Modern concepts of primary aneurysmal bone cyst

Pathological Fractures in Aneurysmal Bone Cysts: A Systematic Review

Background: Aneurysmal bone cysts (ABCs) are osteolytic, non-malignant, vascular lesions of the bone. Pathological fractures can be a manifestation of the ABCs, which occur in about 8% of ABCs. Different treatments have been described in the literature, but, nowadays, an optimal management of the pathological fractures in patients with ABCs is still a matter of debate and there are no standard guidelines for treatment nor any shared indication about the best surgical intervention. The aim of our study is to review the current literature available on this matter exploring and confronting different surgical treatments for pathological fractures in ABC in order to clarify the surgical approach to these patients. Methods: A systematic review of the literature indexed in PubMed, MEDLINE, and Cochrane Library databases was carried out. The Preferred Reporting Items for Systematically Reviews and Meta-Analyses (PRISMA) were followed. Results: A total of 37 articles were relevant and were finally included in the study. In total, we reached a population of 140 patients. Of the 140 patients included in the review, 124 patients (88.6%) underwent curettage surgery, 15 patients (10.7%) underwent en bloc resection surgery. A total of 47% of patients (70) underwent synthesis surgery with a plate, screw, nail, or external fixator. Adjuvant treatments were used in 8.6% of patients (12). Complications involved 20.7% of the patients (29). Conclusions: In conclusion, the treatment of pathological fractures in aneurysmal bone cysts requires careful patient assessment, considering factors such as age, the presence of open growth plates, the location of the lesion, and the surgeon's expertise.

Aneurysmal bone cyst: Is selective arterial embolization effective as curettage and bone grafting?

INTRODUCTION

Aneurysmal bone cyst (ABC) is a lytic benign bone lesion representing about 1% of all primary bone tumors. Method to treat ABC's have developed over time. The standard of care cure for ABC has been curettage with or without bone grafting of the defect but is burdened by recurrence rates of approximately 25%-31%. Based on the assumption that ABCs usually supplied by one or more pathological feeding arteries, selective arterial embolization has been described as an adjuvant preoperative procedure to reduce intra-operative hemorrhage, and as primary treatment for lesions in difficult surgical access. In the current study, we therefore asked whether (1) a single or a repeat selective arterial embolization (SAE) for treating ABCs would produce comparable healing rates compared with curettage and bone grafting; (2) evaluated the relationship of recurrence in relation to the site of the cyst, the age, and gender of the patients; and (3) the two techniques differ in term of long-term complication.

MATERIAL AND METHODS

We retrospectively reviewed 265 patients who underwent curettage and bone grafting or SAE performed at our institute from 1994 to 2018. The diagnosis of ABC was always established with percutaneous CT-guided biopsy or open biopsy. Patients were followed clinically with plain radiographs or CT scan at 3, 6, 9, and 12 months then annually in the absence of symptoms. Treatment success was determined evaluating pre- and postprocedural imaging according to Chang classification.

RESULTS

Two hundred and nineteen were treated with curettage and bone grafting (curettage group), and 46 with SAE Group. Of the 219 patients treated with Curettage and bone grafting (curettage group), 165 out of 219 (75.3%) experienced bone healing, while local recurrence was observed in 54 cases (24.7%) after 12 months on average (range: 3-120 months) from surgery. After the first SAE, bone ossification was seen in 27 (58.7%), without needing any further treatment. Eleven recurred patients were treated with SAE (four patients need two while seven need three SAE to heal), and eight patients with curettage and bone grafting. Thirty-eight out of 46 (82%) patients experienced bone ossification regardless the number of SAE. The overall rate of local recurrence for all patients was 26.7%. SAE group presented a lower complication rate (6%) where two patients experienced skin necrosis, and one limb-length discrepancies (2% of all cohort).

DISCUSSION

The use of SAE is an attractive option to treat ABC as it combines on one hand a lower complication rate than curettage and bone grafting, on the other it can be carried out in case of nonresectable ABCs, significantly reducing the size of viable ABC lesions, fostering bone remodeling and mineralization, and most importantly, significantly improving the patient's quality of life.

Polidocanol sclerotherapy for the treatment of aneurysmal bone cyst, with or without pathological fractures: A prospective, comparative study

Introduction

Polidocanol sclerotherapy in the treatment of aneurysmal bone cysts (ABCs) with or without pathological fractures has been a topic of debate. While some studies recommend intralesional curettage as the preferred treatment, others suggest intralesional sclerosants as an effective alternative.

Material and methods

This study evaluates the use of polidocanol-based percutaneous sclerosant therapy in 28 patients with ABCs, of which 8 patients had pathological fracture. The patients received injections every four weeks based on clinical and radiological evaluation of the cyst, and the study assessed the results and complications of the treatment.

Results

In group A (without pathological fractures), 14 out of 17 (82.4 %) lesions healed without any significant residual lesion. Three out of 17 (17.6 %) patients required further surgical intervention and were treated by curettage and bone grafting, definitively. Minor local inflammatory reaction was observed in 3 patients, which resolved without intervention within 3-4 days. In group B, all the 8 patients (100 %) with pathological fracture in their lesions healed as Grade 1 healing, without any significant residual lesion. One patient developed an episode of anesthesia related complication (delayed recovery) which resolved within an hour, without any residual effect. At final follow up, no recurrence was seen in any patient.

Conclusion

The study concludes that polidocanol sclerotherapy is an effective treatment option for patients with ABCs, with or without pathological fractures, and has the potential to become the new treatment of choice for pathological fractures due to its low invasiveness, low morbidity, and affordability. However, further research is needed to confirm the efficacy of polidocanol sclerotherapy in larger patient populations and to compare its effectiveness with other treatment options.

Malignant transformation of an aneurysmal bone cyst of the femoral neck: A case report

Aneurysmal bone cyst (ABC) is a benign, distending, osteolytic and locally aggressive bone tumor that is mostly associated with trauma. Approximately 1% of bone tumors are ABCs, which are most prevalent in adolescents and are usually detected in the spine and long tubular bones. The diagnosis of ABC mainly relies on histopathology, malignant transformation is rare, and the chance of malignancy increases if there are multiple recurrences. Due to the rarity of reports of malignant transformation of ABCs into osteosarcoma, there is still considerable debate on the appropriate treatment strategy. The current paper presents a case of aneurysmal bone cyst malignant to osteosarcoma and the therapeutic measures to provide expertise for the diagnosis and treatment of ABCs that are malignant to osteosarcoma.

Single dose intralesional doxycycline foam infusion promotes bone growth and resolution of an odontoid aneurysmal bone cyst

Background

Aneurysmal bone cysts (ABCs) are locally invasive bone tumors that most commonly arise in long bone metaphyses, the vertebral column, and pelvis, often presenting in the second decade of life. ABCs can be treated with resection, radiation, arterial embolization, and intralesional curettage. More recently intralesional doxycycline foam injections, which appear to act through the inhibition of matrix metalloproteinases and angiogenesis, have been used successfully, although multiple treatments are often required with this approach.

