RESUMEN
The clavicle is an infrequent location for primary tumors in general, and aneurysmal bone cyst (ABC) of the clavicle is particularly rare. The challenge of the functional and esthetic result in the treatment of these lesions in the pediatric population is high when considering the reconstruction of critical bone defects. In this article, we present the case of a seven-year-old boy with an ABC in the middle third of the clavicle, treated by resection and reconstruction with free autograft of the fibula stabilized by using an intramedullary titanium nail. We offer a description of the used technique, considerations about treatment options in children, and a follow-up of more than two-and-a-half years.
Asunto(s)
Quistes Óseos Aneurismáticos , Clavos Ortopédicos , Trasplante Óseo/métodos , Clavícula , Disección/métodos , Peroné/trasplante , Procedimientos de Cirugía Plástica , Quistes Óseos Aneurismáticos/patología , Quistes Óseos Aneurismáticos/fisiopatología , Quistes Óseos Aneurismáticos/cirugía , Niño , Clavícula/diagnóstico por imagen , Clavícula/patología , Clavícula/cirugía , Humanos , Masculino , Radiografía/métodos , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Resultado del TratamientoRESUMEN
OBJECTIVES: Aneurysmal bone cysts (ABC) are benign, rapidly growing osteolytic lesions. Solid variant of ABC (SVABC) is a rare subtype of ABC that has not been reported in the temporal bone. METHODS: We report the case of a 6-year-old boy presenting with a slowly enlarging bony protuberance over the right zygomatic/malar eminence region. Computed tomography and magnetic resonance imaging demonstrated a 2.6 × 5.8 × 5.1 cm temporal bone mass involving the right mastoid, petrous, and temporal squamosal calvarium, with extradural intracranial extension to the middle cranial fossa. RESULTS: The patient underwent preoperative embolization of feeder arteries followed by combined neurosurgical and neurotologic resection. Histopathology revealed characteristic ABC features with interspersed areas of intralesional osteoid formation. CONCLUSION: Solid variant of ABCs are rare lesions of the skull base that present a diagnostic challenge given their unique radiographic and histologic features. Thorough cytogenetic evaluation is warranted to rule out potential malignant secondary causes. Early surgical resection is essential due to the risk of intracranial extension. This is the first report of ABC of any type with concurrent involvement of the squamous, mastoid, and petrous portions of the temporal bone and the first report of SVABC of the temporal bone.
Asunto(s)
Quistes Óseos Aneurismáticos , Embolización Terapéutica/métodos , Procedimientos Neuroquirúrgicos/métodos , Hueso Temporal , Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/fisiopatología , Quistes Óseos Aneurismáticos/cirugía , Niño , Disección/métodos , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Cuidados Preoperatorios/métodos , Hueso Temporal/diagnóstico por imagen , Hueso Temporal/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
El quiste óseo aneurismático sólido es una lesión ósea benigna muy infrecuente de la que no existe consenso en relación a su origen etiopatogénico. Presenta características clínicas, radiológicas e histológicas inespecíficas, por lo que los estudios ultraestructurales son fundamentales para su diagnóstico y clasificación. El diagnóstico diferencial es extenso e incluye múltiples lesiones óseas como el granuloma reparativo de células gigantes e incluso tumores malignos como el osteosarcoma. El tratamiento de elección es la cirugía conservadora. La recidiva se debe fundamentalmente a la extirpación incompleta(AU)
Solid aneurysmal bone cyst is a rare benign bone lesion for which no consensus exists regarding its origin. It has nonspecific clinical, radiological and histological features so ultrastructural studies are essential for diagnosis and classification. The differential diagnosis is extensive and includes a variety of bone lesions, such as giant cell reparative granuloma, and even malignant tumors like osteosarcoma. The treatment of choice is conservative surgery. Recurrence is due mainly to incomplete resection(AU)
Asunto(s)
Humanos , Femenino , Niño , Quistes Óseos Aneurismáticos/complicaciones , Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/cirugía , Granuloma de Células Gigantes/complicaciones , Granuloma de Células Gigantes/diagnóstico , Radiografía Panorámica/métodos , Radiografía Panorámica , Quistes Óseos Aneurismáticos/fisiopatología , Quistes Óseos Aneurismáticos , Mandíbula/patología , Mandíbula , Neoplasias Mandibulares/patología , Neoplasias Mandibulares/cirugía , /tendenciasRESUMEN
Aneurysmal bone cysts are non-neoplastic, expansile, osteolytic tumor-like conditions. All bones may be involved, but the most commonly affected is the metaphysis of the long bones, especially the tibia, humerus and femur. We present a 13-year-old female patient with a cystic lesion with cortical continuity and a large bone cyst in the coronoid process of the ulna. The bone cyst was treated with curettage, phenol application and cement implantation following cyst debulking. Aneurysmal bone tumors are rare tumor-like conditions and localization at the coronoid process of the ulna with mechanical block of the elbow motion has yet to be reported. Debulking and curettage of the lesion and bone cement implantation are useful methods for local control of aneurysmal bone cysts.
