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Proença Caetano A, Neves T, Pedrosa C, Portela J, Gomes FV, Coimbra É, Bilhim T. Aggressive Giant Extraskeletal Aneurysmal Bone Cyst of the Thigh: Overcoming Challenges with a Multidisciplinary Approach. ACTA MEDICA PORT 2024. [PMID: 39153197 DOI: 10.20344/amp.19801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/17/2024] [Indexed: 08/19/2024]
Abstract
Aneurysmal bone cysts are vascular benign fibroblastic lesions usually found in bone that are locally destructive, with a greater incidence in the first and second decades of life. Patients usually undergo curettage or, less frequently, surgical resection, which may lead to growth disturbances and deformities in cases of large or complex lesions. Minimally invasive techniques such as sclerotherapy and endovascular embolization have been developed as an alternative or complement to surgery, with promising results. The authors present a rare case of an extraskeletal aneurysmal bone cyst successfully treated with minimally invasive techniques followed by surgical resection and provide a literature review of the current treatment options.
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Affiliation(s)
- António Proença Caetano
- Interventional Radiology Unit. Hospital de Curry Cabral. Unidade Local de Saúde São José. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Teresa Neves
- Interventional Radiology Unit. Hospital de Curry Cabral. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Carlos Pedrosa
- Department of Orthopedic Surgery and Traumatology. Hospital de Curry Cabral. Unidade Local de Saúde São José. Lisboa. Portugal
| | - José Portela
- Department of Orthopedic Surgery and Traumatology. Hospital de Curry Cabral. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Filipe Veloso Gomes
- Interventional Radiology Unit. Hospital de Curry Cabral. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Élia Coimbra
- Interventional Radiology Unit. Hospital de Curry Cabral. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Tiago Bilhim
- Interventional Radiology Unit. Hospital de Curry Cabral. Unidade Local de Saúde São José. Lisboa. Portugal
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Key BM, Callstrom MR, Filippiadis D. Musculoskeletal Interventional Oncology: A Contemporary Review. AJR Am J Roentgenol 2023; 221:503-516. [PMID: 37222277 DOI: 10.2214/ajr.23.29110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Musculoskeletal interventional oncology is an emerging field that addresses the limitations of conventional therapies for bone and soft-tissue tumors. The field's growth has been driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaboration with medical, surgical, and radiation oncology. Safe, effective, and durable pain palliation, local control, and stabilization of musculoskeletal tumors are increasingly achieved through an expanding array of contemporary minimally invasive percutaneous image-guided treatments, including ablation, osteoplasty, vertebral augmentation (with or without mechanical reinforcement via implants), osseous consolidation via percutaneous screw fixation (with or without osteoplasty), tumor embolization, and neurolysis. These interventions may be used for curative or palliative indications and can be readily combined with systemic therapies. Therapeutic approaches include the combination of different interventional oncology techniques as well as the sequential application of such techniques with other local treatments, including surgery or radiation. This article reviews the current practice of interventional oncology treatments for the management of patients with bone and soft-tissue tumors with a focus on emerging technologies and techniques.
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Affiliation(s)
- Brandon M Key
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Matthew R Callstrom
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Dimitrios Filippiadis
- Department of Diagnostic and Interventional Radiology, University General Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Laliotis N, Konstantinidis P, Chrysanthou C, Giannakopoulou L, Papadopoulou E. Restoration of Limb Length Discrepancy and Alignment With the Ilizarov Device After Management of an Aneurysmal Bone Cyst Crossing the Distal Femoral Physis. Cureus 2023; 15:e46259. [PMID: 37908925 PMCID: PMC10615118 DOI: 10.7759/cureus.46259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
An aneurysmal bone cyst (ABC), when located juxta-physeal, may rarely penetrate the growth plate and extend into the epiphysis. The recurrence rate is considered higher when ABC is in contact with the active growth plate. Treatment methods usually focus on cyst healing and the rate of cyst recurrence. We present the method of treatment used for addressing the lesion of the growth plate following the surgical management and healing of a juxta-physeal ABC. A seven-year-old girl had an aggressive ABC in the juxta-physeal area of the distal femur, penetrating the growth plate and extending in the epiphysis. Surgical treatment was performed, including curettage and autologous bone grafting, avoiding the growth plate. The cyst healed; however, physis presented an obliteration. The affected limb developed valgus deformity and severe leg length discrepancy (LLD). To address this issue, once our patient completed her growth, we proceeded with distraction osteogenesis, using the Ilizarov device, with asymmetrical lengthening of the rods. We achieved the correction of the limb alignment and resolved the LLD. ABCs in the juxta-physeal area of a growing child are benign metaphyseal tumors that exceptionally may penetrate the physis and extend into the epiphysis. Our report highlights that the growth plate's lesion, despite the cyst's healing, may compromise the final result. The use of the Ilizarov device is an effective method for correcting the malalignment and the LLD that may emerge.
