1
|
Bakarman KA. Diagnosis and Current Treatment of Aneurysmal Bone Cysts. Cureus 2024; 16:e53587. [PMID: 38449944 PMCID: PMC10915701 DOI: 10.7759/cureus.53587] [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: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
The purpose of this review is to increase awareness about the evolution and development of current trends in the diagnosis and treatment of aneurysmal bone cysts (ABCs). ABCs are benign, but locally aggressive bone tumors that mainly affect children. ABCs comprise 1% of all primary bone tumors and occur most frequently during the first two decades of life. The diagnosis is made using a variety of imaging modalities and has the characteristic features of an expansile, radiolucent lesion that is often seen in the metaphyseal region of the bone and has fluid-fluid levels that are apparent on MRI. In the pediatric population, telangiectatic osteosarcoma and unicameral bone cyst (UBC) are the main differential diagnoses of an ABC. Giant cell tumors (GCTs) also include in differential diagnosis, which often manifest in patients older than 15 and do not penetrate the open physis although they develop after the physeal closure. Imaging alone cannot rule out telangiectatic osteosarcoma; therefore, a biopsy is recommended. A variety of treatment options have been described; traditionally, most patients are treated with curettage and bone grafting. Curettage alone, however, usually results in tumor recurrence following excision. A variety of adjuvants have been utilized with varying degrees of effectiveness to reduce the risk of local recurrence. When a cyst is in the pelvis, its location and size are such that surgery is a very risky option. Selective arterial embolization has significantly contributed to the development of effective treatments for these situations. Embolization or radiation, as well as denosumab therapy, are widely used as therapies for ABCs in anatomic locations where surgery would significantly increase morbidity.
Collapse
|
2
|
Darwish AE, Hasan BZ, Elgebery AO, Badr IT. The Clinical and Radiological Outcome of Stages 1 and 2 Enneking Benign Bone Lesions with Pathological Fracture. Injury 2021; 52:2920-2925. [PMID: 33541686 DOI: 10.1016/j.injury.2021.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Presentation of benign lesions with a pathological fracture may be confusing to general orthopedic surgeons regarding missing a fracture in a pathological bone, the need for special care for these lesions, and the potential for healing of these fractures. The objective of this work was to evaluate the clinical and radiological outcomes of the treatment of patients with stages 1 and 2 Enneking benign bone-tumors presented with pathological fractures. METHODS This retrospective study included 66 patients who presented with a pathological fracture through stage 1 or 2 Enneking benign bone lesions and were received at the emergency unit of the orthopedic department between 2014 and 2018. Demographic data and patient's evaluation were collected. Lesion-size (length, width, and depth) was calculated from the X-ray. Surgical intervention was planned in 28 patients. The indication for surgery was either fracture fixation or curettage of the lesion with or without augmentation. There were no repeated surgeries or local recurrences. The filling of the cavity was classified according to modified Neer's classification. RESULTS Sixty-six patients, 45 males, and 21 females were included. Forty-two affections were right while 24 were left. The mean age was 14.9 ± 8.6 (range, 3-40) years. The most common radiological diagnoses were simple bone-cysts 43.9% (n = 29), followed by non-ossifying fibroma 27.3% (n =18). The mean length of the lesions was 4.4 ± 2.6 (range, 1 - 12) cm, width was 1.6 ± 0.8 (range, 0.3- 4.5) cm, and depth was 1.8 ± 0.9 (range, 0.3 - 5) cm. The mean follow-up was 24.15 ± 18.7 months. Minor complications occurred in 7 patients (10.6%). Fifty-four out of 65 lesions (83%) showed either almost complete or partial filling of the lesions. There was no significant difference regarding the filling of the lesions according to the modified Neer's classification between those who were treated conservatively and those who underwent surgical intervention P-value = 0.783. CONCLUSION Careful diagnosis of a pathological fracture through stages 1 and 2 Enneking benign bone tumors is essential before initiating treatment. These fractures have good potential for bone healing and a low incidence of complications even with conservative treatment. Special surgical care of the lesion is not mandatory in all situations and should be individualized. LEVEL OF EVIDENCE Level III, retrospective.
