Tumores benignos que producen fracturas en niños / Benign tumors that cause fractures in children

Resumen: Introducción: Se define fractura patológica a la que se produce a través de un hueso anormal. Cada año se diagnostican aproximadamente 20,000 neoplasias benignas del sistema musculoesquelético. A menudo, el dolor de la fractura es el primer síntoma de un proceso patológico en el hueso. El sitio, la edad y la apariencia radiográfica crean un diagnóstico diferencial para las fracturas patológicas que sigue siendo amplio. El examen clínico evalúa la condición de la piel, palpar cualquier masa de tejido y determinar si hay signos inflamatorios locales como eritema, calor o edema. La toma de biopsia es muy recomendable para confirmar el diagnóstico de una fractura patológica. Objetivo: Determinar qué tumores óseos benignos y qué lesiones seudotumorales producen fracturas en huesos de niños con mayor frecuencia en nuestro hospital. Material y métodos: Estudio retrospectivo transversal, se revisaron expedientes de pacientes con diagnóstico de fractura en terreno patológico, atendidos en el período de Marzo de 2013 a Marzo de 2017. Resultados: Los tumores benignos que ocasionaron fracturas en terreno previamente dañado fueron: quiste óseo aneurismático 13, encondroma cinco, osteoma osteoide tres, tumor de células gigantes dos. Conclusión: En nuestra institución, los quistes óseos aneurismáticos fueron los tumores benignos que con mayor frecuencia producen fracturas patológicas en niños, con predominio en el sexo masculino.

Abstract: Introduction: A pathological fracture is defined as that which occurs through an abnormal bone. Approximately 20,000 benign neoplasms of the musculoskeletal system are diagnosed each year. Often the pain of the fracture is the first symptom of a pathological process in the bone. The site, age and radiographic appearance create a differential diagnosis for pathological fractures that remains broad. The clinical examination evaluates the condition of the skin, palpating any tissue mass and determining if there are local inflammatory signs such as erythema, heat or edema. The biopsy is highly recommended to confirm the diagnosis of a pathological fracture. Objective: To determine which benign bone tumors and pseudotumoral lesions produce fractures in children's bones more frequently in our institution. Material and methods: Cross-sectional retrospective study, review of records of patients with diagnosis of pathological fracture, attended in the period from March 2013 to March 2017, were reviewed. Results: The benign tumors that caused fractures in previously damaged areas were: aneurysmal bone cyst 13, enchondroma 5, osteoid osteoma 3, giant cell tumor 2. Conclusion: At our institution, aneurysmal bone cysts were the benign tumors that most frequently produce pathological fractures in children, with predominance in males.

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.

Paraplejia secundaria a quiste óseo aneurismático de columna torácica / Paraplegia due to aneurismatic bone cyst of the thoracic spine

Objectives: Case report of progressive paraparesis secondary to Aneurysmal Bone Cyst of thoracic spine presenting over 40 years. Describe diagnostic triad: clinical, imaging and anatomopathologic examination. Describe the choice of surgical treatment and clinical outcomes. Performed literature review of Spine Aneurysmal Bone Cyst.

Objetivo: Dar a conocer el caso de un paciente que presenta una paraparesia progresiva secundaria a quiste óseo aneurismático (QOA) de columna torácica de presentación sobre los 40 años. Describir la triada diagnóstica en patología tumoral: clínica, imágenes y estudio anatomopatológico. Describir la elección del tratamiento quirúrgico y los resultados clínicos del caso. Se realiza revisión de la literatura publicada de QOA de columna.

Quiste óseo aneurismático de la columna vertebral: reporte de un caso / Aneurysmal bone cyst of the spine: case report

El quiste óseo aneurismático es un tumor de naturaleza neoplásica indefinida, de comportamiento benigno, crecimiento rápido y ocasionalmente de comportamiento agresivo, cuyo tratamiento de elección es la resección completa, aunque existe el riesgo de sangrado transquirúrgico excesivo. Se presenta el caso de una paciente con deformidad en columna torácica, con parestesias y debilidad muscular progresivas en extremidades inferiores, que evolucionó hasta la parálisis de dichas extremidades e incontinencia de ambos esfínteres. Mediante estudios de gabinete se localizaron lesiones líticas en cuerpos vetebrales T7 a T9 e invasión a conducto raquídeo. Los estudios electrofisiológicos identificaron bloqueo completo de la vía somatosensorial. Previa biopsia incisional, se realizó resección de la lesión y estabilización de la columna toracolumbar. La paciente evolucionó sin mejoría de la función medular. Los hallazgos morfológicos correspondieron a quiste óseo aneurismático en T8. Esta lesión se localiza principalmente en huesos largos y con mucho menor frecuencia en la columna vertebral, donde puede provocar inestabilidad y compresión de la médula espinal. Es posible confundirla con otras neoplasias, por lo que el diagnóstico definitivo mediante biopsia es imprescindible a fin de establecer el plan terapéutico adecuado, que elimine el riesgo de recurrencia o secuelas neurológicas asociadas, y lograr la estabilidad adecuada de los segmentos vertebrales afectados.

The aneurysmal bone cyst (ABC) is a fast-growing tumor of undefined neoplastic nature. It is occasionally an aggressive benign lesion whose treatment of choice is a complete resection, even though the risk of profuse transoperative bleeding exists. We present a female patient with thoracic spine deformity, with progressive paresthesias and muscle weakness of lower extremities that evolved to paralysis of both lower extremities and sphincter incontinence. Based on radiographic films, lytic lesions were identified at T7 to T9 vertebrae as well as medullary space invasion. In electrophysiologic tests, a complete somatosensorial pathway block was reported. Prior to resection of the neoplastic lesion and thoracolumbar stabilization, an incisional biopsy was performed. There was no postoperative medullary functional improvement. Morphological findings corresponded to an aneurysmal bone cyst at T8. This lesion is mainly located in the long bones and less frequently of the spine, where instability and medullary compression may occur. It is possible to confuse this neoplasia with other lesions. Hence, definite diagnosis with biopsy is necessary for determining an adequate therapeutic plan to eradicate recurrence risk or associated neurologic sequelae, as well as to gain proper stability at the involved vertebral segments.

Management of an ancurysmal bone cyst

Aneurysmal bone cyst is a rare, non-neoplastic, expansile bony lesion that mainly affects children and young adults. It may cause diagnostic confusion with a bone tumor. These cysts are frequently treated surgically, but recurrence is very common and surgery is hazardous, especially when the lesion is adjacent to the growth plate. A case report of an aneurysmal bone cyst in an 11 year old child is presented with serial radiographic changes and discussion on its management