Shantharam
Shetty M*, Ajith Kumar M** ,Sandeep S.
Ireshanavar***
* HOD
Department of Orthopaedics, Tejasvini Hospital and DEAN K S HEGDE
MEDICAL ACADEMY,Mangalore
** Consultant Orthopaedic Surgeon, Tejasvini Hospital
*** Registrar in Orthopaedics, Tejasvini Hospital
Address for Correspondence:
Prof.M.Shantharam Shetty
Tejasvini Hospital And Ssiot
Kadri, Mangalore ,
Karnataka
Fax : +91 824
2225998
E-mail: shettyortho@hotmail.com, drsandeepsi25@yahoo.com
|
Abstract:
Aneurysmal
bone cysts are a well-known and well described clinical entity,
their presence in small bones of the hand are not a common
occurrence, only 2-4 % of the aneurysmal bone cysts
are localized in the hand and foot bones.
The fourth metacarpal of the Right hand was affected
(Enneking stage 2). Excision of the involved metacarpal
performed and was replaced by fibular strut graft. The
graft healed without complications with excellent functional
results.
J.Orthopaedics 2007;4(3)e11
Keywords:
Aneurysmal
bone cyst, fibular strut, hand bones
Introduction:
Aneurysmal
bone cyst was considered a variety of giant cell tumor untill
1942, when Jaffe and Lichenstein isolated it and suggested it
was an independent pathology in itself [1].
Aneurysmal bone cyst is a benign expansile lesion that
remains a diagnostic and therapeutic challenge [2,3,4].
Primary Aneurysmal bone cyst is a rare lesion with an incidence
of about 1.4/100000 per year [5].The
overall prevalence is estimated to be 1% of the biopsied primary
bone tumors [6].The aetiology of aneurysmal bone cyst is not clearly established.
Case
Report :
A
25 year old female patient presented
with a swelling of
the right hand since
1 year duration [Figure
1-2 ]. The swelling was associated with pain, which was
exaggerated by movements. A differential diagnosis of
Enchondroma, Aneurysmal bone cyst, giant cell tumor were
entertained. All the
Blood parameters were within normal limits. Chest radiograph was
normal.
During surgery there was no break in the cortex of the
tumor. The involved
metacarpal was excised in toto
except 1cm from each end of the articular
surfaces of the fourth metacarpal & replaced with a
fibular strut graft & secured with Kirshner wire[FIGURE
3-4]. K wire removal was done after 2 months and total
Consolidation of the graft was achieved at the end of 6 months[FIGURE
5], at 2½ year follow up there is no sign to recurrence[FIGURE
6], with excellent functional movement of the fingers and
hand.[FIGURE 7-9]
|
Discussion :
The
etiology of is not clearly established .It is regarded as a
reactive ,highly vascular lesion resulting from local
hemodynamic impairment [6,7]. The chromosomal abnormalities have
also been noted [8].
Aneurysmal
bone cyst consists constitute 1 % of
all primary Bone tumors and 2-4-% of them involve the
Bones of the hand and these require a differentiated treatment [6,9,10].
Spectrum of
modalities suggested for treatment of aneurysmal bone cyst
include intralesional procedures, radiation therapy, subtotal or
total excision. Aneurysmal bone cyst
of the hand bones are rare only 2-4 % of all Aneurysmal
bone cysts. Because
these lesions may demonstrate aggressive local biologic
behaviour, when the diagnosis of aneurysmal bone cyst of the
small bones of the hand is considered, prompt diagnostic and
therapeutic intervention should be performed. Early recognition
and management of this lesion is essential to prevent amputation
[9,10,11].
The
natural history is divided into 4 phases
lysis, expansion, stabilization and healing [12,13,14,15]
.Diagnosis generally occurs
during expansion or stabilization phase.Healng may occur either
spontaneously or after biopsy, which is uncommon.
Curetagge
with or without bone grafting is the most widely used treatment
in aneurysmal bone cysts [7,16]
.Campanacci et al reported 95 cysts that were treated with
curettage and bone grafting[16].
Other
modalities of treatment like selective arterial embolization and
radiation therapy there were cases of recurrence in them
upto 5-14 % [7,9,16
].
Steroid
injections involve atleast 3
successive injections over a period of 8 months and the
recurrence was upto 100% [17].
The
induction healing with use of demineralised
bone and autogenous
bone marrow is a new approach[11].
