DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20201738

Endoscopy assisted extended curettage in a rare case of aneurysmal bone cyst involving the 2nd metatarsal of a child

Bhaskar Borgohain, Kashif A. Ahmed, Tashi G. Khonglah

Abstract


Aneurysmal bone cysts account for only 1% of all bone tumours and of these only a handful of reported cases occur in the foot. They can mimic other bone tumours on imaging studies, thus making histological diagnosis mandatory. Aneurysmal bone cyst of a metatarsal is very rare especially in children and only few cases have been reported in the literature. We report the novel management option for a rare case of an Aneurysmal bone cyst localized to the second metatarsal in a 5 years old boy who presented with limping, local pain, and minimal swelling in his left foot. Tissue diagnosis was confirmed on the basis of needle biopsy. Surgery was in the form of extended curettage using an endoscope with a high-speed burr and cautery. The remnant cavity was filled up with artificial bone graft. Histopathology analysis of the resected tissue was consistent with Aneurysmal bone cyst. There was complete healing at final follow-up at 2 years. Endoscopy assisted extended curettage appears to be an ideal treatment option as it provides a perfect visualisation of the interior of the entire cyst and use of cautery and burr more accurately under direct vision which potentially leaves only a minimal scope for recurrence. Use of artificial bone grafts instead of conventional autogenous bone grafts to reduce graft site morbidity in children and stimulate local foreign body reaction for enhancing residual tumour cell kill if any and also to promote bony sclerosis for healing.


Keywords


Aneurysmal bone cyst, Metatarsal, Curettage, Endoscopy, Artificial bone graft, Benign bone tumour

Full Text:

PDF

References


Jaffe HL, Lichtenstein L. Solitary unicameral bone cyst: with emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg. 1942;44(6):1004-25.

Fletcher CDM, Unni KK, Mertens F. Pathology and genetics of tumours of soft tissue and bone. In: World Health Organization classification of tumours. Lyon: IARC Press; 2002.

RatcliVe PJ, Grimer J. Aneurysmal bone cyst arising after tibial fracture. J Bone Joint Surg (Am). 1993;75:1225-27.

Leithner A, Machacek F, Haas OA, Lang S, Ritschl P, Radl R, et al. Aneurysmal bone cyst: a hereditary disease. J Pediatr Orthop B. 2003;13:214-7.

Campanacci M, Bertoni F, Bacchini P. Aneurysmal bone cyst. In: Campanacci M, Bertoni F, Bacchini P, eds. Bone and soft tissue tumors. Vienna: Springer; 1990; 725-751.

Althof PA, Ohmori K, Zhou M, Bailey JM, Bridge RS, Nelson M, et al. Cytogenetic and molecular cytogenetic windings in 43 aneurysmal bone cysts: aberrations of 17p mapped to 17p13.2 by Xuorescence in situ hybridization. Mod Pathol. 2004;17:518-25.

Cottalorda J, Gouin F. Kysteosseuxanevrismal (Aneurysmal bone cyst). In: Chotel F, Gouin F (eds) Tumeurs osseuses benignes (Benign osseous tumors). Paris: Elsevier; 2005: 188-200.

Mankin HJ, Hornicek FJ, Cruz OE, Villafuerte J, Gebhardt MC. Aneurysmal bone cyst: a review of 150patients. J Clin Oncol. 2005;23:6756-62.

Cottalorda J, Bollini G, Panuel M, Scheiner C, Jouve JL, Labriet C, et al. Le kysteanevrismal des oschez l’enfant (Aneurysmal bone cysts in childhood). Rev Chir Orthop. 1993;79:272-80.

Caprio DMR, Murphy MJ, Camp RL. Aneurysmal bone cyst of the spine with familial incidence. Spine. 2000;25:1589-92.

Leithner A, Long S, Windhager R, Karlic H, Koyz R, Haas OA. Expression of insulin like growth factor - (IGF-1) in ABC. Mod Pathol. 2001;14:1100-4.

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;363:176-9.

Toepfer A, Lenze U, Gerdesmeyer L, Pohlig F, Harrasser N. Endoscopic resection and allografting for benign osteolytic lesions of the calcaneus. Springer Plus. 2016;5:427.

Mendenhall WM, Zlotecki RA, Gibbs CP, Reith JD, Scarborough MT, Mendenhall NP. Aneurysmal bone cyst. Am J Clin Oncol. 2006;29(3):311-5.

Mankin HJ, Hornicek FJ, Cruz OE. Aneurysmal bone cyst: a review of 150 patients. J Clin Onocol. 2005;23:6756-62.