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.     

Juxtaphyseal aneurysmal bone cysts.

Aneurysmal bone cysts are benign primary or secondary lesions that commonly arise in long bones and often before skeletal maturity. Little has been written about aneurysmal bone cysts that abut the physeal plate. The records of 15 patients with juxtaphyseal aneurysmal bone cysts were reviewed. Fourteen of the patients were referred with abnormal radiographs after evaluation for pain in the affected limb. One patient presented with abnormal radiographs after fracture about the aneurysmal bone cyst. None of the patients had evidence of growth plate disruption. The children's ages ranged from 2 to 14 years, with a mean of 9.8 years. There were 10 boys and five girls. Lesion locations included: six in the proximal tibia, three in the distal fibula, two in the distal tibia, two in the proximal femur, one in the distal femur, and one in the distal radius. All of the lesions abutted the physeal plate and fell into one of the types in Campanacci's classification of juxtaphyseal aneurysmal bone cysts. Three lesions were classified as Type 1, eight were Type 2, and four were Type 3. This study included no cases of Type 4 or 5 lesions. Treatment of all lesions consisted of excision, curettage, and bone grafting with care taken to preserve the growth plate. Adjunctive cauterization was performed in two cases. There were no incidences of postoperative physeal plate arrest. Overgrowth of the fibula occurred in one patient. Three patients experienced recurrent lesions. One of the children underwent repeat curettage and bone grafting with no additional recurrence. In the other two children with recurrence, the lesion had grown away from the physeal plate while remaining static in size and asymptomatic. Based on this study, juxtaphyseal aneurysmal bone cysts may be treated satisfactorily with intralesional surgery and bone grafting with expectation of normal physeal growth.     

Adjunctive treatment of enchondromas with CO2 laser

STUDY DESIGN/MATERIALS AND METHODS: Fourteen enchondromas, in eight patients, involving the tubular bones of the hand, were treated with curettage, CO2 laser sterilization of the tumor margins followed by autologous bone grafting. Average follow-up time was 35.4 months (14-106 months). Average patients age was 29 years. RESULTS: At follow-up there were no clinical recurrences, none had pain, and all patients reported satisfactory hand function without limitations. Minimal decrease in range of motion without functional limitation was encountered following excision of two lesions (14%) in one patient. One patient reported an increase in range of motion after excision. Grip strength was only minimally decreased. There was no radiographic evidence of recurrence. CONCLUSION: The use of CO2 laser is safe and effective as an adjunct to curettage and bone grafting in the management of relatively large enchondromas of the tubular bones of the hand.     

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.     

Aneurysmal bone cysts of the pelvis in children: a multicenter study and literature review

The authors analyzed a series of 15 pelvic aneurysmal bone cysts (9 boys and 6 girls) in children and adolescents who were reviewed with an average follow-up of 50.3 months. Pain and limp were the main symptoms. Four patients had no treatment after the open biopsy. Eleven patients were treated with curettage. Preoperative selective arterial embolization was performed in three cases before curettage. Two recurrences were noted after curettage; recurrences were treated successfully with further curettage. As a result, the authors recommend curettage; more aggressive operative intervention does not appear to be indicated. No major intraoperative vascular complications occurred. Spontaneous healing in a few cases (even in active or aggressive lesions) argues for clinical and radiologic observation after biopsy when possible. In case of a propitious evolution, observation must be continued and surgery might be avoided, but if the lesion increases, treatment must be proposed.     

Simple bone cysts of the calcaneus. Differential diagnosis and therapy

Fifty-two calcaneal simple bone cysts from our clinic were evaluated. The lesions had a pathognomonic radiologic appearance and diagnosis was histologically confirmed in all operatively treated cases. Four cases presented with pathological fractures, three of which were treated by open reduction internal fixation and bone grafting, while one was treated nonoperatively. In addition, six patients with large cysts without apparent fracture but spontaneous pain were treated by curettage and subsequent autogenous bone grafting or calcium phosphate cement filling, and there were no recurrences. The majority of cysts (42 of 52) were however asymptomatic and thus followed up nonoperatively. This review reports on one of the largest series of cysts in this location. The results indicate that nonoperative management is justified in most asymptomatic cases. However, the potential risk of fracture as indicated by four fractured calcaneal cysts in this series suggests that large cysts should be clinically monitored and that operative intervention is useful in all symptomatic cases to prevent pathologic fractures. In the latter cases, curettage and bone grafting as well as the use of bone substitute material yielded uniformly good results.     