Case Description

A 13-year-old male with an incidentally discovered ABC filling much of the odontoid process but not violating the native odontoid cortex was treated with a single intralesional doxycycline foam injection delivered through a transoral approach with an excellent radiographic result. After placing a Crowe-Davis retractor, a transoral exposure of the odontoid process was performed with neuronavigation guidance. A fluoroscopy-guided Jamshidi needle biopsy was performed and via the needle doxycycline foam (2 mL 50 mg/mL doxycycline, 2 mL 25% albumin, and 1 mL Isovue 370 mixed with 5 mL of air) was infused, filling the cystic cavities of the odontoid process. The patient tolerated the operation well. Two months postoperatively, a computed tomography (CT) scan demonstrated a decrease in the size of the lesion with substantial new bone formation. Repeat CT at 6 months showed no residual cystic lucency, formation of dense new bone, and only minimal irregularity of the cortex at the prior needle biopsy site.

Conclusion

This case illustrates that the use of doxycycline foam can be an excellent option when managing ABCs that cannot be resected without incurring significant morbidity.

The treatment of aneurysmal bone cysts

PURPOSE OF REVIEW

Aneurysmal bone cysts are rare, locally aggressive bone tumors. Optimal treatment of ABCs is still matter of debate as therapies including sclerotherapy, selective arterial embolization and systemic treatment with denosumab are increasingly utilized, in addition to or instead of traditional curettage. The purpose of this review is to discuss current concepts and difficulties in diagnosing and treating primary ABCs, based on latest available literature.

RECENT FINDINGS

In diagnostics, multiple new fusion partners of USP-6 have been described on next-generation sequencing specifically for primary ABCs. In a recent systematic review, failure rates of percutaneous injections and surgery were comparable. In a literature review, the use of denosumab seemed effective but resulted in multiple cases of severe hypercalcemia in children.

SUMMARY

Accurately diagnosing primary ABC is crucial for treatment decisions. Curettage remains a valid treatment option, especially with adjuvant burring, autogenous bone grafting and phenolization. Percutaneous sclerotherapy represents a solid alternative to surgery, with polidocanol showing good results in larger studies. Systematic therapy with denosumab exhibits favorable results but should be reserved in the pediatric population for unresectable lesions, as it may result in severe hypercalcemia in children. When selecting a treatment option, localization, stability and safety should be considered.

Do's and Don'ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients

BACKGROUND

Aneurysmal bone cysts (ABC) are rare benign cystic bone tumors, generally diagnosed in children and adolescents. Proximal femoral ABCs may require specific treatment strategies because of an increased pathologic fracture risk. As few reports are published on ABCs, specifically for this localization, consensus regarding optimal treatment is lacking. We present a large retrospective study on the treatment of pediatric proximal femoral ABCs.

METHODS

All eligible pediatric patients with proximal femoral ABC were included, from 11 tertiary referral centers for musculo-skeletal oncology (2000-2021). Patient demographics, diagnostics, treatments, and complications were evaluated. Index procedures were categorized as percutaneous/open procedures and osteosynthesis alone. Primary outcomes were: time until full weight-bearing and failure-free survival. Failure was defined as open procedure after primary surgery, >3 percutaneous procedures, recurrence, and/or fracture. Risk factors for failure were evaluated.

RESULTS

Seventy-nine patients with ABC were included [mean age, 10.2 (±SD4.0) y, n=56 male]. The median follow-up was 5.1 years (interquartile ranges=2.5 to 8.8).Index procedure was percutaneous procedure (n=22), open procedure (n=35), or osteosynthesis alone (n=22). The median time until full weight-bearing was 13 weeks [95% confidence interval (CI)=7.9-18.1] for open procedures, 9 weeks (95% CI=1.4-16.6) for percutaneous, and 6 weeks (95% CI=4.3-7.7) for osteosynthesis alone ( P =0.1). Failure rates were 41%, 43%, and 36%, respectively. Overall, 2 and 5-year failure-free survival was 69.6% (95% CI=59.2-80.0) and 54.5% (95% CI=41.6-67.4), respectively. Risk factors associated with failure were age younger than 10 years [hazard ratios (HR)=2.9, 95% CI=1.4-5.8], cyst volume >55 cm 3 (HR=1.7, 95% CI=0.8-2.5), and fracture at diagnosis (HR=1.4, 95% CI=0.7-3.3).

CONCLUSIONS

As both open and percutaneous procedures along with osteosynthesis alone seem viable treatment options in this weight-bearing location, optimal treatment for proximal femoral ABCs remains unclear. The aim of the treatment was to achieve local cyst control while minimizing complications and ensuring that children can continue their normal activities as soon as possible. A personalized balance should be maintained between undertreatment, with potentially higher risks of pathologic fractures, prolonged periods of partial weight-bearing, or recurrences, versus overtreatment with large surgical procedures, and associated risks.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Allogenic Bone Impaction Grafting: Mid-to Long-term Results

OBJECTIVE

Recurrence is the main hinderance in treatment of aneurysmal bone cysts (ABCs). Therefore, several treatment modalities and adjuvant therapies have been proposed. In this study, we aim to evaluate the long-term effectiveness of percutaneous curettage and allogenic bone grafting as a new, minimally invasive modality in treating ABCs.

METHODS

We performed a retrospective review of the medical records of patients diagnosed with primary ABCs at a university hospital over a 10-year period (2000-2010). We selected all patients who were diagnosed with primary ABC in the extremities and pelvis, treated with the same surgical procedure, and were followed for at least 2 years postoperatively. All patients underwent the same procedure of percutaneous curettage and impaction of allogenic pulverized fine bone fragments (harvested from locally stored femoral heads) mixed with autologous bone marrow aspirate from the iliac bone. We reported patient's characteristics (age and gender), site and size of the lesion, presenting symptoms, Capanna classification, follow-up duration, and post-operative complications. Assessment of cyst healing was based on the appearance on radiographs according to the modified Neer classification.

RESULTS

Nineteen patients were included in this study; 10 patients were males and nine were females. The mean age was 9.6 years (range 3-15). The location of the lesions was as follows: femur (eight), tibia (four), pelvis (four), proximal humerus (one), distal radius (one), and calcaneus (one). The most common presenting symptom was pain in the involved area. Pathological fracture was the presenting feature in two patients. The mean follow-up duration was 6.4 years (range 2-18). The earliest radiological sign of incorporation of the allograft was seen at 3 months after surgery. All patients showed bone remodeling and radiographic resolution (classified as either A or B on the modified Neer classification) of their cystic lesions within 6 months. No local recurrence, infection, or pathological fractures occurred during the follow-up period.

CONCLUSION

Percutaneous curettage and impaction of allogenic bone graft mixed with autogenic bone marrow aspirate is an efficient, minimally invasive, reproducible, and affordable procedure for the treatment of primary ABCs.

