A comparison of cyst wall curettage and en bloc excision in the treatment of aneurysmal bone cysts

World Journal of Surgical Oncology

Kryspin Niedzielski²  Marta Kolacinska-Flont¹  Pawel Flont² 

[1] Clinic of Internal Diseases, Asthma and Allergy, Medical University of Lodz, Kopcinskiego 22, Lodz 90-153, Poland;Clinic of Orthopaedic and Traumatology, Polish Mother’s Memorial Hospital Research Institute, Rzgowska 281/289, Lodz 93-338, Poland

关键词: Recurrences;    En bloc excision;    Curettage;    Children;    Aneurysmal bone cyst;   

Others  :  825378
DOI  :  10.1186/1477-7819-11-109

 received in 2012-11-27, accepted in 2013-05-12,  发布年份 2013

【 摘 要 】

Background

The recurrence rate after aneurysmal bone cyst (ABC) treatment is quite high despite its benign nature. In ABC therapy, curettage is the treatment of choice; en bloc excision results in a lower recurrence rate, but more extensive reconstructive surgery is needed with associated morbidity. The aim of the present study was to compare the outcomes of the two treatment options.

Methods

A retrospective analysis was performed on 26 patients treated for ABCs: 16 by curettage and 10 by en bloc excision. Each lesion was classified according to Enneking and patients were followed up for a mean time of 9.2 years. On follow-up, radiological examination and functional assessment (range of motion, muscle strength) were performed. Recurrence was defined as the presence of an osteolytic lesion, especially one with a tendency to grow.

Results

On follow-up, the following symptoms were more prevalent in the en bloc excision group compared to the curettage group: pain (en bloc 20% versus curettage 6.25%), limb length differences (en bloc 20% versus curettage 12.5%), reduced range of motion (en bloc 20% versus curettage 6.25%) and muscle strength impairment (en bloc 50% versus curettage 31.2%); however, the differences were not statistically significant (P >0.05). In the curettage group, two cases of postoperative complications and two cases of recurrence were seen, while in the en bloc excision group one case of complications was noted.

Conclusions

Curettage is a standard procedure in ABC management. En bloc excision is another option, albeit more technically demanding, that may be considered in recurrent lesions with extensive bone destruction or for cysts in an expendable location.

