Aneurysmal bone cyst of clavicle

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.     

Detection of viral genome in non-neural tissues of cattle experimentally infected with bovine herpesvirus 1

Various bone disorders become manifest as cystic lesions. The differential diagnosis must include benign and malignant tumors and also non-tumorous lesions, such as osteomyelitis. The most important and most frequent types of genuine bone cyst are juvenile bone cyst and aneurysmal bone cyst. When juvenile bone cysts occur in adults they are called solitary bone cysts. Despite intensive research the pathogenesis of bone cysts is still unknown to this day, so that successful causal therapy is impossible. The main problem in the treatment of bone cysts is their high rate of recurrence, rates ranging between 20% and 50% having been cited in the international literature. A critical review of the literature reveals few publications with helpful follow-up results. Most of the publications are case reports, and they frequently merely describe various forms of treatment. More recent reports are mainly concerned with such methods as curettage, steroid injections, and continuous decompression with perforated screws. Until the early 1980s, segmental bone resection was the treatment of choice. Because of its high complication rate it has since been abandoned. In the last analysis, the only well-established method for which long-term results obtained in studies of any size have been published, is curettage of the cyst and grafting with cancellous bone from the iliac crest. In our series, 41 patients were treated with this method, and we recorded a recurrence rate of 17.1%. Complications were rare. The risk of recurrence depended on the age of the patient. A higher recurrence rate must be expected in children under the age of 10 years. For this reason, operative treatment should not be performed until after that age if possible. Newer methods, such as steorid injections and continuous decompression by means of perforated screws, had better results in some studies, but only according to a few authors. Further research is needed to show whether our method will yield good results in the long term when applied in larger patient collectives.     

Synergistic effect of counterregulatory hormones during insulin-induced hypoglycemia in rats: participation of lipolysis and gluconeogenesis to hyperglycemia

Aneurysmal bone cyst of the long bones in a purely intracortical or subperiosteal location is unusual. Three such cases are reported, and the radiographic and pathologic differential diagnoses are discussed. Those subperiosteal or intracortical aneurysmal bone cysts with radiographic features similar to the intramedullary variety should suggest the same diagnosis. However, the radiographic features may be less specific, so that a diagnosis of aneurysmal bone cyst must be entertained when considering a subperiosteal or intracortical lytic lesion.     

Miscellaneous lesions of bone

There are several tumors and tumorlike entities of bone that do not easily fit into the specific classifications provided elsewhere in this issue. In this article, several seemingly unrelated entities are discussed, including cystic diseases of bone (simple bone cysts and aneurysmal bone cysts), Langerhans' cell histiocytosis, benign and malignant vascular tumors of bone, and adamantinoma of long bone and its relationship to osteofibrous dysplasia.     

Angiography in giant-cell tumours of bone

The angiographic appearance of 9 cases of genuine giant-cell tumour of bone, 6 cases of aneurysmal bone cyst and one case of non-ossifying fibroma is described. Differential diagnosis would appear to be possible to a certain extent. The non-ossifying fibroma was poorly vascularized. The genuine giant-cell tumours were hypervascularized as well as some of the aneurysmal bone cysts making a differential diagnosis in these cases impossible. On the other hand, a poorly vascularized tumour devoid of soft tissue component and arteriovenous fistulas is probably an aneurysmal bone cyst. A hypervascular soft tissue component is of great prognostic value in cases of geniune giant-cell tumour.     

Spinal aneurysmal cyst with medullary compression. Apropos of a case with preoperative embolization

The authors report the case of a vertebral aneurysmal bone cyst, at the thoracic level, with spinal cord compression. 16 months after operation, the initial neurological signs reappeared. Selective angiography pointed out a good picture, through not specific, of the lesion; the embolisation, then performed, provided considerable relief for the complete removal of the important vascular bone formation. The diagnostic, therapeutic and pathogenic problems of the vertebral aneurysmal bone cysts are discussed.     

