Cystic Bone Lesions Research Articles

Bone lesions in systemic lupus erythematosus.

Routine joint radiographs of 125 patients with systemic lupus erythematosus were studied. A total of 121 patients had a clinical history of articular symptoms. Cystic bone lesions were found in 51 patients (41%). The lesions, which were typically located subchondrally in the small joints of hands and feet, appeared as well-defined radiolucent areas surrounded by either normal bone or a narrow sclerotic zone. Nutritional disturbance in the bones, caused by the vasculitis associated with systemic lupus erythematosus, is proposed as a possible pathogenetic mechanism of the cystic lesions.

EQUINE ARTHROGRAPHY

To obtain detailed radiographic information about the joint capsule, joint cavity, or articular cartilage, negative (air), positive, or double contrast arthrography is required. Negative and positive contrast arthrograms are easily obtained in a standing horse. Aseptic technique must be utilized. Aspiration of synovial fluid is followed by injection of contrast medium. For double contrast arthrography the horse must be anesthetized. After removal of some synovial fluid and the injection of air and positive contrast medium with the horse in lateral recumbency, the position of the horse is altered. Use of double contrast arthrography is limited to larger joints. In small joints distribution of air and positive contrast medium will be unequal, resulting in false‐positive or false‐negative findings. The diagnostic value of negative contrast arthrograms is relatively poor. Such arthrograms are useful only for the visualization of radiolucent joint mice or for the differentiation of intraarticular and extraarticular bone fragments. Positive contrast arthrograms are useful for the detection of larger synovial abnormalities, e.g., villonodular synovitis, herniation, or rupture of the joint capsule, or for the visualization of communication between the joint cavity and cystic bone lesions or cystic periarticular soft tissue masses. Double contrast arthrograms provide more detailed information than negative or positive arthrograms. Minor abnormalities of the articular cartilage or the synovial membrane can be visualized.

副甲状せん機能高進症の２症例

Two patients with hyperparathyroidism and cystic bone lesions were reported. Case 1: A 32-year-old female was admitted to our clinic because of right lower leg pain. Radiographs of the long bones showed cystic bone lesions and subperiosteal bone resorption was found in the hands. The right fibula had pathologic fracture. Laboratory investigations disclosed hypercalcemia (11.4mg/dl) and hypophosphatemia (1.8mg/dl). The serum alkaline phosphatase was 94 K-Au and the PTH level was 2.4ng/ml. The serum 1, 25-(OH)2-D3 level was 105.9pg/ml. A parathyroid chief cell adenoma was removed. Case 2: A 23-year-old female was admitted to our clinic because of right forearm pain. Radiographs showed groundglass appearance of the right humerus, radius, first metacarpus and proximal and distal phalanx. Laboratory studies showed normal serum calcium, phosphorous and alkaline phosphatase values. The serum PTH level was elevated to 4.9ng/ml. Resection and bone grafting was done. This case was recognized as polyostotic fibrous dysplasia associated with primary hyperparathyroidism.

Experience with meta-, diaphysectomy. Special reference to the surgical treatment of the benign cystic bone lesions.

Our experience with meta-, diaphysectomy in nine cases of benign cystic bone lesion is reported. Non-invasive treatment, such as injection of methylprednisolone into cyst cavity, is preferable, especially for a cyst of non-weight bearing bone. Surgical treatment, however, is needed if the risk of recurrent fracture is to be avoided and when it is not practical to restrict the activities of a child during the growing years to prevent a refracture. Roentgenographic end results were evaluated and assessed by the criteria proposed by Baker and all cases were rated 5 with no significant roentgenographic evidence of cyst.

Membranous Lipodystrophy (Lipomembranous Polycystic Osteodysplasia)

Membranous lipodystrophy, a hereditary disease, is characterized by symmetric multiple cystic bone lesions and progressive neuropsychiatric symptoms. In two patients, a 22-year-old woman and a 30-year-old man, as in others reported in the literature, neither the etiology nor the pathogenesis was apparent. Histologically, the lesions consisted of convoluted membranes interlaced with lipoid structures.

