[Aneurysmal cysts. Bone cysts. Affinity and differences].
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An unusual case of aneurysmal bone cyst recurring after operation as a simple bone cyst is reported. Different theories on etiology and pathogenesis of aneurysmal bone cyst, simple bone cyst, and central giant cell granuloma of the jaws are resumed and similarities demonstrated. It is suggested that these three lesions have a common dysvascular etiology and that local environmental factors within the bone may differentiate the pathogenesis.
Three cases of simple bone cysts (S.B.C) in association with cementum-like bone production are reported. Analysis of our cases and the 2 previously reported in the literature as so-called cementomas has led us to conclude that the "cementoma" of long bone is not a distinct entity, but merely, a form of S.B.C. associated with a peculiar, poorly cellular form of bone which mimics tooth cementum by light microscopy only. Electron microscopic studies of this substance demonstrate collagen fibers and numerous matrix vesicles which form the initial sites of calcification. Matrix vesicles are a product of osteoblastic activity and are never found in the cementum of the tooth or oral cementum producing tumors. We also report the first ultramiscroscopic observations on the wall of the simple bone cyst and its lining. Two cell types constitute the lining, having features identical to those described for type A and type B synovial cells. Because of this new observation, we believe, the most reasonable explanation for the simple bone cyst is that it represents a congenital "rest" of synovial tissue displaced into the thin, cortical metaphyseal region of bones at the synovial-capsularbone reflection. Its benign nature and slow growth would explain its discovery in early childhood and the marked preponderance of its proximal humerofemoral location dependent upon the fact that these 2 bones have the largest area of capsular to metaphyseal bone reflection.
Aneurysmal bone cysts occurring within the calvarium are uncommon. The following case report describes the radiological and pathological findings of a temporal bone aneurysmal bone cyst with intra- and extracranial manifestations. The pertinent literature is reviewed.
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A six year-old boy. He complained of a swelling of the left forehead since October of 1971, the region of his upper eyelid has then been gradually swollen. He was admitted to our institute on the 24th of February, 1973, without the past history of head trauma. We found that the swollen region had a diameter of about 4 centimeters covered from the left upper eyelid to the forehead with a slight tenderness on pressure. We had no neurological findings. According to the results of skull X rays, the superior margin of left orbit and zygomatic process of frontal bone were swollen and like honey combs. An irregular, long and narrow osteolytic legion was found, which was about 4 centimeters long and 5 centimeters wide. According to the results of the left selective external carotid angiography, after injection of 60% Urografin, for more than 2.5- 10 seconds, at the left frontal bone an abnormal shadow (patchy contrast filling) was noted, which was about 4 centimeters long and 5 centimeters wide. After the direct injection of Urografid into the lesion, the cyst of one centimeter long and 3 centimeters wide was observed at the zygomatic process of the frontal bone. Operation was performed to excise the outer plate of the swollen bone and to curette the lesion after the ligature of the left external carotid artery. Histological examination showed many blood lakes and some multinuclear giant cells in the specimens and we diagnosed it was an aneurysmall bone cyst. This case is the first one of aneurysmall bone cyst confirmed by the selective external carotid angiography and the direct puncture of lesion.
An aneurysmal bone cyst is a benign, locally aggressive bone process which frequently recurs after excochleation. Exocochleation can be extended without loss of bone tissue by making use of cryosurgery. This combined technique was used in the treatment of 5 patients, without complications. None of the patients described had a demonstrable recurrence 12-60 (average 35) months after this combined therapy.
Aneurysmal and juvenile bone cysts are characterized by frequent recurrence and pathological fractures caused by such bone cysts also recur frequently. Curettage of the cyst and spongiosaplasty is often unsuccessful. According to our experience, excochleation must be followed by drilling the cyst wall and fraising off the compact substance. Densely packed homologous spongiosa must then be implanted. In case of recurrence or if the cyst increases in size, radical en-bloc resection is indicated and the defect must be bridged by osteoplastic and osteosynthetic methods. We have treated four difficult cases successfully with this procedure. In one case, resection with limb shortening lead to full recovery.
Two aneurysmal bone cysts are described. They presented difficulties in diagnosis because the patients were rather older than usual for this lesion and because of the uncommon location of the cysts. The nature of aneurysmal bone cysts is discussed.
