Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts:A single-center experience

BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.

A Case Report of Multiple Aneurysmal Bone Cysts

A 30-year old male patient, admitted in our hospital for a fracture of the upper end of the left humerus in February, 2006, received treatment with curettage of the lesion in combination with an autologous bone graft from the right ilium plus internal fixation. A post-operative pathological examination indicated that there was a simple bone cyst in the area of the fracture, with a satisfactory postoperative recovery.

Treatment of Unicameral and Aneurysmal Bone Cysts by Minimally Invasive Percutaneous Injection of Grafton DBF Putty Using the Kyphon Cement Delivery System

Background: Simple Unicameral and Aneurysmal Bone Cysts are benign lesions that may heal spontaneously especially after fracture which may be the first symptom. However, often size increases causing pain, and complications of fractures can severely compromise the patient. Aim: The results in a series of cases treated minimally invasive using a new device for the application of allogenic bone material appear highly promising and shall be presented. Patients and Methods: Eight consecutive patients with symptomatic Unicameral Bone Cysts (UBC) were treated by percutaneous instillation of Grafton? DBF Putty (demineralised allogenic bone containing fibers) mixed with autologous bone marrow using the Kyphon? Cement Delivery System (Medtronic), which allows the injection of this high viscosity paste by controlled high pressure. Five patients with Aneurysmal Bone Cysts (ABC) were treated accordingly after inactivation by Aethoxysclerol 3% and lacking bone formation. Using this approach a high rate of bone regeneration was observed in these patients at 8 months to 5 years follow-up (f/u). Conclusion: The presented technique of a minimally invasive biologic treatment led to highly satisfying results using the Grafton? DBF Putty with its higher potential for bone regeneration than demineralized bone matrix not containing fibres (DBM).

Ilizarov technique for treatment of a giant aneurysmal bone cyst at the distal femur:A case report

BACKGROUND Aneurysmal bone cyst(ABC)is a benign cystic of unknown etiology,characterized by multiple chambers and a high recurrence rate.Current treatment options include vascular embolization,surgical excision,curettage with cavity filling,sclerosing agent injection into the cavity,radiotherapy,and systemic drug therapy.Among these,surgical excision and curettage are the preferred treatment modalities.However,when the cyst reaches a large size,extensive removal of diseased tissue during surgery can hinder bone healing.In our department,we treated a case of a large ABC at the distal end of the femur in a child using the Ilizarov technique.The tumor was completely excised,and reconstruction was achieved through autologous femoral bone transfer.The follow-up at two years post-surgery indicated good results without tumor recurrence,and the growth and development of the child were essentially unaffected.CASE SUMMARY An 11-year-old boy was presented with an accidental fracture of his right leg.Despite having been examined at other hospitals,he had not received treatment.Given the potential for significant bone defects and the difficulty of the surgery,our doctors opted to use the Ilizarov technique to minimize harm to the patient.Upon admission,the patient underwent a needle biopsy and complete tumor resection-the Ilizarov technique assisted in the transport and reconstruction of the autologous femoral bone.Postoperatively,the patient exhibited regular followups,during which bone transport was gradually performed,and the external fixation frame was removed on time.Follow-up X-rays of the right lower limb displayed no tumor recurrence,with a normal appearance.Bone formation at the cutting site was satisfactory,and the union of the bone ends indicated good healing.After two years of follow-up,the patient had essentially returned to normal.CONCLUSION We successfully applied the Ilizarov technique to treat ABC,reducing the financial burden of patients and the pain of multiple surgeries.In cases where significant bone defects occur,the Ilizarov technique has demonstrated satisfactory therapeutic outcomes.