Giant cell tumor and aneurysmal bone cyst of the talus: clinicopathological review and two case reports

Two cases of giant cell tumor and aneurysmal bone cyst of the talus were analyzed with a review of eight cases from the literature. This anatomic setting represents a distinct clinical and roentgenographic entity with a less aggressive natural history than the more common sites. All lesions presented a characteristic radiographic involvement of the head and neck of the talus. Eight of ten lesions were treated by curettage, with or without bone grafting, and healed. Two underwent partial en bloc resection. None developed late fracture, recurrence, avascular necrosis, or metastases. We concluded that a giant cell tumor or aneurysmal bone cyst when located in the talus may be difficult to differentiate but tends to exhibit a less aggressive biological behavior and a more favorable prognosis than the more classical proximal lesion. Talectomy is not indicated in the primary treatment. Curettage with or without bone graft has a high success rate. Cryosurgery should be reserved for a recurrent lesion.     

Quantitative analysis of the plain radiographic appearance of aneurysmal bone cysts

RATIONAL AND OBJECTIVES: To quantitate radiographic features that distinguish the plain radiographic appearance of aneurysmal bone cyst (ABC) from other solitary lesions of bone. MATERIALS AND METHODS: Seven hundred nine cases of focal bone lesions, including 32 ABCs were analyzed according to demographic, anatomic, and plain radiographic features. Vector analysis of groups of features was performed to determine those that are most sensitive and specific for the appearance of ABC in contrast with other lesions in the data base. RESULTS: Aneurysmal bone cysts most consistently are medullary-based, either eccentric or centric (94%), show lysis (100%), cortical thinning (97%), enlargement of the host bone (100%), and geographic bone destruction (94%). They have well-defined edges (84%), no fallen fragment (100%), no evidence of periosteal reaction (75%), and no visible matrix (91%). Although they typically occur in the metadiaphysis of long bones, the anatomic location and demographic data did not significantly affect the sensitivity or specificity for detection of ABCs. The vector analysis-generated differential diagnoses include giant cell tumor, unicameral bone cyst, nonossifying fibroma, enchondroma, and fibrous dysplasia as the major lesions.     

Expression, purification, reconstitution and inhibition of Ustilago maydis sterol 14 alpha-demethylase (CYP51; P450(14DM))

PURPOSE: To assess the efficacy of percutaneous embolization with an alcoholic solution of zein in the treatment of aneurysmal bone cysts. MATERIALS AND METHODS: Eighteen patients with aneurysmal bone cysts were treated percutaneously with alcoholic zein. The cysts were in the lower limb (n = 7), upper limb (n = 5), pelvis (n = 3), cervical spine (n = 2), and mandible (n = 1). All patients were symptomatic, three had previously undergone surgery. Percutaneous embolization was performed with fluoroscopic or computed tomographic guidance with the patient under general anesthesia. Clinical and imaging follow-up lasted 18 months to 4 years. RESULTS: Percutaneous embolization was performed in 16 cases. In two cases, cystograms showed marked venous drainage and thus embolization was not attempted. Six patients underwent repeat embolization. Complications consisted of a local transitory inflammatory reaction (n = 5), aseptic osteitis (n = 1), and a small pulmonary infarct without sequelae (n = 1). Relief of symptoms was achieved in all patients except one, who underwent surgery. At imaging, improvement was total in 13 cases (87%) and partial in two cases (13%). No recurrence was noted during follow-up. CONCLUSION: Percutaneous embolization of aneurysmal bone cysts with alcoholic zein should be considered a reliable alternative to surgery, especially in cases with a difficult surgical approach or cases of postsurgical recurrence.     

Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives?

Cystic epithelial lesions of the sellar and parasellar region are classified on the basis of histology and location into Rathke's cleft cysts, epithelial cysts, epidermoid cysts, dermoid cysts, and craniopharyngiomas. A retrospective review of the clinical presentation, radiological findings, and histology was performed on 19 such lesions, and a survey of the literature pertinent to the classification, clinical presentation, and embryology of these lesions was conducted. Presentation was nonspecific and not predictive of histology. Imaging studies were generally useful in distinguishing these tumors, with the exception of Rathke's cleft cysts, suprasellar epidermoid cysts, and craniopharyngiomas, which frequently could not be differentiated. On microscopic examination, most lesions fit into distinct categories; however, overlap was common among all and some could not be definitively categorized by histological criteria. Evidence supportive of an ectodermal ancestry for sellar and parasellar epithelial-lined cystic lesions is presented. Based on the current findings and a review of the literature, it is suggested that these lesions represent a continuum of ectodermally derived cystic epithelial lesions.     