Asunto(s)
Quistes Óseos Aneurismáticos , Articulación del Codo , Procedimientos Ortopédicos/métodos , Cúbito , Adolescente , Cementos para Huesos/uso terapéutico , Quistes Óseos Aneurismáticos/patología , Quistes Óseos Aneurismáticos/fisiopatología , Quistes Óseos Aneurismáticos/cirugía , Legrado , Desinfectantes/administración & dosificación , Articulación del Codo/patología , Articulación del Codo/fisiopatología , Articulación del Codo/cirugía , Femenino , Humanos , Instilación de Medicamentos , Fenol/administración & dosificación , Rango del Movimiento Articular , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Cúbito/patología , Cúbito/cirugíaRESUMEN
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.
Asunto(s)
Quistes Óseos Aneurismáticos/cirugía , Procedimientos Ortopédicos , Quistes Óseos Aneurismáticos/clasificación , Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/fisiopatología , Trasplante Óseo , Ablación por Catéter , Legrado , Diagnóstico Diferencial , Embolización Terapéutica , Humanos , EscleroterapiaRESUMEN
Objetivo. Se presenta un caso poco frecuente de quiste óseo aneurismático por su localización y por su forma de presentación clínica y radiográfica inicial. Caso clínico. Mujer de 13 años que consultó por dolor atraumático en el borde externo del pie derecho con radiografía inicial normal y presentación al cabo de un mes de una lesión tumoral subperióstica en la diáfisis del quinto metatarsiano, cuyo diagnóstico definitivo fue de quiste óseo aneurismático tipo iv de Campanacci. Conclusiones. Existen pocos casos en la literatura médica de quiste óseo aneurismático que presenten estas características. Por su localización poco frecuente, este tipo de lesiones pueden plantear dificultades diagnósticas con otro tipo de enfermedades, como tumores, fracturas de estrés o infecciones (AU)
Objective. We present s a case of aneurysmal bone cyst, unusual and rare, both for its location and its initial clinical and radiographic presentation. Case report. A girl of 13 years consulting for atraumatic pain in the outer edge of right foot, with a normal initial X-ray and then one month later presented with a subperiosteal tumour lesion in the fifth metatarsal shaft, which was definitively diagnosed as an aneurysmal bone cyst, Campanacci type IV. Conclusions. There are few cases in the literature of aneurysmal bone cyst with these characteristics. Such lesions may pose significant diagnostic difficulties with other pathologies, such as tumours, stress fractures or infections, due to its unusual presentation (AU)
Asunto(s)
Humanos , Femenino , Niño , Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/cirugía , /métodos , Osteosarcoma/cirugía , Osteosarcoma , Quistes Óseos Aneurismáticos/fisiopatología , Quistes Óseos Aneurismáticos , Diáfisis/patología , Diáfisis/cirugía , Huesos Metatarsianos/patología , Huesos Metatarsianos , Metatarso/patología , Metatarso/cirugía , Huesos Metatarsianos/fisiopatologíaRESUMEN
BACKGROUND: Minimally invasive approaches such as sclerotherapy have been introduced to treat aneurysmal bone cysts. Sclerotherapy has been associated with reasonable healing rates during the past two decades. However, it is unclear whether sclerotherapy compares with the more traditional extended curettage and bone grafting. QUESTIONS/PURPOSES: We therefore compared the healing rates and functional scores in patients having percutaneous repetitive sclerotherapy using polidocanol (Group 1) with those with intralesional excision (extended curettage with a high-speed burr) and bone grafting (Group 2) for treatment of aneurysmal bone cyst. PATIENTS AND METHODS: We randomly divided 94 patients into two treatment groups. We assessed healing rates (primary outcome measure), pain relief, time to healing and recurrence, hospital stay, and the Enneking functional score. Forty-five patients from Group 1 and 46 from Group 2 were available for study. The minimum followup was 3.2 years (mean, 4.4 years; range, 3.2-6.1 years). RESULTS: At last followup, 93.3% in Group 1 and 84.8% in Group 2 had achieved healing. Complications in Group 1 were minor and resolved. In Group 2, three patients had deep infections and five had superficial infections, and two had growth disturbances. Although the healing rates were similar, we found higher rates of clinically important complications, worse functional outcomes, and higher hospital burden associated with intralesional excision. CONCLUSIONS: Repetitive sclerotherapy using polidocanol is a minimally invasive, safer method of treatment for aneurysmal bone cysts compared with intralesional excision and bone grafting. In this preliminary study, we found similar recurrence rates for the two treatment methods, however, this will require confirmation in larger studies. LEVEL OF EVIDENCE: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Asunto(s)