Solid-variant aneurysmal bone cysts in the craniofacial skeleton: the role of genomic analysis

BACKGROUND

Solid variant aneurysmal bone cysts (SVABCs) are a rare but well-described subtype of ABCs. While classic ABCs are readily identified radiographically, SVABCs lack these characteristic radiographic features and thus have a wide differential diagnosis on presentation (including Ewing sarcoma, Langerhans cell histiocytosis, osteosarcoma, metastasis, and giant cell tumor). Genomic/molecular analyses are often necessary for the diagnosis of SVABCs, with USP6 rearrangements being a characteristic finding. We present two cases in which genomic analysis was critical in the diagnosis of SVABCs and revealed unique gene fusions that may provide insight into SVABC pathogenesis.

CASE DESCRIPTIONS

Two 13-year old male children presented to our institution with new mass lesions involving the craniofacial skeleton. Magnetic resonance imaging (MRI) in both cases revealed predominantly solid, avidly enhancing masses, one of the squamous portion of the temporal bone, and the other arising from the sphenopalatine foramen with extension into the ipsilateral maxillary and ethmoid sinuses. Histopathology displayed predominantly solid morphology, and next generation sequencing (NGS) revealed a FAT1-USP6 gene fusion in the temporal lesion, and a MIR22HG-USP6 gene fusion in the maxillofacial lesion, the latter of which was not identified on fluorescence in situ hybridization (FISH). These findings were most consistent with a diagnosis of SVABC in each case.

CONCLUSIONS

These two cases highlight novel gene fusions in atypically located SVABCs and emphasize the ability of NGS to more accurately and consistently identify USP6 gene fusions, particularly in SVABCs that may otherwise be indistinguishable from alternative pathologies.

Multiple Primary Aneurysmal Bone Cysts: A Case Report and Literature Review

Herein, we report the case of a 12-year-old boy diagnosed with multiple aneurysmal bone cysts (ABCs) who had previously undergone surgery on the proximal left tibia, proximal left femur, and distal tibia. During follow-up after the surgery, he developed another lesion on the proximal left humerus. Although rare, the pathological diagnosis was multiple ABCs.

Minimally invasive treatment of aneurysmal bone cysts: Systematic literature review

INTRODUCTION

The optimal treatment of aneurysmal bone cysts (ABC) remains controversial. Surgery has long been considered as the treatment that yields the best outcomes. Some authors now prefer using less invasive options as the primary treatment. The primary objective of this systematic literature review was to determine if treatments that are less invasive than surgery are also effective in curing the ABC. The secondary objective was to determine the respective role of each treatment in the therapeutic arsenal.

HYPOTHESIS

Less invasive treatments can replace surgery as the base treatment for ABC.

PATIENTS AND METHODS

A PubMed® search was carried out for this review. The inclusion criteria were ABC treatment without cyst removal, case series, clinical case reports, reviews, publication in French or English. Excluded were articles that described the results of surgical treatment only, cranial or maxillofacial cysts, secondary ABC, duplicates, no abstract available. Based on the first six items of the "MINOR criteria", we selected 42 studies. For each selected study, we analyzed the number of cases, clinical response to treatment, radiological healing, recurrence or failure rate, complications and side effects of the treatment.

RESULTS

This review found that less invasive treatments generate results that are at least as good as surgery, often with fewer complications. Thus, in certain cases, these treatments can be recommended as first-line therapy. This category includes selective arterial embolization, sclerotherapy (alcohol, polidocanol) and injection of demineralized bone matrix.

DISCUSSION

Selective arterial embolization yields good results. While this is a difficult, operator-dependent technique that is not suitable for all ABCs (no identifiable feeding vessel), we recommend it as the primary treatment for spinal ABCs. For ABCs in other locations, sclerotherapy can be used as the primary treatment. However, this treatment becomes inconvenient if the number of injections is too high. Radiation therapy is not a first-line treatment because of its side effects. Bisphosphonates and denosumab can be used when the other treatments are contraindicated.

Aneurysmal bone cyst of the proximal femur concomitant with Graves' disease and Moyamoya disease: report of a rare case

Aneurysmal bone cyst is a type of benign bone pathology with expansile and osteolytic features whose etiology remains unclear. Graves' disease is an autoimmune disease characterized by diffuse goiter and hyperthyroidism. Moyamoya disease is a progressive cerebral vasculopathy. It has been reported that Graves' disease and Moyamoya disease share a similar etiology involving cytokines and autoimmune and genetic factors. There are no previous reports regarding the relationship between aneurysmal bone cyst and Graves' disease. Here, we present the rare case of a 25-year-old woman with suspected aneurysmal bone cyst of the left proximal femur and a definite preoperative diagnosis of Graves' disease, in whom lesion resection combined with left total hip replacement was indicated. Biopsy confirmed the diagnosis of aneurysmal bone cyst. Three days postoperatively, the patient developed acute ischemic cerebral infarction owing to Moyamoya disease, which was subsequently confirmed. This case elucidates the potential interaction among aneurysmal bone cysts, Graves' disease, and Moyamoya disease and provides lessons regarding appropriate perioperative preparation for patients with Graves' disease who require surgery to avoid potential severe complications.

Clinicoradiological spectrum of primary aneurysmal bone cysts of the maxillofacial region: A series of 31 cases

OBJECTIVES

The aim of the current study was to analyse the demographic, clinical and radiological features of primary aneurysmal bone cysts (ABCs) involving the maxillofacial region.

METHODS

Histologically confirmed cases affecting the maxillofacial region were retrospectively reviewed over a 21 year period (2000-2021). Cases were collected from the archives of five Oral Pathology laboratories from three countries: South Africa, Guatemala and Brazil. The information was analysed, with emphasis on the clinical and radiological spectrum.

RESULTS

Following the inclusion criteria, a total of 31 cases of primary ABCs were included in the study. A nearly equal male-to-female distribution was seen, with ABCs occurring in males at an earlier age compared to females. Localised swelling was the main clinical presentation. ABCs had a mandibular predominance, particularly in the posterior regions. All ABCs presented as blow-out expansile well-demarcated radiolucent lesions with the majority having a multilocular appearance. Cortical expansion was seen in 91% of cases with loss of cortical integrity being common (78%).

CONCLUSION

Primary ABCs involving the maxillofacial region are extremely rare with the majority of current published literature consisting of isolated case reports. The current study is the first large series detailing the radiological features.

Primary Aneurysmal Bone Cyst of Nasal Cavity and Sinuses in a Child: Case Report and Literature Review

INTRODUCTION

Aneurysmal bone cysts (ABCs) are a rare benign bone lesion, which are divided into primary and secondary categories, and occur mainly in the vertebra and the long tubular bones. Primary ABCs in the nasal cavity and the sinuses are rare.

CASE PRESENTATION

We reported on a one-year-old boy who suffered from progressive nasal obstruction and intermittent nosebleeds over a period of approximately 1 month. The patient had no history of trauma or surgery. Physical examination showed a red tumor in his right nasal cavity. A magnetic resonance imaging scan showed a multicystic lesion arising from the ethmoid sinus. The lesion was resected under a nasal endoscope without any complications. Histological evaluation confirmed that the lesion was an aneurysmal bone cyst. Because an osteoma was found during the surgery on the cyst, the lesion was considered secondary clinically. However, fluorescence in situ hybridization testing showed a rearrangement of the USP6 (ubiquitin-specific protease 6) oncogene on chromosome 17. No recurrence was observed after 1 year.

