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Giantini-Larsen AM, Chakravarthy VB, Barzilai O, Newman WC, Wexler L, Bilsky MH. The role of neoadjuvant denosumab in the treatment of aneurysmal bone cysts: a case series and review of the literature. J Neurosurg Pediatr 2022; 30:547-554. [PMID: 36282899 DOI: 10.3171/2022.8.peds22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aneurysmal bone cysts (ABCs) are benign cystic lesions most commonly occurring in the long bones of pediatric patients. Spinal ABCs may be difficult to resect given their invasive, locally destructive nature, proximity to critical structures such as the spinal cord, and their intrinsic hypervascularity, for which complete embolization is often constrained by radiculomedullary segmental feeders. Denosumab, a monoclonal antibody that binds the receptor activator of nuclear factor kappa B (NF-κB) ligand, has been utilized in the treatment of ABCs most often as a rescue therapy for recurrent disease. Here, the authors present 3 cases of neoadjuvant denosumab use in surgically unresectable tumors to calcify and devascularize the lesions, allowing for safer, more complete resection. METHODS This is a single-center, retrospective case series treated at a tertiary care cancer center. The authors present 3 cases of spinal ABC treated with neoadjuvant denosumab. RESULTS All 3 patients experienced calcification, size reduction, and a significant decrease in the vascularity of their ABCs on denosumab therapy. None of the patients developed new neurological deficits while on denosumab. Subsequently, all underwent resection. One patient continued denosumab during the immediate postoperative period because a subtotal resection had been performed, with stabilization of the residual disease. No complications were associated with denosumab administration. CONCLUSIONS The use of denosumab in unresectable ABCs can cause calcification and devascularization, making safe resection more likely.
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Affiliation(s)
- Alexandra M Giantini-Larsen
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | | | | | | | - Leonard Wexler
- 3Pediatrics, Memorial Sloan Kettering Cancer Center, New York; and
| | - Mark H Bilsky
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
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van Ballegooie C, Wretham N, Ren T, Popescu IM, Yapp DT, Bally MB. PEG Conjugated Zein Nanoparticles for In Vivo Use. Pharmaceutics 2022; 14:1831. [PMID: 36145579 PMCID: PMC9504474 DOI: 10.3390/pharmaceutics14091831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/11/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Zein can be utilized to form nanoscale particles for drug delivery applications. Despite the ease of synthesis, these particles often aggregate when exposed to physiologically relevant conditions (e.g., pH and salt concentrations). This instability has prevented their further development in applications requiring intravenous administration. To mitigate this colloidal instability, this research explored Zein nanoparticles (NP)s that were modified with polyethylene glycol (PEG) either through functionalized PEG pre- or post-NP formation. The results suggest that the pre-functionalization of the Zein using N-hydroxysuccinimide ester terminated PEG is the method of choice for synthesizing Zein NPs with conjugated PEG (Zein:PEG-Zein NPs). Zein:PEG-Zein NPs formed using this method displayed excellent stability in physiologically relevant conditions over 72 h and were stable at 4 °C for at least 3 months. When the NPs were cultured with cells for 72 h, no cytotoxicity or early signs of apoptosis were identified. Cellular uptake of the Zein:PEG-Zein NPs did not seem to be impacted by the amount of PEG incorporated in the NP but were concentration-, time-, and temperature-dependent. The lowest percent, stable Zein:PEG-Zein NP formulation (80% unmodified Zein and 20% PEG-modified Zein) induced no observable toxicity over 14 days in CD-1 mice dosed at 70 mg/kg via the tail vein. However, repeat dose pharmacokinetic (PK) studies demonstrated that following the first dose, the second dose caused health issues that required euthanasia shortly after administration. For those animals that survived, there was faster plasma elimination of the Zein:PEG-Zein NPs. Despite this, the Zein:PEG-Zein NPs represent a significantly improved formulation approach, one that displays a long circulation half-life and is suitable for single-use administration. Repeat dose applications will require additional methods to silence the immune response that is generated when using these NPs intravenously.
