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Deventer N, Toporowski G, Gosheger G, de Vaal M, Luebben T, Budny T, Deventer N. Aneurysmal bone cyst of the foot: A series of 10 cases. Foot Ankle Surg 2022; 28:276-280. [PMID: 33715952 DOI: 10.1016/j.fas.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND 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 foot. METHODS This single-center study is a retrospective review of ten patients with primary ABCs of the foot which underwent an intralesional curettage or a polidocanol instillation. RESULTS After intralesional curettage a local recurrence was observed in 3/5 cases. The instillation of polidocanol showed a significant reduction of the initial cyst volume (p=0.0267). In the instillation subgroup a primary complete healing was achieved in three cases. Due to a persisting disease two cases were converted to intralesional curettage without local recurrence in the follow-up. CONCLUSIONS Percutaneous instillation of polidocanol is a minimally invasive treatment option for ABCs of the foot and especially for small bones. Nevertheless, several sequential instillations and a conversion to intralesional curettage can be necessary.
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Affiliation(s)
- Nils Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Gregor Toporowski
- Department of Orthopedics and Tumororthopedics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Marieke de Vaal
- Department of Orthopedics and Tumororthopedics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Timo Luebben
- Department of Orthopedics and Tumororthopedics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Tymoteusz Budny
- Department of Orthopedics and Tumororthopedics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Niklas Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
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Deventer N, Deventer N, Gosheger G, de Vaal M, Budny T, Luebben T, Frommer A, Vogt B. Evaluation of different treatment modalities for fractured and non-fractured simple bone cyst: A single-center review of 68 patients. Medicine (Baltimore) 2021; 100:e26703. [PMID: 34397806 PMCID: PMC8341315 DOI: 10.1097/md.0000000000026703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/07/2021] [Indexed: 12/04/2022] Open
Abstract
Simple bone cysts (SBCs) occur most frequently in the proximal aspect of the humerus and femur in growing age and are associated with intercurrent pathological fractures in up to 87%. Therapeutic management of SBCs remains controversial. The aim of this study was to examine the outcome of conservative and various surgical treatment modalities considering the specific anatomic location and integrity of the SBC.In this retrospective study, we analyzed 68 cases of SBCs who underwent a conservative or surgical treatment between 2009 and 2020 with a mean follow-up of 30.1 months. The epidemiological characteristics, complications, clinical, and radiographic outcome after conservative or surgical treatment were assessed.The study includes 50 male (73.5%) and 18 female (26.5%) patients with a mean age of 9.1 years. The most common locations were the proximal humerus (69.2%, n = 47) and femur (16.2%, n = 11). In 43 cases (63.2%; upper limb n = 40, lower limb n = 3) a pathological fracture occurred. Fifty patients (73.5%; upper limb n = 40, lower limb n = 10) underwent a conservative treatment. In 11 cases (16.2.1%; upper limb n = 4, lower limb n = 7) an intralesional curettage and defect reconstruction with bone substitute without stabilization were performed. Five patients (7.3%; upper limb n = 4, lower limb n = 1) received an osteosynthesis, in two cases (2.9%; upper limb 1; lower limb 1) combined with an intralesional curettage and defect reconstruction with bone substitute. All 32 pathological fractures treated conservatively (upper limb n = 31, lower limb n = 1) healed within 6 weeks; 17/43 patients (39.5%) suffered at least one second fracture. After intralesional curettage and defect reconstruction with bone substitute local recurrence was observed in 5/13 cases (38.5%). Spontaneous consolidation, at least partially, was observed in three cases (4.4%) following conservative treatment after fracture. No relevant secondary angular or torsional deformity was observed after treatment.The majority of 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. Load-dependent pain or the inability to mobilize timely after fracture can necessitate surgical treatment in SBCs affecting the lower extremity. Spontaneous resolution, especially after fracture, can be seen in rare cases.
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Affiliation(s)
- Niklas Deventer
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Nils Deventer
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Marieke de Vaal
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Tymoteusz Budny
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Timo Luebben
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Adrien Frommer
- Department of Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Bjoern Vogt
- Department of Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
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Deventer N, Deventer N, Gosheger G, de Vaal M, Budny T, Laufer A, Heitkoetter B, Luebben T. Chondroblastoma: Is intralesional curettage with the use of adjuvants a sufficient way of therapy? J Bone Oncol 2020; 26:100342. [PMID: 33364155 PMCID: PMC7750402 DOI: 10.1016/j.jbo.2020.100342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 12/27/2022] Open
Abstract
Chondroblastoma represents a rare pathology. An aggressive intralesional curettage leads to low recurrence rates. Hydrogen peroxide as adjuvant lowers the risk of local recurrence.
