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A histologically proven case of solitary bone cyst of a cervical vertebral body seems not to have been previously reported. Cysts of sufficient size to be a potential source of pathologic fracture should be excised and filled with autologous bone grafts.
An unusual case of a lytic, expanding lesion of the manubrium with histological diagnosis of aneurysmal bone cyst in a 13-year-old girl is presented. After a recurrence following primary surgery, the patient was treated successfully by external beam radiotherapy. A total dose of 25.2 Gy was delivered using conventional fractionation (1.8 Gy day(-1)) to the whole sternum. She remains recurrence- and symptom-free 46 months after the end of the treatment. This is the sixth patient with primary aneurysmal bone cyst in the sternal region, the first paediatric patient for this location, and the first case of its kind treated exclusively by radiotherapy ever reported in the literature. The histopathological, radiological and clinical findings of the patient are presented, relevant literature is reviewed, and radiotherapeutic management of such lesions is discussed.
Through a series of similarly produced panoramic films, a chronologic picture of a traumatic bone cyst is demonstrated. This case represents a progressive rather than static lesion. The progression of the lesion is indicative of a etiologic process other than the solitary inciting event usually associated with traumatic bone cysts.
A review in depth of the recent literature relating to bone cysts and their treatment discloses many important differences in case material, and concern about the frequency of recurrence after surgical treatment by curretage and the insertion of grafts. The newer forms of treatment, subtotal resection, with or without the insertion of autogenous grafts, and even diaphysectomy, should still be considered to be on trial, despite the fact that the first patients who had these operations have now been followed for five to 15 years. Definitive evaluation of each procedure awaits its use in a large enough number of cases, well documented as to criteria for selection, clinical data, complications, and follow-up.
Seven children were treated surgically as a result of a pathologic fracture through a simple bone cyst in the subtrochanteric region of the proximal femur. Average age at surgery was 10.6 years. Six children were treated primarily. One child was operated for a refracture through a persistent cyst and malunion of a previous fracture that had been treated nonoperatively. Surgery included curettage of cysts in all patients. The cysts were filled with autologous bone graft in five patients and Osteoset bone substitute in two patients. The fracture was stabilized using a blade plate in three patients, a screw and side plate in three patients and an external fixator in one. At average follow-up of 4.7 years, all fractures had healed uneventfully. The cyst was fully obliterated in five patients and partially obliterated in two patients. One patient had a relative lengthening of 2 cm on the affected side. All patients were asymptomatic, fully active and had full range of motion.
Contemporary views on etiology and treatment for solitary bone cyst are presented. Coehn theory of metaphyseal blood flow disturbances as the cause of solitary cyst formation has been emphasized. Minimally invasive treatment modalities have been honored as steroid or autogenous marrow injections into the cyst. Campannaci classification, the most versatile one, embracing various types of cyst remodeling after treatment has been introduced in Polish literature for the first time.
The authors have operated on 12 children with solitary unicameral bone cysts of the upper femoral extremity. They opened the cysts widely, resecting one third of the bone circumference, reinforcing the bone solidity by a nail plate and filling the cavity with autogenous bone grafts. 11 cysts healed, 1 recurred. Some residual deformities were noted (coxa valga or vara).
Aneurysmal bone cyst (ABC) is a benign lesion and generally occurs in the long bones and vertebral column. ABC of the rib is an uncommon entity. Two cases of ABC involving the rib are reported. Its occurrence in the eight decade of life as manifested in one of our patients is extremely rare. The aetiology, clinical manifestations, pathology and treatment are briefly discussed. En bloc resection of the lesion is curative, and offers a good cosmetic and functional result.
Results of treatment of 17 patients operated because of aneurysmal bone cyst have been assessed. Age at the onset of symptoms ranged from 4 to 39 years, 14 on an average. There were 6 aggressive and active cysts in this series according to the Campanacci classification. Treatment consisted of segmental resection of the bone in 5 patients, curettage of the lesion filing of the defect with autogenous bone in 11 cases. Recurrence of the cyst has been observed in 3 patients, only one of them had aggressive type of tumor.
Aneurysmal bone cysts (ABC) are benign osteolytic lesions that are more common in young people than in adults and involve the skull only exceptionally. The origin of ABC is still debated; indeed, some authors consider ABC to be an anomalous bony reaction that is secondary to traumas or tumours. Conversely, others consider ABC to be a distinct entity. A case of a healthy young female affected by a left frontal ABC is reported here. The clinical onset was characterised by the sudden appearance of a tender and mildly painful frontal mass. Neuroradiological assessment showed a well-circumscribed lytic lesion of the frontal bone with predominantly outward extension. En bloc surgical removal of the lesion was successfully achieved; a reconstructive cranioplasty was also performed to repair the cranial defect. The rarity of the condition described, together with the absence of clear guidelines, prompted us to review the more recent literature with the twin goals of identifying radiological features and becoming able to address the diagnosis and rules for treatment of such a rare entity.
Ninety-five consecutive cases of unicameral bone cyst treated at the Istituto Ortopedico Rizzoli by intracystic injections of methylprednisolone acetate were retrospectively reviewed. Eighty per cent of the patients had a satisfactory result. Of the 20% failures, 13.5% had a recurrence of the cyst. Recurrence after methylprednisolone acetate treatment is a previously unrecognized entity, with recurrence risk factors associated with multiloculation, cyst size and age of the patient.
Scapular clicking with shoulder motion has been described for a variety of conditions. Two unusual cases, a lymphangioma of the thoracic wall in a 42-year-old man and an aneurysmal bone cyst of the scapula in an 8-year-old boy, are presented. The lymphangioma was treated by marginal excision of the lesion and the aneurysmal bone cyst, by excision of the infraspinal portion of the scapula with resolution of symptoms.
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Three cases of aneurysmal bone cyst affecting the hand are reported. Some aspects of incidence, aetiology and treatment are discussed.
Aneurysmal bone cysts in the skull vault are reported in two patients 7 and 9 years old, who presented with vomiting and headaches caused by raised intracranial pressure. CT showed the cystic lesion in the diploë, with predominantly inward expansion. Fluid-fluid levels were seen on both CT and MRI; the latter also showed bleeding within the cyst. MR angiography showed compression of the superior sagittal sinus in the second case.