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Affiliation(s)
- Courtney van Ballegooie
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, BC V5Z 4E6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- NanoMedicines Innovation Network, Vancouver, BC V6T 1Z3, Canada
| | - Nicole Wretham
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, BC V5Z 4E6, Canada
| | - Tanya Ren
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, BC V5Z 4E6, Canada
| | - Ioana-Mihaela Popescu
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, BC V5Z 4E6, Canada
| | - Donald T. Yapp
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Marcel B. Bally
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, BC V5Z 4E6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- NanoMedicines Innovation Network, Vancouver, BC V6T 1Z3, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Medication Management of Selected Pathological Jaw Lesions. Oral Maxillofac Surg Clin North Am 2021; 34:179-187. [PMID: 34602322 DOI: 10.1016/j.coms.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Most jaw lesions are treated surgically. Areas of abnormal proliferation or destruction in bone are commonly treated by regional curettage, excision, or resection. However, surgery is invasive and leaves a defect where the lesion was removed. Surgical trauma to adjacent healthy tissue, including vital neurovascular bundles is often unavoidable, and can be especially traumatizing to the pediatric patient. Select jaw lesions with well-studied nonsurgical pharmaceutical treatments are presented here.
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Gold-Protein Composite Nanoparticles for Enhanced X-ray Interactions: A Potential Formulation for Triggered Release. Pharmaceutics 2021; 13:pharmaceutics13091407. [PMID: 34575482 PMCID: PMC8471296 DOI: 10.3390/pharmaceutics13091407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Drug-delivery vehicles have been used extensively to modulate the biodistribution of drugs for the purpose of maximizing their therapeutic effects while minimizing systemic toxicity. The release characteristics of the vehicle must be balanced with its encapsulation properties to achieve optimal delivery of the drug. An alternative approach is to design a delivery vehicle that preferentially releases its contents under specific endogenous (e.g., tissue pH) or exogenous (e.g., applied temperature) stimuli. In the present manuscript, we report on a novel delivery system with potential for triggered release using external beam radiation. Our group evaluated Zein protein as the basis for the delivery vehicle and used radiation as the exogenous stimulus. Proteins are known to react with free radicals, produced during irradiation in aqueous suspensions, leading to aggregation, fragmentation, amino acid modification, and proteolytic susceptibility. Additionally, we incorporated gold particles into the Zein protein matrix to create hybrid Zein-gold nanoparticles (ZAuNPs). Zein-only nanoparticles (ZNPs) and ZAuNPs were subsequently exposed to kVp radiation (single dose ranging from 2 to 80 Gy; fractionated doses of 2 Gy delivered 10 times) and characterized before and after irradiation. Our data indicated that the presence of gold particles within Zein particles was correlated with significantly higher levels of alterations to the protein, and was associated with higher rates of release of the encapsulated drug compound, Irinotecan. The aggregate results demonstrated a proof-of-principle that radiation can be used with gold nanoparticles to modulate the release rates of protein-based drug-delivery vehicles, such as ZNPs.
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Deventer N, Deventer N, Gosheger G, de Vaal M, Vogt B, Budny T. Current strategies for the treatment of solitary and aneurysmal bone cysts: A review of the literature. J Bone Oncol 2021; 30:100384. [PMID: 34367902 PMCID: PMC8326748 DOI: 10.1016/j.jbo.2021.100384] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 02/09/2023] Open
Abstract
SBCs can mostly be treated conservatively. In ABCs a biopsy is compulsory. ABCs can be treated by polidocanol instillations adequately.
