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1.
Cureus ; 16(8): e66428, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39246995

RESUMEN

Introduction This study focuses on the management of primary aneurysmal bone cysts (ABCs) through comprehensive curettage, hydrogen peroxide lavage, and non-vascularized strut fibular grafting. Methods The research encompassed 20 cases, predominantly males (80%), with an average age of 11.35 years. Patient assessment involved thorough history-taking, clinical examinations, and radiological evaluations, including plain radiographs, CT scans, and MRI. The study evaluated healing, bone consolidation, and complications, with patients assessed using the Musculoskeletal Tumor Society (MSTS) upper limb score. Results and discussion The results demonstrated a mean MSTS score of 91.55%, indicating favorable outcomes compared to prior studies. The utilization of non-vascularized autogenous fibular grafts offered effective mechanical stabilization and facilitated an early return to normal function, even prior to complete cavity filling. Our research underscores the efficacy of this treatment approach for primary ABC, particularly in achieving satisfactory functional outcomes. Moreover, the findings contribute to the understanding of optimal management strategies for ABC, considering factors such as patient age, lesion location, vascularity, and size. Conclusion The study advocates for the adoption of thorough curettage, hydrogen peroxide lavage, and non-vascularized strut fibular grafting as a reliable treatment modality for primary ABC. This approach highlights its potential to enhance patient outcomes and functional recovery.

2.
J Clin Med ; 13(15)2024 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-39124789

RESUMEN

Background/Objective: Surgical treatment of aneurysmal bone cysts (ABCs) can be challenging, especially in the spine. Non-surgical treatments such as with denosumab have shown promising results in different osteolytic pathologies. This retrospective observational study aimed to evaluate the long-term clinical and radiologic response of patients with ABCs of the mobile spine treated with denosumab and propose an updated treatment algorithm. Methods: Six patients with relapsed and symptomatic ABCs of the mobile spine were treated with denosumab (120 mg subcutaneously on days 1, 8, 15, 29, and every 4 weeks thereafter) between 2012 and 2023. Disease assessments were conducted using CT and MRI at 3, 6, 9, and 12 months post-treatment. Clinical data, including pain levels, symptoms, and adverse events, were documented from patients' charts. Results: Patients underwent an initial phase of treatment with denosumab, receiving a mean of 22 administrations (range 13-42) over a median follow-up period of 41 months (range 15-98 months). Clinical improvement was observed in all patients after 4 weeks of treatment, and all patients demonstrated a radiological response after 12-24 weeks on denosumab. Three patients were progression-free after discontinuing denosumab following 13, 15, and 42 administrations, respectively. At the last follow-up, after 38, 43, and 98 months, these patients remained stable without relapse of the disease. Three patients had a relapse of disease after denosumab; two of them underwent denosumab re-challenge, while one patient received one mesenchymal stem cells (MSCs) injection. All patients showed clinical and radiological improvement and were resulted to be disease-free at the last follow-up. Conclusions: This study demonstrates the long-term efficacy and safety of denosumab in treating ABCs of the mobile spine, as well as the potential of re-challenge in managing recurrence. A treatment algorithm is proposed, positioning denosumab as a viable therapeutic option after other local treatments. Careful patient selection, monitoring, and further research are necessary to optimize denosumab use for ABCs.

3.
Int J Surg Case Rep ; 119: 109802, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38788635

RESUMEN

INTRODUCTION AND IMPORTANCE: Aneurysmal bone cyst (ABC) is a benign lytic bone tumor of the skeletal system but locally destructive lesion of unknown origin. It often occurs in childhood and usually involves the metaphyseal region of long bones; thus, its localisation in the calcaneum remains rare; its atypical presentation in our case makes it remarkable. CASE PRESENTATION: We describe a case of a young patient who suffered from chronic heel pain, in whom the clinical examination finds swelling and pain on palpation. A complete radiological assessment was carried out, which revealed a solitary and expansive osteolytic lesion within the calcaneus. Treatment included tumor curettage and reconstruction with allograft and cement. The biopsy report was consistent with an ABC. The postoperative follow-up at 18 months was marked by a good radio-clinical evolution and no recurrence. CLINICAL DISCUSSION: ABCs are benign cystic expansive tumors that are reactive, locally destructive and blood-filled, their occurrence in the calcaneus has been reported in only 1.6 % of total reported cases. Talalgia is the most frequent sign associated with swelling. Liquid-liquid level images on MRI is a pathognomonic sign of these lesions but the gold standard diagnosis remains histology. Their treatment is based on curettage - filling by grafting. CONCLUSION: Curettage combined graft makes results butter and improves the quality of life.

