Spinal aneurysmal bone cysts - case series.

Aneurysmal bone cysts are benign neoplastic lesions that are extensively vascularized and can occasionally exhibit destructive and expanding activity. They typically affect young people, with a small predilection toward females, and most frequently arise during the second decade of life. Aneurysmal bone cysts account for about 1% of all bone tumors and usually develop in long tubular bones, with the spine being much less commonly affected.

Case report illustrating evolution of an intraosseous lipoma: Radiology findings and differentials.

A 21 year old female patient presented with mild left ankle pain for 2 months. Left ankle radiograph was performed, showing a lucent lesion with narrow zone of transition at anterior body of the calcaneus. Further evaluation with MRI showed T1 hypointense and T2 hyperintense signals within said lesion, with fluid-fluid level. The working diagnosis was aneurysmal bone cyst. Follow-up MRI performed 3 years later showed predominant macroscopic fat within the lesion. This case demonstrates composition change of intraosseous lipoma over time.

Sclerotherapy as a Primary or Salvage Procedure For Aneurysmal Bone Cyst: A Case Report.

Introduction: A benign and locally aggressive tumour, aneurysmal bone cysts (ABCs) can develop in any bone but are more common in the metaphysis of long bones. Case Report: A 10 year old Female patient arrived at our outpatient department two years ago with a history of recurring discomfort, edema, and limited movement in her right shoulder and proximal 1/3 of her right arm. X-ray and Magnetic Resonance Imaging (MRI) of the humerus was performed and was diagnosed as aneurysmal bone cyst of proximal humerus. Patient was managed with sclerotherapy with polidocanol injections. The patient experienced significant symptoms improvement was seen two months after starting treatment, and there were no post operative side effects. Monthly progress reports were started, and after three months, physiotherapy was added to improve shoulder range of motion because there were no indications of a recurrence. A two-year follow-up showed improvement and no indications of a relapse. Conclusion: Percutaneous Sclerotherapy can be used as a primary procedure for aneurysmal bone cyst.

Sclerotherapy with absolute alcohol in a child with spinal aneurysmal bone cyst: A case report.

Aneurysmal bone cyst (ABC) is a benign and locally proliferative vascular disorder in the form of a non-neoplastic bone lesion commonly found in children and young adults. Several treatments and therapeutic options are available. Percutaneous sclerotherapy is an alternative treatment for ABC with less morbidity than other therapies. An 11-year-old girl presented with a lump in her left flank since 10 months ago with paresthesia, and leg weakness. The patient was unable to raise her legs and walk. The patient underwent posterior surgical and stabilization procedures with tumor extirpation. Three months postsurgery, the lump progressively increased and tenderness. MRI showed an expansile destructive lytic lesion, firm borders, regular margins, and multiple septa with clear transition zones, without periosteal reactions, forming a picture of a "soap bubble appearance" surrounding the lumbar paravertebral. The patient underwent sclerotherapy using 5 ml of absolute alcohol under visual fluoroscopy guidance. After the sclerotherapy, the patient showed clinical improvement and decreased lump size. No side effects or massive bleeding were experienced postsclerotherapy. Thoracolumbar x-ray post sclerotherapy showed a decreased mass size in the posterior lumbar area. This case demonstrates that sclerotherapy presents a secure alternative for pediatric patients in contrast to spinal ABC surgery. It offers minimal invasiveness and reduced morbidity. The percutaneous administration of absolute alcohol proves effective in treating spinal ABC. In this case, the patient experienced clinical improvement, leading to a decrease in lump size. There were no instances of significant bleeding around the lump postsclerotherapy.

A Classical Case of Sessile Osteochondroma in a 13-Year-Old Boy.

This case report highlights the understanding of the swelling feature of the right knee in a young adult and gives an overview of bone tumors. We are presenting a case of right knee swelling in a 13-year-old boy who was anxious before the investigations. Additionally, this report provides an approach for an accurate diagnosis of swelling. It highlights the approach to bone swelling and provides an overview of how to classify bone tumors. With the help of advanced technology such as magnetic resonance imaging (MRI), it gives detailed information about the nature of bone tumors, especially in the case of sessile osteochondroma. This case report also gives us information about the classification of bone tumors and their progression and guides us toward management with the help of an MRI.

Giant Cell Tumor With Secondary Aneurysmal Bone Cyst in the Left Distal Humerus: A Case Report.

