Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features
Objectives. Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor. It has several challenging features. The aim of this study is to identify challenges in the diagnosis and treatment of ABC especially in patients with unusual features. Methods. This retrospective study involved medical...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Advances in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2019/2905671 |
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| author | Ziyad M. Mohaidat Salah R. Al-gharaibeh Osama N. Aljararhih Murad T. Nusairat Ali A. Al-omari |
| author_facet | Ziyad M. Mohaidat Salah R. Al-gharaibeh Osama N. Aljararhih Murad T. Nusairat Ali A. Al-omari |
| author_sort | Ziyad M. Mohaidat |
| collection | DOAJ |
| description | Objectives. Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor. It has several challenging features. The aim of this study is to identify challenges in the diagnosis and treatment of ABC especially in patients with unusual features. Methods. This retrospective study involved medical record review of primary ABC patients with one or more of the following features: unusual clinical presentation with a mass or a pathological fracture especially at an unusual age, rare locations, radiological findings suggesting other diagnoses especially sarcoma, and a nondiagnostic histopathology of biopsy samples. Results. 25 patients (17 males and 8 females) were included. Most patients were either younger than 10 or older than 20 years. 10 patients presented with a mass or a pathological fracture. Unusual locations include the scapula, the olecranon, the hamate, the calcaneus, and the first metatarsal bone. Extension into the epiphysis occurred in 2 patients with proximal fibula and olecranon ABCs. Two separate synchronous cysts existed in the proximal epiphysis and middiaphysis of one humerus. Radiological imaging suggested other primary diagnoses in 8 patients. Core needle biopsy was diagnostic in only 2 of 7 patients. The main treatment was intralesional resection/curettage with bone grafting. Wide resection was performed in 4 patients. Recurrence rate was 28%. Recurrence risk factors included the following: age less than 10 years, male gender, and proximal femur location. Late recurrence occurred in 3/7 patients. One patient with asymptomatic radiological recurrence showed subsequent spontaneous resolution one year later. Conclusions. This study presented multiple unusual features of ABC including: unusual age, rare locations, and nondiagnostic radiological and histopathological findings. These features can complicate the diagnosis and management. Given these features, especially with pathological fractures, a well-planned incision, the use of frozen section examination, and the application of either external fixation or plate osteosynthesis for fracture fixation can be recommended. |
| format | Article |
| id | doaj-art-c8ffe94c81f54efaa8dd34bae892e5ce |
| institution | Kabale University |
| issn | 2090-3464 2090-3472 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Advances in Orthopedics |
| spelling | doaj-art-c8ffe94c81f54efaa8dd34bae892e5ce2025-02-03T05:45:27ZengWileyAdvances in Orthopedics2090-34642090-34722019-01-01201910.1155/2019/29056712905671Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual FeaturesZiyad M. Mohaidat0Salah R. Al-gharaibeh1Osama N. Aljararhih2Murad T. Nusairat3Ali A. Al-omari4Orthopedic & Spine Surgeon, King Abdullah University Hospital, Irbid 22110, JordanOrthopedic Surgery Resident, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, JordanOrthopedic Surgery Resident, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, JordanOrthopedic Surgery Resident, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, JordanOrthopedic & Spine Surgeon, King Abdullah University Hospital, Irbid 22110, JordanObjectives. Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor. It has several challenging features. The aim of this study is to identify challenges in the diagnosis and treatment of ABC especially in patients with unusual features. Methods. This retrospective study involved medical record review of primary ABC patients with one or more of the following features: unusual clinical presentation with a mass or a pathological fracture especially at an unusual age, rare locations, radiological findings suggesting other diagnoses especially sarcoma, and a nondiagnostic histopathology of biopsy samples. Results. 25 patients (17 males and 8 females) were included. Most patients were either younger than 10 or older than 20 years. 10 patients presented with a mass or a pathological fracture. Unusual locations include the scapula, the olecranon, the hamate, the calcaneus, and the first metatarsal bone. Extension into the epiphysis occurred in 2 patients with proximal fibula and olecranon ABCs. Two separate synchronous cysts existed in the proximal epiphysis and middiaphysis of one humerus. Radiological imaging suggested other primary diagnoses in 8 patients. Core needle biopsy was diagnostic in only 2 of 7 patients. The main treatment was intralesional resection/curettage with bone grafting. Wide resection was performed in 4 patients. Recurrence rate was 28%. Recurrence risk factors included the following: age less than 10 years, male gender, and proximal femur location. Late recurrence occurred in 3/7 patients. One patient with asymptomatic radiological recurrence showed subsequent spontaneous resolution one year later. Conclusions. This study presented multiple unusual features of ABC including: unusual age, rare locations, and nondiagnostic radiological and histopathological findings. These features can complicate the diagnosis and management. Given these features, especially with pathological fractures, a well-planned incision, the use of frozen section examination, and the application of either external fixation or plate osteosynthesis for fracture fixation can be recommended.http://dx.doi.org/10.1155/2019/2905671 |
| spellingShingle | Ziyad M. Mohaidat Salah R. Al-gharaibeh Osama N. Aljararhih Murad T. Nusairat Ali A. Al-omari Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features Advances in Orthopedics |
| title | Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features |
| title_full | Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features |
| title_fullStr | Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features |
| title_full_unstemmed | Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features |
| title_short | Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features |
| title_sort | challenges in the diagnosis and treatment of aneurysmal bone cyst in patients with unusual features |
| url | http://dx.doi.org/10.1155/2019/2905671 |
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