Unicameral bone cyst with fracture

In this paper we have presented a 13-year-old boy whose unicameral bone cyst of the proximal humerus was, after sustaining a pathological fracture, obliterated with conservative management of the fracture. The literature is uncertain as to how many similar cases will go on to refracture union and cyst resolution. Therefore, we feel that invasive procedures should be delayed until the fracture heals. If healing of the cyst is not evident at six to eight weeks and if the cyst is small and monoloculated or adjacent to the growth plate, methylprednisolone acetate would be a recommended procedure. In cases of larger and/or multiloculated cysts or cysts that resist steroidal treatment, curettage and bone grafting is warranted.     

Aneurysmal bone cyst of the rib.

Aneurysmal bone cysts are uncommon lesions, especially in the ribs. Four patients with aneurysmal bone cysts of the rib are presented and previously reported cases reviewed. A brief discussion of the clinical manifestations, pathology, aetiology, and current treatment of aneurysmal bone cyst is also included.     

Treatment of aneurysmal bone cyst]

The authors present the results of surgical treatment of 16 cases of aneurysmal bone cyst between 1998 and 2000. Age of patients at the onset of symptoms ranged from 5 to 15 years (average 11.3 years). In 12 cases the cysts were aggressive, and in 5 cases they were active (according to the capanne classification). In 12 cases the characteristic lining of the cyst was removed, curettage was performed and bone grafts were inserted into the bone cavity. In 3 cases autografts were used, in 2 cases both allografts and autografts were used, and in 7 cases only allografts were applied. Two cysts of the fibula were removed en-bloc, a cyst located in the scapule was treated with radiotherapy. In 15 cases the cyst was successfully managed surgically. While in 1 case a revision procedure was performed.     

Aneurysmal bone cyst

Summary Authors report on the results of treatment of 52 primary and 16 secondary aneurysmal bone cysts (ABC). ABC grow rapidly; 84% of them have already destroyed more than the half of the bone width at recognition. En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. Careful curettage and bone grafting still remains the surgical method of choice in the majority of cases, when the ABC is more destructive and affects the subchondral bone of the joints. Segmental resection is only indicated when removal of the affected bone does not influence the function of the extremity. Superselective embolization of the cyst was performed in seven cases with excellent results. This method is suggested for ABC in certain locations inaccessible to surgical intervention, e.g., the pelvis, or to avoid excessive bleeding in hypervascularized tumors. In one case, however, an incomplete rebuilding of the ABC could only be achieved by the administration of calcitonin. The 16 cases of secondary ABC were observed mostly in association with osteoblastomas, giant-cell tumors, and osteosarcomas. The incidence of the secondary ABC was 23% in the whole ABC group but not more than 2–4% among the osteosarcomas and giant-cell tumors. Secondary ABC may confuse the histological and clinical diagnoses and that, especially in cases of osteosarcoma, may have fatal consequences.     

Aneurysmal bone cyst

Aneurysmal bone cysts are rare skeletal tumors that most commonly occur in the first two decades of life. They primarily develop about the knee but may arise in any portion of the axial or appendicular skeleton. Pathogenesis of these tumors remains controversial and may be vascular, traumatic, or genetic. Radiographic features include a dilated, radiolucent lesion typically located within the metaphyseal portion of the bone, with fluid-fluid levels visible on MRI. Histologic features include blood-filled lakes interposed between fibrous stromata. Differential diagnosis includes conditions such as telangiectatic osteosarcoma and giant cell tumor. The mainstay of treatment is curettage and bone graft, with or without adjuvant treatment. Other management options include cryotherapy, sclerotherapy, radionuclide ablation, and en bloc resection. The recurrence rate is low after appropriate treatment; however, more than one procedure may be required to completely eradicate the lesion.     