Bone grafting unnecessary in the treatment of enchondromas in the hand

Twenty-eight consecutive patients with enchondromas in the hand skeleton had simple curettage of the tumor without bone grafting. The patients were followed-up with a radiologic examination mean six years (range from 0.5 to 16 years) after operation. Results were classified according to the amount of new bone formed in the cavity left after curettage. Results in fifteen patients with excellent bone formation were classified as grade one, in nine patients with good bone formation as grade two, and in four patients with scanty bone formation as grade three. There were no patients without new bone formation (grade four), nor were there any recurrences or postoperative fractures in this series. We conclude that simple curettage without bone grafting is a safe and effective treatment of enchondromas in the hand.     

Giant cell tumor of bone: Multimodal approach

Background:

The clinical behavior and treatment of giant cell tumor of bone is still perplexing. The aim of this study is to clarify the clinico-pathological correlation of tumor and its relevance in treatment and prognosis.

Materials and Methods:

Ninety -three cases of giant cell tumor were treated during 1980-1990 by different methods. The age of the patients varied from 18-58 yrs with male and female ratio as 5:4. The upper end of the tibia was most commonly involved (n=31), followed by the lower end of the femur(n=21), distal end of radius(n=14), upper end of fibula (n=9), proximal end of femur(n=5), upper end of the humerus(n=3), iliac bone(n=2), phalanx (n=2) and spine(n=1). The tumors were also encountered on uncommon sites like metacarpals (n=4) and metatarsal(n=1). Fifty four cases were treated by curettage and bone grafting. Wide excision and reconstruction was performed in twenty two cases. Nine cases were treated by wide excision while primary amputation was performed in four cases. One case required only curettage. Three inaccessible lesions of ilium and spine were treated by radiotherapy.

Results:

19 of 54 treated by curettage and bone grafting showed a recurrence. The repeat curettage and bone grafting was performed in 18 cases while amputation was done in one. One each out of the cases treated by wide excision and reconstruction and wide excision alone recurred. In this study we observed that though curettage and bone grafting is still the most commonly adopted treatment, wide excision of tumor with reconstruction has shown lesser recurrence.

Conclusion:

For radiologically well-contained and histologically typical tumor, curettage and autogenous bone grafting is the treatment of choice. The typical tumors with radiologically deficient cortex, clinically aggressive tumors and tumors with histological Grade III should be treated by wide excision and reconstruction.     

Osteofibrous dysplasia of the tibia. Is there a need for a radical surgical approach?

Osteofibrous dysplasia is an unusual developmental condition of childhood, which almost exclusively affects the tibia. It is thought to follow a slowly progressive course and to stabilise after skeletal maturity. The possible link with adamantinoma is controversial and some authors believe that they are part of one histological process. We retrospectively reviewed 16 patients who were diagnosed as having osteofibrous dysplasia initially or on the final histological examination. Their management was diverse, depending on the severity of symptoms and the extent of the lesion. Definitive (extraperiosteal) surgery was localised "shark-bite" excision for small lesions in five patients. Extensive lesions were treated by segmental excision and fibular autograft in six patients, external fixation and bone transport in four and proximal tibial replacement in one. One patient who had a fibular autograft required further excision and bone transport for recurrence. Six initially underwent curettage and all had recurrence. There were no recurrences after localised extraperiosteal excision or bone transport. There were three confirmed cases of adamantinoma. The relevant literature is reviewed. We recommend extraperiosteal excision in all cases of osteofibrous dysplasia, with segmental excision and reconstruction in more extensive lesions.     

Aneurysmal bone cysts of the spine

Thirteen patients with aneurysmal bone cyst of the spine (excluding sacral lesions) were retrospectively reviewed. Treatment for aneurysmal bone cysts remains controversial, but surgical resection, irradiation, and embolization are common treatment modalities for those involving the spine. Of 102 patients with aneurysmal bone cysts, 15 had a lesion of the spine, including 2 sacral cases. Of the 13 patients with a lesion of the thoracic or lumbar spine, 9 underwent resection of the lesion, 2 curettage and cementation, and 2 only currettage. Eleven patients underwent segmental arthrodesis with instrumentation after treatment of the primary or recurrent lesion, while 2 patients underwent segmental arthrodesis using autogeneic bone. Nine patients did not develop a local recurrence after resection of the lesion. However, the 2 patients who underwent curettage alone developed local recurrences. None of 4 patients developed recurrences after curettage and cementation. After recurrence, 1 patient underwent additional resection with irradiation, and 1 patient underwent resection alone. At the final follow-up, all lesions were under control. In one patient, lumbar kyphosis developed after segmental arthrodesis with instrumentation, and arthrodesis was performed again. Radical resection of aneurysmal bone cysts of the spine with instrumentation is the optimal method of acquiring a high degree of local control and preventing spinal deformity. Received: 30 April 1998     

Management of skeletal giant cell tumors of the phalanges of the hand

Five cases of unicentric benign giant cell tumors of the phalanges of the hand are reported. Three patients were initially treated with curettage and bone grafting; two had recurrences that necessitated ray resection as the definitive treatment, and one was free of disease at 16 years' follow-up. The two patients who were primarily treated with ray resection were free of disease at follow-up of 2 and 1 years, respectively. Enneking's surgical staging system and Lodwick's x-ray grading of bone tumors were used to evaluate management methods.     