Giant cell tumor (GCT) is a common benign aggressive tumor that mostly occurs in the proximal tibia, distal radius, and distal femur but is rarely seen in the distal region of the humerus. It originally presents between the ages of 30 and 50 with suddenly occurring pain. Treatment is generally curettage adjuvant treatment if necessary and reconstruction if required. In our case report, we present the clinical and radiological findings, diagnosis, and management of a 33-year-old female patient with a giant cell tumor (GCT) accompanied by a secondary aneurysmal bone cyst (ABC) in the left distal humerus, where the patient experienced pain for many years without significant history of trauma. Upon clinical examination, the patient displayed tenderness over the medial side of the elbow but no noted swelling, redness, or hotness. She had a painless full range of motion, with an intact distal neurovascular examination. Imaging concluded GCT with secondary ABC. A biopsy confirmed the diagnosis, ruling out metastatic lesions. The patient underwent surgical intervention, with plate fixation, which yielded excellent outcomes.

Rare Aneurysmal Bone Cyst Presentation in the Orbit: A Systematic Review of the Literature with an Illustrative Case Report.

OBJECTIVE: Aneurysmal bone cysts (ABCs) are benign but aggressive vascular lesions within bone. Orbital ABCs, though rare, are clinically significant due to the risk of debilitating symptoms such as vision loss. METHODS: Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Google Scholar, Embase, and SCOPUS databases to identify and assess primary articles exploring orbital ABC cases. Additionally, we present an illustrative case report. RESULTS: Among the 54 cases from the 51 studies included, the mean age was 16.87 years, with 23 males, 29 females, and 2 unspecified. The most prevalent symptoms were exophthalmos (N = 36) and diplopia (N = 21). Regarding laterality, the right orbit was most commonly affected (N = 27), followed by the left orbit (N = 21), with 4 cases of bilateral involvement. Within the orbit, the medial wall most frequently impacted location (N = 14), followed by the orbital roof (N = 13), posterior wall (N = 7), lateral wall (N = 3), and orbital floor (N = 2), with 15 cases involving multiple locations. Surgical resection was the primary treatment, resulting in complete resolution in 44 cases. In our case, a 30-year-old male with an orbital ABC was managed surgically through bifrontal craniotomy with superior orbitotomy for lesion excision and orbital roof reconstruction. CONCLUSIONS: ABCs in the orbit can be challenging, and complete removal of the lesion is essential for achieving optimal patient outcomes.

Soft tissue aneurysmal bone cyst presenting as an enlarging neck mass: Case report and review of the head and neck literature.

Soft tissue aneurysmal bone cysts (STABCs) are rare neoplasms histopathologically identical to aneurysmal bone cysts. These benign lesions are characterized by thin, peripheral ossification and no skeletal continuity. STABC may be difficult to distinguish from myositis ossificans (MO) and malignant entities from imaging and fine needle aspiration, due to rarity and overlapping features. We present a case of a STABC occurring in the paraspinal cervical muscles. The imaging, histopathology, molecular analysis, and treatment are discussed. Four other published cases of STABC of the head and neck are reviewed.

Juvenile trabecular ossifying fibroma associated with central giant cell granuloma and aneurysmal bone cyst like changes - A triple hybrid tumour? Or a pathologic sequelae?

Hybrid tumours encompass lesions containing two or more pathologic entities. The pathogenesis of these lesions is barely understood and described. Juvenile trabecular ossifying fibroma (JTOF) is a benign but locally aggressive fibro-osseous neoplasm commonly affecting the maxilla of the adolescent age group. Hybrid lesions of JTOF have been reported along with central giant cell granuloma (CGCG), aneurysmal bone cyst (ABC) and traumatic bone cyst, respectively. However, the co-occurrence of JTOF with CGCG and ABC in a single patient has not yet been reported in the literature, hence, making ours the first case report of this kind. Theories describing the pathogenesis of this rare phenomenon have also been proposed and elaborated.

Nanopore DNA Sequencing Detected Chromothripsis-Induced PAFAH1B1::USP6 Rearrangement in Periosteal Solid Aneurysmal Bone Cyst Initially Diagnosed as Osteosarcoma.