Background Chondroblastoma is a rare benign cartilaginous bone tumor that represents 1–2% of all primary bone tumors. It is characterized by aggressive growth, possible recurrence after surgical treatment and, in rare cases, metastasis. Surgical management is the primary treatment and includes intralesional curettage with or without adjuvants. Local recurrence rates vary between less than 10% up to more than 30%. Methods In this retrospective study between 2009 and 2020 we analysed 38 cases of chondroblastoma with a mean follow-up of 27.9 months who underwent a surgical treatment in our institution. Epidemiological data, radiographic and histological examinations, different surgical techniques, complications and local recurrence were evaluated to comment on the question if curettage with or without adjuvants is a sufficient way of therapy. Results The study includes 25 male (65.8%) and 13 female (34.2%) patients with a mean age of 17.2 (11–51) years. The most common location of manifestation was the proximal epiphyseal humerus (34.2%), followed by the proximal tibia (26.3%) and the distal femur (15.8%). Joint involvement occurred in 28 patients (73.7%). In all cases intralesional curettage was performed; in 25 cases (65.8%) the resulting cavity was filled with bone substitute, in 7.9% (3 cases) with bone cement and in 10.5% (4 cases) with autogenous bone graft. Adjuvant hydrogen peroxide was used in 64.9% of the cases. The overall recurrence rate was 39.5% (15 cases). The following subgroup analysis showed a recurrence rate of 100% (4/4 cases) after curettage and defect reconstruction with autogenous bone. In the case of intralesional curettage and filling of the cavity with bone substitute but without use of adjuvant the recurrence rate was 50% (4/8 cases). A low recurrence rate of 11.8% (2 cases) was observed in the case of intralesional curettage, using hydrogen peroxide as adjuvant (17 cases) and bone substitute for defect reconstruction. Conclusions Chondroblastoma represents a rare pathology. Therapeutically an aggressive intralesional curettage with use of hydrogen peroxide as adjuvant and filling up the defect with bone substitute leads to low recurrence rates.
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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
| | - Tymoteusz Budny
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Andrea Laufer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Birthe Heitkoetter
- Gerhard-Domagk-Institute of Pathology, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Timo Luebben
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Deventer N, Deventer N, Gosheger G, Budny T, de Vaal M, Riegel A, Heitkoetter B, Kessler T, Poeppelmann M, Rossig C, Juergens H, Luebben T. Aneurysmal bone cyst inadvertently treated with chemotherapy-A series of three cases. Pediatr Blood Cancer 2020; 67:e28638. [PMID: 32761959 DOI: 10.1002/pbc.28638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 01/11/2023]
Abstract
Aneurysmal bone cyst (ABC) is a benign locally aggressive tumor that occurs in childhood and early adulthood. Most relevant differential diagnoses are the telangiectatic osteosarcoma and the giant cell tumor. In the present case series chemotherapy following the EURAMOS or the Euro-Ewing 99 protocol was externally applied in three patients with the misdiagnosis of ABC as malignant bone tumor. In all three cases, a significant reduction of the volume of the ABC was achieved. This is the first report about the use of neoadjuvant chemotherapy in ABC. Chemotherapy reduces the size of an ABC and leads to progressive sclerosis.
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Affiliation(s)
- Niklas Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Muenster, Germany
| | - Nils Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Muenster, Germany
| | - Tymoteusz Budny
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Muenster, Germany
| | - Marieke de Vaal
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Muenster, Germany
| | - Arne Riegel
- Department of Clinical Radiology, University Hospital Munster, Muenster, Germany
| | - Birthe Heitkoetter
- Gerhard-Domagk-Institute of Pathology, University Hospital Munster, Muenster, Germany
| | - Torsten Kessler
- Department of Medicine A, University Hospital Munster, Muenster, Germany
| | - Monika Poeppelmann
- Gerhard-Domagk-Institute of Pathology, University Hospital Munster, Muenster, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Hospital Munster, Muenster, Germany
| | - Heribert Juergens
- Department of Pediatric Hematology and Oncology, University Hospital Munster, Muenster, Germany
| | - Timo Luebben
- Department of Orthopedics and Tumororthopedics, University Hospital Munster, Muenster, Germany
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