Cerebellar deficient folia (cdf): a new mutation on mouse chromosome 6

OBJECTIVE: To discuss the case of an 8-yr-old boy with an aneurysmal bone cyst of the right proximal humerus, including the features imaged on plain film radiography, computed tomography (CT), magnetic resonance imaging (MRI), including spin echo and fast field echo imaging. CLINICAL FEATURES: The patient suffered for 1 yr from intermittent but progressive pain in his right upper arm and shoulder area. There was no history of trauma or known systemic disease. There was decreased range of motion in abduction of the glenohumeral joint and pain on focal pressure along the deltoid muscle. A complete imaging evaluation consisting of plain film radiography, CT and MRI was performed, which revealed the classical imaging features of an aneurysmal bone cyst. An additional cystic lesion was detected by the MRI that was not appreciated on the plain films or CT. INTERVENTION AND OUTCOME: The patient was referred for biopsy to confirm the preliminary diagnosis of aneurysmal bone cyst. No treatment was instituted. CONCLUSION: Evaluation of aneurysmal bone cyst may be completed with CT scanning and more specifically with MRI MRI coronal T2, weighted images are advantageous for visualization of the main cystic lesion and any additional cysts. Fast field echo images show a better contrast between the cyst and bone marrow with extension of the cyst into the epiphysis as evident in this case. Follow-up studies revealed complete healing of the cyst with only residual densities in the humeral metaphyseal area.     

Female genital mutilation

The purpose of this communication is to describe atypical simple bone cysts of the femoral neck seen in adult patients. Two patients, aged 56 and 49, having cystic lesions which did not conform to a typical simple bone cyst, are reported. Common features including eccentric location, and thick lining tissue and sclerotic margin are not those of typical simple bone cysts seen in children. Local mechanical characteristics might be related to the atypical presentations.     

Calcaneus cyst--an indication for surgery? Case report and review of the literature

Simple bone cysts are asymptomatic, benign lesions which are usually an incidental finding on a radiograph. Etiology and treatment are controversially discussed. The weight-bearing status of the calcaneus and possible pathologic fracturing lead many authors to recommend therapeutic measures after diagnosis has been made. We present a case report of an intact unicameral bone cyst of the calcaneus concomitant with tibial and talar fractures following crush trauma. Several types of treatment for simple bone cysts of the calcaneus have been suggested. The question whether treatment is unconditionally necessary is controversially discussed. It is the author's opinion, that asymptomatic bone cysts of the calcaneus require no further treatment.     

Isolated epithelial cysts of the uvula in children: a report of three cases

Epidermoid cysts are unusual benign cysts that occur in the oral cavity less than 2% of the time. Epidermoid cysts isolated to the uvula are rare. A review of the literature has revealed only three confirmed cases of isolated uvular epidermoid cysts. We present a series of three such cases, two of which presented with significant symptomatology. The diagnosis and management of these unusual lesions will be discussed, as well as the differential diagnosis.     

Sonographic features of mammary oil cysts

Mammographic lesions that are pathognomonic for oil cysts require no further evaluation. Oil cysts, however, may first be discovered by ultrasonography. Between 1988 and 1995, we performed sonography of 26 oil cysts in 15 patients. Sonography was used to evaluate a palpable finding when an oil cyst was not initially perceived on the mammogram (47%) or as an initial evaluation of a palpable lump (33%); in addition, oil cysts were identified incidentally in 20% of cases. Retrospective review showed that the sonographic appearance of oil cysts is highly variable; only 8% mimic simple apocrine cysts. Twelve percent mimic an intracystic mass. Most have smooth walls (88%), are hypoechoic (65%), and have neither enhancement or shadowing (50%). The sonographic appearance of oil cysts can be suggestive of a pathologic lesion such as an intracystic carcinoma. Unnecessary biopsy can be avoided using directed mammography.     