4.
Cureus ; 16(3): e56474, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38638726

RESUMEN

Aneurysmal bone cysts (ABCs) are uncommon benign bone lesions that consist of blood-filled vascular spaces surrounded by fibrous tissue septa. Their diagnosis and surgical management are challenging in a war-torn region. In this case report, we present a rare case of a giant aneurysmal bone cyst located around the acetabulum in a 10-year-old female child who presented with an antalgic limp and left hip pain. The lesion was successfully treated with curettage and mixed autologous and synthetic bone grafts, and the follow-up for two years revealed a complete resolution of symptoms and radiological evidence of bone regeneration. This case highlights the successful surgical treatment of a challenging case of ABC in a difficult setting during the Syrian conflict.

5.
Cureus ; 16(2): e53587, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38449944

RESUMEN

The purpose of this review is to increase awareness about the evolution and development of current trends in the diagnosis and treatment of aneurysmal bone cysts (ABCs). ABCs are benign, but locally aggressive bone tumors that mainly affect children. ABCs comprise 1% of all primary bone tumors and occur most frequently during the first two decades of life. The diagnosis is made using a variety of imaging modalities and has the characteristic features of an expansile, radiolucent lesion that is often seen in the metaphyseal region of the bone and has fluid-fluid levels that are apparent on MRI. In the pediatric population, telangiectatic osteosarcoma and unicameral bone cyst (UBC) are the main differential diagnoses of an ABC. Giant cell tumors (GCTs) also include in differential diagnosis, which often manifest in patients older than 15 and do not penetrate the open physis although they develop after the physeal closure. Imaging alone cannot rule out telangiectatic osteosarcoma; therefore, a biopsy is recommended. A variety of treatment options have been described; traditionally, most patients are treated with curettage and bone grafting. Curettage alone, however, usually results in tumor recurrence following excision. A variety of adjuvants have been utilized with varying degrees of effectiveness to reduce the risk of local recurrence. When a cyst is in the pelvis, its location and size are such that surgery is a very risky option. Selective arterial embolization has significantly contributed to the development of effective treatments for these situations. Embolization or radiation, as well as denosumab therapy, are widely used as therapies for ABCs in anatomic locations where surgery would significantly increase morbidity.

6.
J Orthop Case Rep ; 14(1): 109-113, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38292092

RESUMEN

Introduction: Aneurysmal bone cysts (ABCs) are non-neoplastic expansile, vascular, osteolytic benign tumors in the long bone, spine, and sternum. The location in the pelvis is sparse. Case Report: A 12-year-old female presented with pain in her left pelvis for 6 months. On radiological examination, we found an expansile balloting lytic lesion involving almost the whole ilium and sparing the hip joint. There were multiple fluid levels seen on magnetic resonance imaging. The initial biopsy suggested ABC. Curettage and bone grafting were done along with electrocauterization and chemical cauterization. At 1-year follow-up, she is doing well without any complaints. Conclusion: This case report demonstrates a rare ABC of the ilium that was managed with curettage and bone grafting.

7.
J Clin Med ; 12(23)2023 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-38068264

RESUMEN

BACKGROUND: Percutaneous treatment for primary aneurysmal bone cysts (ABCs) has been widely accepted. The study aimed to evaluate the efficacy of various sclerotherapy agents on patients with primary ABCs. METHODS: A meta-analysis of relevant studies. A systematic search was conducted on five databases, resulting in the inclusion of 25 studies with different percutaneous agents. RESULTS: A total of 729 patients with primary ABCs were included. Patients were administered with Ethibloc, doxycycline, embolization, alcohol, polidocanol, and calcitonin with methylprednisolone, respectively. Overall, 542 (74.3%) patients with ABCs had complete healing, 120 (16.4%) had partial healing, 44 (6%) had no-ossification or failure, and 26 (3.5%) had a recurrence. However, there was a total of 45 (6.1%) patients who had surgical curettage after sclerotherapy. Among the sclerotherapy agents, doxycycline showed highly effective results with minimal complications and recurrence, but it required multiple injections per patient. Ethibloc and embolization also proved to be highly effective with fewer injections required but had a higher rate of complications. Absolute alcohol, polidocanol, and calcitonin with methylprednisolone had similar efficacity and favorable success with fewer complications and fewer injections. CONCLUSION: Percutaneous treatment showed promising results in treating primary ABCs. However, more robust research is needed to establish the best approach for sclerotherapy in clinical practice and to address the limitations of the current literature.

