Increased concentrations of nitrate and nitrite in the cyst fluid suggesting increased nitric oxide synthesis in solitary bone cysts

Komiya, Setsuro; Kawabata, Rikimaru; Zenmyo, Michihisa; Hashimoto, Sanshiro; Inoue, Akio

doi:10.1002/jor.1100180217

Cited by 21 publications

(22 citation statements)

References 27 publications

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“…4a) and (Fig. 4b), in keeping with reports by Komiya et al [3] and Yu et al [21]. Interestingly, an abundance of osteoclasts in the paratrabecular region of the cyst lining was demonstrated (Fig.…”

Section: Fibrocellular Membranesupporting

confidence: 90%

The role of osteoblast cells in the pathogenesis of unicameral bone cysts

Aarvold

Smith

Tayton

et al. 2012

Journal of Children's Orthopaedics

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Purpose The pathogenesis of unicameral bone cysts (UBCs) remains largely unknown. Osteoclasts have been implicated, but the role of osteoblastic cells has, to date, not been explored. This study investigated the pathophysiology of UBCs by examining the interactions between the cyst fluid and human bone marrow stromal cells (hBMSCs) and the effect of the fluid on osteogenesis. Methods Fluid was aspirated from two UBCs and analysed for protein, electrolyte and cytokine levels. Graded concentrations of the fluid were used as culture media for hBMSCs to determine the effects of the fluid on hBMSC proliferation and osteogenic differentiation. The fibrocellular lining was analysed histologically and by electron microscopy. Results Alkaline phosphatase (ALP) staining of hBMSCs that were cultured in cyst fluid demonstrated increased cell proliferation and osteogenic differentiation compared to basal media controls. Biochemical analysis of these hBMSCs compared to basal controls confirmed a marked increase in DNA content (as a marker of proliferation) and ALP activity (as a marker of osteogenic differentiation) which was highly significant (p \ 0.001). Osteoclasts were demonstrated in abundance in the cyst lining. The cyst fluid cytokine profile revealed levels of the pro-osteoclast cytokines IL-6, MIP-1a and MCP-1 that were 199, 319 and 359 greater than those in reference serum. Conclusions Cyst fluid promoted osteoblastic growth and differentiation. Despite appearing paradoxical that the cyst fluid promoted osteogenesis, osteoblastic cells are required for osteoclastogenesis through RANKL signalling. Three key cytokines in this pathway (IL-6, MIP-1a, MCP-1) were highly elevated in cyst fluid. These findings may hold the key to the pathogenesis of UBCs, with implications for treatment methods.

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Section: Fibrocellular Membranesupporting

confidence: 90%

The role of osteoblast cells in the pathogenesis of unicameral bone cysts

Aarvold

Smith

Tayton

et al. 2012

Journal of Children's Orthopaedics

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“…This elevation of intracavitary pressure may be the cause of high levels of PGE-2, IL-1β and several enzymes detected in UBC fluid [11,12]. These soluble factors may be the trigger for increased osteoblastic activity and resulting osteolysis [13,14]. …”