Conclusion:
Because these lesions may demonstrate
aggressive local biologic behavior, when the diagnosis of
aneurysmal bone cyst of the small bones of the hand is
considered, prompt diagnostic and therapeutic intervention
should be performed. Early recognition and management of this
lesion is essential to prevent morbidity specially function of
the hand ,the grasp and pinch .Excision of the tumor with
fibular strut graft is
a simple and excellent
method of management of tumors of the metacarpals bones of the
hand since it maintains the length ,shape and function of the
hand.
Reference :
-
Jaffe HL, Lichtenstein L, Solitary unicameral bone cyst,
with emphasis on the roentgen picture, the pathologic appearance
and pathogenesis, Arch Surg 1942;44:1004-25.
-
Kransdorf
MJ, Sweet DE. Aneurysmal
bone cyst: concept, controversy, clinical presentation, and
imaging. AJR Am J
Roentgenol. 1995;
164: 573 – 80.
-
Levy WM, Miller As, Bonakdarpour A. Aegerter E,
Aneurysmal bone cyst secondary to other osseous lesions.
Report of 57 casese.
AM J Clin Pathol. 1975:
63 : 1- 8 .
-
Martinez V. Sissons HA.
Aneurysmal bone cyt.
A review of 123 cases including primary lesions and those
secondary to other bone pathology. Cancer. 1988: 61 : 2291 –
304.
-
Leithner A. Windhager R, Lang S, Haas OA, Kainberger F.
Kotz R, Aneurysmal bone cyst. A population based epidemioiogic
study and literature review.
Clin orthop Relat Res. 1999;363: 176 – 9.
-
Mira MJ. Aneurysmal bone cyst. In: Mirra MJ Picci
P, Gold RH, editors. Bone
tumors: clinical, radiologic and pathologic correlations.
Philadelphia: Lea and Febiger; 1989. p 1267 – 307.
-
Marcove RC, sheth DC, Takemoto S, Healey JH.
The treatment of aneurysmal bone cyst. Clin Orthop Relat
Res. 1995; 311:157 – 63.
-
Sciot R, Dorfman H, Brys P. Dal Cin P. De wever I,
Fletcher CD. Jonson K, Mandahl N, Mertens F Mitelman F, Rosai J,
Rydhoml A, Samson I, Tallini G, Van den Berghe H, Vanni R,
Willen H. Cytogenetic – morphologic correlations in aneurismal
bone cyst, giant cell tumor of bone and combined lesions. A
report from the CHAMP study group.
Modern Pathology. 2000 ; 13 : 1206 – 10.
-
De Cristofaro R, Biagini R, Boriani S, Ruggieri P, Rossi G,
Fabbri N, Roversi R, Selective arterial embolization in the
treatment of aneurysmal bone cyst and angioma of bone.
Skeletal Radiol 1992;21:523-7.
-
Frassica FJ, Amadio PC, Wold L E, Beabout JW. Aneurysmal
bone cyst: clinicopathologic
features and treatment of ten cases involving the hand.
J Hand Surg 1988; 13A : 676 – 683.
-
Pierre
Louis D, and Christian Delloye.Treatment of bone aneurysmal bone
cysts by introduction of demineralised bone and autogenous bone
marrow. J Bone Jt Surg Am 87;2253-2258,2005.
-
Dabska M, Buraczewski J. Aneurysmal bone cyst. Pathology,
clinical course and radiologic appearances, cancer. 1969
: 23 : 371 – 89.
-
Malghem J, Maldaue B, Esseslinckx W, Noel H, De Nayer P,
Vincent A. Spontaneous healing of aneurysmal bone cysts, A
report of three cases. J
Bone joint Surg Br. 1989;71:645-50.
-
Mcqueen
MM,ChaimersJ,Smith GD.Spontaneous healing of aneurysmal bone
cysts.A report of 2 cses.J Bone Joint Surg Br 1985;67:310-312.
-
Wilner D. Radiology of bone tumors and allied disorders,
Philadelphia; saunders; 1982. p 1003 -101.
-
Campanacci
M,Capanna R,Picci P.Unicameral and aneurysmal bone cysts.Clin
Orthop 1986;204:25-36.
-
Scagletti
O,Marchetti P G , Bartolozzi P. Final results obtained in the
treatment of bone cysts with methylprednisolone acetate and a
discussion of results achieved in other bone lesions.Clin Orthop
1982;165:33-42.
|