This review of the literature aims to compare the etiology, the pathogenesis, the clinical diagnostics and the relevant treatment options of two different types of cystic bone lesions: the solitary bone cyst (SBC) and the aneurysmal bone cyst (ABC). Whereas the clinical symptoms and the radiographic appearance can be similar, the diagnostic pathway and the treatment options are clearly different. The solitary bone cyst (SBC) represents a tumor-like bone lesion, occurring most frequently in the humerus and femur in children and adolescents. Pain caused by intercurrent pathological fractures is often the first symptom, and up to 87% of the cysts are associated with pathological fractures. In the majority of cases SBCs can be treated conservatively, especially in the upper extremity. However, if a fracture is completely dislocated, joint affecting, unstable or open, surgical treatment is necessary. Pain under weight bearing or regaining the ability to mobilize after fracture timely can necessitate surgical treatment in SBCs affecting the lower extremity. Spontaneous resolution can be seen in rare cases. The aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor that occurs in childhood and early adulthood. It usually affects the metaphysis of long bones but can also occur in the spine or the pelvis. ABC can be primary but also secondary to other bone pathologies. The diagnosis has to be confirmed by biopsy and histopathological examinations. With cytogenetic studies and the detection of specific translocations of the ubiquitin-specific protease (USP) 6 gene primary ABCs can be differentiated from secondary ABCs and other bone lesions. Among various modalities of treatment i.e. en bloc resection, intralesional curettage with adjuvants, embolization or the systemic application of denosumab, intralesional sclerotherapy using polidocanol is an effective and minimally invasive treatment of primary ABCs.
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Affiliation(s)
- Niklas Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Nils Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Marieke de Vaal
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Bjoern Vogt
- Department of Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Tymoteusz Budny
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Agarwal S. Liquid Absolute Alcohol Based Sclerotherapy - A Boon in Large Grade 3 Aneurysmal Bone Cyst of Proximal Humerus in a Child. J Orthop Case Rep 2021; 10:23-26. [PMID: 33708704 PMCID: PMC7933631 DOI: 10.13107/jocr.2020.v10.i08.1842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Aneurysmal bone cyst (ABC) is a benign intraosseous lesion, usually seen before the age of 20 years and is a lesion filled with blood cavities causing a blowout distension of the bone. It constitutes to about 1% of benign bone tumors. Although benign, a large lesion is liable to develop pathological fracture, so needs prompt addressal. Surgical resection or curettage in large lesions can lead to bone defects, deformities, and even functional abnormalities, especially in children. This article describes a large aggressive ABC of proximal metaphyseodiaphyseal region of proximal humerus in a 12-year-old male patient, which we managed effectively with the use of liquid absolute alcohol based sclerotherapy under fluoroscopic control. Case Report: A 12-year-old boy presented to the outpatient department of our hospital presenting with complaint of swelling in the right shoulder region which was insidious in onset with gradual increase in size and deep aching pain since past 6 months. Plain radiograph revealed a large expansile osteolytic lesion with characteristic blown out “soap bubble appearance” involving the proximal humerus and abutting the growth plate. Hence, percutaneous needle biopsy of the lesion under fluoroscopic guidance was undertaken. The histology was likened to a “blood-filled sponge” composed of blood-filled anastomosing cystic cavernomatous spaces separated by wall composed of fibroblasts, myofibroblasts, and osteoclast such as giant cells, osteoid, and woven bone confirmed the diagnosis of ABC. Radiologically, it was classified as Enneking Stage 3 [1] cyst which is locally aggressive and expanding with significant cortical destruction and Capanna type 2 [2] lesion involving the entire bony segment (proximal metaphyseodiaphyseal region) with marked expansion and cortical thinning. Although resection/excision or curettage with bone grafting are commonly undertaken, concerns were for issues of subsequent bony reconstruction given the size of defect with possibility of need of an implant for stabilization, likelihood of damage to growth plate and functional compromise the shoulder. Hence, a decision to treat the patient with liquid absolute alcohol based sclerotherapy was planned. Conclusion: Sclerotherapy with ethanol 96% is a useful method for the treatment of large aggressive ABC, especially in children. It is a minimally invasive method, with no major complications, which lowers the risks of open surgical intervention and has a good outcome when undertaken with proper precautions.
