Aneurysmal bone cyst.

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

Primary aneurysmal bone cysts in children: percutaneous sclerotherapy with absolute alcohol and proposal of a vascular classification.

BACKGROUND: Percutaneous sclerotherapy is an effective treatment for aneurysmal bone cysts (ABCs). OBJECTIVE: The purpose of this study was to demonstrate the safety and efficacy of sclerotherapy with absolute alcohol and to propose a vascular classification of ABCs based on a retrospective review. MATERIALS AND METHODS: This was a review of children treated with absolute alcohol sclerotherapy for ABC at a single institution from January 1995 until November 2009. Treatment response was evaluated radiographically and clinically. Cyst fluid was classified as clear, partially bloody, or bloody. Presence of any venous drainage of the cyst was assessed by injection of contrast medium into the cyst cavity. RESULTS: Twenty-nine children with ages ranging from 2 to 16 years were included. Treatment response was good in 17 (59%), partial in 9 (31%), and poor in 3 (10%) children. Venous drainage was absent in six out of seven clear-fluid cysts, which we classified as lymphatic. Drainage was present in all seven bloody-fluid cysts, which we classified as venous. In seven partially bloody-fluid cysts, venous drainage was seen in three. CONCLUSION: Sclerotherapy with absolute alcohol is a safe and effective treatment of ABC. We propose classifying ABC as lymphatic or venous and suggest considering ABC intraosseous slow-flow vascular malformations.

Expansile aneurysmal bone cyst in the tubular bones of the hand treated with en bloc excision and autograft reconstruction: a report of 12 cases.

Primary aneurysmal bone cysts (ABCs) in the small tubular bones of the hands are rare and optimal treatment is not yet established. Between August 1997 and June 2009, 12 patients with biopsy-proven expansile primary ABCs of the small tubular bones of the hand were treated with en bloc tumor excision and strut autograft reconstruction. The adjacent joint was preserved if feasible, otherwise it was fused. Patients were followed for at least 2 years (mean = 7 years). All grafts were incorporated except for partial resorption in one. There was only one tumor recurrence about 1 year after the operation. Other complications included premature physeal arrest in one case and limitation of adjacent joint motion in three. A relatively low rate of recurrence and other complications indicates that this technique would serve as a good strategy for patients with expansile ABCs in the hand in terms of safety, simplicity and reduced number of re-operations.

[Aneurysmal bone cysts of the metacarpals and phalanges of the hand. A 6 case series and literature review]. / Kystes anévrismaux des phalanges et des métacarpiens. A propos de six cas et revue de la littérature.

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.

Quiste oseo aneurismático espinal en los niños / Aneurysmal bone cyst of the spine in children

Introducción: El quiste óseo aneurismático es una lesión seudotumoral infrecuente que afecta preferentemente a personas jóvenes. Es una distrofia ósea seudotumoral benigna, osteolítica y expansiva, constituida por espacios de tamaño variable, llenos de sangre, separados por tabiques de tejido conectivo, que contienen trabéculas de tejido óseo u osteoide y células gigantes de tipo osteoclástico. Materiales y métodos: Se analizan en forma retrospectiva 6 casos espinales en niños, tratados entre 1992 y 2002. El seguimiento promedio fue de 7,8 años. Los datos clínicos más frecuentes fueron dolor, daño neurológico y deformidad o limitación funcional. Las lesiones se estadificaron según su comportamiento biológico (Enneking) y extensión anatómica (Weinstein-Boriani-Biagini). La tomografía computarizada y la resonancia magnética fueron los estudios de elección. El tratamiento consistió en curetaje y relleno con hueso autólogo. Se utilizó osteosíntesis cuando se consideró afectada la estabilidad espinal. Resultados: Se obtuvo la cicatrización de la lesión, sin constatar recidiva. Conclusiones: Los resultados favorables dependen esencialmente del diagnóstico y el tratamiento precoces

Aneurysmal bone cyst in children involving infrequent locations. Report on two cases.

Aneurysmal bone cyst is a benign but locally destructive lesion of bone. We present two cases of ABC in uncommon locations in two children. The first case concerns a 14 year old boy who had a mass located in the internal side of the talus. An ABC type V of Campanacci's classification is diagnosed. Complete curettage was carried out with a high-speed burr. We implanted an Orthofix external fixation with a mobil bottom bolster and distal pins located in the calcaneum. Case 2 concerns an ABC in the clavicle of a 9 years old boy. A selective arterial embolization (SAE) with polyvinyl alcohol was carried out. Curettage of the lesion and filling with a cortico-spongy graft were implemented. Two years later, both of the patients are asymptomatic. We believe that external fixation with a bolster is an efficient and valid alternative to traditional immobilization with a cast. The use of SAE also prevented profuse bleeding of the lesion during surgical procedure.

Surface aneurysmal bone cysts: a pictorial review.

The aim of this article is to present the imaging features of surface aneurysmal bone cysts (ABCs). Twenty-three surface ABCs were identified from of a series of 144 histologically proven ABCs treated in our unit over the past 20 years. The surface ABCs showed a high female preponderance with a predilection for the forearm bones, tibia and femur. With the use of radiographs in all cases and CT and MR imaging in 18 cases it was possible to subdivide the series into subperiosteal (11 cases), cortical (8 cases) and mixed (4 cases) categories. The imaging features distinguishing the various categories are illustrated and the differential diagnosis is discussed.

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.

Cementation of primary aneurysmal bone cysts.

The effects of polymethylmethacrylate (bone cement) on the local control of primary aneurysmal bone cysts excluding spinal lesions were analyzed. After intensive curettage of the lesions, 30 patients underwent a bone graft, and 35 patients had the defect packed with bone cement. After cementation (median time lapse, 4.5 months), 30 of 35 patients underwent a cancellous bone graft after removal of the packed bone cement. The followup period ranged between 24 and 161 months (median, 59.5 months). The local recurrence rate after curettage and cementation was 17% and after curettage and bone graft was 37%. The difference of the cumulative 10-year relapse free survival between patients of both groups was significant. The median time between surgery and local recurrence was 17 months (range, 2-90 months).

[Companacci classification and result of treatment for aneurysmal bone cyst]. / Klasyfikacja Campanacciego a wyniki leczenia torbieli tetniakowatej.

Results of treatment of 17 patients operated because of aneurysmal bone cyst have been assessed. Age at the onset of symptoms ranged from 4 to 39 years, 14 on an average. There were 6 aggressive and active cysts in this series according to the Campanacci classification. Treatment consisted of segmental resection of the bone in 5 patients, curettage of the lesion filing of the defect with autogenous bone in 11 cases. Recurrence of the cyst has been observed in 3 patients, only one of them had aggressive type of tumor.

[Juxta-cortical aneurysmal cyst of the 3rd metacarpal bone. Apropos of a case]. / Kyste anévrysmal "juxta-cortical" du troisième métacarpien. A propos d'un cas.

A case of a "juxta-cortical" aneurysmal bone cyst on the third metacarpal is reported with more than three years of follow-up. No recurrence was observed. The nosology and the treatment are discussed. The literature is reviewed.