8.
Cardiovasc Intervent Radiol ; 46(12): 1726-1731, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37978064

RESUMEN

PURPOSE: The aim of this study was to evaluate treatment efficacy of percutaneous injection of hydroxyapatite-osteoconductive-cement in patients with spinal aneurysmal bone cysts. MATERIALS AND METHODS: The study was designed as a retrospective observational clinical study. We included patients who were diagnosed with of spinal aneurysmal bone cyst, at our institution between 2013 and 2020, and treated with percutaneous injection of osteoconductive cement: "Cerament"® (BONESUPPORT AB, Lund, Sweden). Typical clinical and radiological features of the ABCs treatment and follow-up were investigated. RESULTS: Our study included nine patients, two children and seven adults. Three different types of approaches were applied: (single pedicle approach in 3 patients; double pedicle approach in 2 patients; while in the remaining cases, a multiple access approach was used. VAS score decreased from 8.5 ± 0.5 before treatment to 4.1 ± 0.9 at 6-months-follow up. All of the patients reacted well to treatment, with none neurological complications, complete loss of pain and achieved osteosclerosis as radiological marker of treatment success. CONCLUSION: Treatment of symptomatic spinal ABC's with hydroxyapatite cement is effective to achieve complete pain reduction and sclerosis.


Asunto(s)
Quistes Óseos Aneurismáticos , Adulto , Niño , Humanos , Quistes Óseos Aneurismáticos/diagnóstico por imagen , Quistes Óseos Aneurismáticos/terapia , Quistes Óseos Aneurismáticos/complicaciones , Estudios Retrospectivos , Hidroxiapatitas/uso terapéutico , Resultado del Tratamiento , Dolor/tratamiento farmacológico , Cementos para Huesos/uso terapéutico
9.
Cureus ; 15(10): e46534, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37927634

RESUMEN

Of all primary spine tumors, 15% are benign osteolytic lesions known as aneurysmal bone cysts (ABCs). Owing to the involvement of surrounding neurovascular structures and the potential for cervical spine instability, ABCs in the cervical spine represent a relatively uncommon clinical entity with surgical resection that is extremely challenging. This report details a case of an ABC in the cervical spine affecting a 10-year-old child who presented at the Medical Services Center at Imam Muhammad Ibn Saud Islamic University. The patient manifested with neck pain, a history of trauma, limitations in cervical motion, and neurological changes over the course of clinical follow-up. Diagnostic measures included radiography and computed tomography. The child underwent surgery to stabilize the cervical spine and to excise both the tumor and the affected vertebrae. Given the high recurrence rate of previously described lesions, various additional techniques have been utilized in conjunction with surgical resection, such as radiation and embolization. This paper further discusses the patient's progress, the chosen treatment, and the range of available options. More research is needed to develop evidence-based treatment plans for cervical spine ABCs in younger patients.