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Affiliation(s)
- Sharat Agarwal
- Department of Orthopaedics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Cruz GS, Cuevas-Suárez CE, Saavedra JPA, Giorgis R, Teixeira MRK, Muniz FWMG. Percutaneous treatments of primary aneurysmal bone cysts: systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1287-1295. [PMID: 33550464 DOI: 10.1007/s00590-021-02893-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To systematically review the literature to determine recurrence rates of percutaneous treatments for primary aneurysmal bone cysts (ABC). METHODS Search strategies were performed in the following databases: PubMed, SCIELO, LILACS and BVS, using terms in English, Spanish and Portuguese (PROSPERO Registration Number: CRD42020170340). Longitudinal studies, either observational or clinical trials, with at least five patients and with a mean of 18 months of follow-up were included. Studies had to use any type of percutaneous treatments and report the recurrence rates of primary ABC treatment. Studies selection, data extraction and risk of bias assessment were performed independently by two researchers. A global meta-analysis was carried out to assess the proportion of recurrence. Studies were categorized into two subgroups: selective arterial embolization and sclerotherapy. RESULTS Thirteen studies were included in the present study. The average success rate of percutaneous treatments for ABC was 91.11%, with a total of 37 lesions recurrences in the 416 patients. The sex ratio was 1:1. The subgroup of sclerotherapies presented a lower proportion of recurrence. The proportion of recurrence in the subgroup of selective arterial embolization was 19% (95%IC 12.11-27.54) and that of sclerotherapies was 6% (95%IC 3.65-9.19). CONCLUSIONS Both percutaneous treatments for ABC are effective, showing a lower rate of recurrence. Sclerotherapy treatments seem to be promising, but further clinical trials must be conducted with a longer follow-up.
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Abstract
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.
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Affiliation(s)
- Luckshman Bavan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Asanka Wijendra
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alpesh Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Weber MG, Fan J, Jenkins R. An Uncommon Presentation of an Uncommon Bone Tumor: A Case Study of a Pathologic Fracture of an Intertrochanteric Aneurysmal Bone Cyst. Cureus 2019; 11:e6461. [PMID: 32025390 PMCID: PMC6977580 DOI: 10.7759/cureus.6461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Matthew G Weber
- Orthopaedic Surgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Juston Fan
- Orthopaedic Surgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Ryne Jenkins
- Orthopaedic Surgery, Riverside University Health System Medical Center, Moreno Valley, USA
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Vollherbst DF, Do TD, Jugold M, Eichwald V, Macher-Göppinger S, Pereira PL, Bendszus M, Möhlenbruch MA, Richter GM, Kauczor HU, Sommer CM. The Novel X-Ray Visible Zein-Based Non-adhesive Precipitating Liquid Embolic HEIE1_2017: An Exploratory Study. Cardiovasc Intervent Radiol 2019; 42:905-914. [DOI: 10.1007/s00270-019-02179-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/02/2019] [Indexed: 01/10/2023]
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Purnomo G, Wijaya M, Kurniati D, Yurianto H, Ruksal Sal M. Use of Triamcinolone Acetonide as Sclerosing Agent in the Treatment of Aneurysmal Bone Cyst: A Case Report. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.3923/jms.2019.51.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ghanem I, Nicolas N, Rizkallah M, Slaba S. Sclerotherapy using Surgiflo and alcohol: a new alternative for the treatment of aneurysmal bone cysts. J Child Orthop 2017; 11:448-454. [PMID: 29263757 PMCID: PMC5725771 DOI: 10.1302/1863-2548.11.170106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
- I. Ghanem
- Department of Orthopedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - N. Nicolas
- Department of Orthopedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - M. Rizkallah
- Department of Orthopedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon,Correspondence should be sent to M. Rizkallah, Department of Orthopedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon. E-mail:
| | - S. Slaba
- Department of Interventional Radiology, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Chang CY, Kattapuram SV, Huang AJ, Simeone FJ, Torriani M, Bredella MA. Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid. Skeletal Radiol 2017; 46:35-40. [PMID: 27743037 DOI: 10.1007/s00256-016-2503-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/21/2016] [Accepted: 09/27/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs). MATERIALS AND METHODS Our study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015. RESULTS Treatment success based on imaging was categorized as substantial (51-100 %), partial (1-50 %), or none (0 %) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7 female, 2 male; mean age 19 ± 5 (range 12-25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93 months (mean 16 ± 29 months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75 %) had complete symptomatic relief and 2 patients (25 %) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50 %). There was a partial imaging response in 2 patients (25 %) and no imaging response in 2 out of 8 patients (25 %), and all 4 of these patients had local recurrence. There were no complications. CONCLUSION Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence.
