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

Deventer, Niklas; Gosheger, Georg; Vaal, Marieke de; Vogt, B; Budny, Tymoteusz

doi:10.1016/j.jbo.2021.100384

Cited by 35 publications

(56 citation statements)

References 70 publications

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“…The generally preferred method for diagnosing ABC is magnetic resonance imaging (MRI), often combined with histologic confirmation. [2][3][4]11 Both are advised as telangiectatic osteosarcoma has similar imaging characteristics and therefore, this differential diagnosis should be ruled out. 1,4 The goal of this therapy was to achieve local control with healing and remodeling of the lesion and surrounding bone while maintaining function and minimalizing complications like fractures, growth disturbances, and recurrences.…”

Section: Discussionmentioning

confidence: 99%

Do’s and Don’ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients

Geloven¹,

Heijden²,

Laitinen³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Aneurysmal bone cysts (ABC) are rare benign cystic bone tumors, generally diagnosed in children and adolescents. Proximal femoral ABCs may require specific treatment strategies because of an increased pathologic fracture risk. As few reports are published on ABCs, specifically for this localization, consensus regarding optimal treatment is lacking. We present a large retrospective study on the treatment of pediatric proximal femoral ABCs. Methods: All eligible pediatric patients with proximal femoral ABC were included, from 11 tertiary referral centers for musculo-skeletal oncology (2000-2021). Patient demographics, diagnostics, treatments, and complications were evaluated. Index procedures were categorized as percutaneous/open procedures and osteosynthesis alone. Primary outcomes were: time until full weight-bearing and failure-free survival. Failure was defined as open procedure after primary surgery, >3 percutaneous procedures, recurrence, and/or fracture. Risk factors for failure were evaluated. Results: Seventy-nine patients with ABC were included [mean age, 10.2 (±SD4.0) y, n=56 male]. The median follow-up was 5.1 years (interquartile ranges=2.5 to 8.8). Index procedure was percutaneous procedure (n=22), open procedure (n=35), or osteosynthesis alone (n=22). The median time until full weight-bearing was 13 weeks [95% confidence interval (CI)=7.9-18.1] for open procedures, 9 weeks (95% CI=1.4-16.6) for percutaneous, and 6 weeks (95% CI=4.3-7.7) for osteosynthesis alone (P=0.1). Failure rates were 41%, 43%, and 36%, respectively. Overall, 2 and 5-year failure-free survival was 69.6% (95% CI=59.2-80.0) and 54.5% (95% CI=41.6-67.4), respectively. Risk factors associated with failure were age younger than 10 years [hazard ratios (HR)=2.9, 95% CI=1.4-5.8], cyst volume >55 cm3 (HR=1.7, 95% CI=0.8-2.5), and fracture at diagnosis (HR=1.4, 95% CI=0.7-3.3). Conclusions: As both open and percutaneous procedures along with osteosynthesis alone seem viable treatment options in this weight-bearing location, optimal treatment for proximal femoral ABCs remains unclear. The aim of the treatment was to achieve local cyst control while minimizing complications and ensuring that children can continue their normal activities as soon as possible. A personalized balance should be maintained between undertreatment, with potentially higher risks of pathologic fractures, prolonged periods of partial weight-bearing, or recurrences, versus overtreatment with large surgical procedures, and associated risks. Level of Evidence: Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Do’s and Don’ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients

Geloven¹,

Heijden²,

Laitinen³

et al. 2022

Journal of Pediatric Orthopaedics

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“…12 ) and calcitonin mixed with steroids, among others, have become an alternative to surgery. Sclerotherapy is a minimally invasive procedure; however, it may require multiple repeat injections [ 54 , 60 , 61 ]. In a critical systematic review by Bavan et al [ 60 ], that assessed treatment efficacy for ABC involving the spine and long bones (28 articles that included children and adults), no controlled studies were found supporting any particular intervention.…”

Section: Treatmentmentioning

confidence: 99%

“…Because it can be difficult to differentiate an ABC from a malignancy based on imaging alone (Figs. 10 and 11), confirming the diagnosis by means of a biopsy before treatment is imperative [53][54][55]. Performing an image-guided core biopsy of a suspected ABC should be carefully planned with the orthopedic surgeon to discuss the most appropriate approach that would not compromise limb salvage.…”

Section: Treatmentmentioning

confidence: 99%

Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment

et al. 2022

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Aneurysmal bone cyst (ABC) is a benign but locally aggressive lesion that predominantly affects children and young adults. ABC, which accounts for approximately 70% of the cases, is now recognized to be a true neoplasm, whereas ABC-like changes associated to other bone neoplasms (also referred in the literature as secondary ABC) accounts for the remaining 30%. The solid variant of ABC is also considered a true neoplasm but is rare. ABC can involve any bone in the body, and although it has a metaphyseal preference, it can involve any part of a bone and soft tissues. As with any bone tumor, the initial evaluation of ABCs should be done with radiographs followed by magnetic resonance imaging or less frequently computed tomography for further characterization. The imaging appearance of ABC is variable; however, a lytic and expansile lesion with fluid-fluid levels is the most common presentation. The main differential diagnosis of an ABC in the pediatric population is unicameral bone cyst (UBC) and telangiectatic osteosarcoma, therefore a biopsy is recommended before treatment. The therapeutic options of ABC range from curettage with or without adjuncts such as phenol, liquid nitrogen, argon laser and bone grafting or bone substitutes to more recently employed alternatives such as image-guided sclerotherapy with various sclerosing agents and monoclonal antibodies (e.g., Denosumab).

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“…The symptoms of ABC typically involve pain, swelling, and in rare instances, the development of pathological fractures due to the destructive nature of the lesion. 5–7 Nonetheless, the presenting symptoms may vary according to the site of the tumor.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 8 , 9 However, despite the variety of the proposed treatment options, tumor recurrence may reach up to 50%, with the rate varying depending on the treatment modality. 5 , 10 …”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Aneurysmal Bone Cyst of the Pubis: A Case Report and Review of Literature

Dawod¹,

Alisi²,

Rababaa³

et al. 2022

IMCRJ

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Introduction Aneurysmal bone cysts (ABC) are expansile, lytic, and benign but locally aggressive lesions. Pelvic ABCs are rare and sometimes difficult to manage surgically. Case Report A 17-year-old female presented with progressive pain and swelling in the right inguinal region. Pelvis radiograph showed a lytic expansile lesion of the superior pubic ramus. A multiloculated cystic lesion was evident on magnetic resonance imaging, and postoperative histopathological evaluation confirmed the diagnosis of ABC. The patient was treated successfully with an intralesional curettage and bone grafting. The postoperative course was uncomplicated with complete healing and no recurrence after 14 months of follow-up. Conclusion ABC of the pubic ramus is a rare entity. Complete intralesional curettage and bone ‎grafting ‎is an effective treatment for pubic ABC. An individualized management approach ‎considering ‎the surgical team expertise, tumor size, and proximity to neighboring structures ‎is recommended.‎.

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

Cited by 35 publications

References 70 publications

Do’s and Don’ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients

Do’s and Don’ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients

Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment

Surgical Management of Aneurysmal Bone Cyst of the Pubis: A Case Report and Review of Literature

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