Solitary bone cyst of the os calcis. 2 Case reports and review of the literature

The calcaneus is a uncommon site for a unicameral solitary bone cyst. However, because of the concentration of forces through the heel, such solitary bone cysts are usually symptomatic, depending on the proximity to the joint and the size of the cyst and therefore require in most cases surgical treatment. This is a report about two patients with a solitary bone cyst of the os calcis in 1996 and 1997. The diagnosis was confirmed radiologically and histologically. The standard therapie in both cases was the curretage of the cyst by packing the defect with bone graft from the pelvis. The author reviewed the literature concerning ethiology, diagnosis and treatment of unicameral solitary bone cysts of the calcaneus. The diagnosis cannot be based solely on radiological findings because of the variation of solitary bone cysts and the special forms, such as calcifying solitary bone cysts. Therefore exact histological diagnosis is of particular importance.     

Aneurysmal bone cyst of the sphenoid sinus

Aneurysmal bone cysts of the sphenoid sinus are very rare, with only six cases described in the literature. We present a case of an aneurysmal bone cyst of the sphenoid sinus with associated fibrous dysplasia in which the radiological findings had some features of a mucocoele. We discuss the differences in pathogenesis, clinical presentation and radiological appearances between these two lesions, and propose a simple drainage procedure as an effective modality of treatment.     

Solitary calcaneal bone cyst in children]

The author presents results of treatment 10 children with calcaneal bone cyst. The mean age in the time of diagnosis was 13.5 years (10-18 years). The mean follow-up was 23.7 months (12-48 months). 4 children complained of heel pain; the rest were asymptomatic. In one child the cyst was large, filled nearly all bone. The rest were typically localized in the antero-middle part of the calcaneus. Steroid injection in one patient failed. All the patient were treated with curettage and bone grafting. The results were good--all the cysts healed. Curretage and bone grafting is indicated in the cases when cyst is large (more than half of the bone), when is localized in the posterior weight-bearing part of the calcaneus, when is painful or the radiograph is not typical.     

Aneurysmal bone cyst of the zygomatic arch

Background: Aneurysmal bone cysts are rare vascular lesions that are most commonly found in the long bones. They are rare in the head and neck. Only two prior cases of aneurysmal bone cysts of the zygoma have been reported in the world literature. Results: We report a case of aneurysmal bone cyst arising in the zygomatic arch with intracranial extension treated with selective arterial embolization and complete excision via an infratemporal fossa approach. This is the first such case reported in the head and neck surgery literature. Conclusions: Selected cases of aneurysmal bone cyst may be safely treated with selective arterial embolization and complete resection.     

Aneurysmal bone cyst of the spine with familial incidence

STUDY DESIGN: A report of two cases of aneurysmal bone cysts of the spine occurring in a father and daughter. OBJECTIVE: To present an unusual finding of familial incidence of aneurysmal bone cyst and review the literature. SUMMARY OF BACKGROUND DATA: Aneurysmal bone cysts are benign, expanding, locally aggressive lesions. Up to 20% of cases involve the spine. The cause of primary aneurysmal bone cysts remains unclear. There have been three previous reports of a familial incidence supporting the importance of a hereditary component in the cause of aneurysmal bone cysts. METHODS: A 36-year-old man and a 7-year-old girl were diagnosed with aneurysmal bone cyst involving the spine by clinical manifestations, radiographic features, and histologic evaluation. RESULTS: The father remains recurrence- and symptom-free 6 years after primary resection. Five months after surgery, the daughter was found to have recurrent disease by magnetic resonance imaging and underwent a second procedure within 1 year of the primary resection. CONCLUSION: The occurrence of a primary aneurysmal bone cyst in two family members, occurring at adjacent vertebral levels, is suggestive of a hereditary component to the formation of primary aneurysmal bone cyst.     

A new treatment of aneurysmal bone cyst by endoscopic curettage without bone grafting

Curettage and bone grafting are the accepted methods of treatment of aneurysmal bone cysts. Unfortunately, recurrence is common. We treated 4 patients with atypical aneurysmal bone cysts that lacked aneurysmal dilatation by endoscopic curettage without bone grafting. New bone formation and remodeling were observed in all patients. In the patients in whom the follow-up was longer than 30 months, there was no evidence of recurrence. Endoscopic curettage without bone grafting is a simple and effective treatment for aneurysmal bone cysts.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 7 (September), 2001: E28     

Unicameral bone cyst of the talus

Unicameral bone cysts are rarely observed in the foot. A histologically proven unicameral bone cyst occurred in the talus of a three-year-old boy. Six additional cases in the world literature are cited to illustrate the therapeutic and diagnostic problems encountered with this lesion.     