Simple bone cysts of the proximal humerus presented with limb length discrepancy:A case report

BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these observations remain unclear.Additionally,research on the etiology of SBC remains inconclusive,and there has been no consensus on the appropriate timing and methodology for treatment.CASE SUMMARY Here,we present our experience in the successful surgical management of a 10-year-old girl with SBC,who presented with a pathological fracture complicated by malunion of the displaced fracture,varus deformity,and limb length discrepancy.We hypothesized two possible etiologies for the patient’s growth arrest and subsequent humerus varus deformity:(1)Direct disruption of the physis by fluid from the cyst itself;and(2)damage to the epiphysis due to repetitive pathological fractures associated with SBC.In addressing this case,surgical intervention was undertaken to correct the proximal humerus varus deformity.This approach offered the advantages of simultaneously correcting angular abnormalities,achieving mild limb lengthening,providing definitive SBC treatment,and reducing the overall treatment duration.CONCLUSION As per current literature,acute correction of acute angular deformity in proximal humeral SBC is not well comprehended.However,in this specific case,acute correction was considered an optimal solution.

Surgery for fibrous dysplasia associated with aneurysmal-bone-cystlike changes in right proximal femur:A case report

BACKGROUND Fibrous dysplasia associated with aneurysmal bone cyst(ABC)-like changes in the right proximal femur has a low incidence.It is considered more difficult to make early diagnosis than for single fibrous dysplasia.CASE SUMMARY A 14-year-old woman was admitted because of persistent pain in the right hip and abnormal gait over the previous 2 mo.She had no history of present or past illness.Preoperative photography,enhanced computed tomography,and magnetic resonance imaging showed ground-glass appearance with cortical scalloping and expansion of the right proximal femur and femoral neck.Pathological examination by preoperative puncture biopsy revealed fibrous dysplasia of the right proximal femur.The patient was diagnosed with fibrous dysplasia based on medical history,physical examination,and results of laboratory,imaging and pathological examinations.According to final pathological examination,the patient was diagnosed with fibrous dysplasia of the right proximal femur associated with ABC.Curettage and allograft along with fixation of compression screws was performed for fibrous dysplasia associated with ABClike changes.No obvious allograft absorption,loosening of fixation,or secondary fracture were observed during 6-months’follow-up with re-examination by plain radiography and computed tomography.Fibrous dysplasia associated with ABClike changes in the right proximal femur has a low incidence and early diagnosis is considered more difficult than for single fibrous dysplasia.CONCLUSION We report a cases of fibrous dysplasia associated with ABC-like changes in the right proximal femur treated with curettage and allograft along with hip compression screws.

Giant Aneurysmal Bone Cyst of the Right Femur about a Case

Aneurysmal bone cyst (ABC) is a rare bone tumor accounting for 1% - 4% of benign bone tumors. Its etiopathogenesis remains unknown. The main site is the metaphysis of the long bones. ABC occurs almost exclusively in young people, with a slight female predominance. We report an exceptional case of ABC of the femur with involvement of the right hip in a 16-year-old girl in the Medical Imaging Department of Pr Bocar Sidy Sall Hospital of Kati (Mali). We will discuss the clinical and radiological aspects of this pathology. Observation: Mrs N C., aged 16, was referred to the orthopaedic-traumatology department for an X-ray of the right thigh, indicated as having a large, disabling thigh. Clinical examination revealed a large thigh measuring 890 mm in circumference, compared with 300 mm on the contralateral side. Radiographically, the femur showed a blown appearance, with the cortex thinned and broken in places. Exceptionally, the lesion affected the entire femur. On CT scan, we found a voluminous fluid collection occupying the entire right femur, including the right femoral head and homolateral ischium. The cortex was interrupted in places, and the adjacent soft tissues were thinned or laminated, but not infiltrated. Histology revealed haemorrhagic and inflammatory elements compatible with the diagnosis of ABC. Conclusion: ABC is a tumor entity that is often difficult to diagnose. Medical imaging, topographical distribution and histology form an indissociable whole to establish a diagnosis of certainty.

Recurrent aneurysmal bone cyst of talus resulted in tibiotalocalcaneal arthrodesis

Aneurysmal bone cyst(ABC), a locally benign aggressive lytic lesion of either primary or secondary origin, seldom involves the talus. Herein, we present a 25-year-old man with recurrent ABC of the talus after curettage and bone grafting, which was managed by total resection followed by filling the defect using fibular graft and finally tibiotalocalcaneal arthrodesis due to articular surface involvement. At 18 mo postoperatively, no recurrence was detected. Arthrodesis might be a good option in cases with recurrent ABC of the talus especially with articular surface involvement.