An aneurysmal bone cyst (ABC) is a benign bone neoplasm that typically occurs during the first and second decades of life. ABC usually presents as a rapidly growing intramedullary expansile mass with multiple blood-filled cysts in the metaphysis of the long tubular bones. Here, we report a case of a periosteal solid ABC that was initially diagnosed as a high-grade surface osteosarcoma. A 10-year-old male was referred to our hospital for swelling and tenderness of the left upper arm. Radiography revealed periosteal mass without fluid-fluid levels. On performing open biopsy, the tumor showed hypercellular proliferation of uniform spindle to epithelioid cells with brisk mitotic activity (up to 12/2 mm2) and lace-like osteoid formation, which was diagnosed as a high-grade surface osteosarcoma. After one course of chemotherapy using adriamycin and cisplatin, peripheral sclerosis was conspicuous, which led to pathological review and revision of diagnosis as "possibly osteoblastoma." The patient was disease-free for 4 years after marginal resection and curettage. Retrospective nanopore DNA sequencing unexpectedly detected a PAFAH1B1::USP6 rearrangement. The fusion gene was further validated using reverse transcription-polymerase chain reaction and the diagnosis was revised to ABC. Chromothripsis involving chromosome 17 has also been identified. Methylation analysis classified the present tumor as an ABC or non-ossifying fibroma using t-distributed stochastic neighbor embedding and unsupervised hierarchical clustering. This case report highlights the utility of nanopore DNA sequencing for soft tissue and bone tumor diagnosis.

Response of Recurrent Aggressive Aneurysmal Bone Cyst of Distal Tibia to Denosumab Treatment.

Introduction: Aneurysmal bone cysts (ABCs) are aggressive and benign tumors that primarily affect children and adolescents. The standard course of treatment for ABCs involves surgical excision or curettage with a bone transplant or cement to repair the deficiency. Denosumab, a monoclonal antibody that inhibits receptor activator of nuclear kappa B ligand, is used to treat osteoporosis, skeletal metastasis, and giant cell tumors of the bones. Case Report: This case study details the therapeutic treatment of a female patient, age 22, who had a recurring aggressive ABC of the distal tibia. The patient was initially treated using curettage and lesion filling. However, recurrence of the osteolysis was observed 9 months later that led to subsequent interventions involving absolute alcohol sclerotherapy in multiple sessions. However, these interventions failed to achieve ossification. Following unsuccessful surgical and sclerotherapy treatments, the patient was administered denosumab, which led to a positive response. Regular radiographic and clinical follow-up demonstrated significant improvements in ossification and pain reduction. During the course of the 12-month treatment, the frequency of visits was gradually reduced. Further, follow-up and monitoring revealed the effectiveness of the local control and long-term treatment. Conclusion: This case report highlights the ability of denosumab to manage recurrent aggressive ABCs after surgical or sclerotherapy failure.

A New Radiological Scoring System as a Method of Assessing Sclerotherapy Treatment Response for Aneurysmal Bone Cysts: A Retrospective Study.

Background A widely accepted set of imaging criteria or classification has not yet been adopted to evaluate response to treatment by percutaneous sclerotherapy for aneurysmal bone cyst (ABC). In this article, we described and illustrated the Royal Orthopaedic Hospital (ROH) scoring system which is a new, reproducible, and objective tool to evaluate the radiological response. We also reported our institutional experience in the efficacy of computed tomography (CT)-guided sclerotherapy for treating such lesions. Patients and Methods A retrospective analysis was conducted for 19 patients who underwent CT-guided sclerotherapy with doxycycline and albumin to treat ABC. Follow-up magnetic resonance imaging, at a minimum of 12 months, was assessed according to the four ROH scoring system parameters: cystic component, fluid-fluid level, presence of consolidation, and cortical integrity. The cumulative score was used to grade response as either: excellent, good, equivocal, or poor. Results Out of 19 patients with a mean age of 17.8 years, 11 cases occurred in the long bones, 5 cases in the pelvis, and 1 in each of the C3 vertebral body, scapula, and talus. The mean parameter of response score for cystic component was 2, fluid-fluid level was 1.3, consolidation was 2, and cortical integrity was 2.1. Four cases showed excellent response, 12 cases showed good response, 2 cases showed equivocal response, and 1 case showed poor response. Interrater reliability was excellent (κ = 0.9). Conclusion The ROH scoring system provides the radiologist and surgeon with an objective method to score imaging parameters of response independently and achieve a grade based on the cumulative score.

Aneurysmal Bone Cyst in the Anterior Region of the Mandible.

