Aneurysmal bone cysts of the pelvis

Summary Twenty-three cases of pelvic aneurysmal bone cysts treated at the Istituto Ortopedico Rizzoli were rewieved after a mean follow-up of 7 years. Eighteen cysts involved the anterior arch, four extended into the iliac wing and the anterior arch, and one invaded the entire hemipelvis. The acetabulum was involved in 56.5% of the cases. Fourteen patients were treated with surgery (curettage 11; resection 3), and five with radiation therapy; two patients had both modalities; two additional patients refused any treatment after biopsy. The overall recurrence rate was 13% (one case after curettage, one after radiation therapy, and one after combined treatment). Significant complications affected the final functional result in four of seven patients who received radiation therapy, while only one minor complication was seen in the surgical group.     

Aneurysmal bone cysts of the pelvis

Twenty-three cases of pelvic aneurysmal bone cysts treated at the Istituto Ortopedico Rizzoli were reviewed after a mean follow-up of 7 years. Eighteen cysts involved the anterior arch, four extended into the iliac wing and the anterior arch, and one invaded the entire hemipelvis. The acetabulum was involved in 56.5% of the cases. Fourteen patients were treated with surgery (curettage 11; resection 3), and five with radiation therapy; two patients had both modalities; two additional patients refused any treatment after biopsy. The overall recurrence rate was 13% (one case after curettage, one after radiation therapy, and one after combined treatment). Significant complications affected the final functional result in four of seven patients who received radiation therapy, while only one minor complication was seen in the surgical group.     

Epidemiology of aneurysmal bone cyst in children: a multicenter study and literature review

The purpose of this study was to review the demographic data of children and adolescents with aneurysmal bone cysts (ABCs). The authors performed a retrospective, multicenter, pediatric population-based analysis of 156 patients with primary ABCs. Only patients with histologic confirmation of the diagnosis were included. A review of French and English literature of 255 children and adolescents was included regarding sex, location of the lesion and age at diagnosis. There were 212 boys and 199 girls with a median age at diagnosis of 10.2 years (range, 1.5-17 years). Forty-four patients were under 5 years of age; 111 patients were between 5 and 10 years of age, and 139 were older than 10 years of age. The femur, tibia, spine, humerus, pelvis and fibula were the most common locations. In 256 cases (62.7%), ABCs occurred in long bones. We also studied the data and location of 161 ABCs of the mobile spine (13 cases from our series and 148 from the literature review). There were 48 ABCs in the cervical spine, 48 in the thoracic spine, and 65 in the lumbar spine. We found no main differences in site distribution and sex, between the children and the general population.     

Aneurysmal bone cyst of spine: a review of literature

Aneurysmal bone cysts (ABC) are benign, highly vascular osseous lesions characterized by cystic, blood-filled spaces surrounded by thin perimeters of expanded bone. Children and young adults are most affected by spinal ABCs. We document a review of literature.     

Fractures of the pelvis in children: a review of the literature

Trauma is the leading cause of death in children. Pelvic ring injuries account for 0.3–4 % of all paediatric injuries. The pattern of fractures differs to that seen in adults as it is more ductile. Pelvic ring injuries tend to be more stable as the relatively thick periosteum restricts bony displacement. Intrapelvic viscera are not well protected and can sustain injury in the absence of pelvic fractures. These injuries have traditionally been treated non-operatively. In this paper, we comprehensively review the literature and propose a protocol for treatment taking into consideration associated organ injuries, hemodynamic status of the patient, patient’s age, type of fracture and the stability of the pelvic ring.     

Aneurysmal bone cysts of the occipital bone

Two cases of aneurysmal bone cysts are reported. Each patient presented with a palpable mass in the occipital region and signs of compression of structures in the posterior fossa. One of the cases is unique, in that the aneurysmal bone cyst was associated with an epidural hematoma in the posterior fossa. The pertinent literature is reviewed.     

Aneurysmal bone cysts of the spine

Summary Aneurysmal bone cysts of the spine are uncommon. In the English language literature, there have been less than one hundred reported cases. We present five examples, all of which arose in a vertebral body. One case is the first reported arising from the coccyx; one presented at the sixth thoracic vertebral body with complete paraplegia and two with extremely large abdominal masses and catastrophic bleeding during attempted open biopsy. All were resected by a one-stage anterior or combined anterior-posterior approach. Two cases were treated with preoperative irradiation because of profuse, life-threatening bleeding during biopsy, and 4 weeks later complete anterior excision was carried out without difficulty.

