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      Solid variant of aneurysmal bone cist on the distal extremity of the radius in a child Translated title: Variante sólida do cisto ósseo aneurismático na extremidade distal do rádio em uma criança

      case-report

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          Abstract

          The solid variant of aneurismal bone cysts (ABC) is considered rare. It occurs with greater frequency in pediatric patients and in the tibia, femur, pelvis and humerus. We present a case of a metaphyseal lytic lesion on the distal extremity of the radius in a child whose radiograph was requested after low-energy trauma. The hypothesis of a pathological bone fracture secondary to an aneurysmal bone cyst was suggested. After biopsy, the child underwent intralesional excision without bone grafting and the histopathological findings were compatible with the solid variant of aneurysmal bone cyst.

          Resumo

          A variante sólida do cisto ósseo aneurismático (COA) é considerada lesão rara, ocorre com maior frequência nos pacientes pediátricos e nos ossos da tíbia, fêmur, pelve e úmero. Apresentamos o caso de uma lesão lítica metafisária na extremidade distal do rádio de uma criança em que, ao exame radiográfico feito devido a um trauma de baixa energia, foi aventada a hipótese de fratura em um osso patológico secundária a um cisto ósseo aneurismático. Após a biópsia, a criança foi submetida a ressecção intralesional sem interposição de enxerto e o exame histopatológico foi condizente com a variante sólida do cisto ósseo aneurismático.

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          Most cited references18

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          Aneurysmal bone cyst: a review of 150 patients.

          We have reviewed a series of 150 aneurysmal bone cysts treated over the last 20 years. The lesions were principally located in the tibia, femur, pelvis, humerus, and spine and, in most cases, presented the imaging appearance originally described by Jaffe and Lichtenstein as a blowout with thin cortices. Only one of the patients was believed to have an osteoblastoma of the spine with secondary development of an aneurysmal bone cyst, and none of the patients developed additional lesions. The patients were treated primarily with curettage and implantation of allograft chips or polymethylmethacrylate, but some patients were treated with insertion of autografts or allografts. The local recurrence rate was 20%, which is consistent with that reported by other centers. Aneurysmal bone cysts are enigmatic lesions of unknown cause and presentation and are difficult to distinguish from other lesions. Overall, the treatment is satisfactory, but it is possible that newer approaches, such as improved magnetic resonance imaging studies, may help diagnose the lesions and allow the physicians to plan for more effective treatment protocols.
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            An unusual intraosseous lesion with fibroblastic, osteoclastic, osteoblastic, aneurysmal and fibromyxoid elements. "Solid" variant of aneurysmal bone cyst.

            Four examples are reported of an unusual noncystic intraosseous lesion which does not conform to any hitherto recognized entity and which can be mistaken, not only by the general histopathologist but by the osteoarticular pathologist, for a variety of other conditions, including sarcoma and giant-cell tumor. They were in patients aged 5 to 13 years; three in the spine, one in the ethmoid. Local excision, supplemented by low-dose radiotherapy in cases with cord compression, produced a satisfactory outcome in all cases. At presentation the radiologic findings were nonspecific but, following treatment, an eggshell rim of bone developed in those lesions which had been incompletely excised. Histologically, they are characterised by florid fibroblastic or fibrohistiocytic proliferation, osteoblastic differentiation with osteoid production, areas rich in osteoclast-type giant cells, aneurysmal sinusoids, and occasional foci of degenerate calcifying fibromyxoid tissue. Because this combination of histologic features can be found in the solid parts of aneurysmal bone cyst and in no other condition, at this centre we have regarded this lesion as a variant of aneurysmal bone cyst devoid of any cystic component.
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              Solid variant of aneurysmal bone cyst.

              Of the 200 cases of ABC in the Rizzoli Institute files, 15 had solid features on both gross and histologic examination. Inasmuch as fibrous proliferation with giant cell and bone production along with fibromyxoid areas and small aneurysmal spaces were found in the solid parts of the aneurysmal bone cyst, a grossly solid and radiographically osteolytic bone lesion with these microscopic features was called a solid aneurysmal bone cyst. Some authors call the same lesion extragnathic giant cell reparative granuloma. Sixty percent of the patients were female. The metaphysis was the preferred location in the long bones (8/11). Radiographic appearance was not specific, and sometimes a malignant lesion was very difficult to rule out. In seven patients, the lesion was considered radiographically "aggressive." Intralesional excision (curettage) in 12 patients and marginal resection in 3 patients with diaphyseal location was effective in controlling the lesion. No recurrence was detected after a mean follow-up of 59 months. High proliferative activity of the benign-appearing proliferative spindle cells, often with fairly abundant mitoses, associated with benign giant cells and immature bone production are the features of this pseudosarcomatous hyperplastic lesion. It is sometimes is mistaken for a malignant tumor.
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                Author and article information

                Contributors
                Journal
                Rev Bras Ortop
                Rev Bras Ortop
                Revista Brasileira de Ortopedia
                Elsevier
                2255-4971
                30 March 2016
                May-Jun 2016
                30 March 2016
                : 51
                : 3
                : 370-373
                Affiliations
                [0005]Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
                Author notes
                [* ] Corresponding author. vallfmtm@ 123456yahoo.com.br
                Article
                S2255-4971(16)30001-5
                10.1016/j.rboe.2016.03.002
                4887447
                27274493
                276d4128-38d4-432a-b37a-e4f75bf75331

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 5 April 2015
                : 28 May 2015
                Categories
                Case Report

                aneurysmal bone cysts,bone tumor,radius fractures,child,cistos ósseos aneurismáticos,neoplasias ósseas,fraturas do rádio,criança

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