CONCLUSION

An ABC of the nasal cavity and sinuses in such a young child is very rare and needs to be further analyzed according to postoperative pathology and combined with a genetic examination to make a diagnosis. Endoscopic sinus surgery is an effective method of treatment for this kind of disease.

A 5-Year-Old Female With an Aneurysmal Bone Cyst of the Proximal Humerus

An aneurysmal bone cyst (ABC) is a non-malignant, skeletal tumor that is extremely rare and most commonly presents within the first two decades of life. Genetic mutation of the USP6 gene on chromosome 17 remains to be the most commonly accepted reasoning as ABC’s etiology remains unknown. As the radiographic appearance of ABC is quite similar to other kinds of bone cysts, a histological diagnosis is often required to attain a definitive diagnosis. Curettage remains the gold standard treatment with high chances of local recurrence. Evidence has shown the beneficial applications of administering a sclerosing agent. Further trials would improve the level of evidence available for physicians to make a better management plan. We have demonstrated the treatment of an aneurysm bone cyst of the proximal humerus on a 5-year-old female in this report, which might be utilized as a reference for future procedures.

Unilateral Biportal Endoscopic Tumor Removal and Percutaneous Stabilization for Extradural Tumors: Technical Case Report and Literature Review

Background:

Extradural spinal tumors arise from soft or bony tissues in the spine and account for majority of spinal tumors. Interest in the unilateral biportal endoscopic (UBE) technique is rising, because it can easily decompress the bony spinal canal and accommodate all open surgical instruments under endoscopic guidance. However, reports of this technique have been limited to certain diseases. This study first demonstrates the UBE technique for extradural tumor biopsy and removal, and percutaneous stabilization in a 72-year-old female patient with dramatic symptom improvement.

Methods

We used the UBE technique for decompression and the percutaneous screw fixation technique for stabilization in a patient with an extradural mass compressing the thecal sac and destroying the posterior element. Under endoscopic guidance, a unilateral approach was used, and decompression and flavectomy were performed bilaterally. After decompression, tumor removal and biopsy were performed using various forceps and biopsy needles. After confirming sufficient spinal canal decompression, the screw was placed percutaneously. We evaluated the technical process of the procedure, the patient's pre- and postoperative pain (using the visual analog scale), and operative radiology and pathologic results.

Results

Postoperative pain and disability improved clinically, and spinal alignment stabilized radiologically. As the pathology findings confirmed an aneurysmal bone cyst, the treatment was completed without adjuvant therapy.

Conclusions

We treated an unstable spine due to an extradural tumor with the UBE and percutaneous screw techniques.

Aneurysmal Bone Cyst Presenting as Fragility Fracture: A Case Report Focused on the Rehabilitation Approach

Aneurysmal bone cysts are rare lesions, comprising one to six percent of primary bone tumors. Despite benign, those may be locally aggressive. We report a pediatric case with an atypical presentation. The patient was a seven-year-old boy, admitted to an emergency room due to right inguinal pain, without a history of trauma. The symptoms had acute onset and worsened gradually for five days. Radiographs revealed a cystic lesion on the proximal right femur and two longitudinal fractures. After further diagnostic work-up and given the probable diagnosis of an aneurysmal bone cyst, surgical treatment was performed. The diagnosis was then confirmed by histopathological analysis. After surgery, the patient maintained severe pain, having an important range of motion (ROM) and muscular strength reduction on the affected limb. As so, the patient engaged in a daily tailored Physical Medicine and Rehabilitation (PMR) program, for four months. After concluding the treatment plan, the patient was asymptomatic: recovery of both ROM and muscular strength was achieved, as well as the ability to return to previous daily-life activities. This is a paradigmatic case in which a rare condition with a rare presentation was displayed after several others were ruled out, requiring a multidisciplinary approach.

Neoplastic Elbow Diseases and Mimickers

Tumors around the elbow are infrequent, and delayed diagnosis is a common theme because of the low incidence and lack of familiarity. However, just like any other site, the radiologic work-up of musculoskeletal tumors around the elbow remains the same, with plain films the first investigation in a patient with a suspected bone tumor and ultrasound the first modality to evaluate a soft tissue lump. The management of both bone and soft tissue tumors around the elbow is unique because of a large number of important structures in an anatomically confined space and little normal tissue to spare without severely compromising the joint's function. Many benign nonneoplastic entities can mimic bone and soft tissue tumors on imaging. It is important to keep the characteristic imaging appearance in mind while formulating a differential diagnosis to avoid an unnecessary additional work-up. This article reviews the most common benign and malignant bone and soft tissue tumors around the elbow, mimickers, imaging features, and current therapeutic concepts.

Selective arterial embolization of aneurysmal bone cyst in the pubic bone: A possible primary treatment

Aneurysmal bone cyst is a benign highly vascular lesion that occurs in children. Traditionally ABCs were treated by surgical resection. However, lesions at difficult to access anatomical locations such as the pelvis have higher morbidity when treated surgically. Recently with the advances in endovascular treatment selective arterial embolization became a promising option for primary treatment of ABC. The authors present a case of a 14-year-old female with a pelvic ABC that was successfully treated by selective arterial embolization. Selective arterial embolization is a cost-efficient way of managing ABC especially in cases where surgical treatment carries high risk.

Qualitative evaluation of MRI features in aneurysmal bone cysts after percutaneous sclerotherapy

OBJECTIVE

To report MRI findings of changes seen in aneurysmal bone cysts after percutaneous sclerotherapy treatment.

MATERIALS AND METHODS

After applying exclusion criteria, a total of 36 patients who had aneurysmal bone cysts and undergone percutaneous sclerotherapy were included in this study. The pre-treatment and post-treatment MRIs were reviewed and multiple pre-determined MRI findings were evaluated. The presence of each post-treatment finding, as well as the time for each finding to develop, was recorded.

RESULTS

Early post-sclerotherapy changes include increased perilesional edema and enhancement, which appear on MRI on average 5.1 months after the initial sclerotherapy. This is followed by decreased cystic areas, which can be seen on average 5.9 months after the initial treatment. The presence of fibrosis, improved cortical integrity, and improving mass effect are later post-treatment changes and appear on MRI on average 9.7 months, 10.6 months, and 16.1 months after the initial sclerotherapy, respectively.

CONCLUSION

The early and late post-sclerotherapy MR findings of aneurysmal bone cysts were reported in this study.

Aneurysmal Bone Cysts of the Paranasal Sinuses: The Mayo Clinic Experience and Review of the Literature

OBJECTIVE/HYPOTHESIS

Aneurysmal bone cysts (ABCs) are benign, lytic bone lesions, which rarely present in the paranasal sinuses. There is no published consensus on the appropriate diagnostic or treatment approach. Our objective was to elucidate the clinical behavior, treatment, and outcomes for patients with ABCs of the paranasal sinuses (psABCs).

