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Orthopaedics & Traumatology, Surgery &... Feb 2015Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which... (Review)
Review
Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy.
Topics: Adolescent; Biopsy; Bone Cysts; Bone Cysts, Aneurysmal; Child; Female; Fractures, Spontaneous; Humans; Magnetic Resonance Imaging; Male; Prognosis; Risk Factors; Treatment Outcome; Young Adult
PubMed: 25579825
DOI: 10.1016/j.otsr.2014.06.031 -
Pediatric Radiology Aug 2022Aneurysmal bone cyst (ABC) is a benign but locally aggressive lesion that predominantly affects children and young adults. ABC, which accounts for approximately 70% of... (Review)
Review
Aneurysmal bone cyst (ABC) is a benign but locally aggressive lesion that predominantly affects children and young adults. ABC, which accounts for approximately 70% of the cases, is now recognized to be a true neoplasm, whereas ABC-like changes associated to other bone neoplasms (also referred in the literature as secondary ABC) accounts for the remaining 30%. The solid variant of ABC is also considered a true neoplasm but is rare. ABC can involve any bone in the body, and although it has a metaphyseal preference, it can involve any part of a bone and soft tissues. As with any bone tumor, the initial evaluation of ABCs should be done with radiographs followed by magnetic resonance imaging or less frequently computed tomography for further characterization. The imaging appearance of ABC is variable; however, a lytic and expansile lesion with fluid-fluid levels is the most common presentation. The main differential diagnosis of an ABC in the pediatric population is unicameral bone cyst (UBC) and telangiectatic osteosarcoma, therefore a biopsy is recommended before treatment. The therapeutic options of ABC range from curettage with or without adjuncts such as phenol, liquid nitrogen, argon laser and bone grafting or bone substitutes to more recently employed alternatives such as image-guided sclerotherapy with various sclerosing agents and monoclonal antibodies (e.g., Denosumab).
Topics: Bone Cysts; Bone Cysts, Aneurysmal; Bone Neoplasms; Child; Humans; Osteosarcoma; Tomography, X-Ray Computed; Young Adult
PubMed: 35941207
DOI: 10.1007/s00247-022-05396-6 -
Surgical Pathology Clinics Dec 2021The term giant cell-rich tumors of bone refers to a shared morphologic pattern in a group of different osseous lesions, that is, the abundance of osteoclastlike giant... (Review)
Review
The term giant cell-rich tumors of bone refers to a shared morphologic pattern in a group of different osseous lesions, that is, the abundance of osteoclastlike giant cells. Fitting with a broad spectrum of clinical presentations and biological behavior, the recent detection of characteristic molecular alterations in giant cell tumor of bone (H3-3), nonossifying fibroma (KRAS, FGFR1), giant cell granuloma of the jaws (KRAS, FGFR1, TRPV4), and aneurysmal bone cyst (USP6) have contributed significantly to the biological understanding of these morphologically related but clinically distinct lesions and their systematic classification, highlighting differences and pathogenic relationships.
Topics: Bone Cysts, Aneurysmal; Fibroma; Giant Cell Tumors; Giant Cells; Granuloma, Giant Cell; Humans
PubMed: 34742488
DOI: 10.1016/j.path.2021.06.010 -
The Journal of Bone and Joint Surgery.... May 2023Benign bone cysts in children have a high risk of recurrence after bone grafting. The optimal treatment and filling material for these lesions are currently unknown. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Benign bone cysts in children have a high risk of recurrence after bone grafting. The optimal treatment and filling material for these lesions are currently unknown.
METHODS
We compared cyst recurrence after intralesional curettage and filling with allograft versus bioactive glass (BG-S53P4; Bonalive) in a randomized clinical trial. The volume of recurrent cyst at 2-year follow-up was the primary outcome.
RESULTS
Of 64 eligible children, 51 (mean age, 11.1 years) were randomized to undergo filling of the cyst using morselized allograft (26) or bioactive glass (25). Twelve (46%) of the children in the allograft group and 10 (40%) in the bioactive glass group developed a recurrence (odds ratio [OR] for bioactive glass = 0.79, 95% confidence interval [CI] = 0.25 to 2.56, p = 0.77). The size of the recurrent cyst did not differ between the allograft group (mean, 3.3 mL; range, 0 to 13.2 mL) and the bioactive glass group (mean, 2.2 mL; range, 0 to 16.6 mL, p = 0.43). After adjusting for the type of lesion (aneurysmal bone cyst versus other), bioactive glass also did not prevent larger (>1 mL) recurrent cysts (adjusted OR = 0.42, 95% CI = 0.13 to 1.40, p = 0.16). The Musculoskeletal Tumor Society score improved significantly (p ≤ 0.013) from preoperatively to the 2-year follow-up in both groups (to 28.7 for bioactive glass and 29.1 for bone graft). Four (15%) of the children in the allograft group and 6 (24%) in the bioactive glass group required a reoperation during the follow-up (OR for bioactive glass = 1.74, 95% CI = 0.43 to 7.09, p = 0.50).