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Affiliation(s)
| | | | - Chrysanthos Chrysanthou
- Orthopaedics, Interbalkan Medical Center, Thessaloniki, GRC
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Abstract
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.
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Rai AK, Rathod TN, Bansal D, Hadole BS, Rahman SH, Kumar K G G, Prabhu RM. Clinicoradiological outcome of percutaneous intralesional polidocanol in Aneurysmal Bone Cysts: A prospective study of 43 patients in a single tertiary care centre. J Orthop 2022; 32:72-77. [DOI: 10.1016/j.jor.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022] Open
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Diffusion-Weighted Imaging Prior to Percutaneous Sclerotherapy of Venous Malformations—Proof of Concept Study for Prediction of Clinical Outcome. Diagnostics (Basel) 2022; 12:diagnostics12061430. [PMID: 35741240 PMCID: PMC9222207 DOI: 10.3390/diagnostics12061430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 12/18/2022] Open
Abstract
Prediction of response to percutaneous sclerotherapy in patients with venous malformations (VM) is currently not possible with baseline clinical or imaging characteristics. This prospective single-center study aimed to predict treatment outcome of percutaneous sclerotherapy as measured by quality of life (QoL) by using radiomic analysis of diffusion-weighted (dw) magnetic resonance imaging (MRI) before and after first percutaneous sclerotherapy. In all patients (n = 16) pre-interventional (PRE-) and delta (DELTA-) radiomic features (RF) were extracted from dw-MRI before and after first percutaneous sclerotherapy with ethanol gel or polidocanol foam, while QoL was assessed using the Toronto Extremity Salvage Score (TESS) and the 36-Item Short Form Survey (SF-36) health questionnaire. For selecting features that allow differentiation of clinical response, a stepwise dimension reduction was performed. Logistic regression models were fitted and selected PRE-/DELTA-RF were tested for their predictive value. QoL improved significantly after percutaneous sclerotherapy. While no common baseline patient characteristics were able to predict response to percutaneous sclerotherapy, the radiomics signature of VMs (independent PRE/DELTA-RF) revealed high potential for the prediction of clinical response after percutaneous sclerotherapy. This proof-of-concept study provides first evidence on the potential predictive value of (delta) radiomic analysis from diffusion-weighted MRI for Quality-of-Life outcome after percutaneous sclerotherapy in patients with venous malformations.
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Deventer N, Budny T, Gosheger G, de Vaal M, Burkhardt J, Deventer N. Aneurysmal bone cyst of the pelvis and sacrum: a single-center study of 17 cases. BMC Musculoskelet Disord 2022; 23:405. [PMID: 35490224 PMCID: PMC9055713 DOI: 10.1186/s12891-022-05362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background The aneurysmal bone cyst (ABC) is a benign, but locally aggressive cystic lesion of the bone. It usually occurs in the metaphysis of long bones of adolescents and young adults but can also affect the pelvis. Methods This single-center study is a retrospective review of 17 patients with primary ABCs of the pelvis. It examines the importance of polidocanol instillations as minimally invasive treatment option for ABCs of the pelvis compared to intralesional curettage or marginal resection. Results Seventeen patients with the diagnosis of a primary ABC of the pelvis were included in the study. Six patients were male (35%) and 11 patients female (65%); the mean age was 18 (9-49) years. The mean follow-up time was 50 months (12-136 months). The most common location of manifestation was the pubis (6; 35%), followed by the ilium (6; 35%), the sacrum (3; 18%) and the ischium (2; 12%). Eight patients were treated by intralesional curettage with the use of adjuvants, one patient by marginal resection, seven by sequential instillation of polidocanol and one patient by simple observation. Five patients received an additional transarterial embolization. After intralesional curettage local recurrence was detected in 4/8 cases (50%). After instillation therapy six patients (86%) had a stable disease without recurrence, only one patient (14%) had a persistent disease with need of additional treatment and was therefore converted to intralesional curettage without local recurrence in the follow-up. Conclusions Sequential instillations of polidocanol are a promising, minimally invasive treatment method for ABCs of the pelvis and can be well combined with transarterial embolization.