Coexistent Multiple Myeloma and Parathyroid Adenoma

To the Editor.— In the article entitled Coexistent Multiple Myeloma and Primary Hyperparathyroidism (1982; 247:823), Stone et al stated that they were not aware of any other report of a patient in whom overt myeloma and documented primary hyperparathyroidism occurred simultaneously. We wish to point out that we published a case report1describing an elderly man with simultaneous parathyroid adenoma andκlight-chain myeloma. The patient's clinical presentation was characterized by pathological fractures, cystic bone lesions, and hypercalcemia. He survived for 22 months after resection of the adenoma and institution of chemotherapy of the myeloma. He eventually died of refractory hypercalcemia. As the authors observed, literature reports of the simultaneous occurrence of symptomatic myeloma and hyperparathyroidism are sparse. We support their recommendation that in the differential diagnosis of hypercalcemia, the coexistence of these diseases should be considered.

Intraosseous ganglion

The intraosseous ganglion is a cystic lesion of bone most frequently located in the subchondral epiphysis of long bones without direct communication with a joint cavity. Although this entity is becoming well recognized by orthopedic surgeons and radiologists, it has rarely been discussed in the pathologic literature and is frequently overlooked by the surgical pathologist. In this study the clinical and pathologic features of 10 patients, representing 11 instances of intraosseous ganglia, were reviewed with emphasis on the histologic and radiologic features necessary for diagnosis. Common radiologic features usually include a unilocular cyst surrounded by a thin rim of sclerotic bone in the subchondral epiphysis in the absence of other features of degenerative joint disease. Histologically, the ganglia are usually composed of a cystic space without epithelial lining, often filled with gelatinous, mucoid material and occasional foamy macrophages. The radiologic and histologic differential diagnoses, possible etiologic factors, and treatment are discussed.

NEVOID BASAL CELL EPITHELIOMA SYNDROME IN JAPAN

A 49-year-old Japanese man with typical features of nevoid basal cell epithelioma syndrome is reported. The patient had cystic lesions of the jaw bone, multiple basal cell epitheliomas of the scalp and face, pits on the palms and soles, bifid ribs, scoliosis and calcification of the falx cerebri. In Japan five certain cases have been reported previously. We added one new case and reviewed the other five cases briefly.

An unusual cystic lesion of bone

Two cases of unusual cystic lesion are reported.Case 1 A 20-year-old female was seen by authors with tenderness around her right hip.Roentgenogram of her right hip revealed an unusual cystic lesion of great trochanter.At this surgery, the lesion consisted of only cavity. There was no fluid in the cavity and this cavity was not lined by a thin menbran. Histological examination of excised wall showed only bone trabeculae.Case 2 A 22-year-old female was seen by authors with pain on walking.Roentgenogram revealed an unusual cystic lesion of ilium. Macroscopic and micro scopic findings were the same as case 1. There was no organisms in the cavity.The authors could not diagnose these lesions as bone cyst, and the authors consider that the selesions are distinct entity.

Membranous lipodystrophy

Membranous lipodystrophy apparently is a new disease, first reported and named by Nasu and associates 31 in 1971. We have collected six cases of this disease. The initial manifestation was articular pain at adolescence. Symmetrical changes in the bones of the extremities then appeared and the disease seemed to progress slowly with age. The younger patients exhibited only skeletal pain or fractures, while the older patients had some neuropsychiatric changes. Three of the patients died in middle age. The cystic bone lesions contained a yellow, lipid-like substance which histologically showed a characteristic membranocystic appearance. Electron microscopic study showed unique features, but biochemical analysis of the substance did not reveal a definable abnormality.

Aneurysmal Bone Cyst Evaluation of Resection and of Curettage in 20 Cases

The clinical, angiographic and histological aspects of 20 cases of aneurysmal bone cyst suggest that angiography is a valuable aid in the diagnosis of a cyst, differentiating it from other cystic bone lesions. Angiographic information also has a certain bearing on the origin of the lesion. It was demonstrated that other, benign, lesions may exist adjacent to the cyst or prior to it; in most cases, however, the cyst appears in a bone which is otherwise normal. The failure to differentiate between aneurysmal bone cyst and giant cell tumor in relation to sex, age, localizaiton, morphology, and clinical course (e.g. tendency of recurrence and malignant transformation) may be responsible for confusion in the literature on these lesions. Good results of treatment are achievable by resection en bloc and by resection, or curettage with bone grafting. Curettage alone is inadequate. Only two recurrences (10%) were recorded in the present series during the average follow-up period of 4.5 years.