CONCLUSIONS
Filling with bioactive glass and with allograft in the treatment of benign bone lesions provided comparable results in terms of recurrence and complications.
LEVEL OF EVIDENCE
Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Child; Bone Cysts, Aneurysmal; Bone Transplantation; Transplantation, Homologous; Allografts; Glass
PubMed: 36727973
DOI: 10.2106/JBJS.22.00716 -
Joint Bone Spine Jan 2022Aneurysmal bone cyst (ABC) is a benign, locally aggressive tumour that arises predominantly in long bones and spine. Following the encouraging results of denosumab use... (Review)
Review
BACKGROUND
Aneurysmal bone cyst (ABC) is a benign, locally aggressive tumour that arises predominantly in long bones and spine. Following the encouraging results of denosumab use in Giant Cell Tumors (GCT) and the histological similarities between ABC and GCT, the interest on the role of denosumab in the therapeutic arsenal of the most advanced ABC is growing. The purpose of this literature review is to investigate the current state of knowledge about the use of denosumab in ABCs.
METHODS
A literature research was conducted through PUBMED, COCHRANE and GOOGLE SCHOLAR using the keywords "aneurysmal bone cyst" AND "denosumab". Seventeen articles were included.
RESULTS
A total of 43 cases were reported in the literature. There were 23 males, 20 females. The mean age was 15,9±8,1 year. Pain relief and neurological improvement were rapid and sustained. Radiological assessment showed ossification and/or volume reduction in 36/39 patients. Eight patients (18,6%) presented a recurrence after or during denosumab therapy of whom 7 were adults. Adverse events occurred in 11 patients, 5 of them were admitted to the intensive care unit due to hypercalcemia.
CONCLUSION
Denosumab use in non-surgical ABCs has shown a positive impact in pain and neurological symptoms. The oncological outcome remains unclear with a recurrence rate of 18,6% during/after denosumab therapy, mostly in adults. However, regarding the potential clinical benefits, its use might be discussed in the most advanced cases. Further research and clinical trials are mandatory to precise its belonging in the therapeutic arsenal.
Topics: Adult; Bone Cysts, Aneurysmal; Bone Density Conservation Agents; Bone Neoplasms; Bone and Bones; Denosumab; Female; Humans; Hypercalcemia; Infant, Newborn; Male
PubMed: 34481945
DOI: 10.1016/j.jbspin.2021.105260 -
Current Opinion in Pediatrics Feb 2023Aneurysmal bone cysts are rare, locally aggressive bone tumors. Optimal treatment of ABCs is still matter of debate as therapies including sclerotherapy, selective... (Review)
Review
PURPOSE OF REVIEW
Aneurysmal bone cysts are rare, locally aggressive bone tumors. Optimal treatment of ABCs is still matter of debate as therapies including sclerotherapy, selective arterial embolization and systemic treatment with denosumab are increasingly utilized, in addition to or instead of traditional curettage. The purpose of this review is to discuss current concepts and difficulties in diagnosing and treating primary ABCs, based on latest available literature.
RECENT FINDINGS
In diagnostics, multiple new fusion partners of USP-6 have been described on next-generation sequencing specifically for primary ABCs. In a recent systematic review, failure rates of percutaneous injections and surgery were comparable. In a literature review, the use of denosumab seemed effective but resulted in multiple cases of severe hypercalcemia in children.
SUMMARY
Accurately diagnosing primary ABC is crucial for treatment decisions. Curettage remains a valid treatment option, especially with adjuvant burring, autogenous bone grafting and phenolization. Percutaneous sclerotherapy represents a solid alternative to surgery, with polidocanol showing good results in larger studies. Systematic therapy with denosumab exhibits favorable results but should be reserved in the pediatric population for unresectable lesions, as it may result in severe hypercalcemia in children. When selecting a treatment option, localization, stability and safety should be considered.
