A rare case of osteoblastoma associated to aneurysmal bone cyst of the spine. Case report

Stepwise approach for vertebral hemangioma in children: case-reports and treatment algorithm proposal

PURPOSE

To discuss a treatment algorithm for vertebral hemangioma in children.

METHODS

Vertebral hemangioma (VH) is a rare cause of low back pain in children. In most cases, VHs present as incidental findings and do not require invasive diagnostic procedure. In case of symptomatic presentation, different approaches can be used. Over the years, we have developed a treatment algorithm for VH in children based on our clinical experience. In this manuscript, we propose a stepwise approach to treatment of VHs based on tumor extension and the degree of spinal cord/nerves compression with or without neurological deficit.

RESULTS

According to the proposed protocol, we discuss two cases of aggressive VH treated at our institution by a multidisciplinary team. The first case is about a young girl treated with percutaneous one-level posterior instrumentation followed by medical adjuvant therapy for an L4 "Stage 3" VH. The second case is about an 8-year-old boy with rapidly progressive myelopathy due to T11 "Stage 4" VH treated with a combined anterior and posterior surgery (i.e., posterior decompression and fusion followed by vertebrectomy and expandable cage placement) after preoperative arterial embolization.

CONCLUSION

Given the lack of international guidelines and consensus with regard to treatment of VHs in children, we believe our proposal for a stepwise approach combining clinical and radiological characteristics of the lesion may help guide treatment of this condition in children.

Peculiar bony involvement of sinus pericranii in children: Extensive diploic erosion in three "karstic" variants

OBJECT

Sinus pericranii (SP) is a rare, benign, extradural venous anomaly whose extracranial connection consists in an enlarged subgaleal drainage composed of a network of thin-walled veins that form a varix on the external table of the skull. In the present series of three patients we present three variantesof SP which have never been described, characterized by an extensive diploic erosion causing a "karstic" effect.

METHODS

A systematic review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A comprehensive search for relevant articles was performed on PubMed from 1992 to 2022 using the following search words: "sinus pericranii".

RESULTS

The search produced 77 articles with 137 patients. In all the cases analysed, there were not reported any patients with extensive diploic erosion, namely "karstic" variants. So, the authors present clinical history, neuroimages, treatment strategies and outcome of 3 patients with a "karstic" SP with the aim to describe this clinicradiological entity.

CONCLUSIONS

In this study, our group identified a peculiar variant of SP characterized by bony involvement with extensive diploic "karstic" erosion of diploe, with possible tendency to enlarge during time.

Aneurysmal bone cyst and osteoblastoma: an extremely rare combination in the pediatric spine

STUDY DESIGN

Case report.

OBJECTIVE

To report the clinical and imaging findings of a patient with the extremely rare association of aneurysmal bone cyst and osteoblastoma in the cervical spine. To our knowledge, only three cases have been reported in the published literature in children under 16 years of age with this condition in the cervical spine.

METHODS

The patient's history, physical examination, imaging findings, and management with a complete 4-year medical history, surgical intervention and radiological follow-up are reported.

RESULTS

A 4-year 11-month-old boy was diagnosed with aneurysmal bone cyst in association of osteoblastoma and was treated with CT-guided intralesional injection calcitonin and methylprednisolone. During the course of intralesional therapy, a pathological fracture of C2 was produced. Subsequently, a widened intralesional excision and instrumented fusion from occiput to cervical spine (C0-C4) was performed.

CONCLUSION

The association of aneurysmal bone cyst and osteoblastoma in spine is extremely rare. Although both are benign lesions, in the cervical location, complete removal of the tumors is challenging. Wide resection with reconstruction of the segments for stability associated with adjuvant treatment with calcitonin and corticosteroids provides a good option.

Surgical Excision of Thoracic Osteoblastoma with Secondary Aneurysmal Bone Cyst from a 12-Year-Old Child

INTRODUCTION

Osteoblastoma is a primary benign tumour which commonly presents in the younger population during the second decade of life. However, more aggressive osteoblastomas may present with features of aneurysmal bone cyst, and these can occur at uncommon locations.

CASE PRESENTATION

We report the case of a 12-year-old child having an osteoblastoma on the left side of T11 with secondary aneurysmal bone cyst presenting with neurological deficits and myelopathic symptoms. Surgical debulking of the lesion with decompression laminectomy and posterior instrumentation of the spine was performed. The child is currently recovering well with improvement of neurological deficits.

DISCUSSION/CONCLUSION

Osteoblastoma with aneurysmal bone cyst of the thoracic spine is a rare condition with few reports in the literature, and surgical intervention with complete excision has been demonstrated here with recovery of neurological function.

C4 cervical spine osteoblastoma associated with secondary aneurysmal bone cyst in an adolescent patient: 2-year follow-up

Introduction

Osteoblastoma and aneurysmal bone cyst (ABC) are rare bone tumors with individual prevalence of <1%. Their combined occurrence is a rare subclass of tumors in the spinal column with only a few cases reported in literature.

