Aneurysmal Bone Cyst Research Articles

A Case of Aneurysmal Bone Cyst of Fourth Metacarpal Bone: A Rare Entity at Unusual Location

An Aneurysmal Bone Cyst (ABC) is a locally aggressive, rapidly growing, rare benign bone tumour that typically occurs in children and early adulthood. It usually occurs in the first and second decades of life, with a female predominance. The long bones of the lower extremities and spine are common sites for ABC, with rare involvement of the small bones of the hand. An 18-year-old female presented to the hospital with progressive swelling over her left hand for 4 to 5 months, associated with pain. Local examination elicits pain and tenderness over the 4th metacarpal bone with restricted movement at the Metacarpophalangeal (MCP) joint. A histopathological diagnosis of ABC was made due to the presence of osteoclastic giant cells lining a cyst, along with areas showing a pool of haemorrhage and stromal cells. The postoperative period remained uneventful, with no complaints of pain and good healing of the operation site noted during follow-up. Metacarpal bones are rare sites for ABCs.

Pathology of Spinal Tumours

Abstract Spinal tumours are uncommon lesions, but they may cause significant morbidity and mortality. Majority of the spinal tumours are metastatic, that is, spread from tumours in other organs, which are mostly seen in older patients. Primary sarcomas involving the spinal column are rare. Benign tumours and tumour-like lesions of the musculoskeletal system are mostly seen in young patients. Spinal tumours can be subdivided into primary tumours, which are rare, and secondary tumours or metastases, which are much common. Primary vertebral tumours may be benign or malignant. Common benign spinal tumours include osteoid osteoma, osteoblastoma, osteochondroma, aneurysmal bone cyst and giant cell tumour. There are many malignant primary spinal tumours such as- osteosarcoma, chondrosarcoma, and chordoma, Ewing’s sarcoma, plasmacytoma and multiple myeloma. However, all of them, except multiple myeloma, are rare. Intraspinal tumours may be extradural or intradural. Common intradural extramedullary tumours include meningioma, schwannoma and intradural neurofibroma, whereas astrocytoma, ependymoma and haemangioblastoma are a few examples of intradural intramedullary tumours.

Aneurysmal bone cyst defect of the maxilla successfully reconstructed with mesh in rural surgical outreach: A case report

Aneurysmal bone cyst of the maxilla is rare and requires a high index of suspition. It could pose a major health burden to the resource-poor who commonly resort to the medical outreaches for treatment. We report a 41year old who presented with a left maxillary aneurysmal bone cyst of two years which was treated successfully with decortication, gentle curettage and prosthetic reconstruction with mesh in a medical outreach setting. The post resection defects could be reconstructed with a relative ease using a mesh to provide a framework for deposition of fibrous tissue for restoration of normal contour of the maxilla.

Using Denosumab as a Nonsurgical Management of Aneurysmal Bone Cysts in the Pelvis.

Aneurysmal bone cysts (ABCs) are infrequent, benign, and locally destructive lesions that most commonly occur during the first two decades of life. They usually affect the metaphysis of the long bones, but the pelvis is involved in 8%-12% of the cases. The management of pelvic ABCs is a challenging issue due to difficulties in choosing the appropriate approach, adjacent neurovascular bundles, the risk of intraoperative bleeding with difficulty achieving good hemostasis, and the risk of injury to the hip or sacroiliac joints. Limited data exist concerning the use of denosumab as a non-surgical treatment for pelvic ABCs. Our hypothesis was that denosumab might be an effective and safe solo treatment of cases with ABCs in the pelvis. We retrospectively assessed 20 patients with ABCs in the pelvis, who were treated by denosumab as a solo agent without surgery. Patients were assessed regarding disease control, the incidence of recurrence and non-oncological complications, and functional outcome. The mean follow-up period was 38.5 months. Disease control was achieved in 16 patients (80%), with no local recurrence. Tolerable drug-related complications occurred in 15% of cases. The mean Musculoskeletal Tumor Society score was 92.3%. Denosumab may provide a reliable option in the nonsurgical treatment of ABCs of pelvic origin with expected lower morbidity than the surgical solution and tolerable complications. Further studies on the safety profile and long-term effects of denosumab especially in skeletally immature patients are required.