STUDY DESIGN

Retrospective case series and system review of the literature.

METHODS

A retrospective chart review was performed to identify patients evaluated at the authors' institution with psABC and consolidated with literature reports of psABC.

RESULTS

Eighty-nine patients met inclusion criteria. The most common presenting symptom was painless facial swelling (n = 35, 39%). The ethmoid sinuses were the most common site involved (n = 55, 62%). Surgical approach was reported in 74 cases including 20 endoscopic and 54 with an open or combined approach. Fifty-nine patients (71%) underwent gross total resection. Follow up data was reported for 67 patients. Fifteen patients (22%) were found to have recurrence or progression at follow up; 10/15 (66%) patients within the first 12 months, 14/15 (93%) within the first 24 months, and 1/15 (7%) greater than 24 months after treatment. Patients were more likely to have recurrence/progression if they presented with nasal discharge (P = .05), proptosis (P = .01), or orbital involvement (P = .03).

CONCLUSIONS

psABCs typically present with painless swelling or nasal obstruction. Orbital involvement is a negative prognostic indicator with these patients more likely to have recurrence after treatment. Recurrence or progression of disease is most likely to occur within 2 years after treatment. Therefore, patients should be monitored closely during this time.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E2525-E2533, 2021.

Is percutaneous injection of bone marrow concentrate, demineralized bone matrix and PRF an alternative to curettage and bone grafting for treating aneurysmal bone cyst?

To determine the efficacy and safety of a single injection with autologous bone marrow concentrate (BMC) combined with demineralized bone matrix (DBM) and platelet-rich fibrin (PRF) compared to curettage and bone grafting for treating aneurysmal bone cysts (ABC). Two hundred thirty-nine patients were treated with curettage and bone grafting (Curettage Group), and 21 with percutaneous injection of DBM associated with autologous BMC and PRF (DBM + BMC + PRF Group). All patients attended the outpatient clinic to assess ABC healing and clinical results at the first 3, 6, 9 and 18 months after surgery and then annually in the absence of symptoms. The mean follow-up was 42 months for the Curettage Group (range 6-180 months) and 28 months for the DBM + BMC + PRF Group (range, 6-85 months). Out of the 21 patients who had injection with BMC, DBM, and PRF, 17 (80%) require no additional treatment and they were considered healed. Of the 239 patients treated with curettage and bone grafting after core needle or open biopsy, 177 (74%) were considered healed after the first treatment. Injection in comparison with curettage presented the same risk for local recurrence. The overall rate of local recurrence for all patients was 25%. Univariate and multivariate analyses showed a significant difference in local recurrence rates in patients younger than 15 years, and for the cyst located in the long bones of the lower limbs than the cyst located in the long bones of the upper limbs.

Efficacy of treatment interventions for primary aneurysmal bone cysts: a systematic review

AIMS

Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones.

METHODS

A systematic review of the published literature was performed to identify all articles relating to the management of primary ABCs. Studies required a minimum 12-month follow-up and case series reporting on under ten participants were not included.

RESULTS

A total of 28 articles meeting the eligibility criteria were included in this review, and all but one were retrospective in design. Due to heterogeneity in study design, treatment, and outcome reporting, data synthesis and group comparison was not possible. The most common treatment option reported on was surgical curettage with or without a form of adjuvant therapy, followed by injection-based therapies. Of the 594 patients treated with curettage across 17 studies, 86 (14.4%) failed to heal or experienced a recurrence. Similar outcomes were reported for 57 (14.70%) of the 387 patients treated with injection therapy across 12 studies. Only one study directly compared curettage with injection therapy (polidocanol), randomizing 94 patients into both treatment groups. This study was at risk of bias and provided low-quality evidence of a lack of difference between the two interventions, reporting success rates of 93.3% and 84.8% for injection and surgical treatment groups, respectively.

CONCLUSION

While both surgery and sclerotherapy are widely implemented for treatment of ABCs, there is currently no good quality evidence to support the use of one option over the other. There is a need for prospective multicentre randomized controlled trials (RCTs) on interventions for the treatment of ABCs. Cite this article: Bone Jt Open 2021;2(2):125-133.

Aneurysmal Bone Cyst of the Medial Cuneiform: A Case Report

The aneurysmal bone cysts, usually found in the tibia, femur, pelvis, or humerus, are expansile pseudotumor lesions of unknown etiology. An aneurysmal bone cyst is rarely seen in the medial cuneiform. In this case report, a 43-year-old man with an aneurysmal bone cyst in the left medial cuneiform is presented. The cyst was curetted, and the defect was filled with an en bloc iliac crest graft. A screw was placed to fix the graft in the proper position. In the 2-year follow-up of the patient, recurrence was not detected radiologically.

Validating the management paradigm for pediatric spinal aneurysmal bone cysts to optimize long-term outcomes: an institutional experience

BACKGROUND

The optimal clinical management and outcomes of rare pediatric spinal aneurysmal bone cysts (spABC) is largely anecdotal. Current practice is based on bigger adult series, although given the disparities in spine growth of adults versus children, what impact this difference may have on long-term outcomes has yet to be substantiated. Correspondingly, the aim of this study was to describe the clinical course of all pediatric spABC cases managed at our institution to better understand this.

METHODS

A retrospective cohort study of all pediatric spABC cases presenting to our institution between 1993 and 2017 was performed using a predetermined set of selection criteria. Primary outcomes of interest were treatment modalities and their outcomes, recurrence status, and functional status.

RESULTS

A total of 24 pediatric spABC cases satisfied all criteria. Median age of diagnosis was 13.5 years, with 15 females and 9 males. Radicular pain was the presenting symptom in 21 (88%) cases. Diagnostic biopsy was pursued in 9 (38%) cases, pre-operative embolization in 8 (33%) cases, surgical intervention in 23 (96%) cases, and sclerotherapy in 2 (8%) cases. In terms of surgery, there were no intraoperative complications, and gross total resection (GTR) was achieved in 14 of the 23 (61%) cases. Overall, there were 5 (21%) cases which experienced recurrence by a median time of 8 months after initial surgery, all of which had initial subtotal resection. Median follow-up was 5 years, by which all patients demonstrated excellent functional status.

CONCLUSIONS

There are a number of feasible therapeutic modalities and combinations that can be utilized to maximize control of pediatric spABCs and optimize long-term function similar to that of adults, irrespective of developing versus developed spines. The incidence of recurrence is not negligible, and therefore, rigorous long-term surveillance is highly encouraged, particularly within the first post-operative year following mono-modal non-GTR treatment.

Concomitant cemento-osseous dysplasia and aneurysmal bone cyst of the mandible: a rare case report with literature review

Background

Concomitant cemento-osseous dysplasia (COD) and aneurysmal bone cyst (ABC) are rare in the head and neck region. In our search of the English language literature, we found only one case report describing the simultaneous occurrence of COD and ABC in the head and neck region. Here, we report a case of COD associated with ABC. Further, we performed a systematic search of the literature to identify studies on patients with COD associated with nonepithelial lined cysts of the jaws.

