Quistes óseos aneurismáticos. Terapia celular con células mononucleares y seguimiento imagenológico en dos pacientes adolescentes / Aneurysmal bone cysts. Mononuclear cell therapy and imaging follow-up in two adolescent patients

RESUMEN Los quistes óseos aneurismáticos son frecuentes en la edad pediátrica. Para su determinación se cuenta con diversos estudios imagenológicos como la radiografía y la tomografía axial computarizada que pueden colaborar al diagnóstico diferencial con otras lesiones. Existen disímiles opciones terapéuticas, el uso de factores de crecimiento autólogos se ha considerado como alternativa eficaz. Se presentan dos pacientes consultados en el servicio de Ortopedia del Hospital Provincial Pediátrico Universitario «José Luis Miranda¼, de Villa Clara, con diagnóstico clínico e imagenológico de quiste óseo aneurismático que recibieron tratamiento mediante terapia celular con células mononucleares con buena evolución clínica y radiográfica. Esta técnica es aplicable en nuestro medio ya que no requiere de estimables recursos materiales lo que constituye una fortaleza para su implementación. Las radiografías permiten reconocer la evolución posterior al tratamiento.

ABSTRACT Aneurysmal bone cysts are common in children. For its determination, various imaging studies are available, such as radiography and computerized axial tomography, which can collaborate in the differential diagnosis with other lesions. There are dissimilar therapeutic options, the use of autologous growth factors has been considered as an effective alternative. We present two patients seen in the Orthopedics service at "José Luis Miranda" University Pediatric Hospital in Villa Clara, with a clinical and imaging diagnosis of aneurysmal bone cyst who received treatment with mononuclear cell therapy having a good clinical and radiographic evolution. This technique is applicable in our environment since it does not require considerable material resources, which constitutes a strength for its implementation. X-rays allow us to recognize the evolution after treatment.

Monostotic craniofacial fibrous dysplasia: report of two cases with interesting histology

Fibrous dysplasia (FD) is a relatively rare osseous disease of unknown etiology, wherein the normal bone is replaced by collagen-rich tissue, comprising of fibroblasts and variably abundant immature woven bone. Clinically, it may involve a single bone or multiple bones. It commonly arises in the jaw bone, skull, rib, and proximal femur. Those arising in the skull and the jaw are together termed "craniofacial fibrous dysplasia." The differential diagnosis at this location includes meningioma and metastatic carcinoma. In this report, we highlight two diagnostically challenging cases presenting with orbital swelling and headache as the main complaints. Our first case was misinterpreted as meningioma on intraoperative squash smear, and paraffin sections revealed characteristic features of FD. The second case highlights the morphological feature of non-specific cystic degeneration occurring in FD. Radiographs in such cases show cystic swelling, which is indicative of a secondary aneurysmal bone cyst.

Application of elastic intramedullary nail in the treatment of primary aneurysmal bone cyst of extremities / 中华骨科杂志

Objective To compare the treatment effect and study the efficacy of the elastic intramedullary nails for the treatment of primary aneurysmal bone cysts in limbs.Methods Twenty one children with primary aneurysmal bone cystsadmitted to and treated in Shanghai Children's Hospital from 2012 January to 2016 June were studied retrospectively.There were 18 males and 3 females,with overall age of 1-14 years old and median age of 5 years old.The lesions were mainly located in the femur,tibia,fibula and humerus.They were divided into 2 groups according to the treatment plan.The patients of the experimentgroup received curettage and bone grafts with high-speed burring and elastic intramedullary nail.The patients of the control group received curettage and bone grafts with high-speed burring.According to the imaging results (Neer grading) and MSTS functional evaluation,the curative effect of the children of the 2 groups were analyzed statistically.Results The cure children were followed up for more than 2 yearswith follow-up time range of 24-48 months (mean value of 32.29±8.22 months).Five patients had a recurrence,with mean postoperative recurrence time of 10±2.66 months.A total of 5 patients of the control group perceived curettage and bone grafts with high-speed burring and a total of 16 patients of the experimentgroup received curettage and bone grafts with high-speed burring andelastic intramedullary nail.According to the imaging results (Neer grading) and MSTS function evaluation,Neer grading was 3 cases for grade Ⅰ,0 case for grade Ⅱ,1 case for grade Ⅲ and 12 cases for grade Ⅳ in the experiment groups.That was 1 case for grade Ⅰ,1 case for grade Ⅱ,2 cases for grade Ⅲ and 1 case for grade Ⅳ in the control group.The ABC recurrence rate of experimental group (18.8％) was lower than matched group (40％),while there was no significant difference.We found that MSTS functional scores of experimental group was significantly higher than the matched group (28.88±2.22 vs 20.80± 10.38,t=3.058,P=0.006).According to postoperative MSTS functional evaluation,we found that even the patients in the study group with recurrencewere also able to participate in physical exercises,without further occurrence of pathological fracture and the postoperative life quality was greatly improved.Conclusion Curettage and bone grafts with high-speed burring andelastic intramedullary nail can significantly reduce the recurrence rate of primary aneurysmal bone cysts in the four limbs.Meanwhile the MSTS function evaluation of the recurrence cases in this group all achieve to a satisfactory level.The reason of recurrence may be correlated to patient age and the distance between the focus and epiphyseal plate.Therefore,an appropriate treatment protocol is helpful in reducing the relapse rate and improving the patients' postoperative living quality.