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Résumé Les kystes anévrysmaux du rachis ne sont pas fréquents. Il y en a moins de cent rapportés dans la littérature de langue anglaise. Nous en présentons ici 5 cas, tous localisés au niveau d'une vertèbre. L'un d'entre eux est le premier cas publié atteignant le coccyx, un autre était situé sur la sixième vertèbre dorsale entraînant une paraplégie complète et deux déterminaient une volumineuse tuméfaction abdominale qui entraîna, lors de la biopsie, une très abondante hémorragie. Tous furent réséqués en un temps par voie antérieure ou par voie combinée, antérieure et postérieure. Une irradiation pré-opératoire fut effectuée dans deux cas en raison du saignement profus, mettant la vie en danger, survenu durant la biopsie. Quatre semaines plus tard une excision complète par voie antérieure put être réalisée sans difficulté.

     

Aneurysmal bone cysts of the sacrum

BACKGROUND: Aneurysmal bone cysts, first described by Jaffe and Lichtenstein in 1942, are benign lesions that may easily be mistaken for a malignant tumor both radiographically and pathologically. These diagnostic problems are due to their rapid growth, extensive destruction of bone, wide extraosseous tumor masses, and marked cellular exuberance. The differential diagnosis of aneurysmal bone cysts including giant cell tumor, calcified solitary bone cysts, low-grade osteosarcoma, and teleangiectatic osteosarcoma becomes even more complicated when the lesion arises at sites other than the long bones and presents with extensive extraosseous, soft-tissue tumor masses. The latter cases--especially when they occur as sacral or presacral tumors--present challenges with respect to successful treatment, which should combine surgical removal of the entire lesion following oncological criteria to prevent recurrences and osteosynthesis to guarantee the biomechanical stability of the spinal-pelvic junction. Here we report on the clinical case of a female patient with an aneurysmal bone cyst of the sacrum and extensive extraosseous tumor masses. The report includes the diagnostic challenges, the surgical options of sacral and/or presacral tumors, the histopathological findings, and long-term clinical and radiographic surveillance. METHODS: The patient was treated by a combination of preoperative adjuvant selective arterial embolization, radical surgical excision through an anterior approach followed by subsequent osteosynthesis and stabilization through a posterior approach. RESULTS: Clinical and radiographic follow-up for 2 years was uneventful, and the patient is still free of recurrence or any complaints. CONCLUSION: The current report documents the diagnostic and surgical challenge of a gigantic aneurysmal bone cyst of the sacrum and its successful management.     

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.     

Aneurysmal bone cysts of the spine

The article reviews aneurysmal bone cysts of the spine and current diagnostic tests approaches and therapeutic interventions are discussed.     

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     

Aneurysmal bone cyst recurrence in children: a review of 56 patients

BACKGROUND: Aneurysmal bone cysts (ABCs) are benign lesions that are usually treated with intralesional procedures. The clinical behavior of ABCs is reported to be more aggressive in younger patients, with high recurrence rates after surgical treatment by several authors. The purpose of this study was to review longitudinally the demographic data and outcome of current surgical techniques in children with ABC treated at a single institution and to determine the possible risk factors for recurrence, which may be detected at initial examination, including age, presenting complaint, and radiological characteristics. METHODS: The authors performed a retrospective, pediatric population-based (< or =16 years) analysis of 56 cases of ABCs with more than 2 years' follow-up. The subjects were studied and classified on the basis of their age group (< or =5, 5-10, and >10 years of age). The possible risk factors for recurrence were analyzed initially with Student t test and Pearson chi2 test, then a logistic regression analysis model was used for multivariate analysis. RESULTS: Nine patients were younger than 5 years, 17 were between 5 and 10 years old, and 30 were older than 10 years. The most frequent location of the lesion was the humerus (11 cases) followed by proximal femur and fibula. Curettage was the most common treatment modality followed by resection. Recurrence of the lesion occurred in 5 children in the younger age group and in 4 children in the older age group. The difference in persistence or recurrence rates based on age (< or =5 years) and previous surgery was statistically significant. In addition, we have found no significant implication of physeal contact and size of the lesion on recurrence. CONCLUSIONS: The recurrence rates of primary ABC seemed to be higher in younger children. Considering the high cure rates with intralesional procedures even after recurrence, we suggest less aggressive intralesional procedures even in patients with mentioned risk factors; however, the patients' family should be informed about the high probability of recurrence.     

