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PubMed2002

Aneurysmal bone cyst: value of MR imaging and conventional radiography.

Our objective was to investigate the accuracy and the diagnostic value of different imaging features of primary aneurysmal bone cysts (ABC) in conventional radiographs and MRI. Conventional radiographs and MR images of 34 patients with a suspected aneurysmal bone cyst were reevaluated by six independent radiologists in a blinded fashion. Morphological features, MR signal characteristics, and contrast enhancement patterns were assessed. Diagnoses were correlated with histology. Sensitivity and specificity of the different imaging findings for each imaging technique were calculated. In 24 patients ABC was histologically proven. In 10 cases diagnoses other than ABC were established. Conventional radiography and MRI each demonstrated a sensitivity of 76.4 and 77.8% with a specificity of 55.0 and 66.7%, respectively. With combined use of both imaging modalities sensitivity and specificity increased to 82.6 and 70%, respectively. The ABC was significantly more often seen as circumscribed lesion with bone expansion, lobulation, septa, and pathological cortical bone reaction than those cases with different diagnoses. Septal contrast enhancement proved to be a useful MR imaging finding in suspected ABC. The combined use of conventional radiographs and MRI revealed the highest sensitivity in the diagnosis of ABC in relation to histology. Magnetic resonance imaging provides improved diagnostic specificity and valuable information on soft tissue changes.

Adolescent↗
PubMed1987

Treatment of bone cysts with methylprednisolone acetate. A 9 to 11 year follow-up.

The long-term results are reported of the treatment of bone cysts by means of the injection of methylprednisolone acetate (MPA) into the bony cavity using Scaglietti's technique. Eighteen patients were reviewed at a follow-up of 9-11 years from the beginning of the treatment. The results confirm the value of this technique and show a high percentage of recovery. During the growth period, a recurrence of osteolytic activity in the lesion may be observed after complete healing, though this does not happen frequently. In these cases further prompt treatment with MPA injected into the small osteolytic areas brings about their complete resolution. These observations lead us to conclude that a bone cyst can never be considered completely healed before complete skeletal maturity is reached. Regular radiological reviews must be carried out in order to recognise and treat promptly the first signs of a recurrence of cystic activity.

Adolescent↗
PubMedDate not supplied

Unicameral bone cyst of the medial malleolus of the ankle.

Dr. Wu identifies the characteristics of an unicameral bone cyst of the ankle, in a 23-year-old female. Continuous pain caused by the cystic lesion required surgical curettage and iliac bone grafting. Radiographic and histologic features of this entity are illustrated.

Adult↗
PubMed1983

[Principles of the treatment of dystrophic bone cysts in children].

The experience with the treatment of 328 children and juveniles with dystrophic bone cysts is analyzed. Nine patients were cured by conservative methods. The others were operated upon (excohleation--in 4 patients; marginal resection--in 244 patients, segmentary resection in 66 patients etc.). The advantages of the marginal resection and alloplasty by the method of "faggot" are shown.

Adolescent↗
PubMed1994

Simple bone cyst of the calcaneus. A case report and literature review.

The authors presented a case report of a patient presenting with heel pain symptoms and physical findings similar to those associated with a heel spur syndrome. With a standard x-ray, the presence of a simple bone cyst was evident. Although mainly reported in tubular bones, steroid injection therapy has been successful and appears to be replacing surgical curettage and packing as the preferred choice of treatment in many cases. As more reports of the successful eradication of simple bone cysts of the calcaneus with steroid injections are reported, greater confidence for using it as a treatment choice for this particular lesion may be gained. The surgical approach in the patient presented here was chosen because of factors that the authors believe increased the likelihood of a pathologic fracture, such as size and extent of the lesion, history of progressive pain, and activity level of the patient. The larger body weight and the resulting stress of the patient more likely to present with a calcaneal cyst may also be factors to consider.

Adult↗
PubMed1997

Incomplete healing of simple bone cysts after steroid injections.

We reviewed 32 children after the treatment of simple bone cysts by intralesional injections of methylprednisolone acetate. The age of the child and the activity and size of the cyst did not significantly affect the radiological outcome. The earliest time at which the radiological response could be reliably determined was three months. After a median period of review of five years, four (13%) cysts had healed, 20 (62%) cysts were partially visible but sclerotic, four (12.5%) were still visible but opaque and four (12.5%) were clearly visible. The healed and partially visible but sclerotic cysts were classified as having satisfactory radiological healing. This was observed in 13 of 32 cysts (41%) after the first injection, in eight of 21 (38%) after the second injection, but in relatively few of the remaining cysts after subsequent injections. A satisfactory symptomatic outcome was achieved in all of the 18 children with humeral cysts and in the one child with a fibular cyst irrespective of the radiological outcome, but only in nine (67%) of the 13 children with femoral or tibial lesions, in whom the cysts were healed or sclerotic. The remaining four children had exertional bone pain and repeated fractures of their femoral or tibial cysts which were incompletely healed with sclerosis in one and opacities in three. We conclude that the healing response to intralesional corticosteroids is unpredictable and usually incomplete even after multiple injections. The failure rate in weight-bearing bones is too high.