Aneurysmal bone cyst is a rare osteolytic lesion of uncertain etiology, commonly observed in the lower limbs, with only 1-2% of reports in gnathic bones. We present the case of a 27-year-old male patient referred to the oral and maxillofacial surgery and traumatology service due to complaints of paresthesia in the mental region and increased mandibular volume. Physical examination revealed midline shift and hard consistency. Imaging examinations demonstrated a radiolucent/hypodense lesion with disruption of the mandibular cortices. The histopathological examination of incisional biopsy material led to the diagnosis of a central giant cell lesion. The patient underwent surgical resection, and the histopathological analysis of the specimen revealed a predominantly solid lesion, characterized by blood-filled spaces of varying size, not covered by epithelium or endothelium, with the presence of spindle cells, multinucleated giant cells, and basophilic osteoid material, concluding the diagnosis of mixed-type aneurysmal bone cyst. Despite being uncommon, aneurysmal bone cysts should be considered in the differential diagnosis of volumetric increase in the gnathic bones of young patients.

Giant Cell Tumor of the Anterior Arc of the Rib: A Case Report.

Tumors that develop on the chest wall are usually rare. This case report highlights a rare occurrence of a giant cell tumor originating from the anterior arch of the fourth rib. The patient, a 21-year-old male, presented with a bulging mass that had been gradually increasing in size over an eight-month period, reaching dimensions of 12 x 8 cm. Despite the noticeable swelling, the patient reported no associated pain or discomfort and denied any history of weight loss or trauma. The absence of chest pain or cardiovascular symptoms distinguished this case from other chest wall pathologies. This report underscores the importance of considering rare entities such as giant cell tumors in the differential diagnosis of chest wall masses, especially in cases where clinical presentation and patient history do not align with more common conditions.

Total Hip Arthroplasty in a Patient With a Large Proximal Femur Aneurysmal Bone Cyst: A Case Report and Literature Review.

Aneurysmal bone cysts (ABCs) are rare benign bone lesions with a predilection for the metaphysis of long bones. They are often cystic, expansive, and osteolytic and may result in bony deformity. In general, there remains debate about optimal treatment for ABCs; however, the mainstay typically consists of a combination of curettage, bone grafting, and considering the need for internal fixation and osteotomies. The goals of treatment include preserving bony anatomy while eliminating the lesion. There is sparse literature regarding the treatment of osteoarthritis adjacent to benign bony tumors. If total hip arthroplasty is chosen as a treatment option, diligent preoperative planning is required, and the surgeon must assess the patient's bone stock, account for bony deformity, and utilize specific implants and techniques based on the patient's characteristics. We present a case of an adult patient with proximal femur ABC and symptomatic adjacent hip osteoarthritis who underwent treatment with total hip arthroplasty.

Pathological Fractures in Aneurysmal Bone Cysts: A Systematic Review.

Background: Aneurysmal bone cysts (ABCs) are osteolytic, non-malignant, vascular lesions of the bone. Pathological fractures can be a manifestation of the ABCs, which occur in about 8% of ABCs. Different treatments have been described in the literature, but, nowadays, an optimal management of the pathological fractures in patients with ABCs is still a matter of debate and there are no standard guidelines for treatment nor any shared indication about the best surgical intervention. The aim of our study is to review the current literature available on this matter exploring and confronting different surgical treatments for pathological fractures in ABC in order to clarify the surgical approach to these patients. Methods: A systematic review of the literature indexed in PubMed, MEDLINE, and Cochrane Library databases was carried out. The Preferred Reporting Items for Systematically Reviews and Meta-Analyses (PRISMA) were followed. Results: A total of 37 articles were relevant and were finally included in the study. In total, we reached a population of 140 patients. Of the 140 patients included in the review, 124 patients (88.6%) underwent curettage surgery, 15 patients (10.7%) underwent en bloc resection surgery. A total of 47% of patients (70) underwent synthesis surgery with a plate, screw, nail, or external fixator. Adjuvant treatments were used in 8.6% of patients (12). Complications involved 20.7% of the patients (29). Conclusions: In conclusion, the treatment of pathological fractures in aneurysmal bone cysts requires careful patient assessment, considering factors such as age, the presence of open growth plates, the location of the lesion, and the surgeon's expertise.

Management of Recurrent Giant Cell Tumor of Distal Tibia With Intramedullary Hindfoot Fusion Nail and Trabecular Metal Implant Construct.

Reconstruction options for giant cell tumors (GCTs) of bone are limited and challenging due to the amount of structural compromise and the high recurrence rates. This is especially true for GCTs of the foot and ankle, as the area is vital for weight bearing and function. The typical treatment for GCTs is currently excision, curettage, and cementation, although that is not always effective. A 36-year-old otherwise healthy female presented with an original diagnosis of a large aneurysmal bone cyst (ABC) of the distal tibia that had recurred despite two previous attempts at treatment with resection and cementation. She was treated with surgical resection of the lesion, reconstruction, and ankle and subtalar joint arthrodesis with a tibiotalocalcaneal intramedullary nail in combination with a trabecular metal cone. The final pathology of the intraoperative samples was consistent with GCT. Postoperatively, she recovered well, and her imaging was consistent with a successful fusion. This case report provides evidence that tibiotalocalcaneal fusion with a unique combination of hindfoot nail and trabecular metal cone construct in a single procedure is a successful option for the treatment of large, recurrent GCT lesions in the distal tibia.

