesions are difficult to treat. Standard treatment with curettage and bone grafting or other alternatives such as radiation therapy or embolization may not be possible in this location. Percutaneous injection with a variety of agents has also been described. Methylprednisolone and calcitonin were selected in this case in an effort to combine the proposed angiostatic and fibroblastic inhibitory effects of steroid with the proposed osteoclastic inhibitory and promotion of new bony trabeculae formation effects of calcitonin. METHOD: This case was described, and pertinent literature reviewed. RESULTS: Sclerosis and shrinkage of the lesion with concomitant symptom resolution occurred after two injections with calcitonin and methylprednisolone via computed tomography (CT) guidance. No complications occurred. The lesion remained quiescent at a 2-year 7-month follow-up. CONCLUSIONS: Percutaneous intralesional injection of an ABC of the first cervical vertebrae with calcitonin and methylprednisolone in a child via CT guidance was a safe and effective treatment. This is a promising treatment for surgically inaccessible aneurysmal bone cysts.
A report of recurrent simple bone cysts in two cases--a seven-year-old and a six-year-old male--is presented. In each case curettage and cortical banked bone graft were performed. On follow-up, there was no clinical or radiographic evidence of further recurrence.
BACKGROUND: Surgical treatment of aneurysmal bone cysts of the cervical spine, frequently affecting pediatric patients, is a challenge to operating surgeons. Complete tumor resection offers the best chance for cure. CASE DESCRIPTION: We present the case of a child with an expansile aneurysmal bone cyst of the cervical spine that involves all 3 spinal columns. The advantages of combining a posterolateral followed by anterior approach after a preoperative angiography and vertebral artery balloon occlusion testing provided the added safety to maximize the extent of tumor resection. Spinal stabilization was successfully achieved in both approaches. CONCLUSION: The challenge of surgically resecting aneurysmal bone cysts of the cervical spine in children enabled us to achieve a total resection with the help of preoperative angiography and vertebral artery balloon occlusion testing. Spinal instability should be addressed with reconstruction and stabilization techniques.
An unusual case of aneurysmal bone cyst in the metacarpal of a five-year-old girl is described. The lesion was initially diagnosed and treated as a simple bone cyst. Subsequently the affected metacarpal was excised and replaced by an autogenous fibular graft, with good results. A discussion of the pathogenesis of the lesion is given, with a review of the literature.
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