Aneurysmal bone cyst treated with freeze-dried allograft: A rare case presentation

Aneurysmal bone cyst treated with freeze-dried allograft: A rare case presentation

Concurrent Occurrence of Aneurysmal Bone Cyst and Fibrous Dysplasia in the Mandibular Bone of a Neonatal Calf

Concurrent Occurrence of Aneurysmal Bone Cyst and Fibrous Dysplasia in the Mandibular Bone of a Neonatal Calf

Netosis as a process involved in the consolidation of aneurysmal bone cysts in children using hemostatic agents

Netosis as a process involved in the consolidation of aneurysmal bone cysts in children using hemostatic agents

Diagnostic Accuracy of Aneurysmal Bone Cyst (ABC): Immunohistochemical Aspects

The incidence of Aneurismal Bone cyst has increased in worldwide. ABC-like lesions involving Giant (GCTOB) cells, fibrohistiocytic or tumor FD like components can confuse pitfalls of ABC and need to observe and defines. We investigated tissue resources from operative materials of total 28 cases of ABC, selected as primary ABC without any bone pathology (n=17) and ABC-like changes accompanying by Giant cell tumor (n=9) and Fibrous dysplasia (FD) (n=2). Female – 10, male – 18, mean age - 27. Cases were reported according clinical, radiological, histological, localization and recurrence features with special attention to immunohistochemistry (IHC) using different markers: P53, Bcl-2, P63, Ki-67, CD68, Cyclin D1. The results of these assessments were compared for the final histologic diagnosis. Results show that IHC has a positive value in dysplastic and cancerous stroma in GCTOB (P63, Cyclin D1); FD field does not show similar activity, demonstrating improved diagnostic accuracy.

Percutaneous sclerotherapy using polidocanol in the treatment of aneurysmal bone cysts of extremities – a report of 28 consecutive cases

Introduction and aim. Aneurysmal bone cysts (ABC) are aggressive benign lesions with high rates of recurrence rendering its treatment uniquely challenging. We report the outcome in 28 consecutive patients of ABC of extremities treated with percutaneus sclerotherapy using 3% polidocanol over a period of 5 years. Material and methods. In biopsy proven 28 ABC cases, Injection polidocanol 3% was used as sclerosing agent under fluoroscopy guidance. Injections were repeated at 6-week intervals till complete healing of cysts. Radiological and functional results were assessed by Rastogi et al. criteria, VAS score and Enneking scoring method. Results. 25 out of 26 patients (89.28%) displayed good clinical response with an average 2.56 injections per patients. The mean follow-up period was 17.04±7.08 months. Reduction in cyst volume (mean 6.86±1.48 to 0.71±1.48.) and VAS score (mean 6.72±1.51 to 0.56±1.08) and improvement in Enneking score (17.35±3.14 to 28.92±1.35) at last follow up was significant. No recurrence was reported during the study period. Treatment failure, skin sclerosis and infection were reported in one case each. Conclusion. sclerotherapy with polidocanol 3% for primary ABC is safe and effective alternate method with advantage of no surgical morbidity, having better functional score with lesser recurrence and minimal complications.

How successful is synthetic graft treatment for children with pathological hip fractures?

To determine whether synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children. Paediatric patients treated for pathological fractures of the proximal femur between 2013 and 2020 were evaluated retrospectively. 17 patients with a mean age of 10.7 years (range 6-16 years) were assessed. The definitive histopathological diagnoses were SBC (simple bone cyst) (12) and ABC (aneurysmal bone cyst) (5). The median duration of follow-up was 37 months (range 12-70 months). All patients returned to their normal daily routine within 3-8 months following surgery. The mean post-op recovery time was 3.2 months (range 3-6 months). Graft was incorporated at approximately 12 months. No significant radiographic healing was observed in 2 patients. In the remaining 15 patients, the mean duration of healing was 14 months (range 8-24 months). Synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children.