HYBRID EXTERNAL FIXATOR FOR THE TREATMENT OF UNICAMERAL BONE CYSTS WITH PATHOLOGICAL FRACTURE IN THE PROXIMAL HUMERUS

Objective: Unicameral bone cyst is a nonneoplasticbone lesion characterized by its tenacity and risk ofrecurrence. Pathological fracture is common and is often the presenting symptom. The objective of the present study was to evaluate the results of hybrid external fixator for thetreatment of a unicameral bone cyst with a pathologicalfracture. Methods: Hybrid external fixator for thetreatment of a unicameral bone cyst was performed intwelve patients. These patients presented with a pathological fracture and were managed immediately with hybridexternal fixator, of whom four had been managedconservatively at other clinics before they were referred toour department. The cyst was located in the proximalhumerus in all patients. The mean age of the patients at the time of surgery was 8.7 years, and the mean duration offollow-up was 32.6 months. Radiographic evaluation wasperformed according to the criteria of Capanna et al., andthe cyst was classified as completely healed, healed withresidual radiolucency (osteolysis), recurred, or having noresponse. Results: The healing period ranged from three to eight months. Eight cysts healed completely, and threehealed with residual radiolucent areas visible onradiographs. There was recurrence of one cyst that hadhealed with residual radiolucency. All of the cysts in thepresent study responded to treatment. A modulation ofhybrid external fixator was necessary in three patients, asthe bars had become too short after bone growth or the pins had been loose. No major complications were observed.Conclusion: Hybrid external fixator provides earlystability, which allows early mobilization and thus obviates the need for a plaster cast. This method of treatment alsoallows for an early return to normal activity.

Transmedullary Decompression for Humeral Diaphysis Solitary Bone Cysts

Solitary bone cysts are benign, fluid-filled cavities that most often occur in childhood. Several minimally invasive decompression methods have been proposed;however, performing a surgical procedure through the thinned overlying cortex raises the risk of pathological fracture and neurovascular damage, especially in lesions located in the bone diaphysis. We describe a new technique that circumvents these problems: tunneling through the normal cortex and medullary space with a flexible reamer, placing a retrograde medullary nail for cyst decompression.

Soft tissue aneurysmal bone cyst of the mandible:Report of a case

We report the case of a 17-year-old boy with a soft tissue aneurysmal bone cyst(STABC) located in the posterior aspect of the right mandible.Conventional radiography revealed no positive findings.On the computed tomography scan,the lesion appeared to have a nonuniform intralesional density.Magnetic resonance imaging revealed an abnormal soft tissue masses with cystic component in the superficial part of right mandibular body and angle with intact cortex.Following histopathological examination,fibro-histiocytic proliferation,blood-filled spaces and multinucleated giant cells were seen and the lesion was diagnosed as a STABC.The mass together with underlying bone and periosteum on its periphery was surgically resected under general anesthesia.Thirty-six months after surgery the patient was assessed at outpatient clinic and found no sign of recurrence This may be only the first reported case of the mandible in the English literature of this extremely rare benign tumor occurring in soft tissue.

Atraumatic groin pain secondary to an aneurysmal bone cyst:A case report and literature review

BACKGROUND Bone lesions can present the multi-displinary team with a challenge by way of diagnosis as some lesions share many radiological and histological characteristics.Giant cell tumours of the bone(GCTB)are relatively common,benign bone tumours.Aneurysmal bone cysts(ABC)are less common benign osteolytic lesions that are histologically similar to GCTBs but produce blood filled cavities.Both GCTBs and ABCs are locally aggressive and are typically found on meta-epiphyseal regions of long bones with pelvic tumours being less common.CASE SUMMARY A 17-year old female presented with atraumatic right groin pain and was initially diagnosed with a GCTB on the right superior pubic ramus of the pelvis.The patient was treated successfully with a wide excision,curettage and bone graft and underwent open reduction and internal fixation of the right hemi-pelvis.Following further intra-operative histological investigations,the lesion was diagnosed as an ABC.CONCLUSION This patient has had an uncomplicated post-operative course,has returned to comfortable weight bearing and will be reviewed for minimum 5 yr in the outpatient setting to monitor for reoccurrence.

