Differential Diagnosis of OKC and SBC on Panoramic Radiographs: Leveraging Deep Learning Algorithms.

This study aims to determine whether it can distinguish odontogenic keratocyst (OKC) and simple bone cyst (SBC) based solely on preoperative panoramic radiographs through a deep learning algorithm. (1) Methods: We conducted a retrospective analysis of patient data from January 2018 to December 2022 at Pusan National University Dental Hospital. This study included 63 cases of OKC confirmed by histological examination after surgical excision and 125 cases of SBC that underwent surgical curettage. All panoramic radiographs were obtained utilizing the Proline XC system (Planmeca Co., Helsinki, Finland), which already had diagnostic data on them. The panoramic images were cut into 299 × 299 cropped sizes and divided into 80% training and 20% validation data sets for 5-fold cross-validation. Inception-ResNet-V2 system was adopted to train for OKC and SBC discrimination. (2) Results: The classification network for diagnostic performance evaluation achieved 0.829 accuracy, 0.800 precision, 0.615 recall, and a 0.695 F1 score. (4) Conclusions: The deep learning algorithm demonstrated notable accuracy in distinguishing OKC from SBC, facilitated by CAM visualization. This progress is expected to become an essential resource for clinicians, improving diagnostic and treatment outcomes.

Acquired Simple Bone Cyst Associated With Lumbar Spinal Canal Stenosis Progression: A Case Report.

A simple bone cyst (SBC) in the posterior lumbar bone structure is very rare. Here, we report a case of SBC at the L5 lumbar lamina with venous obstruction associated with ligamentum flavum thickening. A 59-year-old woman presented with intermittent claudication due to low back pain and bilateral sciatica. A lumbar MRI showed L4-5 lumbar spinal canal stenosis and a T2-weighted image hyperintense lesion in the L5 lamina. Imaging four years earlier showed no lesions in the L5 lamina. Her symptoms improved after lumbar decompression surgery. The L5 lamina lesion was SBC, leading to a diagnosis of venous infarction. The involvement of neovascularization in the mechanism of degenerative hypertrophy in the ligamentum flavum was suggested. In this case, increased venous perfusion and venous obstruction were involved in the formation of the bone cyst.

Outcomes and complications of surgical treatment modalities for simple bone cysts of the humerus in children and adolescents.

PURPOSE: The aim of this study was to evaluate and compare different surgical treatment modalities for simple bone cysts (SBC) of the humerus regarding their effectiveness and recurrence rate. METHODS: In this retrospective study, patients who received surgical treatment for previously untreated primary SBCs of the humerus were analyzed. Demographic data, cyst-specific as well as treatment-specific parameters, complications, treatment failures, and recurrence rates were collected and correlated with different treatment modalities. Observed procedures were categorized as open procedure (n=20) or osteosynthesis alone (n=3). For the open procedure group, four subgroups could be defined. RESULTS: Twenty-three patients were included. The mean age at diagnosis was 11.6 ± 2.5 years, and the mean postoperative follow-up was 3.9 ± 2.6 years (range 1.0-10.3). After surgical intervention, a total of five (21.7%) patients showed at least one recurrence. Fracture occurred in three (13.0%) cases. The incidence of treatment failure was significantly higher in the curettage, allograft, adjuvants group, with five (83.3%) of six cases showing recurrence, than in the other subgroups (≤ 25.0%) including the osteosynthesis alone group (p=.024). For the open procedure group, the failure-free survival rates were 80.0% after two years and 50.4% after five years. For the three cases treated by osteosynthesis alone, no failures were observed. CONCLUSION: Open procedures showed similar failure rates except for the subgroup using curettage, allograft, and adjuvants which showed significantly higher treatment failure. Promising results were observed in the group which received solely osteosynthesis without cyst excision or filling, as no treatment failure was observed here.

Facial Cellulitis and Skin Abscess: A Case of a Simple Bone Cyst in the Mandibular Bone.