Solitary Bone Cyst and Aneurysmal Bone Cyst: Perplexing Pseudocysts of the Jaws

Pseudocysts of the jaws include two very significant lesions – Solitary bone cyst (SBC) and Aneurysmal bone cyst (ABC). Both these cysts have very similar clinical and radiological findings. Histopathology aids in differentiating the two pathologies, with MRI findings offering confirmatory diagnosis of ABC. Differentiating between the two cysts and establishing a definitive diagnosis cannot be over emphasised as prognosis depends on the correct treatment modality after the diagnosis. A lot of updates with regards to the treatment of these cysts in long bones is available, with the same lacking in the cysts of the jaws. This probably could be due to the relative rarity of these cysts in the jaws. This article aims to address the various aspects of these two enigmatic pseudocysts of the jaws. Keywords: Pseudocysts, Solitary Bone Cyst, Aneurysmal Bone Cyst, Pathogenesis, Hemorrhage, Head & Neck, Oral

Brown Tumor, a Deceptive and Rare Entity: A Case Report

A case of 27 years old male from Jhapa district, who presented to Oral and Maxillofacial department of B&C hospital with firm, non-tender swelling over buccal vestibule for 2 months. Computed tomography (CT) revealed an expansile lytic bony lesion with soft tissue component at the right hemimandible with cortical destruction. Provisional diagnosis of ameloblastoma was made. Incisional biopsy done and specimen was sent to the Pathology department. Haematoxylin and Eosin- stained slides revealed disorderly, fascicular architecture exhibiting clustered distribution of osteoclastic giant cells, surrounded by fibroblastic stromal cells along with reactive new bone formation. The differentials considered were CGCG (Central giant cell granuloma), GCT (Giant Cell tumor), ABC (Aneurysmal Bone Cyst) and Brown tumor. Serum Calcium and Serum PTH (Parathyroid hormone) were advised to ruleout brown tumor in histopathology report and for rest of the differentials excisional biopsy was suggested. Serum calcium and serum PTH were found to be raised. On further probing, the patient has been having right lower back pain and thin urine stream on and off for few months. USG abdomen was done for the same which revealed bilateral nephrolithiasis with left sided PUJ calculus causing gross hydronephrosis along with bilateral medullary nephrocalcinosis. DJ stenting was thus advised by the nephrologist. On identifying the primary cause, hemithyroidectomy with parathyroid removal was done. The decrease in parathyroid hormone level was drastic after the surgery. His urine stream was normal during his post –op stay at the hospital. The patient was advised for regular follow up.

Aneurismal bone cyst of the medial cuneiform bone: a case report of a new surgical approach and literature review

Introduction An aneurysmal bone cyst (ABC) is a rare, non-neoplastic, destructive, hemorrhagic, and expansile lesion accounting for 1 % of all bone tumors. ABC of the foot is very rare. Patients with foot ABC usually complain of pain and swelling of the affected area. Radiographs and MRI may be helpful in the diagnosis of ABC. No single surgical procedure has gained wide acceptance in the treatment of foot ABC.Purpose To show new effective surgical approach in the treatment of patient with ABC of the medial cuneiform bone.Material and methods We present the case of a 47-year-old woman with a 10-months history of pain and swelling in her right foot. Postoperative histopathological evaluation of resected tissues confirmed the diagnosis of ABC. An en bloc resection (total extraction of the remnant of the medial cuneiform bone) was performed and the defect was replaced with a fibular bone graft from the right leg. Allograft (Bio-Ost®) was placed along the autograft. Tibialis anterior tendon was attached to the fibular bone graft. We performed fixation of the foot and ankle using the Ilizarov original apparatus for prevention of bone graft instability and opportunity for early weight-bearing on the operated foot.Results The postoperative period was uncomplicated with complete healing of the bone defect without recurrence after 12 months of observation. AOFAS score increased significantly from 34 points preoperatively to 92 at 1-year follow-up.Discussion The optimal treatment of this lesion is still under discussion. Different treatment modalities have been described in the literature: wide resection, curettage with or without adjuvants, arterial embolization, intralesional sclerotherapy. Biological reconstruction using bone graft seems to be the best option, but fractures and nonunion are common complications of bone grafting.Conclusion The combination of Ilizarov external fixation and bone grafting provided favorable conditions for the healing of foot bone defect due to ABC without complications, allowed mobility and early weight-bearing of the patient. Recurrence was not detected radiologically. Harvesting of the fibular bone graft did not affect the position of the foot and its movements. Our surgical approach should be considered as a treatment option in similar cases.