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Affiliation(s)
- Connie Y Chang
- Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
| | - Susan V Kattapuram
- Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Ambrose J Huang
- Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - F Joseph Simeone
- Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Martin Torriani
- Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Miriam A Bredella
- Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
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Sommer CM, Richter G, Vollherbst D, Macher-Göppinger S, Gnutzmann D, Pereira P, Radeleff B, Kauczor H, Stampfl U. ETHIBLOC_Reloaded: First in-vivo results of the re-designed zein-based fluid embolic agent. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1287644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Christof M. Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
| | - G.M. Richter
- Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
| | - D.F. Vollherbst
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - S. Macher-Göppinger
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Department of General Pathology, University Hospital Mainz, Mainz, Germany
| | - D. Gnutzmann
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - P.L. Pereira
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - B.A. Radeleff
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - H.U. Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - U. Stampfl
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Aneurysmal bone cyst: A 19-case series managed by percutaneous sclerotherapy. Orthop Traumatol Surg Res 2016; 102:213-6. [PMID: 26874446 DOI: 10.1016/j.otsr.2015.11.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/29/2015] [Accepted: 11/23/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sclerotherapy offers an alternative to surgery for the treatment of aneurysmal bone cyst (ABC). The main objective of the present study was to assess the radiological efficacy of sclerotherapy in terms of ossification on MRI. Secondary objectives were to assess clinical efficacy on pain evaluation and to analyze recurrence and complications according to type of sclerosing agent and intraoperative imaging technique. MATERIALS AND METHODS Between 2006 and 2014, 19 patients (7 females, 12 males, aged 3 to 17 years) with ABC treated by sclerotherapy were included. Six received Ethibloc(®), 9 Aetoxisclerol(®), 2 liquid absolute alcohol, and 2 absolute alcohol gel. Assessment used fluoroscopy in 17 cases and CT in 2. Ossification was assessed on MRI and pain on a visual analog scale and HEDEN score. RESULTS Ossification was complete in 11 cases (84.6%) and partial in 2 (15.4%). Eighteen patients (94.7%) were pain-free at 3 months. There was no recurrence, at a minimum 2 years' follow-up. One case of skin necrosis was observed, associated with use of liquid absolute alcohol; there was 1 case of arterial reflux of Ethibloc(®) under CT control. DISCUSSION Sclerotherapy enables minimally invasive treatment of lesions that are deep, difficult of access to surgery and potentially damaging. Use of absolute alcohol gel and fluoroscopic control seems to improve the risk/benefit ratio, limiting complications by vascular extravasation of the sclerosing agent, thanks to real-time visualization of diffusion. Its clinical and radiological efficacy makes sclerotherapy and alternative primary treatment choice in ABC. LEVEL OF EVIDENCE IV, retrospective study.
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Abstract
Most pathologic lesions of the jaws or of oral mucosa are treated successfully by surgical interventions. For treatment of the central giant cell lesion, aneurysmal bone cysts, histiocytosis of the mandible, hemangioma, odontogenic keratocyst, Paget disease, oral submucous fibrosis, and oral lichen planus, medical management consisting of intralesional injections, sclerosing agents, and systemic bisphosphonates is as successful as surgical procedures with fewer complications. Pharmacology of agents used and protocols are presented.
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Affiliation(s)
- Orrett E Ogle
- Mona Dental Program, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica; Oral and Maxillofacial Surgery, Woodhull Medical Center, Brooklyn, NY, USA.
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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.