Cellulitis, abscess, or both are among the most common skin and soft tissue infections. Typically, cellulitis arises due to bacterial penetration through breaches in the skin's protective barrier. However, in cases of facial cellulitis, it is necessary to consider not only the breakdown of the skin barrier but also to differentiate odontogenic cellulitis. A prompt and accurate diagnosis of facial infections stemming from dental issues, coupled with the administration of antibiotics and dental interventions, played a crucial role in resolving this condition. Odontogenic cellulitis often develops as a result of dental caries. However, we experienced a case of odontogenic cellulitis and skin abscess occurring due to a simple bone cyst in the mandible, even in the absence of dental caries. Proper imaging examinations are crucial for diagnosis.

As simple as it sounds? The treatment of simple bone cysts in the proximal femur in children and adolescents: Retrospective multicenter EPOS study of 74 patients.

Purpose: Simple bone cysts are among the most prevalent benign cystic tumor-like lesions in children. Proximal femoral simple bone cysts may require specific treatment because of increased fracture risk. With limited literature available on this specific localization, consensus regarding optimal treatment is lacking. We present a large international multicenter retrospective cohort study on proximal femoral simple bone cysts. Methods: All consecutive pediatric patients with proximal femoral simple bone cyst from 10 tertiary referral centers for musculoskeletal oncology were included (2000-2021). Demographics, primary treatment, complications, and re-operations were evaluated. Primary outcomes were time until full weight-bearing and failure-free survival. Results: Overall, 74 simple bone cyst patients were included (median age 9 years (range = 2-16), 56 (76%) male). Median follow-up was 2.9 years (range = 0.5-21). Index procedure was watchful waiting (n = 6), percutaneous procedure (n = 12), open procedure (n = 50), or osteosynthesis alone (n = 6). Median time until full weight-bearing was 8 weeks (95% confidence interval = 0.1-15.9) for watchful waiting, 9.5 (95% confidence interval = 3.7-15.3) for percutaneous procedure, 11 (95% confidence interval = -0.7 to 13.7) for open procedure, and 6.5 (95% confidence interval = 5.9-16.1) for osteosynthesis alone (p = 0.58). Failure rates were 33%, 58%, 29%, and 0%, respectively (p = 0.069). Overall failure-free survival at 1, 2, and 5 years was 77.8% (95% confidence interval = 68.2-87.4), 69.5% (95% confidence interval = 58.5-80.5), and 62.0% (95% confidence interval = 47.9-76.1), respectively. Conclusion: A preferred treatment for proximal femoral simple bone cysts remains unclear, with comparable failure rates and times until full weight-bearing. Watchful waiting may be successful in certain cases. If not feasible, osteosynthesis alone can be considered. Treatment goals should be cyst control, minimizing complications and swift return to normal activities. Therefore, an individualized balance should be made between undertreatment, with potentially higher complication risks versus overtreatment, resulting in possible larger interventions and accompanying complications. Level of evidence: Level IV, retrospective multicentre study.

Quiste óseo simple de resolución espontánea: reporte de caso y revisión de la literatura / Simple bone cyst of spontaneous resolution: case report and literature review

Introducción: El quiste óseo simple (QOS) es un pseudoquiste intraóseo, de etiología desconocida que representa el 1% de los quistes maxilares. Radiográficamente se observa una imagen radiolúcida de bordes bien definidos, irregulares o festoneados. Su tratamiento consiste en la exploración quirúrgica y curetaje de paredes óseas. En pocas ocasiones se ha descrito resolución espontánea. El propósito de este documento es presentar un caso de QOS de resolución espontánea y realizar una revisión de literatura.Reporte de caso:Mujer de 12 años consulta para evaluación odontológica de rutina. En radiografía panorámica se observa lesión radiolúcida entre raíces de dientes 4.4 y 4.5, de límites bien definidos corticalizados. Se complementó con tomografía computarizada de haz cónico, donde se observó adelgazamiento de tablas óseas. Se realizó un diagnóstico presuntivo de QOS. Se controló a los 3 y 3,5 años observándose hueso de leve mayor densidad que el hueso circundante.Materiales y métodos:Se realizó una revisión de literatura sobre QOS de resolución espontánea en PubMed, Scopus y Web of Science, relacionando los términos libres “simple bone cyst” “spontaneous resolution” “jaws” y sus variantes.Resultados:Se encontraron 13 casos de QOS de resolución espontánea. Las características clínicas y radiográficas de los casos coinciden con la literatura. El 54% de los casos tuvo resolución espontánea en un periodo menor o igual a 5 años.Conclusión:En el presente caso se realizó el seguimiento radiográfico del paciente, demostrando que controlar en el tiempo puede considerarse como tratamiento, ya que la lesión podría resolverse espontáneamente.(AU)