Solid Aneurysmal Bone Cyst of the Distal Metatarsus in a Horse

A horse was presented with a slowly growing mass of the distal metatarsal region of the right hind leg. Radiographic examination revealed an eccentric cyst-like lesion with distortion of the lateral margin of the distal metatarsus. The lesion involved approximately half of the metatarsal width, exhibited fine septa, a sclerosed margin towards unaffected bone and a smooth rim of thin compact bone at the periphery. Longitudinal sectioning of the distal metatarsus revealed a solid pale yellow mass with reddish foci and margin. Histologically, the mass consisted of a cell-rich, well vascularized fibrous stroma, containing numerous irregularly shaped trabeculae of woven bone with regular osteocytes. Osteoblasts were observed around the osteoid, and there were foci of numerous osteoclast-like giant cells. The lesion was diagnosed solid variant of an aneurismal bone cyst.

Treatments for primary aneurysmal bone cysts of the cervical spine： experience of 14 cases

Background Aneurysmal bone cyst （ABC） is a benign lesion with the potential to be locally aggressive.The optimal treatment of cervical spine lesions remains controversial.This retrospective study was designed to evaluate the different treatments for primary ABCs of the cervical spine.Methods This series included eight men and six women diagnosed between 2002 and 2012.A retrospective review of the hospital charts,operating room reports,office charts,and radiographs was performed.The data collected included patient age,sex,radiological features,pathology,treatment method,outcomes,and complications from biopsies and treatments.The mean age at diagnosis was 17.5 years old with a range of 6-35 years.All patients had experienced local pain for a mean of 7.3 months （range,0.5-18.0 months）,and three patients had neurological deficits （one with radiculopathy and two with myelopathy）.The Frankel classification before treatment was E in 12 cases,D in one case,and C in one case.Results Four patients received radiotherapy alone.Ten patients underwent surgery,including five total spondyiectomies,two local resections,and three curettages.Three patients received preoperative selective arterial embolization,and four received adjuvant radiotherapy.The mean follow-up time was 44.5 months （range 12-96 months）,and no recurrence was identified.Three patients with neurological deficits achieved complete recovery,as noted at the final follow-up examination.One patient received radiotherapy without appropriate immobilization as prescribed and developed C1-C2 subluxation with severe spinal cord compression but without myelopathy.He refused further treatment.Conclusions The results can be achieved by different treatments （surgical resection/curettage,selective arterial embolization,and radiotherapy） for ABC of the cervical spine.Reconstruction of stability is also important for the treatment of cervical ABC.

Malignant transformation of aneurysmal bone cysts： a case report

An aneurysmal bone cyst is a non-neoplastic, .destructive and expansile lesion consisting of a＂blood-filled sponge＂ that is defined to represent a benign reactive vascularity. Szendroi et al suggested that the aneurysmal bone cyst corresponds to a haemodynamic disturbance that is primary or secondary venous malformation of the bones. The association with trauma including fracture has also been noted and 25%-71% of such patients have a history of trauma. Conventionally, malignant transformation of aneurysmal bone cysts is perceived as a rare occurrence except those induced by irradiation. Both malignant fibrous histiocytoma and osteosarcoma have been reported in the malignant transformation cases.

