Pathologic fracture of a calcaneal aneurysmal bone cyst

Aneurysmal bone cyst of the calcaneus: A rare case report and review of the literature

INTRODUCTION AND IMPORTANCE

Aneurysmal bone cyst (ABC) is a benign lytic bone tumor of the skeletal system but locally destructive lesion of unknown origin. It often occurs in childhood and usually involves the metaphyseal region of long bones; thus, its localisation in the calcaneum remains rare; its atypical presentation in our case makes it remarkable.

CASE PRESENTATION

We describe a case of a young patient who suffered from chronic heel pain, in whom the clinical examination finds swelling and pain on palpation. A complete radiological assessment was carried out, which revealed a solitary and expansive osteolytic lesion within the calcaneus. Treatment included tumor curettage and reconstruction with allograft and cement. The biopsy report was consistent with an ABC. The postoperative follow-up at 18 months was marked by a good radio-clinical evolution and no recurrence.

CLINICAL DISCUSSION

ABCs are benign cystic expansive tumors that are reactive, locally destructive and blood-filled, their occurrence in the calcaneus has been reported in only 1.6 % of total reported cases. Talalgia is the most frequent sign associated with swelling. Liquid-liquid level images on MRI is a pathognomonic sign of these lesions but the gold standard diagnosis remains histology. Their treatment is based on curettage - filling by grafting.

CONCLUSION

Curettage combined graft makes results butter and improves the quality of life.

Pathological Fractures in Aneurysmal Bone Cysts: A Systematic Review

Background: Aneurysmal bone cysts (ABCs) are osteolytic, non-malignant, vascular lesions of the bone. Pathological fractures can be a manifestation of the ABCs, which occur in about 8% of ABCs. Different treatments have been described in the literature, but, nowadays, an optimal management of the pathological fractures in patients with ABCs is still a matter of debate and there are no standard guidelines for treatment nor any shared indication about the best surgical intervention. The aim of our study is to review the current literature available on this matter exploring and confronting different surgical treatments for pathological fractures in ABC in order to clarify the surgical approach to these patients. Methods: A systematic review of the literature indexed in PubMed, MEDLINE, and Cochrane Library databases was carried out. The Preferred Reporting Items for Systematically Reviews and Meta-Analyses (PRISMA) were followed. Results: A total of 37 articles were relevant and were finally included in the study. In total, we reached a population of 140 patients. Of the 140 patients included in the review, 124 patients (88.6%) underwent curettage surgery, 15 patients (10.7%) underwent en bloc resection surgery. A total of 47% of patients (70) underwent synthesis surgery with a plate, screw, nail, or external fixator. Adjuvant treatments were used in 8.6% of patients (12). Complications involved 20.7% of the patients (29). Conclusions: In conclusion, the treatment of pathological fractures in aneurysmal bone cysts requires careful patient assessment, considering factors such as age, the presence of open growth plates, the location of the lesion, and the surgeon's expertise.

Management of Calcaneal Cysts in the Pediatric Population: A Review

Cysts of the bone are a common pathology that, although benign, are frequently treated because of their tendency to compromise the integrity of affected bone. Two common entities are unicameral bone cysts and aneurysmal bone cysts. Although these are two distinct pathologies, they are treated similarly and thus will be discussed in tandem. The optimal treatment of calcaneal bone cysts in pediatric patients has long been debated among orthopaedic surgeons because of the relatively small number of cases and varied results within the literature. Currently, there are three lines of thought regarding treatment: observation, injection, and surgical intervention. When considering which course of treatment is best for an individual patient, the surgeon must consider the fracture risk without treatment, the risk of complications with treatment, and the recurrence rate with each treatment approach. There are limited data on pediatric calcaneal cysts specifically. Still, there are much data concerning simple bone cysts of long bones in the pediatric population and calcaneal cysts in the adult population. Because of the lack of literature on the subject, there is a need for a review of the available literature and a consensus on the approach to treating calcaneal cysts in the pediatric population.

Tumors and pseudotumors of foot and ankle: Bone lesions

Bone tumors and tumor-like lesions (pseudotumors) are not uncommonly encountered as asymptomatic findings on imaging, or as symptomatic lesions clinically. Radiographic imaging is the first diagnostic tool for their management strategy, since the symptoms are commonly non-specific, such as pain, swelling, and redness. Image findings must be analyzed with attention to the specific features such as lesion location, margination, zone of transition, mineralization, size and multifocality, soft tissue component and/or loco-regional extent. Cross-sectional imaging including CT and MRI serve as complementary methods, providing additional information with respect to the lesion characterization, mineralization, extent and involvement of the adjoining soft tissues. Clinical and/or key imaging features aid in limiting the differential diagnostic possibilities and serve as a guide in determining the benignity or malignancy of the tumor as well as to exclude pseudotumors. This article reviews the key imaging features of foot and ankle lesions. Benign bone lesions include simple and aneurysmal bone cysts, lipoma, hemangioma, chondroblastoma, enchondroma, osteoid osteoma, osteoblastoma, and giant cell tumor. Locally aggressive intermediate category lesion includes hemangioendothelioma. Malignant lesions include osteosarcoma, Ewing's sarcoma, chondrosarcoma. Pseudotumors such as fibrous dysplasia, hemophilic pseudotumor, gout and Madura foot are also discussed with illustrative case examples.