Continuous decompression of unicameral bone cyst with cannulated screws: a comparative study

We determined the role of mechanical decompression in the resolution of unicameral bone cyst. A total of 69 children with unicameral bone cysts were treated either by (i) open curettage and bone grafting, (ii) steroid injection or (iii) cannulated screw insertion. During a mean follow-up of 69 months (range, 12-58), the cysts were evaluated by radiological criteria. The healing rates in the three groups were 25, 12 and 29% after the first treatment, and a further 50, 19 and 65% after the second. The study has demonstrated the advantages of the decompression technique for unicameral bone cysts over other treatment modalities studied.     

Aneurysmal bone cyst of the spine

Summary Long term follow up of three patients with aneurysmal bone cysts has allowed us to draw attention to features which facilitate diagnosis and determine adequate treatment. The lesion occurs usually under the age of twenty with a slight female predominance. Treatment consists in complete local excision. Failing this, curettage should be carried out, and this gives good results. The effectiveness of radiotherapy cannot be assessed from our series, but in our opinion it may not be necessary in every case and shoud be applied judiciously, as postradiation sarcomas have been reported. Special attention must be paid to the tendency for spontaneous regression and cure after incomplete removal, particularly in recurrent cases, with a view to avoiding more aggressive treatment than is necessary. Multi-location (vertebra and distant bone), endothelial proliferation, and obliteration of the lumen of the small blood vessels support the view that this is a vascular lesion.     

Aneurysmal bone cyst of the hand: a report of four cases.

Aneurysmal bone cysts are benign lesions that rarely occur in the bones of the hand. Curettage and bone grafting are the most common treatment modalities performed considering the possible functional loss after total excision. Four cases of aneurysmal bone cyst of the hand were identified. Three out of four cases were treated initially with curettage and bone grafting alone without any other local therapy. One had total excision of the lesion. There were two recurrences in the curettage group. Both were treated with excision and followed up for a minimum of 12 months. Curettage alone was associated with high recurrence rates. Total excision of the lesion was the most successful procedure employed. In view of the high recurrence rates following curettage alone and non-neoplastic nature of the lesion, adjuvant treatment modalities such as cryosurgery, electric cauterisation should be considered for initial treatment of ABC. Resection should be preserved for recurrent cases.     

原发动脉瘤样骨囊肿117例临床回顾分析

背景：刮除植骨是原发动脉瘤样骨囊肿的主要治疗方式,其他治疗方式如切除、激素注射、栓塞也见诸报道,均可获得较为满意的治愈率。目的：回顾性分析117例原发动脉瘤样骨囊肿的流行病学特点及影响其复发的相关因素,探讨原发动脉瘤样骨囊肿的治疗方案。方法：1993年2月至2011年5月共收治原发动脉瘤样骨囊肿117例,男68例,女49例;年龄7～60岁,平均23.1岁,中位年龄21岁;病变主要位于股骨、胫骨、脊柱、骨盆及肱骨。治疗手段主要为病灶刮除,还包括局部切除、激素注射、栓塞、放疗、单纯内固定。结果：1年以上随访期77例,随访时间为12～176个月,平均36个月。7例复发,术后复发时间为6～102个月,中位术后复发时间为20个月,复发率为9.1%。复发病例均为病灶刮除患者,其中骨盆3例,股骨4例。初始行非手术治疗8例,其中6例可见病变修复。结论：病灶刮除仍是原发动脉瘤样骨囊肿的主要治疗手段,骨盆病变及复发病变接受治疗后的复发风险较大,对病变部位手术难度大或术后肢体功能影响较大的病变可试行非手术治疗,合理的治疗方案选择有助于控制复发率并保留肢体功能。     

Solitary bone cyst of the os calcis. 2 Case reports and review of the literature Falldarstellung und Literaturübersicht