Surgical Procedure for a Rare Case of Skull Bone Cysts

Introduction: Bone cysts are inclusive of but not limited to the unicameral bone cyst (UBC) and aneurysmal bone cyst (ABC). UBC have a predilection for males (3:1). UBC make up 3% of primary bone lesions. Most UBCs are found in long bones, most common sites are proximal humerus and femurs, rarely found in flat bones (Skull). Cases of UBC observed following trauma are thought to occur due to intraosseous bleeding when bone organization or repair mechanisms fail. Case Report: Twenty-one-year-old male complained of headache, a history of traumatic brain injury. Motoric examinations show diminished motor function on the left side. CT Scan shows an expansile sclerotic lytic lesion on the right parietal bone. We diagnosed this case with a suggested Bone Cyst on the right parietal, and craniotomy tumor removal with a direct approach was performed. Thickened dura mater was identified, cleansed using NaCL and povidone-iodine, and drilled using a high-speed drill until flattened. The yellowish-colored bony lesion was discovered to contain a semi-translucent substance, the lesion was found to be a unicameral bone cyst. Discussion: UBCs are generally asymptomatic, and usually appear as lesions with lucent characteristics and small zones of transition. As a benign bone tumor, treatments are not required unless the lesion is large and symptomatic, due to the patient's symptomatic condition, craniotomy tumor removal was performed. Conclusion:UBC is a rare condition, that’s scarcely located in the skull. Post-operatively, the patient shows normal motor function and no complaint of pain. Craniectomy tumor removal and flattening of the dura mater using a high-speed drill is sufficient in treating this rare disease.

Aneurysmal Bone Cyst of the Twelfth Rib: A Case Report

Benign tumors of the chest wall are rare. Aneurysmal bone cyst is a benign tumor of the skeleton system which mainly develops at the level of the long bones and the vertebrae, and rarely at the rib level. We present a case of a 17-year-old young female with no medical history who presents a mass at the right basal level of the chest wall. The CT scan shows a multiloculated mass at the level of the twelfth ribs, by an elective incision the tumor was resected. The histology was in favor of an aneurysmal bone cyst.

Buccal Decortication a Treatment Option for Aneurysmal Bone Cyst of Mandible

Buccal Decortication a Treatment Option for Aneurysmal Bone Cyst of Mandible

Current indications for denosumab in benign bone tumours.

Denosumab is a fully humanised monoclonal antibody to RANK ligand, inhibiting the RANK-RANKL pathway. It promotes the apoptosis of osteoclast-like giant cells, a secondary ossification and connective tissue formation. Given its high efficacy, denosumab is the standard treatment of unresectable or metastatic giant cell tumour of bone (GCTB) requiring morbid surgery. Neoadjuvant administration of denosumab may be justified to enable the resection of the tumour in certain cases; it should be considered, however, with caution for joint-saving surgery due to high local recurrence rates. In cases of unresectable or metastatic GCTB, however, denosumab treatment should be administered for years or even as a lifelong therapy. This poses many yet unanswered questions concerning the frequency of denosumab treatment as well as the ratio of the adverse events in the following years. Denosumab suppresses, not directly targets, the neoplastic stromal cells of GCTB. Ongoing in vitro studies suggest that other drugs alone or in combination (e.g. sunitinib) with denosumab may target both the neoplastic and the giant cells. Promising results have been reported regarding the off-label use of denosumab in other giant cell-rich tumours/tumour-like lesions, i.e. aneurysmal bone cysts and central giant cell granulomas. Data are derived, however, mostly from case reports and case series. Large prospective clinical trials are needed to evaluate the role and also the side effects of denosumab in the treatment of these rare diseases.

