Benign Cystic Lesions Of Bone Research Articles

Symptom Interval in Cases of Benign Cystic Lesions of Bone and its correlation with Surgical Intervention.

Benign lesions in bone are less studied in terms of progression and prognosis. There is presently no literature studying symptom interval (SI) in neoplastic bone lesions or determinants of delay in Indian setting. The literature is also sparse on SI in benign lesions of bone, since benign bone lesions have seemingly less menacing symptoms and slow progression as compared to their malignant counterparts. Social and cultural issues peculiar to the region of study have an impact on the symptom interval of benign bony lesions. A prospective, observational study was conducted at a tertiary level University teaching hospital from December 2017 to August 2019. The study included 55 patients presenting with benign cystic lesions of bone. Appropriate radiological investigations along with tissue biopsy were done. All the patients were enquired as per a preformed questionnaire to determine the delay and its determinants. Out of the 55 patients included in the study, wide variety of cystic lesions was observed with varied presentation and delay. Median SI of 175days (range 27-3705days) was observed in the present study. However, it was found that longer SI did not have a statistically significant effect on the type of procedure done (p = 0.206) though diagnostic delay was significantly related to the intervention required (p = 0.004). It was observed that tumor behavior at the time of presentation such as histopathological diagnosis (p = 0.000), presence of cortical breach (p = 0.001), stage of tumor (0.001), and articular involvement (p = 0.000) remained as some of the most important factors in determining the prognosis and outcome in case of benign cystic lesions of bone.

Excisional Curettage of Benign Cystic Lesions.

Treatment of benign cystic lesions of bone with the use of excisional curettage requires careful preoperative planning and patient positioning before the initial incision is made. The initial incision must be carefully planned to expose the entire lesion without violating multiple compartments unnecessarily. A sizeable cortical window must then be made using a high-speed burr followed by evacuation of all cystic contents via curettage. The cavity is copiously irrigated before an adjuvant is used, and the lesion is stabilized, if necessary, before closing. There are many types of alternatives to curettage, such as wide resection, radiation, and embolization of feeding vessels. In orthopaedics, as in all medical specialties, many interventions and techniques have been rendered obsolete and, ultimately, replaced by newer, safer, and more efficient ones. The appeal of curettage has remained because of its procedural simplicity and adaptability in the management of a plethora of diseases such as benign cystic lesions of bone. Additionally, curettage, unlike wide resection, radiation, and embolization of feeding vessels, is minimally invasive and often definitive in nature when used as a treatment modality2. Lastly, curettage grants the performing surgeon the ability to maintain a contained cavity that can be treated with a variety of adjuvant therapies3-17. These reasons listed above make curettage a viable option for the surgical treatment of benign cystic lesions such as giant cell tumors of bone, aneurysmal bone cysts, unicameral bone cysts, chondromyxoid fibromas, and symptomatic nonossifying fibromas.

Treatment of benign cystic lesions of bone with a composite of bone substitute and bone marrow

Background There are many methods for the treatment of unicameral bone cysts, which are benign cystic lesions seen in the metaphseal–diaphyseal region of long bones in growing children. Patients and methods Totally 20 patients, eight boys and four girls with a mean age of 10 years (range: 8–14 years), who had unicameral bone cysts were treated by curettage and a CaSO4–CaPO4 bone substitute mixed with bone marrow aspiration. The lesion size ranged from 2×4 to 3×7 cm. Results New bone formation was noted in all cases with residual defects in five cases ranging from 15 to 25%. No pathological fracture occurred in this study. Recurrence of the lesion occurred in one case and was treated by reoperation with another dose of CaSO4–CaPO4. Complications within this series included superficial infection with serous drainage 3 weeks postoperatively in two cases treated conservatively. Conclusion Early results of this study using the CaSO4–CaPO4 incorporated with bone marrow aspirate are promising in treating benign bone cysts with bone formation, which can stand for normal bone strength and low rate of complications.

Percutaneous Method of Management of Simple Bone Cyst

Introduction. Simple bone cyst or unicameral bone cysts are benign osteolytic lesions seen in metadiaphysis of long bones in growing children. Various treatment modalities with variable outcomes have been described in the literature. The case report illustrates the surgical technique of minimally invasive method of treatment. Case Study. A 14-year-old boy was diagnosed as active simple bone cyst proximal humerus with pathological fracture. The patient was treated by minimally invasive percutaneous curettage with titanium elastic nail (TENS) and allogenic bone grafting mixed with bone marrow under image intensifier guidance. Results. Pathological fracture was healed and allograft filled in the cavity was well taken up. The patient achieved full range of motion with successful outcome. Conclusion. Minimally invasive percutaneous method using elastic intramedullary nail gives benefit of curettage cyst decompression and stabilization of fracture. Allogenic bone graft fills the cavity and healing of lesion by osteointegration. This method may be considered with advantage of minimally invasive technique in treatment of benign cystic lesions of bone, and the level of evidence was therapeutic level V.