The calcaneus is a uncomon site for a unicameral solitary bone cyst. However, because of the concentration of forces through the heel, such solitary bone cysts are usually symptomatic, depending on the proximity to the joint and the size of the cyst and therefore require in most cases surgical treatment. This is a report about two patients with a solitary bone cyst of the os calcis in 1996 and 1997. The diagnosis was confirmed radiologically and histologically. The standard therapie in both cases was the curretage of the cyst by packing the defect with bone graft from the pelvis. The author reviewed the literature concerning ethiology, diagnosis and treatment of unicameral solitary bone cysts of the calcaneus. The diagnosis cannot be based solely on radiological findings because of the variation of solitary bone cysts and the special forms, such as calcifying solitary bone cysts. Therefore exact histological diagnosis is of particular importance.     

Successful treatment of aggressive aneurysmal bone cyst of the pelvis with serial embolization

Intralesional surgery is most commonly used for aneurysmal bone cysts. Rarely is en bloc resection used for active, aggressive, recurrent lesions and those located in expendable bones. However, persistence or recurrence of aneurysmal bone cysts is common. The clinical behavior of aneurysmal bone cysts is more aggressive in younger patients. Selective embolization is used as the primary treatment for aneurysmal bone cysts in surgically difficult anatomical locations and as an adjuvant to surgical treatment to reduce intraoperative blood loss and facilitate curettage.This article describes a 3-year-old boy with an aggressive aneurysmal bone cyst of the pelvis involving the right ischiopubic rami that achieved curative treatment with 3 embolizations with N-2-butyl-cyanoacrylate. Biopsy was diagnostic; however, the clinical course was misleading. Twenty days after the first embolization, despite complete occlusion of the feeding vessels, the patient experienced severe pain, increased size of the lesion, and lateral subluxation of the right hip. Based on the imaging and histological diagnosis, intralesional hemorrhage was assumed, and repeat embolization was performed. After the second embolization, the patient experienced perineal skin necrosis from normal vessel embolization; it was treated with wound dressing changes and healed uneventfully. A third embolization was performed because of a persistent lesion. Six years after treatment, the patient was symptom free, and imaging showed complete ossification of the cyst.Selective catheterization and occlusion of the feeding arteries with the appropriate embolic agent provide tumor devascularization, size reduction, pain relief, and induction of new bone formation. Multiple procedures are often necessary, and complications may occur.     

The surgeon's procedure in dystrophic bone cysts in children]

The authors set apart childhood dystrophic cyst as a separate nosological unit. The underlying factor of the development of a bone cyst is dysplasia of vessels filling the bone-marrow canal and a concomitant dystrophic process in the surrounding bone tissue. The nonneoplastic nature of the cysts led to the search for sparing methods of treatment, namely, the puncture method. The administration of demineralized bone shavings during therapeutic puncture (after osteoperforation of the wall, scraping off the fibrous membrane) produces good results. The clinical material consists of 46 cases. There were 8 cases of aneurysmal bone cyst, 23 with active and 15 with passive bone cysts. In 44 cases treatment by two or three punctures led to recovery in 2-4 months. In 2 patients with aneurysmal bone cysts three punctures proved ineffective and an operative intervention was undertaken. It is concluded that treatment by puncture is indicated in dystrophic bone cysts. Operation is indicated in poor outcomes of puncture treatment in patients with aneurysmal bone cysts.     

Aneurysmal bone cyst

Summary Twenty cases of aneurysmal bone cyst were reviewed, with an average follow-up of 10.3 years. Twelve patients still had open growth plates at diagnosis, but all of them were fully grown at follow-up. The treatments performed were: resection of the cyst or of the whole affected bone, curettage, and curettage and bone grafting. Radiation therapy was a complementary treatment in three cases. Two patients relapsed, one that had been treated by curettage alone and one by curettage and bone grafting. Five patients showed skeletal deformities at follow-up. Two had lesions of the growth plate, most likely caused by radiation therapy, whereas in the other three growth had probably been impaired by surgical trauma.