Collapse
Affiliation(s)
- Amr Eid Darwish
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Bahaa Zakarya Hasan
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Ahmed Osama Elgebery
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Ismail Tawfeek Badr
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt.
| |
Collapse
|
3
|
Gangopadhyay P, Emory C, Bonvillian J, Brackney C. Atypical Presentation of Navicular Aneurysmal Bone Cyst in a Symptomatic Pediatric Flatfoot Deformity: A Case Report. J Foot Ankle Surg 2021; 60:609-614. [PMID: 33612404 DOI: 10.1053/j.jfas.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/13/2020] [Accepted: 09/03/2020] [Indexed: 02/03/2023]
Abstract
Aneurysmal bone cysts (ABCs) are rare in the foot, accounting for 4% to 6.3% of all ABCs found in the body. Approximately 80% of patients diagnosed with an ABC are in the second decade of life. While benign, pain and deformity are often the presenting symptoms. This report's objective is to describe, to our knowledge, the first reported case of a pediatric navicular ABC in association with pediatric flatfoot deformity that was successfully treated with curettage and bone grafting. An additional goal of the report is to highlight how the diagnosis of these osseous tumors can easily be missed given the overlap in symptoms with pediatric flatfoot deformity. An 11-year-old female presented to clinic with a chief complaint of painful, flatfoot deformity and discomfort to the medial midfoot after walking for more than 2 city blocks. The patient was conservatively treated for pediatric flatfoot deformity at an outside institution and advised that a surgical flatfoot reconstruction would be necessary to relieve her symptomology. On examination, the patient exhibited focal pain to the medial aspect of the navicular. Radiographs revealed an ill-defined, expansile, sclerotic lesion of the navicular, and MRI demonstrated a multicystic lesion filling the navicular, consistent with an ABC. Treatment included curettage and packing with allograft. At 1-year follow-up, the patient is well, with minimal pain and return to full activity without functional limitations. Local recurrence of an aneurysmal bone cyst following curettage and bone grafting is as high as 22% with patient age and lesion size comprising the main risk factors. This report demonstrates successful curettage of an ABC within the navicular and preservation of osseous articulations in a pediatric patient. At 1-year follow-up, the patient had minimal pain with no evidence of recurrence.
Collapse
Affiliation(s)
- Paula Gangopadhyay
- Instructor, Podiatry Section Research Director, Orthopaedic Surgery Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Cynthia Emory
- Section Chief, Orthopaedic Surgery, Associate Professor Orthopaedic Surgery Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - John Bonvillian
- Resident, Wake Forest Baptist Medical Center, Winston-Salem, NC.
| | - Clark Brackney
- Resident, Wake Forest Baptist Medical Center, Winston-Salem, NC
| |
Collapse
|
4
|
Dharmshaktu G, Agarwal N. Aneurysmal bone cyst of head of fibula with transient postoperative neuropraxia of common peroneal nerve. MATRIX SCIENCE MEDICA 2021. [DOI: 10.4103/mtsm.mtsm_4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
Bone Marrow Concentrate in the Treatment of Aneurysmal Bone Cysts: A Case Series Study. Stem Cells Int 2020; 2020:8898145. [PMID: 32904542 PMCID: PMC7456472 DOI: 10.1155/2020/8898145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction A recent attractive option regarding mesenchymal stem cells (MSC) application is the treatment of bone cystic lesions and in particular aneurysmal bone cysts (ABC), in order to stimulate intrinsic healing. We performed a retrospective evaluation of the results obtained at our institution. Methods The study group consisted of 46 cases with an average follow-up of 33 months. Forty-two patients underwent percutaneous treatment as the first approach; four patients had curettage as first treatment. In all cases, autologous bone marrow concentrate (BMC) was associated too. The healing status was followed up through a plain radiograph 45 days and 2 months after the procedure. Results and Conclusions. At the final follow-up, thirty-six patients healed with a Neer type II aspect, nine healed with a type I aspect, and one patient was not classified having total hip arthroplasty. Bone marrow concentrate is easy to obtain and to manipulate and can be immediately available in a clinical setting. We can assert that the use of BMC must be encouraged being harmless and having an unquestionable high osteogenic and healing potential in bone defects.
Collapse
|
6
|
Ulici A, Florea DC, Carp M, Ladaru A, Tevanov I. Treatment of the aneurysmal bone cyst by percutaneous intracystic sclerotherapy using ethanol ninety five percent in children. INTERNATIONAL ORTHOPAEDICS 2018; 42:1413-1419. [PMID: 29492610 DOI: 10.1007/s00264-018-3841-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 02/11/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Aneurysmal bone cyst (ABC) is a benign intraosseous lesion filled with blood that can determine a blowout distension of the bone. The purpose of this study is to evaluate the efficacy of sclerotherapy by percutaneous intralesional administration of ethanol 96% for the treatment of this pathology in paediatric patients. METHOD The retrospective study includes 17 paediatric patients with ABC who were treated by repeated intracystic injection with ethanol 96%, 1 ml/kg, in our clinic between December 2015 and July 2017. Fluoroscopic guidance was used to inject the cyst with contrast agent. The mean follow-up period was 11 months. RESULTS AND DISCUSSION All cysts are healed or are in the healing process. The mean age was 11 years old. Seven patients needed three repeated injections and ten patients needed two injections until healing. We observed a mean reduction in the size of the lesions, measured on plain X-rays, of 68%. The complications that were observed included the following: dizziness after injection, skin pigmentation at the injection site, local inflammatory reaction, and pain after injection. The current study approves the importance of this minimally invasive treatment with no recurrence after a follow-up of 19 months. The healing rate was 100%. A limitation of this study consists in the small number of patients. CONCLUSION Sclerotherapy with ethanol 96% is a useful method for the treatment of ABC. It is a minimally invasive method, with no major complications, which lowers the risks of open surgical intervention and has a good rate of success.
