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The computed tomographic and magnetic resonance appearance of a calvarial aneurysmal bone cyst is described. Both forms of imaging demonstrate an epidural mass in the right occiput. The fluid-fluid levels in the mass on the T2-weighted images are characteristic of, though not specific for, aneurysmal bone cyst.
A case of aneurysmal bone cyst of the patella in a 15-year-old woman was presented. An ABC occurring in a female patient is rare, and to our knowledge this is the first report in the literature. All other reports of patellar ABCs reported have occurred in young black men [2, 3]. The radiographic findings and clinical presentation were stressed since they are typical of all benign patellar tumors. Although radiographic findings are usually typical of patellar tumors, CT and MRI may be used for staging and standardization of operative treatment. MRI is also helpful for examining the integrity of the patellar tendon and quadriceps since many of these patients present with malfunction of the extensor mechanism [14].
Giant cell tumors of the talus are very uncommon. Secondary aneurysmal bone cyst changes are well documented in the literature with giant cell tumors being one of the most common underlying lesions. However, no previous case of this combination has been documented in the podiatric literature. The diagnosis of these lesions can be very challenging since they share many common features. Although previous reports describe a higher recurrence rate of giant cell tumors when found in the small bones of the hands and feet, reported cases of this entity in the talus indicate a less aggressive natural history with rare malignant transformation. A case report and review of the literature are presented.
A rare case of simple bone cyst in the mandibular condyle of a 33-year-old woman is reported. The condition was difficult to diagnose because the cyst was accompanied by severe osteoarthritis. T1-weighted magnetic resonance (MR) images revealed a cystic lesion with intermediate signal intensity within the condylar head and an irregular margin with intermediate signal intensity on the superior surface of the condyle. The patient was treated by high condylectomy, discectomy and reconstruction by sagittal split ramus osteotomy. Histopathological examination showed a simple bone cyst in the condylar head and erosion of the anterior articular surface due to degenerative changes.
A special method of subperiosteal segmental resection is described as an operative treatment for solitary bone cysts in long bones. This procedure exploits the high osteogenetic potency of the periosteum in adolescence. An autogenous or homologous fibula bone graft locked between the ends of the cyst serves to maintain the length of the bone fragments and acts as a guiding rod for continued subperiosteal new bone formation. There is full reconstruction of bone stability and function at both the cyst region and the donor region (fibula).
The authors report an aneurismal bone cyst in the second metacarpal of a 16-year-old patient. It was an aneurismal bone cyst of the agressive diffuse variety involving the proximal metaphyseal, diaphyseal and distal epiphyseal zones. Conservation of the MCP joint of the index was the priority. The authors report the technique used as well as the clinical and radiological results.
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Simple bone cyst (SBC) is an intra-osseous pseudocystic lesion lined by a thin fibrovascular membrane but lacks an epithelial lining. SBC is uncommon and comprises of approximately 1% of all jaw cysts. The lesion is usually discovered incidentally during the first two decades of life. Males are affected slightly more frequently than females. The most common sites of occurrence are the molar and premolar regions of the mandible; maxillary lesions are uncommon. The lesion is usually solitary, radiolucent, well demarcated, and non-expansile. Margins may be scalloped, between vital teeth, and root resorption is rare. A surgical approach to the lesion reveals an empty cavity with serosanguinous fluid. Histologically, the cavity lining consists of a loose connective tissue layer and hemosiderin-laden macrophages. Pathogenesis and etiology of SBC are still not clearly understood. It is assumed that the cyst forms following traumatic intra-osseous hemorrhage with subsequent lysis and resorption of the cellular content. Trauma, as the main cause of SBC, is not always conclusive and the origin of the lesion may be multifactorial. Treatment of SBC is by curettage. Intralesional hemorrhage due to either intentional curettage or during exploratory procedure may induce a reparative process. A rare occurrence of SBC in a 71 year old healthy male, referred to the Oral and Maxillofacial Outpatient Clinic, Sheba Medical Center by his dentist, because of a large radiolucent lesion in the left mandibular body is reported. The patient received a complete lower denture 3 months earlier. He returned to his dentist with a complaint of local pain and an ulcer under the denture. A panoramic radiograph revealed a large unilocular radiolucent lesion with demarcated borders in the left mandibular body and bone erosion in the upper alveolar border of the lesion Clinical examination showed a deep ulcer in the denture-bearing area of the left posterior alveolar ridge. There was no cortical expansion of the mandible. Incisinal biopsy revealed an empty cavity lined by fibrous connective tissue with no epithelial lining. According to the clinico-radiologic and histologic findings, a diagnosis of a simple bone cyst was made. The incidence of SBC is higher in younger age groups (second decade). Occurrence of the lesion in the elderly is rare with only a few reports in the literature. In the present case, the fact that SBC is asymptomatic, may be responsible for the late discovery of the lesion.