Topics: Humans; Child; Denosumab; Bone Cysts, Aneurysmal; Hypercalcemia; Neoplasm Recurrence, Local; Polidocanol; Treatment Outcome
PubMed: 36409159
DOI: 10.1097/MOP.0000000000001205 -
The Pan African Medical Journal 2022
Topics: Humans; Bone Cysts, Aneurysmal
PubMed: 36405656
DOI: 10.11604/pamj.2022.42.280.36079 -
Indian Journal of Dental Research :... 2011The solitary or traumatic bone cyst (TBC) is an uncommon non-epithelial lined cavity of the jaws. The lesion is mainly diagnosed in young patients most frequently during... (Review)
Review
The solitary or traumatic bone cyst (TBC) is an uncommon non-epithelial lined cavity of the jaws. The lesion is mainly diagnosed in young patients most frequently during the second decade of life. The majority of them are located in the mandibular body between the canine and the third molar. Clinically, the lesion is asymptomatic and is often accidentally discovered on routine radiological examination. The definite diagnosis of traumatic cyst can only be determined at surgery. Often, the material for histological examination may be scanty or non-existent. We present a documented case of a solitary bone cyst involving the body of the mandible. A brief review of literature regarding the main characteristics of the lesion is provided.
Topics: Adult; Humans; Incidental Findings; Jaw Cysts; Male; Mandibular Diseases; Radiography; Treatment Outcome
PubMed: 21525701
DOI: 10.4103/0970-9290.79993 -
Neurology India 2020The study was done to review the literature about the intriguing aspects of the aneurysmal bone cyst and to describe our experience with these cases. (Review)
Review
AIMS
The study was done to review the literature about the intriguing aspects of the aneurysmal bone cyst and to describe our experience with these cases.
DESIGN
Retrospective.
MATERIAL AND METHOD
We reviewed the records of all patients with primary spinal tumours whom we managed over last 8 years. We selected the patients with biopsy proven aneurysmal bone cyst (ABC) for our study.
RESULTS
Four patients (two males and two females) were included. The age ranged from 15-18 years. Three of them had neurological deficits and one had only pain. All of them were operated and three required instrumentation for stabilization. Neurological deficits improved in all the cases. However we had to re- operate one of the cases for recurrence and that patient was administered adjuvant radiotherapy.
CONCLUSIONS
ABC is not a tumour in real sense but due to destructive nature that are classified as tumours. The patients have an excellent outcome as the disease is benign and has very low recurrence rates if surgical excision is complete. Best treatment modality is complete excision. Aneurysmal bone cyst is one of the uncommon tumors of the spine, and many of its features continue to be unclear even today. There is ambiguity about the definition, etiopathogenesis, radiological characteristics, histopathology and treatment modalities. They are common in young age and etiology is not clear. The presentation is varied with pain being the common symptom and neurological deficit depends on extent of cord involvement. The best treatment is controversial although surgery is believed to be curative in the majority of cases. We here describe our experience with four such cases who had varied clinical presentation and outcome.
Topics: Adolescent; Bone Cysts, Aneurysmal; Cervical Vertebrae; Female; Humans; Male; Neoplasm Recurrence, Local; Retrospective Studies; Spinal Diseases
PubMed: 32859826
DOI: 10.4103/0028-3886.293465 -
Romanian Journal of Morphology and... 2014To assess the results of surgical treatment in aneurysmal bone cysts.
AIM
To assess the results of surgical treatment in aneurysmal bone cysts.
MATERIALS AND METHODS
31 patients with aneurysmal bone cysts underwent surgical treatment in our department. In almost half of cases, the lesion was located in the femur. In 12 cases, a pathological bone fracture was the first clinical sign. The treatment consisted in curettage, abrasion of the cavity inner walls using a motorized burr and filling with morsellized bone grafts (autografts ± allografts) or bone substitutes (four cases). Microscopically, the diagnosis relies on cystic spaces filled with blood, divided by fibrous septae consisting in immature bone trabeculae, hemosiderin filled macrophages and fibroblasts. We performed multiple bioptic probes from different levels of the lesion.
RESULTS
Macroscopically, the osseous lesion appeared as a multi-loculated blood-filled cavity (cavities separated by septa) in 30 (96.77%) cases and as a solid tumor in one (3.23%) case. At 12 months after surgery, grafts osteointegration was present in 24 cases. At an average follow-up time of six years and four months, refilling with bone grafts was necessary in two cases and no local recurrence was observed.
CONCLUSIONS
Aneurysmal bone cyst is most frequent in the second decade of age. Its prevalence in female gender is double compared to the male gender. The positive diagnosis relies on the histopathological examination. Because of the strong relationship with a number of precursor lesions (giant cell tumor, fibrous dysplasia, non-ossifying fibroma, chondroblastoma, osteoblastoma) multiple bioptic probings are mandatory, in order to diagnose, if possible, a primary lesion, which may modify the therapeutic attitude. Treatment by curettage, abrasion of the cavity inner walls and filling with morsellized grafts has very good results. The risk of recurrence is very low.
Topics: Adolescent; Adult; Bone Cysts, Aneurysmal; Female; Humans; Intraoperative Care; Male; Radiography; Young Adult
PubMed: 25329131
DOI: No ID Found