Introduction: Simple bone cyst (SBC) is an intraosseous pseudocyst, of unknown etiology, which represents 1% of maxillary cysts. Radiographically, a radiolucent image with well-defined, irregular or scalloped edges is observed. Treatment consists of surgical exploration and curettage of bone walls. Spontaneous resolution has rarely been described. The purpose of this paper is to present a case of spontaneous resolution of SBC and perform a literature review.Case Report:A 12-year-old woman attends to a routine dental evaluation. Panoramic radiography shows a radiolucent image between roots of teeth 4.4 and 4.5, of well-defined corticated borders. It was complemented with cone-beam computed tomography examination, where thinning of cortical bone was observed. A presumptive diagnosis of SBC was performed. Controls at 3 and 3,5 years were performed and bone of slightly higher density than the surrounding bone was observed.Materials and methods:A literature review on SBC of spontaneous resolution was performed in PubMed, Scopus and Web of Science, relating the free terms “simple bone cyst” “spontaneous resolution” “jaws” and their variants.Results:13 cases of spontaneous resolution of SBC were found. The clinical and radiographic characteristics of the cases coincide with the literature. 54% of cases had spontaneous resolution in a period of 5 years or less.Conclusion:In the case presented, radiographic follow-up of the patient was performed, demonstrating that following-up can be considered as treatment, since the lesion could resolve spontaneously.(AU)

Treatment of a calcaneal unicameral bone cyst by percutaneous CT-guided cement injection using a double-needle technique: A case report.

Simple bone cysts (SBCs) are benign cavitary lesions that most commonly affect adolescent males in the first 2 decades of life. They are mainly asymptomatic but can manifest with pain or pathological fractures. Despite numerous proposed methods for managing calcaneal SBCs, the optimal approach toward these lesions remains controversial. Herein, we report a case of a 16-year-old girl with a calcaneal SBC. On local examination, tenderness was the only noteworthy sign. In an outpatient setting, under conscious sedation, 2 interosseous needles were simultaneously inserted into the cyst under the guidance of CT fluoroscopy. Without aspiration, a radiopaque bone cement mixture was injected into the cyst from 1 needle until serosanguineous fluid efflux from the second needle ceased. Over a 2-year follow-up period, the patient recovered without any complications. This novel technique has the potential to be used as a feasible and minimally invasive approach in the management of symptomatic unicameral calcaneal bone cysts.

Allogenic Cancellous Bone versus Injectable Bone Substitute for Endoscopic Treatment of Simple Bone Cyst and Intraosseous Lipoma of the Calcaneus and Is Intraosseous Lipoma a Developmental Stage of a Simple Bone Cyst?