Juxtacortical chondroma of the hand: treatment by resection of the tumour and the adjacent bone cortex

A recurrence of a juxtacortical chondroma of the finger after marginal excision prompted us to review the treatment of this condition. Although the recommended treatment is simple curettage or marginal excision, the reported recurrence rate is significantly higher for lesions in the hand than those in other locations and recurrences only occurred in patients who had local treatments which did not include excision of the adjacent bone cortex. We report five patients with juxtacortical chondroma of the fingers. The first patient underwent marginal excision without resection of the underlying bone cortex. The other four patients underwent intralesional, marginal or wide excisions of tumour with resection of the bone cortex underlying the lesion. Recurrence was only seen in the patient who did not undergo resection of the bone cortex. Resection of the underlying bone cortex after excision of this tumour may be advisable for the treatment of this tumour in the hand to reduce the rate of recurrence.     

Kalkaneuszysten

Fifty-two calcaneal simple bone cysts from our clinic were evaluated. The lesions had a pathognomonic radiologic appearance and diagnosis was histologically confirmed in all operatively treated cases. Four cases presented with pathological fractures, three of which were treated by open reduction internal fixation and bone grafting, while one was treated nonoperatively. In addition, six patients with large cysts without apparent fracture but spontaneous pain were treated by curettage and subsequent autogenous bone grafting or calcium phosphate cement filling, and there were no recurrences. The majority of cysts (42 of 52) were however asymptomatic and thus followed up nonoperatively. This review reports on one of the largest series of cysts in this location. The results indicate that nonoperative management is justified in most asymptomatic cases. However, the potential risk of fracture as indicated by four fractured calcaneal cysts in this series suggests that large cysts should be clinically monitored and that operative intervention is useful in all symptomatic cases to prevent pathologic fractures. In the latter cases, curettage and bone grafting as well as the use of bone substitute material yielded uniformly good results.     

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     

Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr

BACKGROUND: Aneurysmal bone cyst is a benign, locally destructive lesion of bone. The rates of local recurrence after curettage have varied widely. Therefore, we performed a retrospective study of patients who had had an aneurysmal bone cyst in order to identify the rate of local recurrence and the prognostic factors related to local recurrence after use of contemporary methods of curettage with a high-speed burr. METHODS: We reviewed the cases of forty patients who had been managed by the same surgeon for an aneurysmal bone cyst, as diagnosed on the basis of the latest pathological review, between January 1, 1976, and December 31, 1993. The patients were evaluated with regard to age, gender, the duration and type of symptoms, the presence or absence of pathological fracture, the status of the growth plate, the bone and part of the bone that were involved, the type of operative procedure, the outcome, the radiographic stage, the findings on magnetic resonance imaging and computerized tomography (when it became available) and on bone scintigraphy, and histological parameters. The median duration of follow-up was eighty-seven months (range, fifteen to 267 months). According to the criteria of Enneking, no patient had a stage-1 lesion (one with a surrounding rim of cortical bone), twenty-four had a stage-2 lesion (one with a clearly defined border but no cortical bone), and sixteen had a stage-3 lesion (one with no clearly defined border). RESULTS: Of the forty patients, thirty-four had curettage with use of a high-speed burr. Of these thirty-four, twenty-two had filling of the defect with a cancellous autogenous graft; four, with a cancellous allograft; and three, with polymethylmethacrylate. In five patients, no material was put into the defect. The remaining six patients had resection through the margin of the lesion. Four (12 percent) of the thirty-four patients who had curettage had a local recurrence. No patient who had an excision through the margin of the lesion had a local recurrence. All local recurrences were in skeletally immature girls who were three, four, ten, and eleven years old. Univariate analysis with use of the chi-square, Fisher exact, and Wilcoxon log-rank tests showed that local recurrence was associated only with a young age (p = 0.0036) and open growth plates (p = 0.039). All local recurrences occurred within two years postoperatively, at two, seven, nine, and twenty-four months, and all were treated successfully with a second operation. CONCLUSIONS: Rates of local control of almost 90 percent can be achieved with thorough curettage with use of a mechanical burr and without use of liquid nitrogen, phenol, or other adjuvants in patients who have an aneurysmal bone cyst of an extremity. A young age and open growth plates are associated with an increased risk of local recurrence.     

