Differential diagnosis of bone cysts of long tubular bones of the extremities in children

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Abstract

BACKGROUND: Bone cysts are characteristic tumor-like bone lesions occurring in childhood. Overall, they represent 21% to 57% of all benign tumors and tumor-like bone lesions in children. Clinical and X-ray symptoms of aneurysmal and simple bone cysts are similar. Like some other, often occurring, benign bone lesions, such as enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects.

AIM: This study aims to identify the main clinical and instrumental characteristics of simple and aneurysmal bone cysts that allow us to differentiate them from some similar destructive bone neoplasms (enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects) and to develop indications for various diagnostic surgical interventions.

MATERIALS AND METHODS: A retrospective analysis of the results of the survey of 206 patients aged 3 to 18 years who were treated at our facility from 2000 to 2015 was performed. The features of the diagnostic tactics and their effectiveness were rated.

RESULTS: The main clinical and instrumental diagnostic criteria have been established. They enable the differentiation of bone cysts from some similar benign bone lesions at the pre-morphological stage. The indications for diagnostic surgical interventions have been formulated.

CONCLUSION: The main difficulties in the differential diagnosis of bone cysts and some similar benign bone lesions have been revealed. An algorithm for applying various diagnostic surgical interventions in patients with these diseases has been proposed.

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About the authors

Ihar E. Shpileuski

Republican Scientific and Practical Center of Traumatology and Orthopedics

Author for correspondence.
Email: ihar760@yandex.com
ORCID iD: 0000-0001-8098-6129

MD, PhD

Belarus, 60 building 4 Lieutenant Kizhevatov str., Minks, 220024

References

  1. Demichev NP, Tarasov AN. Diagnostika i kriokhirurgiya kostnyh kist. Moscow: MedPress-inform; 2005. (In Russ.)
  2. Nejshtadt JeL, Markochev АВ. Opukholi i opukholepodobnye zabolevaniya kostej. Saint Petersburg: Foliant; 2007. (In Russ.)
  3. Fletcher C, Bridge J, Mertens F, editors. WHO Classification of tumours of soft tissue and bone. 4th ed. Lyon: WHO; 2013.
  4. Rogozhin DV, Konovalov DM, Bolshakov NA, et al. Anevrizmal’naya kostnaya kista u detej i podrostkov. Voprosy gematologii/onkologii i immunopatologii v pediatrii. 2017;(2):33–39. (In Russ.)
  5. Martinez V, Sissons H. Aneurysmal bone cyst. A review of 123 cases including primary lesions and those secondary to other bone pathology. Cancer. 1988;61:2291–2304.
  6. Santini-Araujo E, Kalil RK, Bertoni F, Park Y-K. editors. Tumors and tumor-like lesions of bone. London: Springer-Verlag; 2015.
  7. Lagunova IG. Opukholi skeleta. Мoscow: Medgiz; 1962. (In Russ.)
  8. Hakim D, Pelly T, Kulendran M, et al. Benign tumours of the bone: A review. J Bon Oncol. 2015;4:37–41.
  9. Starosel’tseva OA, Mnatsakanova IV, Nudnov NV. Klinicheskoe nablyudenie: Anevrizmaticheskaya kostnaya kista u rebYonka do i posle lecheniya. Meditsinskaya vizualizatsiya. 2020;1:105–112. (In Russ.)
  10. Adler C, Kozlowski K. Primary bone tumors and tumorous conditions in children. London: Springer-Verlag; 1993.
  11. Greenspan A, Jundt G, Remagen W. Differential diagnosis in orthopedic oncology. Philadelphia: Lippincott, Williams & Wilkins; 2007.
  12. Pope T, Bloem LH, Beltran J, et al. Musculoskeletal imaging. 2nd ed. Philadelphia: Elsevier; 2015.
  13. Khanna A, editor. MRI for orthopedic surgeons. New York, Stuttgart: Thieme; 2010.
  14. Meyers S. MRI of bone and soft tissue tumors and tumorlike lesions, differential diagnosis and atlas. New York: Thieme; 2008.
  15. Picci P, Manfrini M, Fabbri N, et al., editors. Atlas of musculoskeletal tumors and tumorlike lesions. The Rizzoli Case Archive; 2014.

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2. Fig. 1. Metaphyseal fibrous defect (a, roentgenogram, b, computed tomography scan): an eccentric focus with clear contours (“soap bubbles”) is determined, separated from the growth zone by intact spongy bone; and the estimated residual strength of the segment is 65%

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3. Fig. 2. Bone cysts: a, solitary bone cyst, “radiographic finding”; radiography was performed for trauma, no clinical manifestations of the pathological process were revealed; b, solitary bone cyst, pathological fracture; there were no clinical manifestations of the pathological process before the fracture; c, aneurysmal bone cyst; the cellular–trabecular structure of the lytic focus was found radiographically; a computed tomogram shows a single cavity with walls of uneven thickness, with a site of endo-osseous bone formation; d, aneurysmal bone cyst; structureless lytic focus, a computed tomogram revealed areas of cortical wall destruction, and the bone septa in the cavity are absent; magnetic resonance imaging showed individual cavities separated by soft tissue partitions

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4. Fig. 3. Enchondroma: a, roentgenogram: an eccentric pathological focus with an indistinct sclerotic rim is determined; primary diagnosis (at an outpatient visit in a primary care facility), bone cyst (?); b, computed tomography scan, with well visualized “spottedness” of the tumor tissue (arrow)

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5. Fig. 4. Giant cell tumor: a, lytic form (radiographic and computed tomography images); a sharp thinning of the cortical layer with areas of destruction; the tumor affects the epimetaphysis (destroyed growth plate); b, cellular–trabecular form (radiographic and gross specimen images); on the cross section of the gross specimen, separate, non-communicating cavities divided by bone bridges are visible; destroyed growth zone

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6. Fig. 5. Fibrous dysplasia: a, roentgenogram; b, computed tomography scan shows a pathological focus of the proximal metadiaphysis with a ground-glass opacity pattern, with cyst-like areas at the apex of the “shepherd’s stick” type femur deformity characteristic of fibrous dysplasia

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Copyright (c) 2021 Shpileuski I.E.

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