Unsuspected Bone and Soft Tissue Lesions Identified at Cancer Screening using Positron Emission Tomography

[F-18]-fluorodeoxy-D-glucose (18FDG) positron emission tomography (PET) is a sensitive modality for detecting malignant lesions. The purpose of the present study was to describe unknown bone and soft tissue lesions in adults identified at cancer screening using PET. A total of 4283 individuals of more than or equal to 40 years of age were enrolled. All individuals underwent scans from the base of the skull to proximal thigh. The images were reviewed and a consensus was reached by two board-certified radiologists and a nuclear medicine specialist for the diagnoses. Diagnoses of the lesions were confirmed by histological examination, typical radiologic findings, obvious progression in number and/or size of the lesion on follow-up examinations, and medical examination of interview. Unsuspected focal abnormality in the bone and soft tissue were found in 62 individuals (1.4%). The mean size of the lesion was 26 mm (range, 6-155 mm). There were 29 bone lesions (47%) and 33 soft tissue lesions (53%). A malignant lesion was found in one case (1.6%) and histologic diagnosis was primary non-Hodgkin lymphoma of the vertebra. Other major diagnoses were healing bone (n = 11, 18%) and benign cystic lesions of bone and soft tissue (n = 9, 15%), and brown fat of soft tissue (n = 4, 6%). Unsuspected bone and soft tissue lesions of a wide variation of pathologic and clinical diagnoses were encountered at cancer screening using PET. Correlation with clinical history and other imaging findings is essential in the differential diagnosis.

Aneurysmal Bone Cyst: the Role of Fibular Graft in its Treatment

Aneurysmal bone cyst is a relatively uncommon benign bone lesion for which curettage and cancellous bone grafting is a widely accepted method of treatment. This paper presents a report of eight patients with aneurysmal bone cysts; four in the humerus, three in the femur and one in the proximal phalanx of the index finger. Seven patients were treated by curettage and cancellous bone graft and one by autogenous fibular graft combined with cancellous allograft. Patients treated by cancellous bone grafting developed recurrence within a year. Three of these recurrent cysts were then treated by autogenous fibular graft combined with allograft. All four patients treated by fibular graft showed satisfactory healing of the cysts with no recurrence at three years' follow-up. Analysis of these patients suggests that recurrence of the aneurysmal bone cyst is very frequent after curettage and cancellous bone grafting. It is recommended that where total excision of the cyst is not feasible, the treatment of choice should be curettage and autogenous fibular bone grafting combined with cancellous bone graft. Removal of the fibula form its middle third does not cause any disability and the fibula regenerates completely within a period of three months.

顎骨に発生した脈りゅう性骨嚢胞の２例

Aneurysmal bone cyst is a benign cystic lesion of bone, and the incidence of this disease in the jaw is low. We reported two cases of aneurysmal bone cyst of the jaw. A 31-year-old woman presented with complaints of pain and swelling at the left side of the face. Since X-ray and CT-scan suggested a cystic lesion, cystectomy was performed. The lesion was histologically diagnosed to be an aneurysmal bone cyst. The other patient, a 40-year-old man, showed swelling at the right mandible. The patient's occlusion was impaired by the gingival swelling. X-ray findings showed the presence of a honeycomb-like lesion at the body and ramus of the mandible. CT-scan findings showed buccal and lingual expansion at the molar region. Microscopic features of the biopsy specimen were consistent with diagnosis of an aneurysmal bone cyst. We performed conservative curettage of the lesion. The postoperative courses of both of these cases were uneventful, and there has been no sign of recurrence after 7 years and 4 years, respectively.

Allograft in the treatment of benign cystic lesions of bone.

Seventeen patients with benign cystic osseous lesions were treated by curettage and grafting using allogenic decalcified bone. Human bones were partially decalcified using 0.6 N HCl and preserved in 90% ethanol in a deep freezer at -16 degrees C. The cystic lesions were: 5 cases of fibrous dysplasia, 4 aneurysmal bone cysts, 3 simple bone cysts, 2 giant-cell tumours, 1 chondromyxoid fibroma, 1 non-ossifying fibroma and 1 fibrous cortical defect. The bones involved were: femur, tibia, humerus, fibula and calcaneum. Infection was a complication in three patients. In two of these it did not interfere with healing, but in one it persisted for more than 1 year with partial resorption of the graft. The time to adequate incorporation of the graft varied from 6 to 9 months in children and 9 to 15 months in adults. The overall response compares favourably with that to allograft from more sophisticated bone banks.

Allogenic decalbone in the repair of benign cystic lesions of bone.

Forty-six cases of benign cystic lesions of bone were treated by curettage and compact filling using partially decalcified allogenic bone graft (Decalbone); of these, 35 were available for study. Decalbone was prepared by partial decalcification with 0.6 N hydrochloric acid (HCl) of human bones generally obtained from freshly amputated limbs. The commonest lesions of bone were giant cell tumours (14) and aneurysmal bone cysts (15), and the commonest bones involved were the femur (23) and the tibia (12). There was one failure and four recurrences. Five cases were infected but this did not interfere with healing of the primary lesion. Radiological incorporation of the graft was seen at about 3 months in unicameral bone cysts, at 4-6 months in aneurysmal bone cysts and at 6-9 months in giant cell tumours. There was no recurrence in any case of giant cell tumour, but three aneurysmal bone cysts recurred. There was no clinical immune reaction.

Intraosseous Ganglion—A Solitary Subchondral Lesion of Bone

Intraosseous ganglia are benign cystic lesions of bone and are found in the distal metaphyses of long bones of young and middle-aged adults. The location and roentgenographic appearance are constant and characteristic. Radiologists should consider this entity in the differential diagnosis of benign lesions of bone.