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CASE REPORT

Aneurysmal Bone Cyst Of The Metacarpal Bone-A Case Report

 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 2 year follow up there is no sign to recurrence[FIGURE 6], with excellent functional movement of the fingers and hand.[FIGURE 7-9]

Fig.1

Fig.2

Fig.3

Fig.4

Fig.5

Fig.6

Fig.7

Fig.8

Fig.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 :

  1. 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.

  2. Kransdorf MJ, Sweet DE.  Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging.  AJR Am J Roentgenol.  1995; 164: 573 80.

  3. 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 .

  4. 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.

  5. 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.

  6. 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.

  7. Marcove RC, sheth DC, Takemoto S, Healey JH.  The treatment of aneurysmal bone cyst. Clin Orthop Relat Res. 1995; 311:157 63.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Dabska M, Buraczewski J. Aneurysmal bone cyst. Pathology, clinical course and radiologic appearances, cancer. 1969  : 23 : 371 89.

  13. 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.

  14. 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.

  15. Wilner D. Radiology of bone tumors and allied disorders, Philadelphia; saunders; 1982. p 1003 -101.

  16. Campanacci M,Capanna R,Picci P.Unicameral and aneurysmal bone cysts.Clin Orthop 1986;204:25-36.

  17. 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.

 

This is a peer reviewed paper 

Please cite as :Shantharam Shetty M :Aneurysmal Bone Cyst Of The Metacarpal Bone-A Case Report

J.Orthopaedics 2007;4(3)e1

URL: http://www.jortho.org/2007/4/3/e1

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