10.
Skeletal Radiol ; 2023 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-38015230

RESUMEN

Aneurysmal bone cyst (ABC) is a rare and usually painful condition, representing about 1% of all bone tumors. A geographical lytic, expansile, and septated radiological pattern, with fluid-fluid levels on MRI, is classically displayed. ABC can be a primary bone lesion (70% of patients) or can arise in an underlying condition and is subsequently named "ABC-like changes" (30%). ABC-like changes are more frequently encountered in skeletal segments affected by chondroblastoma, fibrous dysplasia, giant cell tumor, osteoblastoma, non-ossifying fibroma, and osteosarcoma. In this article, we describe the first case of ABC-like changes developed in association with an ultra-rare sclerosing bone disease: melorheostosis. Melorheostosis is characterized by recognizable patterns on radiological studies with a pathological increased bone density and a cortical thickening within the periosteal or endosteal space, usually with a "dripping candle wax" appearance. More rarely, other different radiological patterns can be observed, such as "osteopatia striata-like," "osteoma-like," "myositis ossificans-like," and mixed patterns. Pain and limb hypotrophy are the most common clinical manifestations. We report the case of a Caucasian male with a clinic-radiological diagnosis of melorheostosis (with epiphyseal osteopoikilosis) since the age of twelve. At the age of nineteen, he suffered from increased pain in the proximal right thigh, and the radiological control revealed an expansive septated lesion at the right proximal femoral bone. The diagnosis of ABC-like changes developed in melorheostosis was obtained after CT-guided bone biopsy and confirmed by open-incisional biopsy.

11.
Cureus ; 15(6): e39954, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37415990

RESUMEN

The optimal treatment for aneurysmal bone cysts (ABCs) of the spine remains controversial. No treatment guidelines exist for the use of denosumab in aneurysmal bone cysts. In this report, we describe the results from a representative case and compare our experience with those of previously published reports. A 38-year-old male was referred for pain in the lower back and left leg. Radiographs and a needle biopsy specimen revealed a lumbar aneurysmal bone cyst, which was treated with denosumab chemotherapy. The pain in the lower back and left leg gradually improved, and at 16 weeks, the symptoms had resolved. Once a satisfactory local effect was achieved, denosumab therapy was discontinued. However, the erosive lesion subsequently expanded. After re-initiation of treatment, there was no subsequent evidence of recurrence. Single-therapy denosumab is an option for aneurysmal bone cysts. However, recurrences have been documented after denosumab termination, and the timing for cessation of denosumab is controversial.

12.
Int J Surg Case Rep ; 108: 108414, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37352769

RESUMEN

INTRODUCTION AND IMPORTANCE: Aneurysmal bone cysts (ABCs) are relatively uncommon tumor-like lesions that require careful management. Reporting such cases is crucial to highlight the importance of understanding the physiopathology and treatment options associated with ABCs. Literature-based writing emphasizes the significance of reporting cases like the one presented here. The aneurysmal bone cyst, classified as a Tumor Rich in Giant Cells according to the latest World Health Organization (WHO) classification of soft tissue and bone tumors, has posed several hypotheses and challenge. This aggressive form and rare localization of this lesion necessitates thorough discussions regarding its management. CASE PRESENTATION: We present a compelling case of a 37-year-old patient, without any specific pathological history, with a giant diaphyseal aneurysmal bone cyst located in the right femur. Remarkably, the lesion had been progressing for a decade, leading to extensive destruction of the entire femoral diaphysis despite undergoing previous surgical interventions. The patient's unique circumstances highlight the unpredictable behavior and destructive potential of aneurysmal bone cysts in rare anatomical locations. DISCUSSION AND CONCLUSION: This case underscores the need for a comprehensive understanding of aneurysmal bone cysts and their management. The utilization of denosumab, an inhibitor of the RANK/RANKL system, as a medical treatment in conjunction with surgery resulted in a favorable therapeutic response, including a reduction in tumor mass. The current WHO classification, recognizing ABCs as Tumors Rich in Giant Cells, consolidates previous hypotheses and enables the development of new therapeutic protocols. The integration of surgery and medical treatment holds promise for improving outcomes in patients with aneurysmal bone cysts. In conclusion, advancements in understanding the physiopathology and treatment options are crucial for developing effective therapeutic protocols to these aggressive forms of ABCs.