Simple bone cysts (SBCs) and intraosseous lipoma (IOL) of the calcaneus are rare tumor entities that are primarily diagnosed due to unspecific heel pain, incidental findings, or rarely due to pathological fractures. Compared to traditional open tumor resections, endoscopic resection of these benign tumors aims to minimize surgical morbidity and maximize surgical efficiency without compromising safety. Grafting is regularly performed to reduce the risk of recurrence and stimulate osseous consolidation of the lytic lesion. As the incidence is low and treatment strategies are heterogeneous, there is no clear consensus for the treatment of simple cysts or intraosseous lipomas of the calcaneus. The objectives of this study are (a) to present medium to long-term results after endoscopic resection and grafting with allogenic cancellous bone or bioresorbable hydroxyapatite and calcium sulfate cement, and (b) to add further evidence to the discussion of whether calcaneal SBC and IOL are the same entity at different developmental stages. Between 2012 and 2019, a total of 25 benign bone tumors consisting of 17 SBCs and 8 IOLs were treated by A.T. with endoscopic resection and grafting, comprising the largest cohort to date. For grafting, 12 patients received allogenic cancellous bone (group A) and 13 patients received injectable bone substitute (group B). Pre- and postoperative imaging using plain X-rays and MRI was retrospectively analyzed with a mean follow-up time of 24.5 months to assess tumor size, osseous consolidation (modified Neer classification), and tumor recurrence. A retrospective chart analysis focusing on adverse intra- and perioperative events and other complications associated with the surgical procedure was performed using the modified Clavien-Dindo classification (CD1-3). A total of 12/13 cases with allogenic bone grafting showed a Neer Type 1 osseous healing of the tumorous lesion after endoscopic resection, whereas only 5/11 cases with injectable bone substitute showed sufficient healing (types 1 and 2). There were three recurrent cysts (Neer 4) and two persistent cysts (Neer 3) after using injectable bone substitute. Two CD1 complications were observed in group A (prolonged wound drainage, sural neuritis) and eight complications were observed in group B (6× CD1, 2× CD3). At least two IOLs diagnosed preoperatively using MRI were ultimately identified as SBCs upon histopathologic examination. Allogenic cancellous bone grafting after endoscopic resection of calcaneal SBC or IOL showed a very low rate of complications and no tumor recurrence in our series. On the other hand, depending on the material used, injectable bone substitute showed a high rate of "white-out" (excessive drainage), resulting in multiple complications such as prolonged wound healing, insufficient permanent defect filling, recurrence, and revision surgery. Over time, calcaneal SBC may transform into IOL, exhibiting distinct features of both entities simultaneously during ossoscopy and histopathological analysis.

Primary Benign Neoplasms of the Spine.

Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features.

Association of simple bone cyst and cemento-osseous dysplasia: A long-term follow-up.

Cemento-osseous dysplasia (COD) is a non-neoplastic, usually asymptomatic condition characterized by the presence of amorphous cement-like calcifications located exclusively in the tooth-bearing regions of the jawbone. Simple bone cysts (SBCs) of the jaws are benign intraosseous cavities, empty or filled with serous, serohematic, or blood fluid. They are characterized by the absence of an epithelial lining. COD and SBCs are two distinct lesions of the jaws that have long been described separately in the literature; however, their co-occurrence remains rare and only a few cases have been reported illustrating this relationship. This association can be considered as a distinct entity since it presents specific epidemiological, clinical, and radiological data. The aim of this article was to report a new case of association between COD and SBC by illustrating a florid COD formation in mandibular SBC detected in a 31-year-old patient followed over a period of 11 years.

No NFATC2 fusion in simple bone cyst of the jaw.

AIMS: Simple Bone Cysts (SBCs) predominantly occur in long bones and 59% harbour NFATC2 rearrangements. Jaw SBC is rare and was previously referred to as traumatic bone cyst. It can rarely occur in association with cemento-osseous dysplasia (COD). To determine whether jaw SBCs represent the same entity as SBC of the long bones, or if they have a different molecular signature, we collected 48 jaw SBC cases of 47 patients to assess NFATC2 rearrangement. METHODS AND RESULTS: Out of the 48 cases, 36 could be used for fluorescence in-situ hybridization (FISH), of which nine (two of which associated with COD) were successful using an NFATC2 split probe. The remaining cases failed to show adequate FISH signals. All nine cases lacked NFATC2 rearrangement and five of these showed no detectable gene fusions using Archer FusionPlex. CONCLUSION: In our study, NFATC2 rearrangement is absent in solitary jaw SBC (n = 7) and COD-associated SBC (n = 2). Our findings suggest that SBC presenting in the jaw is molecularly different from SBC in long bones. Future molecular studies may confirm the absence of clonal molecular aberrations in SBC of the jaw which would support a non-neoplastic, reactive origin.

Implementation of Copy Number Variations-Based Diagnostics in Morphologically Challenging EWSR1/FUS::NFATC2 Neoplasms of the Bone and Soft Tissue.