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Pelle DW, Ringler JW, Peacock JD, Kampfschulte K, Scholten DJ, Davis MM, Mitchell DS, Steensma MR. Targeting receptor-activator of nuclear kappaB ligand in aneurysmal bone cysts: verification of target and therapeutic response. Transl Res 2014; 164:139-48. [PMID: 24726460 DOI: 10.1016/j.trsl.2014.03.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 01/04/2023]
Abstract
Aneurysmal bone cyst (ABC) is a benign tumor of bone presenting as a cystic, expansile lesion in both the axial and appendicular skeleton. Axial lesions demand special consideration, because treatment-related morbidity can be devastating. In similar lesions, such as giant cell tumor of bone (GCTB), the receptor-activator of nuclear kappaB ligand (RANKL)-receptor-activator of nuclear kappaB (RANK) signaling axis is essential to tumor progression. Although ABC and GCTB are distinct entities, they both contain abundant multinucleated giant cells and are osteolytic characteristically. We hypothesize that ABCs express both RANKL and RANK similarly in a cell-type specific manner, and that targeted RANKL therapy will mitigate ABC tumor progression. Cellular expression of RANKL and RANK was determined in freshly harvested ABC samples using laser confocal microscopy. A consistent cell-type-specific pattern was observed: fibroblastlike stromal cells expressed RANKL strongly whereas monocyte/macrophage precursor and multinucleated giant cells expressed RANK. Relative RANKL expression was determined by quantitative real-time polymerase chain reaction in ABC and GCTB tissue samples; no difference in relative expression was observed (P > 0.05). In addition, we review the case of a 5-year-old boy with a large, aggressive sacral ABC. After 3 months of targeted RANKL inhibition with denosumab, magnetic resonance imaging demonstrated tumor shrinkage, bone reconstitution, and healing of a pathologic fracture. Ambulation, and bowel and bladder function were restored at 6 months. Denosumab treatment was well tolerated. Post hoc analysis demonstrated strong RANKL expression in the pretreatment tumor sample. These findings demonstrate that RANKL-RANK signal activation is essential to ABC tumor progression. RANKL-targeted therapy may be an effective alternative to surgery in select ABC presentations.
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Affiliation(s)
- Dominic W Pelle
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich; Department of Orthopaedic Surgery, Grand Rapids Medical Education Partners, Grand Rapids, Mich.
| | - Jonathan W Ringler
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich
| | - Jacqueline D Peacock
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich
| | - Kevin Kampfschulte
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich
| | - Donald J Scholten
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Mary M Davis
- Department of Pathology, Spectrum Health Medical Group, Grand Rapids, Mich
| | - Deanna S Mitchell
- Department of Pediatric Hematology-Oncology, Helen DeVos Children's Hospital, Grand Rapids, Mich
| | - Matthew R Steensma
- Laboratory of Musculoskeletal Oncology, Center for Skeletal Disease and Tumor Metastasis, Van Andel Institute, Grand Rapids, Mich; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Mich; Department of Surgery, Spectrum Health Medical Group/ Helen DeVos Children's Hospital, Grand Rapids, Mich
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Abstract
Aneurysmal bone cyst (ABC) is a benign lesion that commonly involves the metaphysis or metadiaphyseal region of long bones in children. The WHO defined ABC as an expansile osteolytic lesion consisting of blood-filled spaces and channels that are divided by connective tissue septa that may contain osteoid tissue and osteoclast-like giant cells. ABCs are usually treated with intralesional procedures, and variables including surgeon technique, young patient, juxtaphyseal tumors, and tumor location have been associated with recurrence. Juxtaphyseal lesions breaching the physis have been described. There is only one case of primary ABC of the epiphysis in the literature. We present a second case in a 13-year-old boy who presented with a primary ABC of the distal tibial epiphysis, including diagnostic evaluation and treatment.
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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.
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Affiliation(s)
- K Lambot-Juhan
- Pediatric Radiology, Hôpital Necker Enfants Malades, 149-161 rue de Sèvres, Paris, 75015, France.
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