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Affiliation(s)
- Niklas Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Tymoteusz Budny
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Marieke de Vaal
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jana Burkhardt
- Department of General Paediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Nils Deventer
- Department of General Paediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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Wong MN, Braswell LE, Murakami JW. Doxycycline sclerotherapy of cervical spine aneurysmal bone cysts: single-institution 13-year experience. Pediatr Radiol 2022; 52:1528-1538. [PMID: 35305122 PMCID: PMC9271102 DOI: 10.1007/s00247-022-05328-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/29/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aneurysmal bone cysts (ABCs) are benign, locally aggressive neoplasms that typically affect patients during their first two decades of life. Curettage with or without bone grafting or adjuvants is the current standard treatment; however, other surgical and medical treatments, such as sclerotherapy, have been reported. Treatment options for cervical spine ABCs are more limited because the proximity of ABCs to critical structures leads to greater risk of spontaneous or treatment-related adverse events, including death. OBJECTIVE To retrospectively review all children and young adults with cervical spine ABCs treated with doxycycline sclerotherapy at one referral center to assess its viability as a standalone treatment. MATERIALS AND METHODS We retrospectively reviewed the clinical notes and imaging of 16 patients treated with doxycycline sclerotherapy for pathologically proven cervical spine ABCs at our institution between May 2008 and March 2021. All patients underwent image-guided percutaneous doxycycline sclerotherapy to ablate the ABC and stimulate bone formation. We assessed clinical outcomes through chart review and described post-treatment imaging outcomes using modified Neer scoring. RESULTS Of the 16 total children and young adults treated, 2 were lost to follow-up, leaving 14 patients with a median age of 14.5 years. Twelve of these 14 patients were successfully treated with doxycycline sclerotherapy for a success rate of 86%. One patient experienced one treatment-related complication (Society of Interventional Radiology [SIR] adverse event classification D), before ultimately being successfully treated. Doxycycline treatment failed in two patients, who then underwent surgical management. Post-treatment imaging of successfully treated cases had a mean modified Neer score of 1.3, whereas post-treatment imaging in failed cases had a mean score of 3.5. CONCLUSION Doxycycline sclerotherapy is a viable standalone treatment for cervical spine ABCs because it is safe and effective while avoiding the morbidity associated with open surgical treatments.
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Affiliation(s)
- Megan N Wong
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Leah E Braswell
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - James W Murakami
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Restrepo R, Zahrah D, Pelaez L, Temple HT, Murakami JW. Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment. Pediatr Radiol 2022; 52:1601-1614. [PMID: 35941207 PMCID: PMC9360065 DOI: 10.1007/s00247-022-05396-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/05/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
Aneurysmal bone cyst (ABC) is a benign but locally aggressive lesion that predominantly affects children and young adults. ABC, which accounts for approximately 70% of the cases, is now recognized to be a true neoplasm, whereas ABC-like changes associated to other bone neoplasms (also referred in the literature as secondary ABC) accounts for the remaining 30%. The solid variant of ABC is also considered a true neoplasm but is rare. ABC can involve any bone in the body, and although it has a metaphyseal preference, it can involve any part of a bone and soft tissues. As with any bone tumor, the initial evaluation of ABCs should be done with radiographs followed by magnetic resonance imaging or less frequently computed tomography for further characterization. The imaging appearance of ABC is variable; however, a lytic and expansile lesion with fluid-fluid levels is the most common presentation. The main differential diagnosis of an ABC in the pediatric population is unicameral bone cyst (UBC) and telangiectatic osteosarcoma, therefore a biopsy is recommended before treatment. The therapeutic options of ABC range from curettage with or without adjuncts such as phenol, liquid nitrogen, argon laser and bone grafting or bone substitutes to more recently employed alternatives such as image-guided sclerotherapy with various sclerosing agents and monoclonal antibodies (e.g., Denosumab).
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Affiliation(s)
- Ricardo Restrepo
- grid.415486.a0000 0000 9682 6720Department of Radiology, Nicklaus Children’s Hospital, Miami, FL USA
| | - David Zahrah
- grid.4367.60000 0001 2355 7002School of Arts and Sciences, Washington University, St. Louis, MO USA
| | - Liset Pelaez
- grid.415486.a0000 0000 9682 6720Department of Pathology, Nicklaus Children’s Hospital, Miami, FL USA
| | - H. Thomas Temple
- grid.26790.3a0000 0004 1936 8606Department of Orthopedic Surgery, Miller School of Medicine, University of Miami, Miami, FL USA
| | - James W. Murakami
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
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