Quistes Óseos Aneurismáticos/terapia , Trasplante Óseo , Legrado , Polietilenglicoles/uso terapéutico , Soluciones Esclerosantes/uso terapéutico , Escleroterapia , Adolescente , Adulto , Quistes Óseos Aneurismáticos/diagnóstico por imagen , Quistes Óseos Aneurismáticos/fisiopatología , Quistes Óseos Aneurismáticos/cirugía , Trasplante Óseo/efectos adversos , Niño , Legrado/efectos adversos , Femenino , Humanos , Tiempo de Internación , Modelos Logísticos , Masculino , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Polidocanol , Polietilenglicoles/efectos adversos , Radiografía , Recuperación de la Función , Recurrencia , Medición de Riesgo , Factores de Riesgo , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas , Adulto JovenRESUMEN
The article reviews aneurysmal bone cysts of the spine and current diagnostic tests approaches and therapeutic interventions are discussed.
Asunto(s)
Quistes Óseos Aneurismáticos/epidemiología , Quistes Óseos Aneurismáticos/patología , Enfermedades de la Columna Vertebral/epidemiología , Enfermedades de la Columna Vertebral/patología , Columna Vertebral/patología , Quistes Óseos Aneurismáticos/fisiopatología , Diagnóstico por Imagen/normas , Embolización Terapéutica/métodos , Humanos , Incidencia , Procedimientos Neuroquirúrgicos/métodos , Recurrencia , Curvaturas de la Columna Vertebral/etiología , Curvaturas de la Columna Vertebral/fisiopatología , Enfermedades de la Columna Vertebral/fisiopatología , Columna Vertebral/fisiopatologíaRESUMEN
Our case report describes a primary aneurysmal bone cyst (ABC) of the maxillary sinus in a 12-year-old girl. The young patient presented with progressive diplopia, strabismus, and rapidly growing painless swelling of the left cheek. Imaging studies showed a heterogeneous contrast enhancing mass expanding the left maxillary sinus. The lesion was completely resected endoscopically and histological examination reported it as an ABC. The patient recovered well and is free of recurrence 9 months following surgery. ABC is a benign lesion usually associated with other bone pathology (fibrous dysplasia). It may behave aggressively and invade the orbit; so resection is necessary. Minimally invasive techniques such as endoscopic sinus surgery can be performed successfully in select cases. Long follow up is important because recurrence may occur, in which case further resection is warranted.
Asunto(s)
Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/cirugía , Seno Maxilar/patología , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/cirugía , Quistes Óseos Aneurismáticos/fisiopatología , Niño , Diplopía , Endoscopía , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Seno Maxilar/cirugía , Enfermedades de los Senos Paranasales/fisiopatología , Estrabismo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the efficacy of percutaneous sclerotherapy in the treatment of aneurysmal bone cysts. MATERIALS AND METHODS: Seventeen patients (7 girls, 10 boys) with aneurysmal bone cysts were treated by the percutaneous approach with Ethibloc ( n=14) and histoacryl glue ( n=3) in our institution between January 1994 and June 2000. The cysts were located in the extremities ( n=6), pelvis ( n=2), spine ( n=2), mandible ( n=5), rib ( n=1) and sphenoid bone ( n=1). Percutaneous sclerotherapy was performed with fluoroscopic and/or computed tomographic guidance under general anesthesia. Clinical and imaging follow-up lasted from 24 months to 9 years and 6 months (mean: 57.3 months). The results were quantified as: excellent (residual cyst less than 20% of the initial involvement), satisfactory (residual cyst 30-50%), unsatisfactory (residual cyst more than 50%). RESULTS: The age of the patients ranged from 4 years and 6 months to 15 years and 8 months (mean: 11 years and 2 months). In nine patients, the therapeutic procedure was repeated 2-5 times. Excellent regression was observed in 16 (94%), satisfactory results in 1 (6%). There was no failure (unsatisfactory result or no response to treatment) in this reported series. The complications were minor and included: local inflammatory reaction ( n=2), small blister ( n=1), and leakage ( n=1). Relief of symptoms was achieved in all patients. No recurrence was noted during follow-up. CONCLUSION: Percutaneous sclerotherapy of aneurysmal bone cysts with Ethibloc is safe and effective. It is an important alternative to surgery, especially when surgery is technically impossible or not recommended in high-risk patients.