Isolated calvarial aneurysmal bone cyst in a pediatric patient: illustrative case.

BACKGROUND: Aneurysmal bone cysts (ABCs) are benign, osteolytic lesions that can occur in long bones, vertebrae, or rarely, the skull. Here the authors present the case of a 15-year-old male with a primary ABC of the left frontoparietal skull along with a review of the literature to provide insight into the nature of this rare disease. OBSERVATIONS: An otherwise healthy 15-year-old male presented with a tense, painful lesion of the left frontoparietal scalp. He could not identify any inciting trauma, but first noted the lesion less than 2 weeks prior to presentation with progressive enlargement. Cranial imaging revealed a lytic skull lesion with fluid-fluid levels suggestive of ABC. Curative therapy was provided via wide excision of the lesion and calvarial reconstruction of the resultant skull defect. This was performed without complication, and histopathological evaluation confirmed the diagnosis of primary ABC. LESSONS: ABCs of the skull are rare entities and most often arise in the skull base versus the calvaria. Typically, these lesions are associated with an underlying bone pathology (secondary ABCs) but can be rarely seen as isolated lesions (primary ABCs). Clinical management consists of excision and adjuvant therapy for underlying pathology where appropriate.

Pubic Aneurysmal Bone Cyst Following Penile Inversion Vaginoplasty: A Case Report.

Background: Aneurysmal bone cysts (ABCs) are aggressive, expansile, and locally destructive vascular lesions. The exact etiology of ABCs is currently unknown and hypothesized to be related to vascular malformations or disruption of osseous vascularity. To date, there have been no reports describing the development of pubic ABCs following penile inversion vaginoplasty (PIV). Methods: This report describes the development of a pubic ABC in a transgender patient who had previously undergone PIV, possibly indicating a very rare complication of this gender-affirming operation. Results: A 37-year-old transgender female was initially referred to the orthopedic oncology clinic for evaluation of a 12-month history of left hip and groin pain. She had undergone gender-affirming PIV about 19 months prior to presentation. Magnetic resonance imaging (MRI) with contrast revealed a low T1 signal intensity and heterogenous T2 hyperintensity 7.5 × 4.9 × 4.3-cm destructive mass in the left superior pubic ramus extending across the pubic symphysis into the right superior pubic ramus. A needle core bone biopsy demonstrated a variably cellular spindle and round lesion with islands of osteoid formation and focal necrosis. The cells were negative for CD34, S100, and desmin. There was no evidence suggesting osteosarcoma, and final review favored the diagnosis of an ABC. Given the highly destructive nature of the mass, it was resected, and the resulting wound was reconstructed with a biologic dermal mesh. Conclusions: Although it is impossible to distinguish coincidence from causation in this case, the patient's recency of PIV and development of a rare ABC in a nearby bone warrants the speculation and discussion provided in this report.

Aneurysmal Bone Cyst of the Third Metatarsal Treated Using Free Nonvascular Fibular Strut Graft-A Rare Case Report.

Introduction: An aneurysmal bone cyst (ABC) is an unusual, non-cancerous bone lesion that is characterized by its lytic (causing bone loss), hemorrhagic, and expanding nature. ABCs are relatively rare, making up only 1% of all bone tumors. These cysts are typically found in long bones and the spine but are very rarely seen in the metatarsal bones, making such occurrences quite uncommon. Case Report: In this case report, we present a case of ABC of the 3rd metatarsal in a 26-year-old female with complaints of long-standing foot pain and gradually increasing swelling of the dorsum of the foot. After radiological evaluation, she had undergone histopathological evaluation. An en bloc resection of the metatarsal along with the tumor mass was performed and the gap was replaced with an ipsilateral fibular strut graft. Histopathological examination of the resected tissue was suggestive of ABC without any evidence of malignancy. At the end of 1 year of follow-up, she is now completely pain free with intact rom of foot and ankle. Conclusion: The present study aims to describe a case of ABC of the metatarsal, a condition that not only poses a diagnostic dilemma but also constitutes a challenge in the management of lesion.