Diseases of Bone and Joints

This text of skeletal diseases is an excellent, concise reference for all physicians, regardless of specialty or general orientation. It deals Primarily with the pathological features of the non-neoplastic disorders of bones and joints, but it is very descriptively written with excellent clinical and radiographic correlations. The otolaryngologist in particular will find this text to be an excellent reference source for such craniofacial disorders as fibrous dysplasia, Paget disease, various cystic lesions of bone, histiocytosis-x, and the osteopathies secondary to endocrine and other metabolic disorders. A chapter devoted to the effects of irradiation and chemicals on bone, including flourine, lead, and mercury, is particularly pertinent to much of the contemporary work in otolaryngology. Each chapter is followed by an excellent list of well-selected references. Although this text may not be one most otolaryngologists would consider for purchase for their private professional libraries, it should be considered for inclusion as a

Surgical treatment of solitary bone cysts.

A special method of subperiosteal segmental resection is described as an operative treatment for solitary bone cysts in long bones. This procedure exploits the high osteogenetic potency of the periosteum in adolescence. An autogenous or homologous fibula bone graft locked between the ends of the cyst serves to maintain the length of the bone fragments and acts as a guiding rod for continued subperiosteal new bone formation. There is full reconstruction of bone stability and function at both the cyst region and the donor region (fibula).

Polyostotic cystic bone lesions in a dog.

ABSTRACTThe clinical, radiological, and pathological features of a polyostotic cystic bone lesion in a 9‐month‐old Doberman Pinscher are described. The patient was diagnosed as having nutritional secondary hyperparathyroidism at 6 weeks of age and after dietary correction it remained clinically normal until 9 months when there was sudden left hind‐limb lameness due to a pathological fracture through a cystic lesion in the distal femur. Radiography revealed additional cystic structures in the metaphyses of the left radius, and left and right tibia. Pseudofractures were associated with two of the cystic lesions.In some areas the cysts were crossed by trabeculae and in others there were bony ridges on the inner cystic wall. The cavities were lined with flesh‐coloured fibrillar material which formed a lacy network extending into cavities. Histologically, multiple small cysts were present adjacent to the larger cavities noted radiographically. The secondary spongiosa and the metaphyseal periosteum were the major abnormal tissue sites. The small cysts appeared to arise in an oedematous and congested metaphyseal spongiosa. The cysts were accompanied by small foci of intense osteoclasis but unattended by compensatory bone production, and the consequent possibility of pseudofractures is an important clinical consideration. Earlier reports demonstrated that resolution of the lesions will follow surgical drainage and curettage of the cystic cavity. Of six cases of polyostotic cystic bone lesions observed in the dog, five were in the Doberman Pinscher breed.

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.

An unusual cystic lesion of bone, limited to the pelvis and lower extremities; osteogenesis imperfecta cystica?

This is a single case report of an unusual bone lesion in a young Negro male. The diagnosis was complicated by major abnormalities in several other systems of the body, which may or may not be related. Roentgenograms taken at an interval of four years were available for study and two biopsies were done. A 26-year-old Negro (Fig. 1) was first seen at North Carolina Memorial Hospital on Aug. 26, 1954. He and his parents were unreliable in relating his history and had little sense of the passage of time. It was established that he was in good health until the age of three to six years. Sometime during that interval, while he was kneeling to pray, his legs suddenly gave way beneath him. Since then he had had “crooked legs” and had been bedridden. Four or five years after the initial mishap, sinuses exuding blood and pus appeared on both thighs. In 1950, the patient was examined in another hospital, where he was found to have anemia and hypertension (230∕150), as well as marked deformity of the lower extremities. Amputation was suggested but was refused. Films obtained at that time were made available for the present study. Family History: The patient had two siblings who died of tuberculosis, and four younger brothers had died in infancy of unknown causes. To the knowledge of the family, none had anemia or deformity of the limbs. Both parents were reported to be in good health. Physical Examination: The oral temperature was 97.8° F., pulse 100, respirations 44 per minute, blood pressure 120∕80. The patient had the head of a man but the torso of a boy. He appeared acutely and chronically ill. He did not complain of pain but was quite dyspneic. The sclerae were normal in color. The fundi showed brownish streaks on the retinae, and there were arteriolar thinning and narrowing with increased tortuosity. The tongue and oral mucosa had a brownish tinge. The heart was enlarged, with regular rhythm and a grade II systolic murmur heard best at the apex. The liver was palpable just below the costal margin, but the spleen was not felt. The testes were quite small, the penis was of normal size, and axillary and pubic hair was sparse. The upper extremities appeared normal, but the lower extremities were misshapen, enlarged, and grotesque. There were flexion contractures of both hips, knees, and ankles, with severe limitation of passive motion. The patient himself could move only his toes. Sinuses, draining pus and blood, were present on the lateral aspect of the right thigh and the anterior aspect of the left thigh. On the left a bony sequestrum could be palpated and seen but could not be extracted.