【 授权许可】

   
2013 Flont et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Oliveira AM, Chou MM, Perez-Atayde AR, Rosenberg AE: Aneurysmal bone cyst: a neoplasm driven by upregulation of the USP6 oncogene. J Clin Oncol 2006, 24:e1.
• [2]Oliveira AM, Perez-Atayde AR, Dal Cin P, Gebhardt MC, Chen CJ, Neff JR, Demetri GD, Rosenberg AE, Bridge JA, Fletcher JA: Aneurysmal bone cyst variant translocations upregulate USP6 transcription by promoter swapping with the ZNF9, COL1A1, TRAP150, and OMD genes. Oncogene 2005, 24:3419-3426.
• [3]Oliveira AM, Perez-Atayde AR, Inwards CY, Medeiros F, Derr V, Hsi BL, Gebhardt MC, Rosenberg AE, Fletcher JA: USP6 and CDH11 oncogenes identify the neoplastic cell in primary aneurysmal bone cysts and are absent in so-called secondary aneurysmal bone cysts. Am J Pathol 2004, 165:1773-1780.
• [4]Freiberg AA, Loder RT, Heidelberger KP, Hensinger RN: Aneurysmal bone cysts in young children. J Pediatr Orthop 1994, 14:86-91.
• [5]Gibbs CP Jr, Hefele MC, Peabody TD, Montag AG, Aithal V, Simon MA: Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr. J Bone Joint Surg Am 1999, 81:1671-1678.
• [6]Lin PP, Brown C, Raymond AK, Deavers MT, Yasko AW: Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients. Clin Orthop Relat Res 2008, 466:722-728.
• [7]Kreicbergs A, Lönnqvist PA, Nilsson B: Curettage of benign lesions of bone. Factors related to recurrence. Int Orthop 1985, 8:287-294.
• [8]Marcove RC, Sheth DS, Takemoto S, Healey JH: The treatment of aneurysmal bone cyst. Clin Orthop Relat Res 1995, 311:157-163.
• [9]Campanacci M, Capanna R, Picci P: Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res 1986, 204:25-36.
• [10]Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK: Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer 1992, 69:2921-2931.
• [11]Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC: Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol 2005, 23:6756-6762.
• [12]Enneking WF: A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 1986, 204:9-24.
• [13]Whitley AS, Sloane C, Hoadley G, Moore AD, Alsop CW: Clark’s Positioning in Radiography. 12th edition. London, UK: Hodder Headline Group; 2010.
• [14]Reese NB, Bandy DW: Joint Range of Motion and Muscle Length Testing. 2nd edition. St. Louis, MO: Saunders; 2010.
• [15]Ryf C, Weymann A: Range of Motion - AO ASIF Neutral-O Method. Davos, Switzerland: Thieme Verlag; 1999.
• [16]Bohannon RW: Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil 1997, 78:26-32.
• [17]van den Beld WA, van der Sanden GA, Sengers RC, Verbeek AL, Gabreëls FJ: Validity and reproducibility of hand-held dynamometry in children aged 4–11 years. J Rehabil Med 2006, 38:57-64.
• [18]Daltroy LH, Liang MH, Fossel AH, Goldberg MJ: The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. Pediatric Outcomes Instrument Development Group. Pediatric Orthopedic Society of North America. J Pediatr Orthop 1998, 18:561-571.
• [19]Haynes RJ, Sullivan E: The Pediatric Orthopedic Society of North America pediatric orthopedic functional health questionnaire: an analysis of normals. J Pediatr Orthop 2001, 21:619-621.
• [20]Feigenberg SJ, Marcus RB Jr, Zlotecki RA, Scarborough MT, Berrey BH, Enneking WF: Megavoltage radiotherapy for aneurysmal bone cysts. Int J Radiat Oncol Biol Phys 2001, 49:1243-1247.
• [21]De Cristofaro R, Biagini R, Boriani S, Ricci 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, 21:523-527.
• [22]Rossi G, Rimondi E, Bartalena T, Gerardi A, Alberghini M, Staals EL, Errani C, Bianchi G, Toscano A, Mercuri M, Vanel D: Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate. Skeletal Radiol 2010, 39:161-167.
• [23]Guibaud L, Herbreteau D, Dubois J, Stempfle N, Bérard J, Pracros JP, Merland JJ: Aneurysmal bone cysts: percutaneous embolization with an alcoholic solution of zein - series of 18 cases. Radiology 1998, 208:369-373.
• [24]Garg NK, Carty H, Walsh HP, Dorgan JC, Bruce CE: Percutaneous Ethibloc injection in aneurysmal bone cysts. Skeletal Radiol 2000, 29:211-216.
• [25]Varshney MK, Rastogi S, Khan SA, Trikha V: Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts? Clin Orthop Relat Res 2010, 468:1649-1659.
• [26]Papagelopoulos PJ, Choudhury SN, Frassica FJ, Bond JR, Unni KK, Sim FH: Treatment of aneurysmal bone cysts of the pelvis and sacrum. J Bone Joint Surg Am 2001, 83:1674-1681.
• [27]Dormans JP, Hanna BG, Johnston DR, Khurana JS: Surgical treatment and recurrence rate of aneurysmal bone cysts in children. Clin Orthop Relat Res 2004, 421:205-211.
• [28]Ozaki T, Hillmann A, Lindner N, Winkelmann W: Aneurysmal bone cysts in children. J Cancer Res Clin Oncol 1996, 122:767-769.
• [29]Steffner RJ, Liao C, Stacy G, Atanda A, Attar S, Avedian R, Peabody TD: Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? J Bone Joint Surg Am 2011, 93:1221-1229.
• [30]Cummings JE, Smith RA, Heck RK: Argon beam coagulation as adjuvant treatment after curettage of aneurysmal bone cysts: a preliminary study. Clin Orthop Relat Res 2010, 468:231-237.
• [31]Schreuder HW, Veth RP, Pruszczynski M, Lemmens JA, Koops HS, Molenaar WM: Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting. J Bone Joint Surg Br 1997, 79:20-25.
• [32]Ozaki T, Hillmann A, Lindner N, Winkelmann W: Cementation of primary aneurysmal bone cysts. Clin Orthop Relat Res 1997, 337:240-248.
• [33]Zehetgruber H, Bittner B, Gruber D, Krepler P, Trieb K, Kotz R, Dominkus M: Prevalence of aneurysmal and solitary bone cysts in young patients. Clin Orthop Relat Res 2005, 439:136-143.
• [34]Leithner A, Windhager R, Lang S, Haas OA, Kainberger F, Kotz R: Aneurysmal bone cyst. A population based epidemiologic study and literature review. Clin Orthop Relat Res 1999, 363:176-179.
• [35]Ramírez AR, Stanton RP: Aneurysmal bone cyst in 29 children. J Pediatr Orthop 2002, 22:533-539.
• [36]Owen RJ: Embolization of musculoskeletal tumors. Radiol Clin North Am 2008, 46:535-543.
• [37]Peraud A, Drake JM, Armstrong D, Hedden D, Babyn P, Wilson G: Fatal ethibloc embolization of vertebrobasilar system following percutaneous injection into aneurysmal bone cyst of the second cervical vertebra. AJNR Am J Neuroradiol 2004, 25:1116-1120.
• [38]Adamsbaum C, Kalifa G, Seringe R, Dubousset J: Direct Ethibloc injection in benign bone cysts: preliminary report on four patients. Skeletal Radiol 1993, 22:317-320.
• [39]Topouchian V, Mazda K, Hamze B, Laredo JD, Penneçot GF: Aneurysmal bone cysts in children: complications of fibrosing agent injection. Radiology 2004, 232:522-526.