In the last decade, new tumor entities have been described, including EWSR1/FUS::NFATC2-rearranged neoplasms of different biologic behavior. To gain further insights into the behavior of these tumors, we analyzed a spectrum of EWSR1/FUS::NFATC2-rearranged neoplasms and discuss their key diagnostic and molecular features in relation to their prognosis. We report five patients with EWSR1/FUS::NFATC2-rearranged neoplasms, including one simple bone cyst (SBC), two complex cystic bone lesions lacking morphological characteristics of SBC, and two sarcomas. In three cases, fluorescence in situ hybridization (FISH) and in all cases copy number variation (CNV) profiling and fusion analyses were performed. All patients were male, three cystic lesions occurred in children (aged 10, 14, and 17 years), and two sarcomas in adults (69 and 39 years). Fusion analysis revealed two FUS::NFATC2 rearrangements in two cystic lesions and three EWSR1::NFATC2 rearrangements in one complex cystic lesion and two sarcomas. EWSR1 FISH revealed tumor cells with break-apart signal without amplification in one complex cystic lesion and EWSR1 amplification in both sarcomas was documented. CNV analysis showed simple karyotypes in all cystic lesions, while more complex karyotypes were found in NFATC2-rearranged sarcomas. Our study supports and expands previously reported molecular findings of EWSR1/FUS::NFATC2-rearranged neoplasms. The study highlights the importance of combining radiology and morphologic features with molecular aberrations. The use of additional molecular methods, such as CNV and FISH in the routine diagnostic workup, can be crucial in providing a correct diagnosis and avoiding overtreatment.

Simple Bone Cyst (Benign Osteolytic Lesion) of 1st Metacarpal: A Rare Case Report.

Introduction: A benign cystic lesion, the simple bone cyst (unicameral/essential bone cyst), it may be found in any long bone (most commonly found in femur and proximal humerus), usually in immature skeletal persons. Metacarpal simple bone cyst is an exceedingly rare occurrence and few treatment options have been described for the same. Case Report: A 42-year-old manual laborer male (right hand dominant) came with history of trivial trauma to right hand thumb with hammer. He complained of mild swelling and pain since trauma. On imaging the right hand, an expansive lytic lesion was seen in the metaphyseo-diahyseal region of the first metacarpal. There was thinning of the cortex with break in cortex visible at mid diaphyseal region. There was absence of any soft-tissue involvement or periosteal reaction. Magnetic resonance imaging reported a T2 hyperintense and T1 isointense benign osteolytic lesion with pathological fracture. On aspiration, a reddish tinged fluid was found. A closed fixation was performed with the help of an intramedullary k-wire. Conclusion: Simple bone cyst, although rare in metacarpal bone, is an important differential diagnosis in cases with cystic lesion. Simple bone cyst, although a benign lesion, can cause extensive involvement of the metacarpal bones and destroy the entire diaphysis. It requires adequate treatment which is simple and effective.

Endoscopic curettage and allografting of simple bone cysts of the calcaneus in young soccer players: Report of three cases.

Open curettage with bone graft has been the traditionally suggested surgical treatment for the symptomatic simple (or unicameral as they used to be called) calcaneal bone cyst. Less invasive endoscopically assisted treatment with curettage and bone grafting with allograft have recently provided less postoperative morbidity. The aim of the present study is to present our experience with this method in young soccer athletes. Between April 2014 and May 2016 three consecutive young soccer players with symptomatic calcaneal bone cysts underwent endoscopic curettage, and percutaneous injection of demineralized bone matrix allograft. The mean age was 17.3 (16, 17 and 19 years old), and the mean follow-up was 32.1 (range 24-47) months. Both radiographic and functional follow-up, using the AOFAS score, showed good to excellent results. All lesions were radiographically healed. Preoperative AOFAS score (max. 100 pts) was 78.6 ± 4.7, improving to 98.0 ± 4.1. The patients returned to their initial level of sports activities within 18.3 (range 17-19) weeks after surgery. Evidence suggests an earlier return to sports using bone substitutes. However, the present study showed that endoscopic curettage and percutaneous injection of bone allograft is also an excellent treatment option for young athletes with a symptomatic calcaneal bone cyst. LEVEL OF CLINICAL EVIDENCE: 4.