Gout as a cause of isolated circumscribed cyst of the patella; report of a case.

Isolated, circumscribed cysts of the patellae are of great interest to the radiologist and orthopedic surgeon because of their differential diagnostic and therapeutic significance. A cystic lesion in the patella may indicate such generalized or systemic conditions as leukemia, multiple myeloma, fibrous dysplasia, cystic tuberculosis of bone, reticulosis, metastases, or metabolic disorders. Such a lesion may, on the other hand, be primary in the patella, as a solitary “benign” cyst or hemangioma or tumor of bone. A search of the literature revealed no record of a solitary cystlike area in the patella related to gout. The present case is reported, therefore, as an example of a solitary patellar lesion indicating a major systemic condition, i.e., a metabolic disease. It serves to re–emphasize the fact that in such instances final therapy can be instituted only after a diagnosis has been established and that the determination of the nature of cystic lesions of bone must be made by biopsy. Case Report W. E. M....

POLYOSTOTIC FIBROUS DYSPLASIA IN ONE OF NEGRO TWIN GIRLS

Excerpt Introduction Interest in cystic lesions of bone was greatly stimulated by the successful removal of a parathyroid adenoma by Mandl1in 1925. Since that time generalized osteitis fibrosa cyst...

Differential Diagnosis of Cystic Lesions of Bone

Differential Diagnosis of Cystic Lesions of Bone

Multiple Cystic Tuberculosis of Bones: Its Roentgen Picture and Reparative Process as Seen in Serial Roentgenograms

DURING the past four years I have had the opportunity of closely following the healing process, through roentgenograms, of widely disseminated cystic bone lesions of tuberculous origin in a young girl. A complete clinical report of this case has been given in another journal (1). The present communication concerns itself mainly with the roentgen picture. The present concept of multiple cystic bone tuberculosis, “osteitis tuberculosa multiple cystica,” is applied to a comparatively rare form of diaphysial bone tuberculosis, usually multiple, and of metastatic origin from a primary thoracic focus. It is insidious in onset, with few or no localizing signs such as pain, tenderness, or external evidence of inflammation. The lesions run a chronic benign course, consist of a circumscribed area of soft tuberculous granulation tissue and degenerated bone which tend to heal slowly. The roentgen picture is fairly characteristic and of distinct diagnostic importance. Two main roentgen types are described; the diffuse and the circumscribed (2, 3). The diffuse is the more acute initial stage. In it, the diaphysis cannot be differentiated into medulla and cortex. Here the cystic areas of decreased density are honeycombed with a web-like structure of increased density. The individual or several apertures in the web vary in size from that of a millet seed to that of a pea. The cystic areas may enlarge to include both medulla and cortex, increase the diameter of the involved bone, and cause destruction of a phalanx. The patient presented demonstrates the circumscribed type. In typical cases the roentgenogram shows round smooth or irregular punched-out like areas of decreased density, with a thin cortex and little or no surrounding sclerosis. There is usually no involvement of the periosteum, no cortical expansion, and no abscess or sequestrum formation. The roentgen picture of these circumscribed lytic tuberculous lesions is not only characteristic but, in the general absence of any localizing physical signs, the diagnosis of multiple cystic bone tuberculosis is contingent on roentgen bone examination in children who have tuberculous thoracic disease. Without roentgen bone examination, the far-flung lytic lesions in my little patient would not have been suspected or detected. In March, 1935, a six-year-old girl was admitted to the Pediatric Service, University Hospital, with an immediate history of kyphotic deformity of the spine which had not improved after three months' treatment in a cast. At the time of admission she was fairly well developed and nourished. Mid-thoracic kyphosis, protuberance of three vertebræ, and some local tenderness were the only positive signs. They justified a diagnosis of spinal tuberculosis which was confirmed by roentgen examination. Figure 1 shows the widely scattered lytic lesions in the bones related to the thorax.