Adolescent↗
PubMed1999

Unusual finding after contrast injection of a solitary bone cyst. A case report.

Injection of radiopaque contrast into a solitary bone cyst (SBC) prior to methylprednisolone acetate (MPA) injection has been previously reported. We report an unusual finding during the injection of radiopaque contrast in the treatment of one case of SBC of the femur: a bicameral appearance of the cyst was observed; no filling of the proximal cavity occurred and immediate perfusion of the femoral vein with contrast was noted. In cases of SBC such as this one, percutaneous autologous marrow or corticosteroid injection may fail to be effective. Furthermore there exists the potential risk of fat embolus secondary to bone marrow injection. Based on these findings in the case reported, we suggest that contrast injection should be performed prior to bone marrow or corticosteroid injection in order to evaluate both the venous drainage of the cyst and its degree of loculation.

Anti-Inflammatory Agents↗
PubMed2000

Development of a solitary bone cyst--a report of a case suggesting its pathogenesis.

The origin and natural course of solitary bone cysts (SBC) still remain controversial. Knowledge of the process of cyst formation and enlargement would be helpful for investigating its pathogenesis. Only two papers have described a radiodense nidus of the diaphysis as a precursor. Their cases were unique in that the initial lesions were in the diaphysis and that the cysts did not abut onto the epiphyseal line. This study reports a case in a patient with a tiny erosive lesion in the endosteal surface of the humeral metaphysis, which developed expansively into a typical large cyst over 6 years. Serial roentgenograms taken every year demonstrated the process of cyst enlargement. This is the first longitudinal study of a case with SBC documented from its onset.

Bone Cysts↗
PubMedDate not supplied

Extraosseous aneurysmal bone cyst.

A 73-year-old man developed an enlarged cystic lesion located in the soft tissues surrounding the left hip. The lesion was surgically removed. The patient was well 1 year after surgery. The lesion was histologically identical to an aneurysmal bone cyst, therefore it was diagnosed as an extraosseous aneurysmal bone cyst. The differential diagnoses and a review of the literature are presented.

Aged↗
PubMed1975

Bone cyst following gunshot wound: case report.

A case of a large bone cyst developing in the distal femur of a 17-year-old boy requiring curettage and grafting 20 months following a low-velocity gunshot wound is reported. The etiology of such cysts remains obscure, and removal of bullets from weight-bearing bones is recommended when feasible, or followup roentgenograms of weight-bearing bones with retained missiles. The literature on civilian gunshot injuries is reviewed and implications from the present case are discussed.

Adolescent↗
PubMed1977

Aneurysmal bone cysts: a clinicopathological study of 105 cases.

A clinicopathological review of 105 cases of aneurysmal bone cyst is reported. Age and sex distribution and localization were in agreement with two previously reported large series. Recurrence occurred in 30.5% of all the cases and in 34.2% of those treated by curettage. Proved incompleteness of surgical removal was an important factor in recurrence (12 out of 17 cases or 70.6%). The recurrence rate was significantly (P2 less than 0.01) higher in cases with a mitotic index of seven or more per 50 fields (X 750) than in those with a lower mitotic index. In relation to the recurrence rate, no statistically significant differences were found between the age groups less than or equal to 15 and greater than 15 years, between the combination age and lesion size, or between four localization groups. The cyst wall and the septa consist of a superficial layer of cellular fibroblastic and histiocytic tissue in which multinuclear giant cells are present, covering a deeper situated zone of less cellular fibrous tissue. This typical layered architecture was found at one or more places in 93 (88.6%) out of 105 cases. However, layered architecture may also be found in cases of teleangiectatic osteosarcoma. It is suggested that the group with a high risk of recurrence be treated more radically, i.e., with cryosurgery.

Adolescent↗
PubMedDate not supplied

Fatal ethibloc embolization of vertebrobasilar system following percutaneous injection into aneurysmal bone cyst of the second cervical vertebra.

A 4-year-old boy developed progressive neck pain and an expansile osteogenic lesion of C2; the diagnosis was an aneurysmal bone cyst. An image-guided biopsy with 3D CT planning was performed followed by Ethibloc injection into the aneurysmal bone cyst. Subsequent CT and MR images demonstrated embolization material in the vertebrobasilar system, and the patient died of brain stem and cerebellar infarction 23 hours after the intervention. The course of events and technical considerations are discussed.

Basilar Artery↗