Percutaneous Curettage and Local Autologous Cancellous Bone Graft: A Simple and Efficient Method of Treatment for Benign Bone Cysts.

Background: Several treatment modalities have been reported to minimize the recurrence after surgical treatment of benign bone cysts. In this study, we evaluated local tumor control, recurrence rate, and bone healing of benign bone cysts after treatment with a simple technique, percutaneous curettage and a local autologous cancellous bone graft. Methods: Retrospective analysis of the records of 16 patients diagnosed with benign bone cysts between 2003 and 2010. We documented the demographic data, radiographic signs of healing (progressive decrease in radiolucency, remineralisation, ossification, consolidation of the cyst, and reconstitution of the bone), healing rate, postoperative complications, and recurrence. Results: Seven of the 16 patients (43.75%) were diagnosed with a simple bone cyst (SBC), while nine (56.25%) had an aneurysmal bone cyst (ABC). On average, radiographic signs of healing were present within 3-6 months, but in two patients these signs presented after 16 months. During the follow-up period, there was no difference in the healing rate between patients with SBC and ABC; no signs of deep or superficial wound infection, no postoperative fracture, and no recurrence in any case over an average of 6.3 years of follow-up. Conclusion: Treatment of benign bone cysts (SBC/ABC) with minimally invasive percutaneous curettage and a local autologous cancellous bone graft is a simple and effective modality with a promising outcome in the local control of recurrence and in enhancing bony consolidation.

Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children.

PURPOSE: Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out. OBJECTIVE: We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation. METHODS: In this retrospective study, we included 30 children (median age 10.5 years; range 1.1-17.8 years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87 months (range 24-156 months). We evaluated the healing of lesions according to Capanna's classification and rated functional outcomes according to Merle d'Aubigné and Postel score. RESULTS: Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5 months (range 3-7 months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d'Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15-17 points) and only 1 (3.3%) patient had a fair result (14 points). CONCLUSION: Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children. LEVEL OF EVIDENCE: Therapeutic, retrospective comparative study-Level III.

Cystic degeneration in cemento-ossifying fibroma: Diagnosis challenge and conservative management - Case report.

INTRODUCTION AND IMPORTANCE: Cemento ossifying fibroma (COF) is an encapsulated lesion that is often found in the mandible of middle-aged females. Cystic degeneration may be associated to several osseous lesion. This particular presentation is not well documented in the jaws. CASE PRESENTATION: Patient presented was referred to oral surgery department for abnormal radiolucency in the right mandible on panoramic X-ray. The patient did not have any specific medical history and reported painful areas in right mandibular region. During diagnosis assessment, ameloblastoma was first considered due to the presence of cystic lesion clusters. But the mixed image in previous X-ray pointed to a fibro-osseous with a change in pathogenesis pathway. Diagnosis buildup was based on previous radiographs, incisional biopsy was proposed to identify the histopathological feature of the lesion before proceeding to further investigation (CBCT) or treatments (decompression or enucleation). COF of the jaws associated to non-specific cystic changes was the histopathological diagnosis. Delay in treatment showed an unexpected outcome with good clinical and bone healing. CLINICAL DISCUSSION AND CONCLUSION: This case shows the importance of previous radiographs, when available, in diagnosis buildup. The fibro-osseous lesion with cystic change may show a good biological response with conservative management. A clinical and radiological surveillance after a conservative treatment may be a better option in treatment of these lesions.

Current strategies for the treatment of solitary and aneurysmal bone cysts: A review of the literature.