The solitary bone cyst is most frequently located in the upper arm and the average age of the affected patients is between 7 and 9 years, thus perceptibly lower than in cases where solitary bone cyst occurs elsewhere, where the average age is 15. The tendency towards recurrence before 10 years of age is twice as great as the tendency after that age. Investigation of the results obtained from the treatment of 26 patients suffering from solitary bone cyst of the humerus showed a recurrence rate of 55% after curettage and filling-in of the defect with cancellous bone grafts, whereas after total subperiosteal resection and bridging the defect with an autologous tibia graft the corresponding recurrence frequency was 7%. The average duration of the plaster cast fixing period after resection treatment was 18 days longer than after curettage, but the low rate of recurrence in the first-mentioned case makes up for this disadvantage. It is absolutely essential to retain the periosteum in cases of cyst resections. The defect is bridged over by an autologous tibia graft, but fibula grafts are also suitable for bridging the defect. Osteosyntheses are not necessary with latent cysts. In the case of active cysts screws, wire loops, Kirschner wires, and thin Küntscher nails can be used as temporary stabilisation means. Plate osteosyntheses constitute an exception. Complete removal of the cyst by resection is the most certain prophylactic method against recurrence, and hence the most reliable form of treatment of the solitary bone cyst of the humerus.
The localisations of bone cysts known under the title of "intraosseous ganglion, synovial cyst of bone and solitary unicameral cyst" are summarised from the literature. Two of the authors' patients are added to the few cases of talar cysts recorded up to the present. In addition, a patient with a calcaneal cyst is described. The cysts can be traumatic or non-traumatic in origin. The various theories concerning their etiology are discussed. The clinical findings, differential diagnosis and therapy of subchondral bone cysts particularly in the region of the foot are considered.
Two atypical solitary bone cysts occurring posterior to the angle of the mandible, and in each case showing delayed healing, are reported. Some speculations are made on the possible aetiology of these lesions in general.
The ultrastructure of 5 cases of primary aneurysmal bone cysts is described. The most frequent cells found are fibroblasts containing varying amounts of glycogen. Primitive mesenchymal cells in different stages of differentiation are seen. The foci of osteoid and bone originate through metaplastic changes of the spindle cell stroma. We feel that the fibroblastic proliferation and bone formation are manifestations of a reactive process. The giant cells are similar to those of other giant cell lesions of bone. A case of cystic chondroblastoma with secondary aneurysmal bone cyst features was studied. It shows, in addition to chondroblastoma cells, elongated cells similar to the reactive fibroblasts of primary aneurysmal bone cyst. We feel that aneurysmal bone cyst is a benign non-neoplastic condition that can develop in bone as a primary bone lesion; it may also be associated with a pre-neoplastic condition that can develop in bone as a primary bone lesion; it may also be associated with a pre-existing bone condition, and occasionally develops following trauma with subperiosteal hematoma.
The traumatic bone cyst is a lesion whose aetiology and pathogenesis have not been conclusively established. There are several theories and names for this lesion and various forms of management have been reported in the literature. This report outlines the clinical and radiographic findings associated with a case of a traumatic bone cyst. Laboratory investigations were also carried out and their findings are reported. This case was treated jointly by the endodontic and oral surgery departments of an institution and demonstrates the need for close follow-up from both departments. In particular, the endodontic aspects of monitoring the pulp status of teeth in the region of such a bone lesion are emphasised.
Ten cases of aneurysmal bone cysts in various parts of the body are presented. Their features are analysed and the relevant literature is reviewed.
Aneurysmal bone cysts are uncommon lesions, especially in the spine. Seventy-eight cases have been previously documented in the English literature and an additional fourteen cases are now reported. There is a definite predilection for the lumbar region and the neural arch is the part of the vertebra most commonly affected. It is recommended that treatment should consist of total excision or when this is not possible, curettage. Radiotherapy should be reserved for those few cases where operation is inadvisable.
Aneurysmal bone cyst is now recognized as a distinct clinicopathologic entity. It has characteristic clinical, radiologic, and pathologic feactures. The two modalities of treatment are surgical resection or curettage and radiotherapy: recurrence rates with each modality are discussed. A case report of an aneurysmal bone cyst presenting in the sphenoid sinus and treated with the compbined modalities of irradiation and surgical curettage is presented.
An unusual case of hemorrhagic bone cyst observed over a period of 12 years is presented. The diagnosis was confirmed by surgical exploration and histological examination of the tissue. The lesion continued to expand in spite of repeated surgical mandible. Finally, bone formation obliterated the cavity completely at the age of 19, when the facial deformity was corrected. It is suggested that this hemorrhagic bone cyst is of developmental origin. Since intramedullary haemorrhage and proliferation of giant cells are both responsible for the cavity formation and expansion, it is possible that aberrant formation of giant cells by fusion of endothelial cells of abnormal blood vessels may be an important factor in the pathogenesis of this condition.