13.
Skeletal Radiol ; 52(12): 2479-2486, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37191930

RESUMEN

PURPOSE: The thin and friable septations composing aneurysmal bone cysts (ABC) may be challenging to target for percutaneous biopsy. The purpose of this study was to describe and evaluate a novel method of ABC biopsy using endomyocardial biopsy forceps as an attempt to capture larger fragments of tissue for diagnosis. METHODS AND MATERIALS: This was a retrospective study performed over a 17-year period. Patients <18 years old who underwent percutaneous biopsy for a presumed ABC, based on pre-procedure imaging, were included. Medical records were reviewed to identify age, sex, lesion location, biopsy procedure details, complications, and pathology results. A diagnostic biopsy was defined as conclusive histologic confirmation. Inconclusive findings or findings suggestive of but not diagnostic of an ABC were treated as non-diagnostic, even if imaging and clinical findings were characteristic. Biopsy device selection and quantity of tissue obtained was at the discretion of the pediatric interventional radiologist. Fisher's exact test was used to compare the diagnostic yield of standard biopsies to those employing biopsy forceps. RESULTS: Twenty-three biopsies were performed in 18 patients (11 female) with a median age of 14.7 years (IQR 10.6-15.6). Lesions were located in the extremities (7, 30.4%), chest (6, 26.1%), pelvis (5, 21.7%), spine (4, 17.4%), and mandible (1, 4.3%). Specimens were obtained using a 13- or 15-gauge bone coring needle (11, 47.8%); 14-, 16-, or 18-gauge soft tissue needle (6, 26.1%); or a combination of bone and soft tissue (4, 17.4%) needles. Endomyocardial biopsy forceps were utilized in 7 cases (30.4%), 2 in which it was the only device used. Overall, a conclusive pathologic diagnosis was made in 13/23 (56.5%) biopsies. Of the diagnostic biopsies, 1 was a unicameral bone cyst and all others were ABCs. No malignancy was identified. Compared to the standard approach, the use of forceps was more likely to result in a diagnostic biopsy (40.0% vs 100.0%, p = 0.008). There were no complications. CONCLUSIONS: Endomyocardial biopsy forceps offer an additional, novel technique to biopsy presumed ABCs and may improve diagnostic yield.


Asunto(s)
Quistes Óseos Aneurismáticos , Quistes Óseos , Humanos , Niño , Femenino , Adolescente , Quistes Óseos Aneurismáticos/diagnóstico por imagen , Quistes Óseos Aneurismáticos/patología , Estudios Retrospectivos , Biopsia , Quistes Óseos/patología , Extremidades/patología
14.
J Laryngol Otol ; 137(4): 462-466, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36093932

RESUMEN

BACKGROUND: Aneurysmal bone cysts are expansile benign lesions associated with compressive destruction and obscure pathogenesis. The most common sites of temporal bone involvement are the petrous apex, squamous portions and mastoid. CASE REPORT: This paper reports a right temporal aneurysmal bone cyst in a 51-year-old man who presented clinically with facial palsy, and hearing loss and impaired vestibular function. Magnetic resonance imaging and computed tomography findings were consistent with a diagnosis of aneurysmal bone cyst. Inter-operative findings showed that the lesion had caused compressive damage to the internal auditory canal. Following surgical excision, the patient experienced vertigo, indicating recovery of vestibular function. Follow-up imaging revealed complete resection without clinical recurrence. CONCLUSION: To our knowledge, this is the first report of aneurysmal bone cyst invasion of the inner auditory canal. Our clinical experience indicates that vestibular nerve damage recovery is relatively uncommon. This case report will hopefully inform future studies.


Asunto(s)
Quistes Óseos Aneurismáticos , Masculino , Humanos , Persona de Mediana Edad , Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/diagnóstico por imagen , Hueso Temporal/cirugía , Hueso Petroso/diagnóstico por imagen , Hueso Petroso/cirugía , Hueso Petroso/patología , Tomografía Computarizada por Rayos X , Imagen por Resonancia Magnética/métodos
15.
Cureus ; 14(7): e26509, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35923481

RESUMEN

Herein, we report the case of a 12-year-old boy diagnosed with multiple aneurysmal bone cysts (ABCs) who had previously undergone surgery on the proximal left tibia, proximal left femur, and distal tibia. During follow-up after the surgery, he developed another lesion on the proximal left humerus. Although rare, the pathological diagnosis was multiple ABCs.

