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Deventer N, Budny T, Gosheger G, de Vaal M, Burkhardt J, Deventer N. Aneurysmal bone cyst of the pelvis and sacrum: a single-center study of 17 cases. BMC Musculoskelet Disord 2022; 23:405. [PMID: 35490224 PMCID: PMC9055713 DOI: 10.1186/s12891-022-05362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background The aneurysmal bone cyst (ABC) is a benign, but locally aggressive cystic lesion of the bone. It usually occurs in the metaphysis of long bones of adolescents and young adults but can also affect the pelvis. Methods This single-center study is a retrospective review of 17 patients with primary ABCs of the pelvis. It examines the importance of polidocanol instillations as minimally invasive treatment option for ABCs of the pelvis compared to intralesional curettage or marginal resection. Results Seventeen patients with the diagnosis of a primary ABC of the pelvis were included in the study. Six patients were male (35%) and 11 patients female (65%); the mean age was 18 (9-49) years. The mean follow-up time was 50 months (12-136 months). The most common location of manifestation was the pubis (6; 35%), followed by the ilium (6; 35%), the sacrum (3; 18%) and the ischium (2; 12%). Eight patients were treated by intralesional curettage with the use of adjuvants, one patient by marginal resection, seven by sequential instillation of polidocanol and one patient by simple observation. Five patients received an additional transarterial embolization. After intralesional curettage local recurrence was detected in 4/8 cases (50%). After instillation therapy six patients (86%) had a stable disease without recurrence, only one patient (14%) had a persistent disease with need of additional treatment and was therefore converted to intralesional curettage without local recurrence in the follow-up. Conclusions Sequential instillations of polidocanol are a promising, minimally invasive treatment method for ABCs of the pelvis and can be well combined with transarterial embolization.
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Affiliation(s)
- Niklas Deventer
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Tymoteusz Budny
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Marieke de Vaal
- Department of Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jana Burkhardt
- Department of General Paediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Nils Deventer
- Department of General Paediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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Abstract
Background Acetabular roof lesions (ARLs) in children are uncommon and may involve a variety of diseases. The acetabular roof is the main weight-bearing area of the hip joint, and lesions affecting the acetabular roof lead to fluid accumulation in the hip joint, causing hip pain and claudication. Methods for diagnosing and treating ARLs and the prognosis after treatment are rarely reported. We present our experience in a group of children and teenagers with ARLs to retrospectively explore the clinical and imaging features and histopathological diagnosis and report the treatment methods and follow-up observations. Methods Patients with ARLs admitted to the Children’s Hospital of Chongqing Medical University from April 2011 to September 2018 were selected retrospectively. We collected the basic information of patients (name, sex, age), main symptoms and signs, results of various laboratory tests, treatment methods, and intraoperative observations through the hospital medical record system. We collected X-ray, computed tomography (CT), magnetic resonance imaging (MRI) and pathological examination data through the Picture Archiving and Communications System. Follow-up data were collected through an outpatient medical record system, telephone, and chat software (such as WeChat). We used descriptive methods to analyze the lesion structure and destruction mode based on the imaging findings and histopathological diagnosis. Results There were 14 ARL patients, including 6 with eosinophilic granuloma (EG), 5 with chronic osteomyelitis, 2 with bone cyst, and 1 with tuberculosis. One patient underwent percutaneous needle biopsy, 2 underwent open biopsy, and 11 underwent curettage; among them, 5 patients also underwent bone grafting. These lesions had no characteristic imaging findings, and the diagnosis was mainly based on histopathological examination. Most patients showed complete symptom resolution and good hip function at the 1-year follow-up. Conclusion ARLs are not common in children. The types of lesions are diverse and mostly benign, with EG being most common. Malignant tumors may also occur, such as Ewing’s sarcoma, non-Hodgkin’s lymphoma, metastases and neuroblastoma. CT and MRI can be helpful in diagnosing certain cases, but incisional biopsy is required in most cases.
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Affiliation(s)
- Jinkui Wang
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, ChongQing, 400013, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Children's Hospital of Chongqing Medical University, Chongqing, PR China
| | - Zhongliang Wang
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, ChongQing, 400013, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,Children's Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Jiaqiang Qin
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, ChongQing, 400013, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Children's Hospital of Chongqing Medical University, Chongqing, PR China
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Abstract
Symptomatic aneurysmal bone cysts with expansible lesions in the pelvis are rare in children. The management of an aggressive vascular lesion in a female child is challenging. The standard treatment for aneurysmal bone cysts is accompanied by a high risk of local recurrence. A 12-year-old female presented with a history of pelvic pain for 5 months. Plain radiographs and magnetic resonance imaging showed a very large expansile lytic lesion arising from the right iliac bone. Intralesional curettage, electric cauterization, chemical sclerotherapy and allogeneic bone graft were performed through the window of the iliac crest. At a follow-up consultation 3.5 years post-surgery, the child had painless full-range movement in the hip joint with no recurrence. Although many treatment options are described, our patient was treated successfully using curettage and allogeneic bone graft without recurrence.
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Affiliation(s)
- Chae Geun Kim
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Seok Hyun Kweon
- Department of Orthopaedic Surgery, Wonkwang University College of Medicine, Iksan, Korea
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Abstract
INTRODUCTION Aneurysmal bone cyst is an expansile, lytic, multiloculated, fluid filled cavities which usually occurs in the metaphysis of the long bones. ABC of the pubic ramus is a rare entity.. CASE REPORT We present a case of a 21 year old male who presented with a swelling of the right inguinal region which was gradually progressive. Radiologically, there was a lytic expansile lesion of the superior pubic ramus. A contrast computed tomography revealed multiloculated cystic cavities and histopathology confirmed the diagnosis of ABC. Surgical excision of the complete tumor by anterior approach was done. Till date (2 years since surgery) patient has no recurrence. CONCLUSION ABC of pubic ramus is a rare entity and other differentials should always be kept in mind with confirmation of diagnosis by histopathology. Treatment with surgical curettage and bone grafting the defect is curative in selective cases but in this case due to size and location excision is the choice of treatment.
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Affiliation(s)
- Ashith Rao
- Department of orthopaedics, Padmashree Dr. D. Y Patil Medical College, Navi Mumbai. India
| | - Prakash D Samant
- Department of orthopaedics, Padmashree Dr. D. Y Patil Medical College, Navi Mumbai. India
| | - Ankit Varshneya
- Department of orthopaedics, Padmashree Dr. D. Y Patil Medical College, Navi Mumbai. India
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