Collapse
Affiliation(s)
- Alexandru Ulici
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32, Iancu de Hunedoara Bvd, 011733, Bucharest, Romania. .,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Daniel-Catalin Florea
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32, Iancu de Hunedoara Bvd, 011733, Bucharest, Romania
| | - Madalina Carp
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32, Iancu de Hunedoara Bvd, 011733, Bucharest, Romania
| | - Alin Ladaru
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Iulia Tevanov
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32, Iancu de Hunedoara Bvd, 011733, Bucharest, Romania
| |
Collapse
|
7
|
Affiliation(s)
| | - Meng Zhang
- Department of Ophthalmology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | | |
Collapse
|
8
|
Mascard E, Gomez-Brouchet A, Lambot K. Bone cysts: unicameral and aneurysmal bone cyst. Orthop Traumatol Surg Res 2015; 101:S119-27. [PMID: 25579825 DOI: 10.1016/j.otsr.2014.06.031] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/29/2014] [Accepted: 06/12/2014] [Indexed: 02/02/2023]
Abstract
Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy.
Collapse
Affiliation(s)
- E Mascard
- Clinique Arago, 93, boulevard Arago, 75014 Paris, France; Service de chirurgie orthopédique, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France; Département de pédiatrie, institut Gustave-Roussy, 94805 Villejuif cedex, France.
| | - A Gomez-Brouchet
- Clinique Arago, 93, boulevard Arago, 75014 Paris, France; Service d'anatomopathologie, institut universitaire du cancer de Toulouse oncopole, Toulouse, France
| | - K Lambot
- Clinique Arago, 93, boulevard Arago, 75014 Paris, France; Service de radiologie pédiatrique, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| |
Collapse
|
9
|
Amouyel T, Deroussen F, Plancq MC, Collet LM, Gouron R. Successful treatment of humeral giant aneurysmal bone cyst: value of the induced membrane reconstruction technique. J Shoulder Elbow Surg 2014; 23:e212-6. [PMID: 25127911 DOI: 10.1016/j.jse.2014.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/21/2014] [Accepted: 05/23/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Thomas Amouyel
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - François Deroussen
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Marie-Christine Plancq
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Louis-Michel Collet
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Richard Gouron
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France.
| |
Collapse
|
10
|
Lambot-Juhan K, Pannier S, Grévent D, Péjin Z, Breton S, Berteloot L, Emond-Gonsard S, Boddaert N, Glorion C, Brunelle F. Primary aneurysmal bone cysts in children: percutaneous sclerotherapy with absolute alcohol and proposal of a vascular classification. Pediatr Radiol 2012; 42:599-605. [PMID: 22237479 DOI: 10.1007/s00247-011-2312-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 10/04/2011] [Accepted: 10/04/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Percutaneous sclerotherapy is an effective treatment for aneurysmal bone cysts (ABCs). OBJECTIVE The purpose of this study was to demonstrate the safety and efficacy of sclerotherapy with absolute alcohol and to propose a vascular classification of ABCs based on a retrospective review. MATERIALS AND METHODS This was a review of children treated with absolute alcohol sclerotherapy for ABC at a single institution from January 1995 until November 2009. Treatment response was evaluated radiographically and clinically. Cyst fluid was classified as clear, partially bloody, or bloody. Presence of any venous drainage of the cyst was assessed by injection of contrast medium into the cyst cavity. RESULTS Twenty-nine children with ages ranging from 2 to 16 years were included. Treatment response was good in 17 (59%), partial in 9 (31%), and poor in 3 (10%) children. Venous drainage was absent in six out of seven clear-fluid cysts, which we classified as lymphatic. Drainage was present in all seven bloody-fluid cysts, which we classified as venous. In seven partially bloody-fluid cysts, venous drainage was seen in three. CONCLUSION Sclerotherapy with absolute alcohol is a safe and effective treatment of ABC. We propose classifying ABC as lymphatic or venous and suggest considering ABC intraosseous slow-flow vascular malformations.
Collapse
Affiliation(s)
- K Lambot-Juhan
- Pediatric Radiology, Hôpital Necker Enfants Malades, 149-161 rue de Sèvres, Paris, 75015, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|