16.
J Orthop ; 32: 72-77, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35619600

RESUMEN

Objective: The study reports the efficacy of sequential instillations of intralesional percutaneous polidocanol in the treatment of skeletal ABC. The study also analyses the pain relief, recurrence, radiological outcome and complications after percutaneous sclerotherapy. Materials and methods: A total of 43 patients with ABC were managed by fluoroscopy assisted percutaneous intralesional sclerotherapy with 3% Injection Polidocanol under suitable anaesthesia. The pain relief was assessed by Visual Analog Scale (VAS) and the progressive healing of the lesion by Rastogi Classification. Patients were evaluated clinico-radiologically, pre-operatively and at monthly interval for the first three months and then at 6 months, one year and two years follow up. Result: The VAS score decreased significantly at six months follow up and was zero (No pain) at one year follow up. Out of 43 patients, 37 patients had Degree I (excellent) residual lesion and 6 patients had degree II (good) lesion at one year follow-up as per Rastogi classification. The lesions resolved completely by two-year follow-up with all 43 patients having Degree (excellent) I resolution. Conclusion: Our study highlights the efficacy of percutaneous intralesional polidocanol in the treatment of ABC's. The procedure is safe, simple and effective with excellent outcome. Sclerotherapy is highly beneficial for deep lesions which are difficult to assess and for comorbid patients who are medically unfit for surgery. Our study strongly advocates the use of sclerotherapy as the first line treatment for ABC, considering its clinical and radiological efficacy.

17.
Pediatr. aten. prim ; 24(93)ene. - mar. 2022. ilus
Artículo en Español | IBECS | ID: ibc-210332

RESUMEN

El quiste óseo aneurismático (QOA) representa el 9% de los tumores óseos benignos. Es una lesión ósea pseudotumoral, formada por pequeños canales llenos de sangre separados por tabiques de tejido conectivo. Tiene su mayor prevalencia en adolescentes, con un ligero predominio femenino. La localización más frecuente es la metáfisis de los huesos largos (50% de los casos) seguida de la columna vertebral. La presentación clínica es variable y a veces puede ser inespecífica, pero en casos de dolor y tumefacción ósea en adolescentes debemos sospechar esta patología. Es por ello por lo que debemos estar atentos a los signos de alarma del dolor de espalda. El diagnóstico se realizará inicialmente mediante pruebas de imagen como la radiografía ósea y la resonancia magnética, en las que se observa una lesión quística expansiva y osteolítica pero circunscrita siendo característico que conserve la cortical, así como la presentación de una lesión multilobulada o en «pompas de jabón» con niveles líquidos. El diagnóstico definitivo se realiza por estudio histológico. Existen distintos abordajes terapéuticos, dependiendo de la lesión. A pesar de no ser maligno, se caracteriza por ser agresivo, por lo que su sospecha en el paciente pediátrico es relevante para un tratamiento precoz y evitar secuelas, que, en ocasiones, como cuando la localización es vertebral, pueden ser irreversibles. Para ilustrar esta patología, presentamos dos casos de localización vertebral en adolescentes (AU)


Aneurysmal bone cysts (ABCs) account for 9% of benign bone tumors. They are tumor-like bone lesions, formed by blood-filled channels separated by connective tissue septa. Their prevalence peaks in adolescence, and they are slightly more common in girls than in boys. They are most commonly found in the metaphysis of long bones (50%) and the posterior spinal elements (12-30%). The symptons can be non-specific, butt his disease should be suspected in adolescents presenting with pain and bone swelling. On radiographs and nuclear magnetic resonance imaging, ABC appears as an expansive, lytic, agressive lesion with a sclerotic rim. Usually, the cortex is intact. They can present as multiloculated lesions with a "soap bubble" appearance and fluid-fluid levels. The definitive diagnosis is based on the histopathological features. There are different approaches to treatment depending on the lesion. Although ABCs are not malignant, they are aggressive, so prompt suspicion in pediatric patients is important for early treatment. We present 2 cases of ABCs involving the spine in adolescents to illustrate this condition. (AU)


Asunto(s)
Humanos , Femenino , Niño , Quistes Óseos Aneurismáticos/diagnóstico por imagen , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Imagen por Resonancia Magnética , Diagnóstico Diferencial
18.
Skeletal Radiol ; 51(4): 819-827, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34436624