Case presentation

The present case is a rare combination of aggressive osteoblastoma with secondary aneurysmal bone cyst masquerading as neck pain, arising from cervical C4 vertebra in a 19-year-old male. The patient presented with complaints of neck pain for 7 months, gradual in onset, dull, aching, and progressively increasing in severity. Neurological examination was normal. Radiology showed an expansile lytic mass arising from the posterior elements of C4 vertebra involving the left lateral mass. Piecemeal total removal was done and a posterior fusion from C3 to C5 was performed for stability. Histopathology confirmed the osteoblastoma with a secondary aneurysmal bone cyst. Postoperatively the patient recovered well, and no recurrence was seen on a 2-year follow-up.

Discussion

Simultaneous presence of an osteoblastoma with a secondary ABC arising from various bones, such as cranial fossa, ethmoid sinus, skull, and mandibular condyle, has rarely been reported. It is often diagnosed late due to nonspecific symptoms; but it has a good prognosis if early and complete resection is performed. Thorough surgical excision is always a challenge in spine cases due to surrounding important structures and meticulousness is required to prevent any recurrences. Hence, we recommend a surgical team comprising both spine and musculoskeletal oncologic surgeons to achieve best results.

Diagnostic challenges and surgical management of co-existent osteoblastoma and aneurysmal bone cyst of the lumbar spine in a child: case report

Background

Osteoblastomas (OTB) with co-existent aneurysmal bone cysts (ABC) of the spine are extremely rare and more so in the lumbar spine. To the authors' knowledge, only one case of lumbar spine involvement has been reported in a paediatric patient.

Objectives

To highlight diagnostic challenges and surgical management of co-existent lumbar OTB-ACB in a child.

Methods

We present a 14-year old female with low back pain and progressive swelling of 2 months. She was evaluated by neuroimaging studies and histopathological assessment of resected tissue.

Results

X-ray showed a lytic lesion in L3 with loss of the left pedicle. Magnetic resonance imaging (MRI) revealed a fluid-filled, heterogeneously enhanced, lobulated lesion posterior to the vertebral bodies of L3, L4 and L5, which infiltrated the quadratus lumborum muscles bilaterally, and histologically diagnosed as ABC. The L3 pedicle also revealed an expanded, heterogeneously enhanced mass lesion which appeared to be different and showed no fluid-filled levels, histologically diagnosed as OTB. Surgical intervention involved tumour excision with partial spondylectomy of L3 vertebra, posterior instrumented stabilization and fusion.

Conclusion

The case highlights the diagnostic challenges of co-existent OTB-ABC and the significant role of surgical management via spinal reconstruction, stabilization and fusion after gross total tumour excision.

Cervical Spine Osteoblastoma with an Aneurysmal Bone Cyst in a 2-Year-Old Child: A Case Report

Osteoblastomas and aneurysmal bone cysts are uncommon benign tumors of the spine. Their presentation can vary between diffuse pain, restriction of neck movements, torticollis, radiculopathy, and myelopathy. Complete excision is the best treatment to achieve a cure, but recurrence is not uncommon. A combination of the two conditions in the pediatric population is extremely rare. To the best of the authors' knowledge, only 2 cases of such a combination in the cervical spine have been reported in the literature. We report the case of a 2-year-old child having a right C4 lateral mass osteoblastoma with an aneurysmal bone cyst. The child underwent complete surgical excision of the lesion with fusion.

Case of Spinal Osteoblastoma in Elderly: Is It Really a Young Patient's Disease?

BACKGROUND

Osteoblastoma is a benign bone-forming tumor, sometimes locally invasive, that may involve any bone. The highest incidence is between 20 and 30 years of age, and there are no cases described in the elderly.

METHODS

We report a case of an elderly patient with a lesion in the lumbar spine in which osteoblastoma diagnosis was made.

CONCLUSIONS

Osteoblastoma is a rare tumor older than 50 years of age, but it should be considered in the differential diagnosis of bone lesions of the spine in adulthood and in the elderly, to avoid a delay in the treatment.

Osteoblastomas of the spine: a comprehensive review

Osteoblastomas are primary bone tumors with an affinity for the spine. They typically involve the posterior elements, although extension through the pedicles into the vertebral body is not uncommon. Histologically, they are usually indistinguishable from osteoid osteomas. However, there are different variants of osteoblastomas, with the more aggressive type causing more pronounced bone destruction, soft-tissue infiltration, and epidural extension. A bone scan is the most sensitive radiographic examination used to evaluate osteoblastomas. These osseous neoplasms usually present in the 2nd decade of life with dull aching pain, which is difficult to localize. At times, they can present with a painful scoliosis, which usually resolves if the osteoblastoma is resected in a timely fashion. Neurological manifestations such as radiculopathy or myelopathy do occur as well, most commonly when there is mass effect on nerve roots or the spinal cord itself. The mainstay of treatment involves surgical intervention. Curettage has been a surgical option, although marginal excision or wide en bloc resection are preferred options. Adjuvant radiotherapy and chemotherapy are generally not undertaken, although some have advocated their use after less aggressive surgical maneuvers or with residual tumor. In this manuscript, the authors have aimed to systematically review the literature and to put forth an extensive, comprehensive overview of this rare osseous tumor.