This review of the literature aims to compare the etiology, the pathogenesis, the clinical diagnostics and the relevant treatment options of two different types of cystic bone lesions: the solitary bone cyst (SBC) and the aneurysmal bone cyst (ABC). Whereas the clinical symptoms and the radiographic appearance can be similar, the diagnostic pathway and the treatment options are clearly different. The solitary bone cyst (SBC) represents a tumor-like bone lesion, occurring most frequently in the humerus and femur in children and adolescents. Pain caused by intercurrent pathological fractures is often the first symptom, and up to 87% of the cysts are associated with pathological fractures. In the majority of cases SBCs can be treated conservatively, especially in the upper extremity. However, if a fracture is completely dislocated, joint affecting, unstable or open, surgical treatment is necessary. Pain under weight bearing or regaining the ability to mobilize after fracture timely can necessitate surgical treatment in SBCs affecting the lower extremity. Spontaneous resolution can be seen in rare cases. The aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor that occurs in childhood and early adulthood. It usually affects the metaphysis of long bones but can also occur in the spine or the pelvis. ABC can be primary but also secondary to other bone pathologies. The diagnosis has to be confirmed by biopsy and histopathological examinations. With cytogenetic studies and the detection of specific translocations of the ubiquitin-specific protease (USP) 6 gene primary ABCs can be differentiated from secondary ABCs and other bone lesions. Among various modalities of treatment i.e. en bloc resection, intralesional curettage with adjuvants, embolization or the systemic application of denosumab, intralesional sclerotherapy using polidocanol is an effective and minimally invasive treatment of primary ABCs.

Primary clinical study of radiomics for diagnosing simple bone cyst of the jaw.

OBJECTIVE: To screen the radiomic features of simple bone cysts of the jaws and explore the potential application of radiomics in pre-operative diagnosis of jaw simple bone cysts. METHODS: The investigators designed and implemented a case-control study. 19 patients with simple bone cysts who were admitted to the Department of Maxillofacial Surgery, Sun Yat-sen University Affiliated Stomatology Hospital from 2013 to 2019 were included in this study. Their clinical data and cone-beam computed tomography (CBCT) images were examined. The control group consisted of patients with odontogenic keratocyst. CBCT imaging features were analyzed and compared between the patient and control groups. RESULTS: Overall, 10,323 image features were extracted through feature analysis. A subset of 25 radiomic features obtained after feature selection were analyzed further. These 25 features were significantly different between the 2 groups (p < 0.05). The absolute value of correlation coefficient was 0.487-0.775. Gray-level co-occurrence matrix (GLCM) contrast, neighborhood gray tone difference matrix (NGTDM) contrast, and GLCM variance were the features with the highest correlation coefficients. CONCLUSIONS: Pre-operative radiomics analysis showed the differences between simple bone cysts and odontogenic keratocysts, can help to diagnose simple bone cysts. Three specific texture features-GLCM contrast, NGTDM contrast, and GLCM variance-may be the characteristic imaging features of simple bone cysts of the jaw.

The role of molecular diagnostics in aneurysmal and simple bone cysts - a prospective analysis of 19 lesions.

Aneurysmal (ABC) and simple bone cysts (SBC) have been traditionally distinguished by radiological and histopathological features. However, there is some radiological and histopathological overlap between ABC and SBC. ABC is characterised by USP6 fusions while, recently, NFATC2 fusions have been found in a large proportion of SBC. Identifying these fusions may assist in confirming the diagnosis of either ABC or SBC. To elaborate the potential benefit of molecular testing, we report a prospective series of 19 consecutive bone cysts with comprehensive radiological, histopathological and molecular diagnostics. Integrating radiological, histopathological and molecular findings, 11 cysts were diagnosed as SBC and 8 as ABC. Radiologically, 6 of 11 SBC and 6 of 8 ABC were diagnosed as ABC. Fibrin-like collagen deposits were identified in 8 of 11 (73%) SBC and 3 of 8 (38%) ABC. Nodular fasciitis-like areas were identified in 6 of 8 (75%) ABC and in 7 of 11 (64%) SBC. A USP6 fusion was identified in all 8 ABC, including a novel RBM5-USP6 fusion. An NFATC2 fusion was found in 7 of 11 SBC (FUS-NFATC2 fusion in 5 and EWSR1-NFATC2 in 2 cases). There is radiological and histopathological overlap between SBC and ABC in a significant proportion of cases. A diagnosis of ABC is frequently suggested radiologically in SBC, and fibrin-like deposits, thought to be specific for SBC, may be found in some ABC. Molecular testing may significantly improve diagnostic accuracy in bone cysts.