The combination of fibrous dysplasia and aneurysmal bone cyst of the skull base is extremely rare yet it should be recognized, lest the rapid growth of the lesion and the radiological picture lead to the wrong diagnosis of a malignant process. We report on a 6(1/2)-year-old patient who suffered from concomitant fibrous dysplasia and aneurysmal bone cyst of the skull base. He is still disease-free 4 years postoperatively. The treatment of choice remains early surgical removal of the maximal amount of involved bone that can safely be achieved. There is no role for radiotherapy in the treatment of these lesions. A review of the literature is included.
An umbrella cockatoo (Cacatua alba) and two cockatiels (Nymphicus hollandicus) were presented with rapidly enlarging masses of the head or wing joints. Historic trauma to these areas was confirmed in two cases. All birds were >2 yr of age, and two were female. Cytologic examination of fluid aspirated from masses in two cases was described as serosanguineous cytologically but failed to reveal inflammation, neoplasia, or microorganisms. Radiographic evaluation of these masses included proliferation and lysis of bone, suggestive of a neoplastic process. Histopathologic examination of surgically excised tissues revealed proliferative new bone and an absence of neoplastic tissue in all cases, consistent with aneurysmal bone cyst formation. Despite the guarded prognosis reported for other companion animals, these case results suggest a good prognosis for aneurysmal bone cyst in psittaciformes. Complete surgical excision and histopathologic examination is recommended for definitive diagnoses of aneurysmal bone cyst. Postoperative bandaging and rational antibiotic use are indicated to prevent excessive motion and secondary infection of affected sites, respectively.
Thirty-one cases of aneurysmal bone cyst of the spine with a minimum follow-up of 1 year as registered by the Netherlands Committee for Bone Tumors are reported. Aneurysmal bone cyst is a benign, sometimes expansive and destructive, lesion frequently occurring between the ages of 10 and 20 years. Located in the vertebral column, it undermines the structural integrity of the spine, and neurologic complications can occur. In all cases the posterior elements were involved, with extension into the vertebral body occurring in 22 cases. Extension to adjacent vertebra occurred 5 times, but the intervertebral disc appeared to be left intact. Twenty-nine of 31 cases were treated surgically. Posterior approaches provided insufficient access to lesions also located to the vertebral body and were associated with a higher recurrence rate (5 of 18 cases) than anterior approaches (1 of 11 cases). Of 10 cases in which the surgical removal was incomplete, 4 healed and 6 had a local recurrence. Selective embolization was used twice, and its application is discussed. On the basis of this material and a review of the literature, treatment by intralesional curettage combined by adjuvant therapy such as preoperative embolization is advised.
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Three cases of aneurysmal bone cysts secondary to chondroblastoma of the patella are described. This association is not particularly uncommon, but its occurrence in the patella is unusual. Treatment consists of curettage and bone grafting; however, if the patella is grossly enlarged or distorted, patellectomy is preferable.
Chondroblastoma of the metacarpal bone has been extremely rare and only seven cases have been reported in the English literature. Here we reported the eighth case of a chondroblastoma that developed on the first metacarpal bone of the right hand of a 21-year-old man. Radiographs showed an expansile osteolytic lesion with a multilocular appearance. In MR images, the lesion showed low intensity in T1 and high intensity in T2-weighted images with multiple fluid-fluid levels, which are findings resembling those of an aneurysmal bone cyst. From the pathological findings, however, it was recognized as a chondroblastoma with aneurysmal bone cyst-like change. Good clinical results was obtained by the subtotal resection of the metacarpal bone with a columnar-shaped iliac bone graft.
The case of a 16-year-old boy with an aneurysmal bone cyst of the fourth lumbar vertebra and a herniated nucleus pulposus of the L4-5 disc is presented. Symptoms included progressive lower back pain and bilateral lower extremity weakness. Roentgenographic studies were consistent with a vertebral aneurysmal bone cyst with an expansile lesion that compromised the neural canal and an L4-5 herniated nucleus pulposus. Surgical treatment included tumor excision, L4-5 discectomy, lumbar decompression, and posterolateral and anterior lumbar fusion. Postoperatively, the lower back pain and lower extremity symptoms resolved. The patient continues to do well at 1-year follow-up.