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

Mechanisms of acute hypercalcemia in pediatric patients following the interruption of Denosumab

PURPOSE

Denosumab is a fully human monoclonal anti-RANK-L antibody that is clinically used to counteract the bone loss induced by exacerbated osteoclast activity. Indeed, its binding to RANK-L prevents the interaction RANK-L/receptor RANK that is essential for osteoclastogenesis and bone resorbing activity. Although there are many medications available to treat bone loss diseases, including bisphosphonates, Denosumab is highly effective since it reduces the bone erosion. The use in pediatric patients is safe. However, some concerns are related to the interruption of the treatment. Indeed, in this study, we reported hypercalcemia in two pediatric patients and alterations of circulating osteoclast precursors.

METHODS

Peripheral Blood Mononuclear Cells (PBMC) were isolated from two pediatric patients with hypercalcemia after Denosumab interruption and from 10 controls. Cytofluorimetric analysis and in vitro osteoclastogenesis experiments were performed.

RESULTS

Increase of CD16^-CD14⁺CD11b⁺ cells was revealed in PBMC from patients reflecting the enhanced in vitro osteoclastogenesis.

CONCLUSION

Our data suggest that precautions must be taken when Denosumab therapy is interrupted and gradual decrease of dose and/or timing of treatment should be performed. To prevent the onset of hypercalcemia that could be in the discontinuation phase, cytofluorimetric analysis of PBMC should be performed to evaluate osteoclast precursors.

Solitary vertebral metastatic glioblastoma in the absence of primary brain tumor relapse: a case report and literature review

BACKGROUND

Metastatic glioblastoma presenting as a solitary osteolytic cervical vertebral mass without primary brain tumor relapse is extremely rare with only 1 reported case in the literature. Because of its rarity, it can be easily overlooked and misdiagnosed, posing a diagnostic dilemma.

CASE PRESENTATION

A 51-year-old man with right temporal glioblastoma was initially treated by tumor resection, radiotherapy and chemotherapy. Eighteen months after surgery, he was readmitted with complaints of neck pain for 2 weeks. Follow-up magnetic resonance imaging (MRI) and fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) revealed a solitary FDG-avid osteolytic lesion in the 4th cervical vertebral body without other abnormal FDG-uptake in the body and in the absence of local recurrence at the resection cavity. Because of the sudden worsening situation and intractable neck pain, the patient underwent tumor resection. Postoperatively, the pain was obviously reduced and the situation was improved. Interestingly, the immunohistochemical findings of glial fibrillary acidic protein (GFAP) indicated the characteristic of metastatic glioblastoma, despite that the histopathological findings of Hematoxylin & Eosin (H&E) staining was suspicious of osteoclastoma. According to the clinical history, imaging findings, pathological and immunohistochemical results, a final diagnosis of solitary vertebral metastasis from glioblastoma without central nervous system (CNS) relapse was confirmed. Then, the patient received radiotherapy on spine and adjuvant chemotherapy with temozolomide. However, he died suddenly 2 months after the tumor resection, nearly 21 months after the initial diagnosis.

CONCLUSION

We emphasize that metastatic glioblastoma should be considered in the differential diagnosis of a solitary FDG-avid osteolytic vertebral mass on PET/CT. And the diagnosis of extracranial metastasis (ECM) from glioblastoma can be achieved through clinical history, imaging findings, pathological examination, and immunohistochemical staining with GFAP.

Aneurysmal bone cyst of the mandible with conservative surgical management: A case report

The aneurysmal bone cyst is a nonneoplastic, osteolytic and locally destructive lesion that mainly affects the metaphyseal area of long bones and only 2% of it is diagnosed in the maxillofacial skeleton. Although surgical treatment is the most common option, it is associated to high morbidity rates. The case of an aneurysmal bone cyst of a considerable size in a 27-year-old male patient illustrating a conservative surgical approach with preservation of the dental structures in the mandible to limit aesthetic and functional side effects is presented. Two-year clinical follow-up was performed with no evidence of recurrence. Key words:Aneurysmal bone cyst; curettage, conservative treatment, mandibular osteotomy.

Capillary Hemangioma as an Unusual Cause of Doughnut Sign on Bone Scan

ABSTRACTS

A 28-year-old woman presented with a mass in her right leg, which, on plain radiograph, appeared as a lytic lesion in the mid-shaft of the tibia with cortical thinning but without periosteal reaction. Tc-MDP 3-phase bone scan demonstrated intense uptake in the periphery of the mass with a photopenic center, the so-called doughnut sign. Histopathology revealed a capillary hemangioma. This case demonstrates that the doughnut sign on bone scan can be caused by capillary hemangioma in addition to other reported bone pathologies, including aneurysmal bone cyst, giant cell tumor, and telangiectatic osteosarcoma.

An Unusual Radiographic Presentation of Aneurysmal Bone Cyst of the Zygoma: A Rare Case Report

Aneurysmal Bone Cyst (ABC) is an uncommon benign lesion affecting mainly the long bones and vertebral column. Its occurrence in the maxillofacial skeleton is rare. So far only five cases of ABC in the zygoma have been reported in the literature. Radiographic features of ABC are not pathognomonic. There can be expansion of bone and it may manifest as cystic lesion with honeycomb or soap bubble appearance. There can be perforation or destruction of cortex of the bone as well. Therefore the differential diagnosis of ABC is quite conflicting with other types of maxillary bone lesions. Here we report a case of ABC in 30-year-old female, at the left zygoma region showing periosteal reaction with sunray effect, which according to the literature is the first case reported based on location and radiographic appearance.

A giant aneurysmal bone cyst of the rib: Case report

An aneurysmal bone cyst (ABC) is a benign tumor of the skeletal system, which most frequently occurs in long bones. An ABC arising from the rib is extremely rare and it is difficult to distinguish from other types of rib tumors. The present study describes an unusual case of a large ABC in the rib of a 17-year-old male. The entity is discussed with particular emphasis on the clinicopathological features, differential diagnosis and treatment. Due to difficulties in the pre-operative diagnosis, a possible diagnosis of ABC should be made aware when confronting an expansile rib mass. An en bloc resection of the mass and the affected portion of the rib is mandatory to obtain a satisfactory outcome.

Aneurysmal bone cyst in a 21-year-old woman presenting with chronic low back pain in a chiropractic office: a case report

OBJECTIVE

To emphasize the importance of early detection, recognition, appropriate investigation, accurate diagnosis, proper referral, and treatment of an aneurysmal bone cyst (ABC) presenting as chronic low back pain (LBP) in a chiropractic office.

CLINICAL FEATURES

A 21-year-old female student presented to the chiropractic office with a 2-year history of severe and progressive LBP. The patient described the LBP as an aching type of pain that was more pronounced during activity and exercises. She also reported weight loss and increased fatigue.

INTERVENTION AND OUTCOME

A detailed clinical, physical, and imaging evaluation was performed. A well-defined, expansile, and lytic bone lesion with the appearance of a possible ABC was detected; it involved the left inferior half and posterolateral aspect of the vertebral body of L3.

RESULTS

Treatment consisted of an L3 hemivertebrectomy resection en bloc and a vertebral fusion from L2 to L4 with tricortical iliac crest graft. After surgery and recovery, LBP was relieved and the bone lesion did not recur.

CONCLUSION

Although uncommon, ABC is an important lesion that can affect the spine. Healthcare providers must be aware that the cause of LBP may extend beyond musculoskeletal dysfunction. It is important to identify an ABC and refer the patient for appropriate evaluation and care.