Asunto(s)
Quistes Óseos Aneurismáticos/diagnóstico por imagen , Quistes Óseos Aneurismáticos/terapia , Diatrizoato/uso terapéutico , Ácidos Grasos/uso terapéutico , Glicoles de Propileno/uso terapéutico , Escleroterapia/métodos , Zeína/uso terapéutico , Adolescente , Quistes Óseos Aneurismáticos/fisiopatología , Niño , Preescolar , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Medición de Riesgo , Soluciones Esclerosantes/uso terapéutico , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Bone cysts are commonly encountered clinical problems in the pediatric age group. The most common types of cysts are the unicameral and aneurysmal bone cysts. These benign lesions vary in their aggressiveness, clinical behavior and treatment. Both of these lesions are poorly understood in terms of their etiology, but effective treatment exists. These lesions represent a source of great consternation to both clinicians and families, for they weaken the bone and may be confused with malignant lesions. This review will focus on the two most commonly encountered cystic lesions in the pediatric population.
Asunto(s)
Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/terapia , Quistes Óseos Aneurismáticos/complicaciones , Quistes Óseos Aneurismáticos/fisiopatología , Niño , Legrado , Fracturas Espontáneas/etiología , Humanos , SucciónRESUMEN
A 16-year-old female with cyclic neutropenia (CN) was incidentally found to have a thoracic vertebral mass during the preoperative work-up for maxillary sinus surgery. An exploratory thoracotomy revealed a very vascular tumor involving T-10 and T-11 vertebral bodies. Gross total resection of the tumor was achieved. Pathology revealed a solid variant of aneurysmal bone cyst. This is a rare benign neoplasm of bone more commonly seen in the mandible and facial bones as well as involving the small tubular bones of the hands and feet. Because of its rarity, location, and an unknown association with CN, we found this case worthwhile to publish.
Asunto(s)
Quistes Óseos Aneurismáticos/etiología , Neutropenia/complicaciones , Adolescente , Quistes Óseos Aneurismáticos/patología , Quistes Óseos Aneurismáticos/fisiopatología , Femenino , HumanosRESUMEN
Two cases of induced healing of aneurysmal bone cyst (ABC) following intralesional implantation of a bone paste made of autogeneic bone marrow and allogeneic bone powder are reported. The calcaneum in one case and the superior pubic ramus in the other were blown out by an ABC and would have required extensive surgery. Via a minimal exposure, the cyst was partially evacuated and filled with an admixture of a partially demineralized bone particles with bone marrow. Ossification of the peripheral shell was the first sign of healing and was observed within the first 3 postoperative months. Successful healing was observed in both cases. The rationale underlying this intralesional treatment was that the bone grafting material might reverse ABC expansion by promoting ossification through a bone induction mechanism. The concept of this treatment was to retain the ABC tissue, using its own intrinsic osteogenic potential to promote healing. By triggering intralesional new bone formation, the bone paste represented an effective means to reverse the expanding phase of ABC. The particulated bone allograft was easy to handle and to introduced in an irregular cavity. Moreover, as a complete cyst evacuation was not required, a minimal surgical approach could be used so that the risks and morbidity associated with an extensive approach were reduced. Its use is of particular interest in poorly accessible areas like the pelvis and spine.