A surgically treated unicameral (solitary) bone cyst of the talus with a 15-year follow-up

Unicameral bone cysts are uncommon in the foot. When they do occur, they must be differentiated from a variety of other benign lesions. The author describes a unicameral bone cyst of the talus, and its surgical management. The patient returned 15 years later with complaint of mild ankle joint arthrosis, although recurrence of the cyst was not demonstrated.     

Localized eosinophilic granuloma (Langerhans' cell histiocytosis) of the orbital frontal bone

Four patients (aged 5, 8, 14, and 51 years at initial manifestation) with isolated eosinophilic granulomas of the orbital frontal bone displayed short symptomatic periods (two weeks to three months) and some combination of erythema of the lids, a soft, palpable anterior orbital mass, periorbital pain, and osteolytic bone lesions on roentgenography. The bone lesions roentgenographically exhibited irregular, serrated, and sclerotic margins, distinguishing them from the more oval appearance of dermoid cysts. Electron microscopy performed in one case disclosed the presence of Langerhans' granules in the cytoplasm of the histiocytes, indicating that the orbital disease is a mild form of "histiocytosis X" and a benign proliferation of a specific kind of histiocyte--the Langerhans' cell. On follow-up (two to 20 years), after incomplete curettage of two lesions coupled with low doses of postoperative radiotherapy, there was reconstitution of the bone defects, whereas more extensive surgery performed on the other two patients resulted in permanent but subclinical bone defects.     

Staphylococcal enterotoxin-A directly stimulates signal transduction and interferon-gamma production in psoriatic T-cell lines

MRI has gained an undisputed place in the evaluation of malignant bone tumors, not only for verifying results of conventional radiographs and clarifying differential diagnoses; it has also become increasingly important for the assessment of the malignant/benign nature of the tumor, its growth rate, definition of adequate sites for biopsy, local preoperative staging, and evaluation of the response to chemotherapy. However, several pitfalls have to be observed regarding choice of technical parameters (coils, sequences, imaging planes), tissue differentiation, and tumor staging. When staging malignant tumors, critical aspects which have to be observed are tumor extension, integrity of the cortical bone, soft tissue components, infiltration of a joint or neurovascular bundle. The use of contrast agents provides important additional information but can also give rise to misinterpretations. Thus, all features of a tumor have to be observed in order to establish a final diagnosis. Particular difficulties can occur with the interpretation of MR images of osteomyelitis, osteoid osteoma, stress and insufficiency fractures, bone infarcts, myositis ossificans, hemangiomas, and aneurysmal bone cysts.     

Magnetic resonance volumetry of the cerebellum in epileptic patients after phenytoin overdosages

BACKGROUND/AIMS: Cystic lesions of the orbit constitute a group of lesions with diverse clinical findings, histopathologic features and pathogenesis. METHODS: We reviewed the histopathologic and clinical records on 128 orbital cystic lesions diagnosed during a 32-year period from 1963 to 1995. RESULTS: Of the 128 orbital cystic lesions, dermoid cysts were the most frequent (38 cases, 29.7%). The other lesions, in decreasing order of frequency, were hydatid cysts (33 cases, 25.8%), mucoceles (31 cases, 24.2%), pyoceles (10 cases, 7.8%), meningoencephaloceles (9 cases, 7.0%), epidermal inclusion cysts (4 cases, 3.1%), hematoceles (2 cases, 1.6%) and teratoma (one case, 0.8%). CONCLUSIONS: Our review showed that 64.1% of patients with cystic lesions were aged 18 years or less. With the exception of mucopyoceles, all the other cystic lesions were more frequent in pediatric patients. Cystic lesions behaved clinically as benign lesions. At a mean follow-up of 6.7 years we did not observe development of malignancy in any of the cystic tumor cases though variable degrees of vision loss developed due to factors such as optic nerve compression, ocular damage and amblyopia.     

Investigations on the distribution of HBs antigen subtypes

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.