Giant bone cysts - البروفيسور فريح ابوحسان - استشاري اورام العظام في الاردن

F.R.C.S.(Eng.), F.R.C.S.(Tr.& Orth.)

Professor of Orthopaedics

Giant Aneurysmal Bone Cyst

3/3/2013 1 Professor Freih Abuhassan - University

of Jordan

Patient profile: A 9-years old male child, MF, Overweight.

Chief complaint:

Progressive painless swelling of the right distal thigh of 14 m duration

Referred to us on the

17th Nov. 2008 3/3/2013 2

Professor Freih Abuhassan - University

of Jordan

History of present illness:

4th Sep. 2007, had pain in the distal femur after a fall while playing.

Diagnosed as pathological fracture of the distal femur.


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4th Sep. 2007


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Treated by complete POP for 3 M

4th Dec. 2007


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19th Jan. 2008

Trivial trauma Supracondylar distal

femur fractures treated by POP for

7 weeks


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19th Jan. 2008 3/3/2013 7


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5th Mar. 2008 3/3/2013 8


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Past medical history

=History of two surgical biopsies with

blood transfusion

Diagnosis: Aneurysmal bone cyst


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Patient offered the following

advices outside JUH

1- Above Knee Amputation

2- Resection and Joint replacement

3- To be treated abroad

Patient was wheel chair dependent

since the start of treatment. 3/3/2013 10


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6th June 2008

Lesion contineued to grow

3/3/2013 11


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26th Sep. 2008


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Physical examination:

General: no abnormality detected

Right lower limb:

= Diffuse swelling of the knee and lower thigh with

10 cm diameter difference form the left thigh

(firm, not tender, not pulsatile)

=Decreased knee ROM due to the bulky swelling

=Normal distal NV examination

17th Nov. 2008


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of Jordan


of Jordan


of Jordan

Laboratory investigation

CBC

KFT

LFT

ESR

CRP

All were Normal


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17th Nov. 2008


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Surgery at JUH

19th Nov. 2008

Local curretage of the cyst +

application of monoplanar external

fixator + Circular Ex.Fix. (across

the knee joint) Ilizarov Frame.

First stage


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Problems 1- Difficult to apply Tourniquet

2- Lateral Scar of previous surgery

3-Soft bone (prolonged disuse)

4-Extensive bleeding

5-Overweight

6-Residual defect after resection.

3/3/2013 25


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Histopathology

ABC 3/3/2013 26


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3/3/2013 27 Professor Freih Abuhassan -

University of Jordan







= Under tourniquet, Anterior approach,

Complete resection of the cyst.

=Turbid hematoma was found inside

the cavity.

=Delay reconstruction of the bone

defect till results of C&S.

=Bone cement spacer was inserted.

16th Dec. 2008 2nd stage Surgery


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Bone cement spacer

Cultures: no bacterial growth

Gram stain:

only WBC’s & RBC’s, no bacteria


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Reconstructive Procedure


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3nd stage Surgery

23rd Dec. 2008 1. Removal of Cement spacer

2. Strut tibial autograft from the mid

ipsilateral tibia, to femur and

stabilized by long screws to the

ilizarov frame.

3. Application of ilizarov to tibia +

bone marrow inserted.


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of Jordan


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Periosteal closure



Bone marrow injection

23rd Dec. 2008 3/3/2013 41

Professor Freih Abuhassan -



of Jordan


of Jordan

5th Jan. 2009

Admitted as a case popliteal fossa

swelling to R/O organised hematoma

U/S: no definite fluid collection but

significant soft tissue edema.

= Percutaneous evacuation of hematoma,

=R/O Orthofix and application of long

Ilizarov plate externally and fixed to the

graft by Schanz screws 3/3/2013 44


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Followed regularly in OPD

Partial weight bearing was started

in the on 21st Jan. 2009.

Now FWB on crutches


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25th March 2009





With Ilizarov family



ABC In 1942, Jaffe and Lichtenstein

first described ABC when they

discovered "a peculiar blood

containing cyst of large size.


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Benign Aggressive Bone Tumor

Locally destructive yet do not

metastasize or show malignant

changes at a cellular levelcellular

level

ABC, GCT, CMF,

Chondroblastoma,

Osteoblastoma. 3/3/2013 50


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WHO

Blood-filled spaces of variable

size,separated by CT containing

trabeculae of bone or osteoid

tissue and osteoclast giant cells

ABCs represent 1%–2% of all

primary bone lesions


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Giant Cell tumour

Aneurysmal bone cyst

Telangiectatic osteosarcoma

Secondary ABC –upto 35% of all ABCs

Most commonly due to GCT (39%)

D.Dx


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No bone is immune

3/3/2013 53

Giant Humerus ABC



Giant femur ABC


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Giant ABCs



Local recurrence rate after

classic surgical procedures

(curettage and grafting) is about

11.8%–30.8%

Treatment depends on

site & size of the lesion.


of Jordan


of Jordan

Health & Medicine

Giant bone cysts - البروفيسور فريح ابوحسان - استشاري اورام العظام في الاردن