Tumors and infections of the growing spine.

The growing spine differs from the adult spine in several ways. Although tumors and infections cause only a small percentage of pediatric back pain incidences, delayed proper diagnosis and treatment may be disastrous. Benign lesions, such as osteoid osteoma, osteoblastoma, and aneurysmal bone cyst in the spine, are predominant during the first two decades of life, whereas malignant bony spinal tumors are rare. In the pediatric population, malignant spine tumors include osteosarcoma, Ewing's sarcoma, lymphoma, and metastatic neuroblastoma. Infections of the growing spine are rare, with the incidence of discitis peaking in patients under the age of 5 years and that of vertebral osteomyelitis peaking in older children. Spondylodiscitis is often a benign, self-limiting condition with low potential for bone destruction. Conservative treatments, including bedrest, immobilization, and antibiotics, are usually sufficient. Spinal tuberculosis is a frequently observed form of skeletal tuberculosis, especially in developing countries. Indications for surgical treatment include neurologic deficit, spinal instability, progressive kyphosis, late-onset paraplegia, and advanced disease unresponsive to nonoperative treatment. Spinal tumors and infections should be considered potential diagnoses in cases with spinal pain unrelated to the child's activity, accompanied by fever, malaise, and weight loss. In spinal tumors, early diagnosis, fast and adequate multidisciplinary management, appropriate en bloc resection, and reconstruction improve local control, survival, and quality of life. Pyogenic, hematogenous spondylodiscitis is the most common spinal infection; however, tuberculosis-induced spondylodiscitis should also be considered. Level of evidence: level 4.

Efficacy of Percutaneous Treatment of Primary Aneurysmal Bone Cysts (ABCs): A Systematic Review and Meta-Analysis

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.

Telengiectatic osteosarcoma of mandible with special emphasis on immunohistochemical and molecular characteristics: A case report with review of literature

AbstractBackgroundTelangiectatic osteosarcoma (TOS) is an uncommon pathology accounting for about 0.4%–12% of all osteosarcomas with predilection for younger adults. It is most frequently seen in the metaphysis of long bones, appearing as painful osteolytic mass that histopathologically characterized by dilated, blood‐filled vascular spaces lined by malignant osteoblasts along with osteoid formation. It has exchangeable clinical, radiological and pathological features with benign lesions like aneurysmal bone cyst and giant cell tumour of bone as well. Thus, delineating this malignancy from its benign counterparts is a crucial part in the therapeutic management.AimTo report a case of telengiectatic osteosarcoma of jaw in a 17 year old female patient with special highlights on molecular diagnostics and therapeutic modules.Materials and MethodsA panel of immunohistochemical markers comprising of SATB2, CDK4, MDM2, panCK, CD31, desmin, NKX2.2 and TLE1 were employed in combination with fluorescent in‐situ hybridization to detect the prevalence of rearrangement in CDK4 and MDM2 genes.ResultsOn immunohistochemistry, the neoplastic cells were strongly positive for SATB2 and negative for CDK4, MDM2, panCK, CD31, desmin, NKX2.2 and TLE1. Fluorescent in‐situ hybridization of CDK4 and MDM2 genes was also negative.ConclusionConsidering its rarity in jaws combined with clinicopathological overlap with other benign pathologies, diagnosis of this entity is crucial in treatment planning and prognostic significance. Moreover, only five cases of TOS have been reported so far in the craniofacial region. Here, we have reported the sixth case of its kind with detailed clarification pertaining to its immunohistochemical and molecular aspects.