RESUMEN

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) characteristics of simple and aneurysmal bone cysts (SBC/ABC) of the proximal humerus and the intermittent difficulty in the imaging differentiation between the two in daily clinical routine. MATERIALS AND METHODS: MR images of 26 patients with suspected SBC/ABC in the proximal humerus were retrospectively assessed by two independent radiologists blinded to the final histological result. Based on a standard MRI protocol, different morphologic features and signal intensities of the lesion on non-enhanced and enhanced sequences were documented. The radiological diagnosis was correlated with histology. RESULTS: Eighteen patients had the image-based diagnosis of an SBC, yet the histology confirmed only 12, the residual 6 were identified as an ABC, despite the imaging criteria corresponding unambiguously to the former. One of the main reasons was the unicameral morphology of lesions, found in 9/14 (64.3%) cases of all ABCs, i.e., in 19/26 cases in total. Therefore, the sensitivity of the radiological diagnosis was moderate (57.14%), yet specificity very high (100%). In total, 69.2% (18/26) presented with a pathological fracture at admission, which correlated strongly with both circumferential (MCC = 0.65, p = 0.01) and septal (MCC = 0.42, p = 0.06) enhancement patterns. Circumferential enhancement was also found to correlate strongly with the histological diagnosis, being recognized in all cases of ABC (MCC = 0.44, p = 0.06). CONCLUSION: MRI characteristics of ABCs/SBCs in the proximal humerus are indifferent and ABCs may morphologically present as SBCs. Radiologists should be aware of the different, often confusing presentation of both entities in daily clinical routine.


Asunto(s)
Quistes Óseos Aneurismáticos , Quistes Óseos , Quistes Óseos/patología , Quistes Óseos Aneurismáticos/diagnóstico por imagen , Quistes Óseos Aneurismáticos/patología , Epífisis/patología , Humanos , Húmero/diagnóstico por imagen , Imagen por Resonancia Magnética , Estudios Retrospectivos
19.
Radiol Case Rep ; 16(9): 2719-2725, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34336077

RESUMEN

Fibrous dysplasia, including McCune-Albright syndrome, is a genetic, non-inheritable benign bone disorder that may involve a single or multiple bone, typically occurring in the diaphysis or the metaphysis of long bones. In very rare instances polyostotic fibrous dysplasia present involvement of the epiphysis in long bones. Aneurysmal bone cysts are benign, expansile, lytic bone lesions formed by cystic cavities containing blood, that may occur de novo or secondary to other lesions of bone, including fibrous dysplasia. We report a case of an 18-year-old female with polyostotic fibrous dysplasia (McCune-Albright syndrome) with diaphyseal and unusual multiple foci of epiphyseal involvement of long bones as well as in the patella, and a simultaneous aneurysmal bone cyst of the left femoral neck with pathologic fracture. This is the first report of a simultaneous aneurysmal bone cyst in a patient with polyostotic fibrous dysplasia (McCune-Albright syndrome) with involvement of diaphysis and epiphysis of long bones, highlighting that fibrous dysplasia should be included in the differential diagnosis of polyostotic tumors involving the diaphysis as well as the epiphysis. In patients with polyostotic fibrous dysplasia there should be an active search for lesions in the epiphysis.

20.
Foot (Edinb) ; 47: 101795, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33957532

RESUMEN

CASE DESCRIPTION: Aneurysmal bone cysts (ABCs) are locally aggressive, cystic lesions of the skeletal system, most commonly seen in the metaphyseal region of long bones. On the other hand, an ABC of the foot (especially the calcaneum) is a rare entity, with very few cases reported in the literature. In this study, we present three such cases who presented to us with the chief complaint of chronic heel pain. All three patients were clinically reviewed following which a comprehensive radiological workup was performed. The latter revealed a solitary, expansile lesion within the calcaneum in all them. Treatment included extended curettage and reconstruction using autologous iliac crest bone grafts. Histopathological analysis of the curetted sample was consistent with features of primary ABC. There were no complications and all lesions had re-ossified at the latest follow up. CONCLUSION: Calcaneal ABCs are rare, atypical lesions warranting a high index of suspicion and correlation of the patient's clinical, radiological and histopathological features to make a correct diagnosis.


Asunto(s)
Quistes Óseos Aneurismáticos , Calcáneo , Quistes Óseos Aneurismáticos/diagnóstico por imagen , Quistes Óseos Aneurismáticos/cirugía , Trasplante Óseo , Calcáneo/diagnóstico por imagen , Calcáneo/cirugía , Legrado , Humanos , Radiografía
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