The Aetiology and Treatment of Simple Bone Cysts

Chigira, Masahiro

doi:10.1097/01241398-198405000-00033

Cited by 53 publications

(95 citation statements)

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“…Trephination and drilling with or without Kirschner wire placement have resulted in failure rates after one treatment of 27% [22], 30% [6], and 52% [36]. Even greater successes have been reported with intramedullary nailing, with failure rates after one treatment of 0% [11,33] and 6% [31].…”

Section: Discussionmentioning

confidence: 99%

“…Some theorize, based on electron microscopy, they are intraosseous synovial cysts [26], whereas others propose they are the result of trauma [18]. Analysis of cyst fluid reveals elevated levels of prostaglandins [35], suggesting a possible role in the pathogenesis and supporting treatment with steroid injection [34], whereas the theory that UBCs form in response to venous congestion of the intramedullary space [8] has prompted others to use trephination, high-speed saline injection, and other methods that restore circulation [3,6,15,22].…”

Section: Introductionmentioning

confidence: 99%

“…However, uncertainty exists regarding the effectiveness of various treatments: even for curettage and steroids, two of the more traditional and well-studied methods, wide ranges of failure rates after initial treatment are reported: 22% [28] to 47% [13] after curettage and 41% [10] to 78% [42] after steroids. Numerous other treatments have been suggested, ranging from subtotal resection [12,25], to flexible intramedullary nailing [9,11,31,33], to placement of Kirschner wires [6,7]. In addition to steroids [4,34], percutaneous injection has been attempted with demineralized bone matrix (DBM) [21], bone marrow [23,42], or a combination of DBM and bone marrow [19,32].…”

Section: Introductionmentioning

confidence: 99%

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Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

Sung

Anderson

Zurakowski

et al. 2008

Clinical Orthopaedics &Amp; Related Research

100

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Between 1979 and 2004, 167 patients younger than 20 years were treated surgically for humeral or femoral unicameral bone cysts with either injection of corticosteroids (steroids), curettage plus bone grafting (curettage), or a combination injection of steroids, demineralized bone matrix, and bone marrow aspirate (SDB) at Children's Hospital of Boston and Massachusetts General Hospital (mean followup, 7.3 years; range, 1 month-27 years). Outcomes included treatment failure (defined clinically as subsequent pathologic fracture or need for retreatment to prevent pathologic fracture) and complications. Information was obtained from medical records and by telephone questionnaire. After one treatment, 84% of cysts treated with steroids experienced failed treatment versus 64% with curettage and 50% with SDB. For unicameral bone cysts requiring retreatment (regardless of first treatment), 76% retreated with steroids had failed treatment versus 63% with curettage and 71% with SDB. Curettage was associated with the lowest rate of posttreatment pathologic fractures and highest rate of pain and other complications. Multivariate logistic regression indicated treatment with steroids alone and younger age were independent predictors of failure. We believe SDB is a reasonable first treatment for unicameral bone cysts in the humerus and femur in patients younger than 20 years, being less invasive yet comparable to curettage in preventing recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

Sung

Anderson

Zurakowski

et al. 2008

Clinical Orthopaedics &Amp; Related Research

100

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“…Cette hypothèse semble corroborée par la fréquence élevée des KOS observées chez les sujets atteints de drépanocytose ; cette maladie génétique, à transmission autosomique récessive, qui affecte la synthèse de l'hémoglo-bine, se traduit par des crises douloureuses dues à des microinfarctus, y compris dans l'os, secondaires à des phénomènes vaso-occlusifs [19]. L'extension du KOS serait aussi favorisée par l'augmentation de la pression intramédullaire [20], due à l'accumulation du fluide intrakystique qui a une composition proche du sérum sanguin. Il contient donc des éléments enzymatiques provenant des zones de remodelage osseux pré-sentes sur la paroi du KOS où la vascularisation est très dense.…”

Section: Processus Pathogèneunclassified

Kyste osseux solitaire des maxillaires : caractéristiques radiologiques et données étiopathogéniques

Harnet¹,

Féki

Lombardi

2010

Med Buccale Chir Buccale

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Mots clés : kyste osseux solitaire / radiographie / pathogénieRésumé -Le kyste osseux solitaire des maxillaires est constitué par une lésion ostéolytique, sans paroi épithéliale et au contenu variable selon le site osseux. Il réalise, dans sa localisation maxillaire, une cavité osseuse de forme géodique dont l'aspect radiologique est très souvent polymorphe. L'approche diagnostique de cette pseudo-tumeur osseuse bénigne ne repose en fait que sur la symptomatologie peu évocatrice, quelques caractéristiques sémiologiques en radiographie standard, la découverte peropératoire d'une cavité vide et l'analyse histologique qui montre l'absence de bordure épithéliale. Parfois, l'extension de la lésion lui donne un aspect très polymorphe et ouvre l'interprétation radiographique à un diagnostic différentiel très large. Une synthèse des connaissances cliniques acquises à travers les localisations osseuses maxillomandibulaires et les localisations métaphysaires humérales et fémorales, beaucoup plus fréquentes, permet de discuter les principales hypothèses étiologiques émises concernant un processus pathogène qui semble varier selon les sites osseux affectés, le mode d'apparition, l'évolution et les réponses aux thérapeutiques médico-chirurgicales proposées. Key words: solitary bone cyst / radiography / pathogenesisAbstract -Solitary bone cyst of the jaws: radiographic features and pathogenesis. The solitary bone cyst of the jaws is an osteolytic lesion, devoid of an epithelial lining, with a content that varies according to the affected skeletal site. It appears as a unilocular cavity but often with a polymorphic radiological aspect. The diagnosis of this pseudo-cyst is mainly based on poor symptomatology, some radiological features on standard X-ray examinations, and the intraoperative finding of an empty cavity along with the absence of an epithelial covering at microscopy. Occasionally, the extent of the lesion produces a polymorphic pattern, which gives rise to a wide array of differential diagnoses. The aim of this paper is to summarize clinical knowledge in relation to both jaws as well as much more frequently observed femoral and humeral metaphyseal locations, and to discuss the main etiologic hypotheses based on presentation, evolution and therapeutic approaches which apparently vary according to the involved site.Pour designer le kyste osseux solitaire (KOS), on a utilisé une terminologie très variée, parfois énigmatique (kyste idiopathique, kyste essentiel, kyste osseux simple) ou qui traduit le processus étiopathogénique suspecté (kyste osseux traumatique, hémorragique ou hématique, ostéodystrophie kystique). Cela démontre que le KOS des maxillaires reste encore une lésion très mal connue.Dans notre spécialité, le KOS est classé parmi les bonerelated lesions dans les tumeurs odontogènes des maxillaires [1]. Il est défini par une lésion ostéolytique se

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“…The pathogenesis of UBCs remains largely unknown, but theories presented in the literature include pressure effects due to blocked fluid drainage [2], local venous obstruction [3,4], increased lysosomal enzyme activity [5], prostaglandins [6], nitric oxide [3], oxygen free radicals [7], disorders of synovial origin [8] and genetic causes [9]. As these hypotheses concerning the pathogenesis of UBCs have evolved, multiple diverse treatment strategies have emerged.…”

Section: Introductionmentioning

confidence: 99%

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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The Aetiology and Treatment of Simple Bone Cysts

Cited by 53 publications

References 0 publications

Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

Kyste osseux solitaire des maxillaires : caractéristiques radiologiques et données étiopathogéniques

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

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