Nasal Dermoid Cyst with Sinus Tract Intranasal Bone: A Case Report

Dermoid cysts are benign tumors originating from germ cells, which can form in various locations, including the nasal area in rare cases. They are of unknown exact etiology, but it is suggested that it is due to abnormal tissue migration during early embryonic development. Nasal dermoid cysts albeit rare, can present in various forms such as sinuses, fistulas, or intracranially extending tracts. They can be asymptomatic and incidentally discovered or present with a visible external mass or sinus that is either painful, infected or cosmetically concerning. If nasal dermoid cysts with an intra-nasal bone sinus tract are left untreated, they can lead to life-threatening complications. This report describes the case of a 6-year-old girl with a nasal dermoid cyst connected to a superficial punctum by an intra-nasal tract. She had undergone surgical excision of a nasal swelling previously diagnosed as a dermoid cyst. One year later, she returned to our clinic with a recurrence of the nasal swelling. Imaging tests revealed a nasal dermoid cyst with a tract extending to the nasal tip, without intracranial expansion. The cyst, along with the entire tract, was successfully removed surgically, and the postoperative follow-up indicated no complications. Histopathology confirmed the diagnosis of a dermoid cyst. This case underscores the significance of considering the dermoid tract in nasal cyst cases and the necessity of its complete removal to prevent recurrence.

Simple bone cysts in children treated with intracystic fibrin sealant injection

Simple bone cyst （SBC）, also known as a unicameral or solitary cyst, is a benign fluid-filled cavity found primarily at the proximal ends of long bones in children. Treatment is warranted if the pain or a pathologic fracture occurs or if a child is at risk of pathologic fractures. The spectrum of treatments proposed for SBC management ranges from simple Kirschner wire drill-hole, resection or curettage with or without bone grafting to using a cannulated screw for continuous decompression, steroid injection and the latest experience of the use of percutaneous autologous marrow grafting. However, clinical practice of these treatments is limited because of their unsatisfactory effect and possible complications.

Arterial embolization of primary sacral aneurysmal bone cyst

Aneurysmal bone cyst （ABC） is a rare and benign disease that demonstrates active biological behavior,can promptly expand,and exhibits an invasive or destructive capability.1 Currently,the major therapy for ABC is complete curettage of the lesion.1,2 However,the therapy for sacral ABC has risks such as severe bleeding and nerve root damage.2 Arterial embolization is used to treat large sacral giant cell tumors and ABCs and can promptly relieve pain,reduce lesion volume,and promote osteogenesis.3

Enucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts

BACKGROUND The odontogenic jaw cyst is a cavity containing liquid,semifluid or gaseous components,with the development of the disease.In recent years,with the rapid development of oral materials and the transformation of treatment of jaw cysts,more options are available for treatment of postoperative bone defect of jaw cysts.Guided bone regeneration(GBR)places biomaterials in the bone defect,and then uses biofilm to separate the proliferative soft tissue and the slow-growing bone tissue to maintain the space for bone regeneration,which is widely used in the field of implantology.AIM To observe the clinical effect of GBR in repairing bone defect after enucleation of small and medium-sized odontogenic jaw cysts.METHODS From June 2018 to September 2020,13 patients(7 male,6 female)with odontogenic jaw cysts were treated in the Department of Oral Surgery,Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine.Adults without hypertension,heart disease,diabetes or other systemic diseases were selected.The diagnosis was based on the final pathological results:11 cases were diagnosed as apical cysts,one as primordial cyst,and one as dentigerous cyst.The lesions were located in the maxilla in seven cases,and in the mandible in six cases.All cases were treated with the same method of enucleation combined with GBR.RESULTS Three to four months after the operation,the boundary between the implant site and the surrounding normal stroma was not obvious in patients with small-sized odontogenic jaw cysts.The patients with tooth defects were treated with implant after 6 mo.For the patients with medium-sized odontogenic jaw cysts,the density of the center of the implant area was close to the normal mass at 6 mo after surgery,and there was a clear boundary between the periphery of the implant area and the normal mass.The boundary between the periphery of the implant area and the normal mass was blurred at 8-9 mo after surgery.Patients with tooth defects were treated with implants at>6 mo after the operation.CONCLUSION Enucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts can shorten the time of osteogenesis,increase the amount of new bone formation,reduce complications,and improve quality of life.

Aneurysmal Bone Cyst of Talus: A Rare Case

Aneurysmal bone cyst is a benign locally aggressive lytic lesion usually involving metaphyseal regions of long tubular bones. It rarely involves talus. It can be primary or secondary in origin. We reported the imaging findings in a case of a 23-year-old male patient with complaints of pain and swelling around left ankle joint one year ago which turned out to be aneurysmal bone cyst on histopathology.