Primary aneurysmal bone cyst of the calcaneum: A report of three cases and review of literature

CASE DESCRIPTION

Aneurysmal bone cysts (ABCs) are locally aggressive, cystic lesions of the skeletal system, most commonly seen in the metaphyseal region of long bones. On the other hand, an ABC of the foot (especially the calcaneum) is a rare entity, with very few cases reported in the literature. In this study, we present three such cases who presented to us with the chief complaint of chronic heel pain. All three patients were clinically reviewed following which a comprehensive radiological workup was performed. The latter revealed a solitary, expansile lesion within the calcaneum in all them. Treatment included extended curettage and reconstruction using autologous iliac crest bone grafts. Histopathological analysis of the curetted sample was consistent with features of primary ABC. There were no complications and all lesions had re-ossified at the latest follow up.

CONCLUSION

Calcaneal ABCs are rare, atypical lesions warranting a high index of suspicion and correlation of the patient's clinical, radiological and histopathological features to make a correct diagnosis.

Primary tumours of the calcaneus

The calcaneus is a rare location for the occurrence and development of primary tumour types. Clinicians are unfamiliar with calcaneal tumour types, which may result in a delay in diagnosis or a missed diagnosis, resulting in unnecessary morbidity and amputation. Heel pain and localized swelling of the ankle are the most common symptoms. X-ray is the first choice for a tentative diagnosis of a calcaneal tumour. The final diagnosis depends on a histological examination. The treatment of calcaneal tumour types varies depending on the Enneking system. The majority of patients with benign tumours heal, except for a few with a palindromia. For malignant tumours, the prognosis is comparatively poor, resulting in disability and a high rate of metastasis. This review describes the spectrum of calcaneal tumour types and specifically illustrates the epidemiology, symptomatology, imagology, histopathology and treatment options that may facilitate diagnosis and improve prognosis.

A rare probable chondroblastoma of the calcaneus in a pre-Columbian subadult from Illinois

Discrete cystic or tumorous intraosseous lesions can arise from a variety of benign and malignant conditions as well as trauma and infection. They are clinically rarely observed in the calcaneus. A fourteen-to-seventeen-year-old subadult recovered from a Late Woodland (∼AD 800-1100) period mortuary context in the Mississippi River Valley of central Illinois presents with a single lytic intraosseous lesion on the posterior right calcaneus that bilaterally perforates the cortex. The lesion, although primarily anterior to the epiphyseal plate, does breach it. There is also a small perforation of the outer cortex of the epiphysis above the insertion of the Achilles' tendon. The lesion is well-defined with a primarily spongy cancellous interior margin. On the body of the calcaneus, there is periostosis and a slightly expansive endosteal reaction. Comparative radiographic assessments undertaken to differentially diagnose the lesion indicate that it was likely not malignant. Based on the posterior location, the radiographic signature, the bilateral cortical perforation and the breach of the epiphysis, the lesion is best interpreted as a chondroblastoma.

Pathological Fracture of Calcaneum: A Case Report

INTRODUCTION

Aneurysmal bone cysts (ABCs) are blood filled fibrous tumor-like cysts that expand the bone giving it a blown out appearance. It is usually seen in the second decade. ABCs were first described by Jaffe and Litchensen in 1942. The exact etiology is unknown. One of the most widely accepted ideas was that aneurysmal bone cyst was a consequence of increased venous pressure and subsequent dilatation and rupture of the local vascular network. However, studies by Panoutsakopoulus et al. and Olivia et al. uncovered the clonal neoplastic nature of ABCs. Here, we report a case of aneurysmal bone cyst of calcaneum, which is one of the rarest sites.

CASE REPORT

A 25-year-old male presented with a history of trivial fall from a ladder and landing on the right heel. He complained of pain and swelling. On examination, he had swelling over the medial aspect of the right heel. The skin over the swelling was stretched, and it was soft in consistency and tender. Curettage and bone grafting was done. The patient was pain-free and was bearing weight fully on the operated limb, 12 weeks postoperatively.

CONCLUSION

Aneurysmal bone cyst of calcaneum although seen rarely should be considered as one of the differential diagnoses in the cystic lesions in calcaneum. Curettage and bone grafting has stood the test of time as standard treatment.

Aneurysmal bone cyst of the calcaneus

Aneurysmal bone cysts (ABCs) are benign, non-neoplastic, expansile, vascular, locally destructive lesions. The lesion may arise de novo (65%) or secondarily (35%) in pre-existing benign or malignant lesions (giant cell tumor, osteoblastoma, chondroblastoma, angioma, and others). The calcaneus is a rare localization for ABC, comprising only 1.6% of the cases. In this paper, we present a case of a female patient with a 3-month history of heel pain that got worse and was accompanied by swelling and difficulty in walking. The magnetic resonance images of the postero-lateral calcaneus showed a contrast-enhanced cystic lesion located in the medullary cavity; exophytic portion of the tumor extended into the soft tissue causing distinctive cortical thinning. Heterogeneous hyperintense septae formations and blood level components were also detected. After correlation with pathology results, the lesion was diagnosed as an ABC. Since an ABC of the calcaneus is a rarely seen phenomenon, we present the radiologic findings in this case and a review of the literature.

Another cystic lesion in the calcaneus: benign fibrous histiocytoma of bone

Benign fibrous histiocytoma is a rare benign primary skeletal tumor that occurs frequently in the long bones and the pelvis. The calcaneus is an unusual location for benign fibrous histiocytoma. We did not identify any case of benign fibrous histiocytoma involving the calcaneus in the relevant literature. We describe a 22-year-old male patient with benign fibrous histiocytoma involving the calcaneus treated with curettage and bone grafting. At the final follow-up visit, 1 year after surgery, the patient was free of pain and walking unaided. We discuss the differential diagnosis of cystic lesions of the calcaneus.