Section: Introductionmentioning

confidence: 99%

Mid- and long-term clinical results of surgical therapy in unicameral bone cysts

Hagmann

Eichhorn

Moradi

et al. 2011

BMC Musculoskelet Disord

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BackgroundUnicameral (or simple) bone cysts (UBC) are benign tumours most often located in long bones of children and adolescents. Pathological fractures are common, and due to high recurrence rates, these lesions remain a challenge to treat. Numerous surgical procedures have been proposed, but there is no general consensus of the ideal treatment. The aim of this investigation therefore was to study the long-term outcome after surgical treatment in UBC.MethodsA retrospective analysis of 46 patients surgically treated for UBC was performed for short and mid-term outcome. Clinical and radiological outcome parameters were studied according to a modified Neer classification system. Long-term clinical information was retrieved via a questionnaire at a minimum follow-up of 10 years after surgery.ResultsForty-six patients (17 female, 29 male) with a mean age of 10.0 ± 4.8 years and with histopathologically confirmed diagnosis of UBC were included. Pathological fractures were observed in 21 cases (46%). All patients underwent surgery for UBC (35 patients underwent curettage and bone grafting as a primary therapy, 4 curettage alone, 3 received corticoid instillation and 4 decompression by cannulated screws). Overall recurrence rate after the first surgical treatment was 39% (18/46), second (17.4% of all patients) and third recurrence (4.3%) were frequently observed and were addressed by revision surgery. Recurrence was significantly higher in young and in male patients as well as in active cysts. After a mean of 52 months, 40 out of 46 cysts were considered healed. Prognosis was significantly better when recurrence was observed later than 30 months after therapy. After a mean follow-up of 15.5 ± 6.2 years, 40 patients acknowledged clinically excellent results, while five reported mild and casual pain. Only one patient reported a mild limitation of range of motion.ConclusionsOur results suggest satisfactory overall long-term outcome for the surgical treatment of UBC, although short-and mid-term observation show a considerable rate of recurrence independent of the surgical technique.

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“…With supporting evidence for a “trauma-hemorrhage” theory underlying SBC formation in the adult bone, surgical strategies, whenever necessary [1], may possibly be “downstaged” to minimally invasive ones, like prophylactic closed intramedullary nailing or bridge plating techniques for the diaphyseal lesion in a long bone or percutaneous reconstruction with grafts or bone substitutes as reported by some authors [42, 44, 45]. This is because, as illustrated by the theory, the traumatic cyst forms from a reactive process creating a defect [13] and not the “formation” process by an active epithelium lining [6]. For the adult-onset SBC, definitely when the “trauma-hemorrhage” theory is proven correct, thorough intralesional curettage may no longer be necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Theories being proposed include local disturbances in bone growth [3], pressure effects due to blocked fluid drainage [4], local venous obstruction [5], nitric oxide [6], increased lysosomal enzyme activity [7], prostaglandins [8], oxygen free radicals [9], disorders of synovial origin [10], and genetic causes [11]. Cases of SBC following trauma have been observed, theorized to be forming consequently from intraosseous hemorrhage when mechanisms of bone organization and repair fail [12, 13].…”

Section: Introductionmentioning

confidence: 99%

An unusual case of proximal humeral simple bone cyst in an adult from secondary cystic change

et al. 2017

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Background: Simple bone cysts (SBC) have been documented to occur in adults with closed physeal plates, most commonly affecting the calcaneus in this patient subset. Although most authors theorize an association to trauma, etiology of simple bone cysts remains an enigma up to now. Case presentation: A 26-year-old kickboxing coach sought consult for a painful right shoulder which on radiographs and magnetic resonance (MR) imaging showed a proximal humeral lesion with signs of ossification. The patient was lost to follow-up but again sought consult after 3 years for the recurring complaint. On repeat radiographs, computed tomography (CT) scan, and MR images, tumor enlargement with cystic findings typical of simple bone cyst were documented. Diagnostic aspiration of the lesion was firstly done, revealing straw-colored fluid. The patient then underwent intralesional curettage with alpha-tricalcium phosphate cement reconstruction of the lytic defect. No perioperative complications were incurred, and on latest follow-up at 3 years postoperatively, Musculoskeletal Tumor Society (MSTS) and visual analog scale (VAS) pain scores were 30/30 and 0/10, respectively. Conclusions: The authors believe their report provides support to a possible association to trauma of simple bone cysts occurring in the adult population with closed physes and suggest this subset of patients may require a different treatment approach from that for juvenile simple bone cysts.

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Increased concentrations of nitrate and nitrite in the cyst fluid suggesting increased nitric oxide synthesis in solitary bone cysts

Cited by 21 publications

References 27 publications

The role of osteoblast cells in the pathogenesis of unicameral bone cysts

The role of osteoblast cells in the pathogenesis of unicameral bone cysts

Mid- and long-term clinical results of surgical therapy in unicameral bone cysts

An unusual case of proximal humeral simple bone cyst in an adult from secondary cystic change

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