Percutaneous Ethibloc injection in the treatment of primary aneurysmal bone cysts

The effects of percutaneous Ethibloc (Ethicon/Johnson & Johnson, St-Stevens-Woluwe, Belgium) injection into primary aneurysmal bone cysts were analysed. Two patients with a venous drainage after injection of a medium contrast were excluded. Twelve patients underwent at least one percutaneous injection of Ethibloc. The average follow-up period was 5.1 years. At final follow-up, six patients had complete healing of the cyst, three had partial healing and three, who had no response, were treated by curettage and bone grafting. Complete healing was observed for all the aggressive lesions. No major complications were noted. Ethibloc injection may be performed as a primary treatment of aneurysmal bone cysts if the technique is followed with precision.     

Aneurysmal bone cyst of the mobile spine: report on 41 cases

STUDY DESIGN: Forty-one cases of aneurysmal bone cyst of the mobile spine were retrospectively reviewed. OBJECTIVES: To evaluate the role of surgical and nonsurgical treatment of aneurysmal bone cyst of the spine. SUMMARY OF BACKGROUND DATA: Ten to 30% of aneurysmal bone cysts arise from the mobile spine, frequently occurring in pediatric patients. The course of the disease depends on the aggressiveness of the tumor, as well as the treatment. Intralesional surgery seems to be an effective treatment, as well as radiotherapy and embolization. METHODS: All charts, radiographs, and images were reviewed. The composite information provided by this review allowed for oncologic and surgical staging of these cases. Thirty-two patients underwent curettage (14 of them followed by radiotherapy), four were submitted to selective arterial embolization, three received radiotherapy alone, and two underwent en bloc-excision. RESULTS: All patients were found alive and disease free at final follow-up evaluation. Two recurrences followed one incomplete curettage and one embolization. The combination of curettage and radiotherapy, although effective, showed the greatest incidence of late axial deformity. Selective arterial embolization was curative in three of four cases and did not affect the possibility of surgery in case of local recurrence. CONCLUSIONS: If confirmed on larger series, selective arterial embolization seems to be the first treatment option for spine aneurysmal bone cyst, because of the low cost-to-benefit ratio. Diagnosis must be certain, based on pathognomonic radiographic pattern or on histologic study.- In case of neurologic involvement, pathologic fracture, technical impossibility of performing embolization, or local recurrence after at least two embolization procedures, complete intralesional excision would be the therapy of choice.     

Aneurysmal bone cysts of the spine

Purpose

Aneurysmal bone cyst is a benign, relatively uncommon lesion, representing 1.4 % of primary bone tumors. The vertebral column is involved in 3–30 % of cases. This report describes clinical characteristics and treatment results of 18 patients with aneurysmal bone cyst of the spine.

Methods

Between 1991 and 2008, 18 patients with aneurysmal bone cyst of the spine were surgically treated in our department. The clinical records, radiographs, histologic sections, and operative reports were analyzed.

Results

There were 11 male and 7 female patients; mean age was 22.1 years (range 7–46 years). Localizations were cervical (3), cervicothoracic (2), thoracic (3), lumbar (4), and sacrum (6). Tumor was localized on the left side in 11 cases, on the right side in 2 and at midline in 5 patients. The two most common clinical features were axial pain (14 patients) and radicular pain (8 patients). Neurological signs were paraparesis in 3, monoparesis in 6. Mean duration of symptoms was 9 months (range 3 months–3 years). All patients underwent surgery: total removal was performed in 13 patients and subtotal resection in 5. Posterior (11), anterolateral (1), or combined anterior-posterior (6) approaches were used. Mean follow-up duration was 112.3 months (range 4–21 years). We detected four recurrences in subtotal excision group (4/5), and one recurrence in total excision group (1/13).

Conclusion

Treatment options for aneurysmal bone cysts are simple curettage with or without bone grafting, complete excision, embolization, radiation therapy, or a combination of these modalities. Radical surgical excision should be the goal of surgery to decrease the recurrence rate. Recurrence rate is significantly lower in case of total excision.     

Solitary enchondromas: is radiographic follow-up sufficient in patients with asymptomatic lesions?

Enchondromas are benign cartilaginous tumours and rarely transform into chondrosarcomas. Curettage is usually performed, and a low rate of complications is assumed. We analysed retrospectively data from 73 patients with enchondromas treated by curettage with respect to symptoms, therapy, complications and recurrences. All patients were treated by curettage of the tumour, in most cases followed by cancellous bone grafting. Twenty-three percent of the patients presented a complication. There were two recurrences but no malignant transformations in the follow-up period. During the same time period 29 patients with chondrosarcomas were treated, including two secondary chondrosarcomas. One had a recurrence of a benign enchondroma of the metacarpal and developed a pulmonary metastasis from a chondrosarcoma. The other was a patient with Ollier's disease who had a secondary chondrosarcoma of the radius. Malignant transformation of a solitary enchondroma to a chondrosarcoma is rare. On the other hand the complication rate of enchondroma curettage is considerable. Regular radiological follow-up of asymptomatic enchondromas may therefore be the better option.