Case presentation

The patient was a 32-year-old woman who was referred from a private dental clinic because of a cystic lesion below the mandibular right first molar. She had no pain or significant systemic disease. After performing panoramic radiography and cone-beam computed tomography, the imaging diagnosis was COD with a cystic lesion, such as ABC or solitary bone cyst. Excisional biopsy was performed, which revealed concomitant COD and ABC.

Conclusion

This case of ABC associated with COD provides insight for the diagnostic process of radiographically mixed lesions with cystic changes.

Primary aneurysmal bone cyst of the scapula in adult patient: two case reports and a review of the literature

Aneurysmal bone cyst (ABC) is a rare, benign but locally aggresive bone tumor of unknown origin tumor. It commonly affects children and usually occurs at the metaphysis of long bones. Scapula is a very rare location and ABCs of the scapula have been sparsely described in the literature. Differential diagnosis can be challenging as it shares common radiological and clinicopathological features with other benign and malignant bone tumors. The degree of diagnostic difficulty increases even more when an unusual tumor site has to be taken into account. Here, we describe rare and challenging cases of a primary ABC located at the scapula that was surgically treated. This is the first case report of ABC involving the scapula in adult patient.

Aneurysmal Bone Cysts of Spine: An Enigmatic Entity

Aims

The study was done to review the literature about the intriguing aspects of the aneurysmal bone cyst and to describe our experience with these cases.

Design

Retrospective.

Material and Method

We reviewed the records of all patients with primary spinal tumours whom we managed over last 8 years. We selected the patients with biopsy proven aneurysmal bone cyst (ABC) for our study.

Results

Four patients (two males and two females) were included. The age ranged from 15-18 years. Three of them had neurological deficits and one had only pain. All of them were operated and three required instrumentation for stabilization. Neurological deficits improved in all the cases. However we had to re- operate one of the cases for recurrence and that patient was administered adjuvant radiotherapy.

Conclusions

ABC is not a tumour in real sense but due to destructive nature that are classified as tumours. The patients have an excellent outcome as the disease is benign and has very low recurrence rates if surgical excision is complete. Best treatment modality is complete excision. Aneurysmal bone cyst is one of the uncommon tumors of the spine, and many of its features continue to be unclear even today. There is ambiguity about the definition, etiopathogenesis, radiological characteristics, histopathology and treatment modalities. They are common in young age and etiology is not clear. The presentation is varied with pain being the common symptom and neurological deficit depends on extent of cord involvement. The best treatment is controversial although surgery is believed to be curative in the majority of cases. We here describe our experience with four such cases who had varied clinical presentation and outcome.

Tailored treatment of aneurysmal bone cyst of the scapula: en bloc resection for the body and extended curettage for the neck and acromion

BACKGROUND

The acromion and neck of the scapula are essential components of shoulder function, but the body section is less critical. We treated aneurysmal bone cysts (ABCs) of the neck and ‏acromion with extended curettage and ABCs of the body with en bloc resection.‏ This article reports on local recurrence and the functional outcomes of this approach.

MATERIALS AND METHODS

Seventeen patients with primary ABCs of the scapula were included in this retrospective study. We treated 10 patients with extended curettage and bone grafting and 5 patients with en bloc resection. In 2 cases, both the body and neck were involved. We treated these patients with a combination of curettage and resection. We used the Musculoskeletal Tumor Society score for functional assessment of outcomes.

RESULTS

The mean age of the patients was 20.5 ± 7.4 years. One local recurrence occurred in patients who underwent extended curettage and bone grafting (1 of 12 cases, 8.3%). No recurrence was observed in patients who underwent en bloc resection alone. The mean Musculoskeletal Tumor Society score was 27.9 ± 1 in patients who underwent curettage alone and 24.86 ± 0.7 in patients who underwent en bloc resection alone or in combination with curettage (P < .001).

CONCLUSION

Despite the higher risk of local recurrence after curettage, this method can be selected for the treatment of ABCs of the acromion and neck of the scapula to minimize shoulder disability. For the body of the scapula, en bloc resection is a more reasonable treatment, despite a higher rate of functional impairment.

Surgical clavicle reconstruction after aneurysmal bone cyst resection in a child: A simple method

The clavicle is an infrequent location for primary tumors in general, and aneurysmal bone cyst (ABC) of the clavicle is particularly rare. The challenge of the functional and esthetic result in the treatment of these lesions in the pediatric population is high when considering the reconstruction of critical bone defects. In this article, we present the case of a seven-year-old boy with an ABC in the middle third of the clavicle, treated by resection and reconstruction with free autograft of the fibula stabilized by using an intramedullary titanium nail. We offer a description of the used technique, considerations about treatment options in children, and a follow-up of more than two-and-a-half years.

Atraumatic groin pain secondary to an aneurysmal bone cyst: A case report and literature review

BACKGROUND

Bone lesions can present the multi-displinary team with a challenge by way of diagnosis as some lesions share many radiological and histological characteristics. Giant cell tumours of the bone (GCTB) are relatively common, benign bone tumours. Aneurysmal bone cysts (ABC) are less common benign osteolytic lesions that are histologically similar to GCTBs but produce blood filled cavities. Both GCTBs and ABCs are locally aggressive and are typically found on meta-epiphyseal regions of long bones with pelvic tumours being less common.

CASE SUMMARY

A 17-year old female presented with atraumatic right groin pain and was initially diagnosed with a GCTB on the right superior pubic ramus of the pelvis. The patient was treated successfully with a wide excision, curettage and bone graft and underwent open reduction and internal fixation of the right hemi-pelvis. Following further intra-operative histological investigations, the lesion was diagnosed as an ABC.

CONCLUSION

This patient has had an uncomplicated post-operative course, has returned to comfortable weight bearing and will be reviewed for minimum 5 yr in the out-patient setting to monitor for reoccurrence.

Rare aneurysmal bone cysts: multifocal, extraosseous, and surface variants

Multifocal, extraosseous, and surface aneurysmal bone cysts are rare variants of the primary lesions. The clinicopathological features are similar, and the optimal treatment is surgical. Although local recurrences may occur, the prognosis is excellent. This review article introduces the readers to a rare diagnosis which they may have been previously unfamiliar with, presents the clinicopathological and imaging features of these rare aneurysmal bone cyst variants, and discusses their diagnosis and treatment. The clinicians who treat patients with aneurysmal bone cysts should be familiar with these uncommon entities and their differential diagnosis.

Secondary aneurysmal bone cysts and associated primary lesions: imaging features of 49 cases

PURPOSE

To describe the imaging, anatomic, and clinical features of a series of secondary aneurysmal bone cysts (ABC) and to ascertain their most commonly associated primary bone lesions.

METHODS

Forty-nine cases of histopathologically proven secondary ABCs were retrospectively reviewed. Demographic data and clinical history were obtained. Radiographic, computed tomographic, magnetic resonance, and nuclear medicine imaging were analyzed. Lesion location, imaging characteristics, and associated primary lesions were documented. Linear regression analysis and Chi-squared testing was performed for statistical analysis.