Asunto(s)
Quistes Óseos Aneurismáticos/cirugía , Trasplante de Médula Ósea/métodos , Trasplante Óseo/métodos , Osteogénesis , Adolescente , Adulto , Quistes Óseos Aneurismáticos/fisiopatología , Calcáneo/diagnóstico por imagen , Calcáneo/cirugía , Femenino , Humanos , Hueso Púbico/diagnóstico por imagen , Hueso Púbico/cirugía , RadiografíaRESUMEN
Cryosurgery using liquid nitrogen is a method for treating benign- and low-malignant skeletal tumors. The advantage of preserving the supportive function of bone should be compared to the risk for its complications; postoperative fracture is well known, but less so the occurrence of intraoperative venous gas embolism. This paper describes 17 patients: 2 patients who had serious hemodynamic complications during cryosurgery and a study of 15 patients in whom end-tidal N2 tension was measured in an attempt to investigate the clinical incidence of venous gas embolism during cryosurgery. In the 15 cases analyzed, we did not detect any exhaled N2 during cryosurgery.
Asunto(s)
Neoplasias Óseas/cirugía , Criocirugía/efectos adversos , Embolia Aérea/etiología , Complicaciones Intraoperatorias/etiología , Adolescente , Adulto , Anciano , Quistes Óseos Aneurismáticos/complicaciones , Quistes Óseos Aneurismáticos/fisiopatología , Quistes Óseos Aneurismáticos/cirugía , Neoplasias Óseas/complicaciones , Neoplasias Óseas/fisiopatología , Niño , Preescolar , Condrosarcoma/complicaciones , Condrosarcoma/fisiopatología , Condrosarcoma/cirugía , Criocirugía/estadística & datos numéricos , Embolia Aérea/epidemiología , Embolia Aérea/fisiopatología , Femenino , Neoplasias Femorales/complicaciones , Neoplasias Femorales/fisiopatología , Neoplasias Femorales/cirugía , Hemodinámica , Humanos , Húmero/cirugía , Incidencia , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/fisiopatología , Masculino , Persona de Mediana Edad , VenasRESUMEN
Between 1966 and 1991, at the Department of Orthopaedics 34 patients with a mean age of 15.7 years (range 7-46 years) underwent surgery because of aneurysmatic bone cysts. Mean follow-up was 11 years (range 1-26.3 years). We observed a total rate of recurrence of 11.8%. In a group of 9 patients who received local phenol therapy after curettage and bone transplantation no recurrence was observed. The different surgical and conservative methods of treatment are discussed also with respect to rates of recurrence stated in the literature.
Asunto(s)
Quistes Óseos Aneurismáticos/cirugía , Fenoles/uso terapéutico , Adolescente , Adulto , Quistes Óseos Aneurismáticos/tratamiento farmacológico , Quistes Óseos Aneurismáticos/fisiopatología , Niño , Preescolar , Legrado , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , RecurrenciaRESUMEN
Aneurysmal bone cysts are uncommon in the hand. An aneurysmal bone cyst in the capitate of a 16-year-old girl is presented, and 32 previously recorded cases are discussed.
Asunto(s)
Quistes Óseos Aneurismáticos/etiología , Gimnasia/lesiones , Esguinces y Distensiones/complicaciones , Traumatismos de la Muñeca/etiología , Adolescente , Quistes Óseos Aneurismáticos/diagnóstico por imagen , Quistes Óseos Aneurismáticos/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Artropatías/diagnóstico por imagen , Artropatías/etiología , Artropatías/fisiopatología , Radiografía , Rango del Movimiento Articular , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/fisiopatologíaAsunto(s)
Quistes Óseos Aneurismáticos/diagnóstico por imagen , Peroné , Dolor/etiología , Tobillo , Quistes Óseos Aneurismáticos/patología , Quistes Óseos Aneurismáticos/fisiopatología , Neoplasias Óseas/diagnóstico , Diagnóstico Diferencial , Femenino , Displasia Fibrosa Ósea/diagnóstico , Histiocitoma Fibroso Benigno/diagnóstico , Humanos , Persona de Mediana Edad , RadiografíaRESUMEN
We reviewed seven young children (< or = 10 years) with aneurysmal bone cysts. There were four girls and three boys. Six had involvement of the long bones and one had involvement of the clavicle. The average age was 5.5 years (range 2.9-10.6 years). Initial treatment was curettage and bone grafting. There were recurrences in five of the seven children (71%). This represented 100% of children with radiographically aggressive or active lesions. The recurrences appeared rapidly, at an average of 8 months from the first procedure. The mitotic index of the initial lesion did not correlate with that of the recurrent lesion. Surgical management of the recurrences must be handled individually, but repeat curettage and grafting is only recommended when surgical resection is not possible. This high rate of recurrence in radiographically aggressive or active aneurysmal bone cysts in young children should be considered when planning treatment, and in the preoperative counseling of parents.