Vertebrobasilar insufficiency caused by cervical aneurysmal bone cyst - case report / Insuficiência vertebrobasilar causada por cisto ósseo aneurismático cervical - relato de caso

Aneurysmal bone cysts (ABC) are benign bone tumors of relatively rare occurrence. Most of the lesions occur at long bones, vertebrae and flat bones. However, the cervical vertebrae involvement is uncommon. Occasionally, the ABCs compress the spinal cord and nerve roots. Depending on the level of involvement and the extent of spinal cord compression, a wide variety of neurological symptoms and signs may be noted later, ranging from mild radiculopathy to complete paraplegia or tetraplegia. A case of aneurysmal bone cyst involving the second and third cervical vertebrae in a 15 years old patient, causing compression of the right vertebral artery and subsequent vertebrobasilar insufficiency is reported. We also discuss the clinical manifestations of the vertebrobasilar insufficiency, of the spinal compression, and the surgery treatment performed in this case.

Cistos ósseos aneurismáticos são tumores ósseos benignos de ocorrência relativamente rara. A maior parte dessas lesões ocorre em ossos longos, nas vértebras e nos ossos planos. No entanto, o envolvimento das vértebras cervicais é incomum. Ocasionalmente, o cisto ósseo aneurismático pode comprimir a medula espinhal e as raízes nervosas. Dependendo do grau de envolvimento e extensão da compressão da medula espinhal, uma ampla variedade de sintomas e sinais neurológicos pode ser observada posteriormente, variando de radiculopatia suave a completa paraplegia ou tetraplegia. Relatamos um caso de cisto ósseo aneurismático envolvendo a segunda e a terceira vértebra cervical em um paciente de 15 anos, causando compressão da artéria vertebral direita e consequente insuficiência vertebrobasilar. Também discutimos as manifestações clínicas da insuficiência vertebrobasilar e da compressão espinhal e o tratamento cirúrgico realizado no caso em questão.

Aneurysmal bone cyst of the mandible managed by conservative surgical therapy with preoperative embolization

A 9-year-old girl visited our hospital, complaining of a rapid-growing and rigid swelling on the left posterior mandibular area. Panoramic radiograph showed a moderately defined multilocular honeycomb appearance involving the left mandibular body. CT scan revealed an expansile, multilocular osteolytic lesion and multiple fluid levels within cystic spaces. Bone scan demonstrated increased radiotracer uptake and angiography showed a highly vascularized lesion. The lesion was suspected as aneurysmal bone cyst (ABC) and preoperative embolization was performed, which minimize the extent of operation and the surgical complication. The lesion was treated by surgical curettage and lateral decortication with repositioning. No additional treatment such as a surgical reconstruction or bone graft was needed. Early diagnosis of ABC is very important and appropriate treatment should be performed considering several factors such as age, surgical complication, and possibility of recurrence.

Imaging diagnosis of aneurysmal bone cyst secondary to giant cell tumor / 中华放射学杂志

Objective To improve recognition and imaging diagnosis of aneurysmal bone cyst secondary to a giant cell tumor.Methods To collect the dates of 12 patients with aneurysmal bone cyst secondary to a giant cell tumor were proved by operation and pathology from January 2003 to October 2006. Analyzed and summarized their imaging manifestations and correlation with pathohistology.Results Six lesions were located in epiphysis and metaphysic regions of long bone.Six lesions were located in pelvis.All cases showed a cystic lesion with expanded and osteolytic,eccentric 10 cases and centric 2 cases.Four cases display trabeculate,the margin is well define with a rim of bone sclerosis in 2 cases.Magnetic resonance imaging(MRI)scans were available in 10 patients.All case showed cystic,dilated lesions with solid areas. Eight cases manifested single or multitude solid nodules in big cystic wall.Two cases appeared solid masses with multitude cysts.The sign of multitude fluid-fluid level,best seen on T_2-weighted images,was present in all patients.Seven cases emerged soft-tissue masses.MR found indicative of large amounts of hemosiderin in one cases.Eight cases were examined by spiral CT with plain scanning and enhancement scanning. Reconstructed image were CTA and 3D-MPR(three dimensions multiplanar reconstruction)imaging.All cases showed cystic,dilated lesions with solid areas.The sign of multitude fluid-fluid level was present in 6 patients.The solid areas and cystic-wall of lesions showed contrast enhancement in 8 patients.3D-MPR imaging showed supply blood vessel of tumors in 3 cases.Arteriovenous malformation did not found in all patients.The surgeons'operative findings and the gross specimens were studied in all patients.All lesions were composed of solid areas and cystic areas.The diagnosis of pathology were ABC with GCT(grade Ⅱ)in 10 cases and ABC with GCT(grade Ⅲ).Conclusion Aneurysmai bone cyst secondary to a giant cell tumor is not rare.Adequately recognizing the pathologic basis of ABC,and selecting imaging techniques correctly (X-ray and MRI,or X-ray and CT)is especially important to diagnose a giant-cell tumor with secondary aneurysmai bone cyst.When an eccentric,expanded,lytic tumor with a cystic-solid lesion in epiphysis of long bone or pelvis shows multiple fluid levels,a giant-cell tumor with secondary aneurysmai bone cyst components should be sufficiently considered.