RESULTS

Twenty-four males and 25 females were included, with an age range of 8-79 years (mean 29.7 + - 4.5 years). Eleven types of primary bone lesion were identified, with giant-cell tumor (n = 17, 35%), chondroblastoma (n = 11, 22%), fibrous dysplasia (n = 6, 12%), osteoblastoma (n = 4, 8%) and osteosarcoma (n = 4, 8%) being the most frequent. The lesions involved chiefly the long bone epiphyses (n = 25, 51%). Secondary ABC imaging findings and locations most closely approximated those of their primary counterparts, although fluid-fluid levels were seen at a higher frequency than previously reported in primary chondroblastoma (9/11, 82%), fibrous dysplasia (2/6, 33%), osteoblastoma (4/4, 100%), osteosarcoma (3/4, 75%), and chondromyxoid fibroma (1/2, 50%).

CONCLUSION

The most common primary lesions associated with secondary ABC were giant cell tumor and chondroblastoma, located in the long bone epiphyses. The majority of the secondary ABCs demonstrate predominant imaging characteristics typical of the primary bone lesions, but with a higher presence of fluid-fluid levels.

An Uncommon Presentation of an Uncommon Bone Tumor: A Case Study of a Pathologic Fracture of an Intertrochanteric Aneurysmal Bone Cyst

Aneurysmal bone cyst (ABC) is a benign, destructive lesion characterized by a expansile fluid-filled cystic structure primarily affecting children and young adults. Common treatment modalities include arterial embolization, curette, intralesional injections and en bloc resection with instrumentation placement. We present the case of a 22-year-old patient presenting to the emergency department with an ABC in the intertrochanteric region of the right femur and a minimally displaced pathologic femoral neck fracture. Open biopsy with curettage, bone grafting and cephalomedullary nailing were performed with fracture stabilization and favorable recovery. Reports of these lesions presenting with pathologic fracture are scarce. We discuss treatment modalities and guidelines for ABCs and pathological fractures. Future studies are needed to assess clinical guidelines for the management of ABCs and pathological fractures.

Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features

Objectives

Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor. It has several challenging features. The aim of this study is to identify challenges in the diagnosis and treatment of ABC especially in patients with unusual features.

Methods

This retrospective study involved medical record review of primary ABC patients with one or more of the following features: unusual clinical presentation with a mass or a pathological fracture especially at an unusual age, rare locations, radiological findings suggesting other diagnoses especially sarcoma, and a nondiagnostic histopathology of biopsy samples.

Results

25 patients (17 males and 8 females) were included. Most patients were either younger than 10 or older than 20 years. 10 patients presented with a mass or a pathological fracture. Unusual locations include the scapula, the olecranon, the hamate, the calcaneus, and the first metatarsal bone. Extension into the epiphysis occurred in 2 patients with proximal fibula and olecranon ABCs. Two separate synchronous cysts existed in the proximal epiphysis and middiaphysis of one humerus. Radiological imaging suggested other primary diagnoses in 8 patients. Core needle biopsy was diagnostic in only 2 of 7 patients. The main treatment was intralesional resection/curettage with bone grafting. Wide resection was performed in 4 patients. Recurrence rate was 28%. Recurrence risk factors included the following: age less than 10 years, male gender, and proximal femur location. Late recurrence occurred in 3/7 patients. One patient with asymptomatic radiological recurrence showed subsequent spontaneous resolution one year later.

Conclusions

This study presented multiple unusual features of ABC including: unusual age, rare locations, and nondiagnostic radiological and histopathological findings. These features can complicate the diagnosis and management. Given these features, especially with pathological fractures, a well-planned incision, the use of frozen section examination, and the application of either external fixation or plate osteosynthesis for fracture fixation can be recommended.

Bone tumours around the elbow: a rare entity

Bone tumours around the elbow are rare. Even nowadays diagnostic dilemmas and delays are common. During recent decades the management and prognosis of patients with elbow bone tumours has improved significantly.Benign tumours can be treated using minimally invasive procedures, whereas malignant ones require a multidisciplinary team approach based on an adjuvant therapeutic regimen of chemotherapy, radiotherapy and limb salvage procedures.This article reviews the most commonly encountered elbow bone tumours and their management. Cite this article: EFORT Open Rev 2019;4:133-142. DOI: 10.1302/2058-5241.4.180086.

A large aneurysmal bone cyst of the rib

An aneurysmal bone cyst is a very rare benign tumor of the ribs. It mainly involves the long bones and vertebrae, and requires histopathological examination for definitive diagnosis. We present a case of large aneurysmal bone cyst of the left 6th rib in young adult male. The diagnosis of aneurysmal bone cyst should be kept in mind in young patients presenting with an expansile lytic lesion of the rib, because it has an excellent outcome after complete surgical resection.

Fibrous dysplasia with secondary aneurysmal bone cyst-a rare case report and literature review

INTRODUCTION

Fibrous dysplasia (FD) and aneurysmal bone cyst (ABC) are uncommon non-neoplastic intraosseous lesions, and the occurrence of concomitant FD and ABC is extremely rare.

CASE REPORT

An 11-year-old boy presented with gradual progressive enlargement of his right zygomatic bone over 4 years prior to presentation. Computed tomography revealed a lesion with a central bony area showing a ground-glass appearance surrounded by a well-defined expansile lesion with internal septations. An incisional biopsy was performed and suggested a fibro-osseous lesion. Resection was performed, followed by immediate reconstruction using autogenous bone graft from the iliac crest. Histopathological examination revealed irregularly shaped trabeculae comprising immature woven bone in a fibroblastic cell-rich stroma. Blood-filled sinusoidal spaces lined by fibrous septa containing scattered multinucleated giant cells were observed peripherally. These findings were compatible with concomitant FD and ABC. The patient was disease-free at the time of his 10-month follow-up.

CONCLUSIONS

Based on our literature search, this report is the first to describe concomitant monostotic FD and ABC in the zygomatic bone. Accurate diagnosis requires careful investigation and examination of clinical, radiographical, and histopathological features. The treatment of choice should provide an esthetic and functional improvement in the patient.

Aneurysmal bone cyst of the clavicle: a series of 13 cases

BACKGROUND

Aneurysmal bone cyst (ABC) is a benign but locally aggressive bone tumor occurring most commonly in the first 2 decades of life. The clavicle is a rare location for tumors, and ABCs of the clavicle have been sparsely described in the literature. We present the largest known series of ABCs of the clavicle to describe this rare condition.

METHODS

Patients were identified retrospectively from an orthopedic oncology database to obtain demographic, diagnostic, and treatment information. A literature search was performed to identify all English language reports of ABC of the clavicle.

RESULTS

We identified 13 patients with ABC of the clavicle, 77% of which were in the acromial end. Most patients (77%) presented with pain or swelling or both. The initial treatment in 11 patients was by curettage, with or without allograft bone packing, and 1 underwent resection/reconstruction of the lateral clavicle. Seven patients (58%) had 1 or more recurrences at an average of 6 months, for which 2 were treated with partial resection of the clavicle.