Aneurysmal bone cysts of the metacarpals and phalanges of the hand. A 6 case series and literature review

Aneurysmal bone cysts arising from tubular bones of the hand occur very rarely and require particular diagnostic and therapeutic management techniques. The authors report the diagnostic and surgical management of a monocentric case series of six aneurysmal bone cysts involving the phalangeal and metacarpal bones. In addition to hightlighting the use of diagnostic MRI and biopsy prior to surgical intervention, the authors describe the favourable outcome of curetage with and without the use of bone graft. An aggressive treatment approach such as cryotherapy or resection with reconstruction should only be used in cases when the articular surface is involved, when full bone invasion of the phalanx or metacarpal has occurred, or in case of more than one recurrence.     

儿童跟骨动脉瘤样骨囊肿:病例报告及文献分析

[目的]跟骨动脉瘤样骨囊肿是一种少见病，本文报告了1例儿童跟骨动脉瘤样骨囊肿患者。[方法]本文结合文献回顾性分析了跟骨动脉瘤样骨囊肿患儿的临床、影像学及组织病理学表现。[结果]肿物累及右侧跟骨，经肿物刮除术和植骨术后恢复良好。组织病理学检查确诊为右侧跟骨动脉瘤样骨囊肿。随访2年无复发。[结论]跟骨动脉瘤样骨囊肿是一种少见病，对于单纯的动脉瘤样骨囊肿，肿物刮除术和植骨术是有效的治疗方法。     

Aneurysmal bone cyst of the paediatric shoulder girdle: a case series and literature review

Limited research has analysed paediatric shoulder girdle aneurysmal bone cyst management and outcomes. This study analysed locations affected, investigations, treatments and recurrence in children treated at the London Bone Tumour Unit between 1998 and 2004 and in English and French literature between 1956 and 2004. The proximal humerus and clavicle are most frequently affected whereas scapula involvement is rare. Radiographs, computed tomography and MRI are valuable. Sole curettage of clavicle and scapula lesions has low recurrence rates. Proximal humerus lesions recur most frequently. Curettage alone or with cementation are the most appealing treatments but are associated with significant recurrence.     

Aneurysmal bone cysts of the dorsal spine

Summary Aneurysmal bone cyst is an uncommon but interesting condition, more so when it involves the vertebrae. Three cases of aneurysmal bone cysts of the dorsal spine, suspected on clinicoradiological findings and confirmed by histopathology, are reported in this paper. The authors believe that when the disease affects the pedicles or transverse processes of a vertebra, the plain roentgenographic findings are quite typical of the disease, and a confident radiological diagnosis is possible in the majority of cases.

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Zusammenfassung Die aneurysmatische Knochenzyste ist eine seltene, aber interessante Läsion, besonders wenn sie an der Wirbelsäule lokalisiert ist. Es werden 3 Fälle einer aneurysmatischen Knochenzyste an der Brustwirbelsäule beschrieben, die bereits aufgrund der klinisch radiologischen Befunde diagnostiziert werden konnten und dann histopathologisch bestätigt wurden. Die Autoren sind der Ansicht, daß beim Befall der Bögen oder Querfortsätze des Wirbels im normalen Röntgenbild ein typischer Befund für die Erkrankung besteht und in der Mehrzahl der Fälle eine zuverlässige röntgenologische Diagnose möglich ist.

     

Aneurysmal bone cyst. A population based epidemiologic study and literature review.

Aneurysmal bone cyst is a rare nonneoplastic expansile osteolytic bone lesion of unknown etiology. To the best of the authors' knowledge, no epidemiologic study concerning its incidence has been reported. The authors performed a retrospective, population based analysis of 94 patients with primary aneurysmal bone cyst and a literature review of 1002 patients regarding gender and age predilection. The annual incidence of primary aneurysmal bone cyst was 0.14 per 10(5) individuals. The male to female ratio was 1:1.04, and the median age was 13 years (range, 1-59 years). The results of this study and data compiled from the literature show that aneurysmal bone cysts occur significantly more often in female patients.