CONCLUSIONS

ABC of the clavicle is a rare condition that we found to occur most frequently in the acromial end of the bone. Most patients were initially treated with curettage and showed a higher rate of recurrence than in other locations. The unique anatomy of the clavicle makes resection a feasible and very functional option, especially if the coracoclavicular ligaments can be preserved. However, the potential resulting deformity may cause patients to opt for a less aggressive and, consequently, less effective treatment method.

Aneurysmal Bone Cyst of 3rd Metacarpal, Management and Follow-up: A Case Report

Introduction:

Aneurysmal bone cysts of the hand are rare, and only few cases are reported in scientific literature. We report a case of aneurysmal bone cyst of 3rd metacarpal treated at our tertiary care hospital, Mumbai.

Case Report:

A 13-year-old young female presented with pain and progressive increase in swelling over the dorsum of the right hand for 7—months. There was pain and tenderness over 3rd metacarpal. There was painful restriction of movement at the metacarpophalangeal joints. Serial radiographic evaluation of the hand from May 2009 to October 2010 showed multilocular expansile lytic lesion with ballooning of 3rd metacarpal with increasing size. The patient was managed surgically with bone grafting. Histopathology section suggested fibrous septa enclosing hemorrhagic cystic space. Septa contained bony chips, spindle cell, inflammatory cell, and few scattered osteoclast. Diagnosis of aneurysmal bone cyst of 3rd metacarpal was made. The patient was followed up after 5 years with good radiological healing with pain-free and good range of motion, good grip strength without any recurrence.

Conclusion:

Aneurysmal bone cyst is a rare, rapidly growing, and destructive benign bone tumor. Many treatment modalities have been reported in literature including radiation, curettage and bone grafting, cryotherapy, and excision. However, controversy exists in the literature regarding optimal treatment. Due to its rarity in the hand, no evidence-based treatment regimen has been established. The patient can be managed surgically with bone grafting with good radiological healing with pain-free and good range of motion, good grip strength without any recurrence.

Hindfoot aneurysmal bone cyst: report of two cases

Osseous tumors of the hindfoot are not usual in the literature, the diagnosis in these cases is difficult and can often go unnoticed. Besides that, surgery and reconstruction are complicated due to the complexity of the local anatomy, which makes these lesions even more challenging for the orthopedic oncological professionals. On the following article two cases of aneurysmal bone cyst of the hindfoot are reported, as well as the alternatives and peculiarities in conducting these cases according to the oncological principles. When the subject are hindfoot tumor lesions, the early diagnosis is extremely important, as well as the proper staging and the management of the case by the orthopedic oncological professional according to oncological principles.

Pediatric Musculoskeletal Interventional MRI

Minimally invasive procedures play a crucial role in the diagnosis and treatment of many pediatric musculoskeletal conditions. Although computed tomography and fluoroscopy are commonly used for image guidance, the associated exposure to ionizing radiation is especially concerning in pediatric patients. Ultrasonography may be used successfully in a subset of interventions, but it is often not useful for complex, deep, and osseous targets. Interventional magnetic resonance imaging (iMRI) facilitates targeting and treatment of musculoskeletal lesions at many locations with high accuracy due to its excellent tissue contrast. Furthermore, MRI provides imaging guidance without the use of ionizing radiation and as such complies with the ALARA practice mandate in a formidable fashion. MRI guidance is our method of choice for lesion that are not visible by other modalities or when other techniques and modalities failed. MRI guidance is especially useful for selective targeting of complex lesions, intra-articular lesions, cyst aspirations in difficult locations of the body, and lesions that are located adjacent to surgical hardware. Tumor-related diagnostic sampling is more frequently performed under MRI; however, MRI guidance is also exquisitely well suited for a variety of therapeutic percutaneous osseous or articular conditions, such as osteoid osteoma, epiphyseal bone bridging, osteochondritis dissecans lesions, and aneurysmal bone cysts. In this article, we will describe the technical aspects and clinical indications of a variety of MRI-guided pediatric procedures in the musculoskeletal system.

Radiation Therapy for Aneurysmal Bone Cysts

PURPOSE

To evaluate the long-term effectiveness of radiation therapy (RT) as an adjuvant or alternative treatment for patients with aneurysmal bone cyst (ABC).

PATIENTS AND METHODS

The medical records of 12 patients who received RT at the University of Florida for ABC between 1964 and 2011 were reviewed and patients were contacted, when possible, for follow-up. Follow-up duration ranged from 3 to 36 years (median, 20.5 y). Patient age at the time of RT ranged from 3 to 23 years (mean, 12.75 y), with 7 females and 5 males. Four patients were treated for recurrent ABCs. Three patients were treated with surgical interventions (intralesional curettage, subtotal resection, or selective arterial embolization) before RT, and the rest received open biopsy only. The prescribed doses ranged from 20 to 60 Gy (mean, 30.15 Gy). Ten (83.3%) patients received between 1.5 and 2.0 Gy per fraction.

RESULTS

All patients were doing well and free of any adverse reaction to RT as of the latest follow-up, including 1 who passed away from cardiac problems 34 years since completing RT and 3 who were lost to follow-up (at 16, 16, and 19 y) but were doing well at the last follow-up.

CONCLUSIONS

RT continues to result in an excellent prognosis for patients with ABC who receive either RT alone or adjuvant RT after surgery.

Sclerotherapy using Surgiflo and alcohol: a new alternative for the treatment of aneurysmal bone cysts

PURPOSE

This study aims to review the results of sclerotherapy using Surgiflo in addition to alcohol in primary aneurysmal bone cysts (ABC).

METHODS

A total of 16 consecutive patients with histologically confirmed diagnosis of primary ABC were treated by percutaneous Surgiflo and alcohol injection at our institution. Clinical follow-up included the assessment of pain, swelling, limping and functional impairment. Radiological parameters included tumour volume, physis-cyst distance, thickness of cyst cortex, and presence of intracystic septations. Mean follow-up was 35,6 months (24-71 months). Treatment was considered successful when the cyst volume decreased by a minimum of 10%, the bone cortex became thicker, and the distance to physis increased.

RESULTS

Mean age at presentation was 9.5 years (5.16-13.84 years). All ABC's were primary and all patients underwent a single Surgiflo and alcohol session except for two (12.5%) who required a second session. All patients had a good clinical result at final follow-up. Satisfactory cyst healing was achieved in 11 cases according to radiological parameters. Tumour volume decreased from a mean of 122 cm³ (111 to 133) before injection to 86 cm³ (76 to 96) at last follow-up (p < 0.01). Physis-cyst distance increased from a mean of 1 cm (0.1 to 2) to 2.1 cm (0.5 to 4) at last follow-up (p < 0.01). Cortical thickness improved from 1 mm (0.5 to 1.5) to 2 mm (1 to 3.5) at last follow-up (p < 0.01).There were no treatment related complications. Surgery was performed in one patient having a C3 vertebra ABC after developing quadriparesis due to tumour progression.

CONCLUSION

Sclerotherapy using Surgiflo and alcohol may be used as an efficient, safe and minimally invasive alternative for the treatment of primary ABCs.