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Treatment of an aggressive aneurysmal bone cyst with percutaneous injection of polidocanol: a case report.

Brosjö O, Tsagozis P - J Med Case Rep (2014)

Bottom Line: Polidocanol sclerotherapy has recently been reported to have excellent results and promises to replace operative treatments, but its efficacy in the case of aggressive aneurysmal bone cysts has not been documented.An 18-year-old woman from Sweden presented with pain in her shoulder and a rapidly progressing cystic bone lesion.She was successfully treated using sequential percutaneous injections of polidocanol after exclusion of malignancy.

View Article: PubMed Central - PubMed

Affiliation: Section of Orthopaedics, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm S-17176, Sweden. tsagozis@gmail.com.

ABSTRACT

Introduction: Aneurysmal bone cysts are benign tumours that usually present in childhood. Aggressive forms have been described, which are often treated with surgery that entails major resection and reconstruction. Polidocanol sclerotherapy has recently been reported to have excellent results and promises to replace operative treatments, but its efficacy in the case of aggressive aneurysmal bone cysts has not been documented.

Case presentation: An 18-year-old woman from Sweden presented with pain in her shoulder and a rapidly progressing cystic bone lesion. The differential diagnosis was a rare, aggressive form of aneurysmal bone cyst or a sarcoma of the proximal humerus. She was successfully treated using sequential percutaneous injections of polidocanol after exclusion of malignancy.

Conclusions: Management of aggressive aneurysmal bone cysts has thus far relied on open surgery. We propose that non-operative treatment with polidocanol is efficient even in the aggressive form of the aneurysmal bone cyst.

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Related in: MedlinePlus

Fluoroscopy picture taken during the 5th injection of polidocanol, showing proper placement of the needle and signs of sclerosis (a), and graphical reconstruction of a computed tomography scan of the proximal humerus, 18 months after the last treatment, showing consolidation of the lesion (b).
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Fig3: Fluoroscopy picture taken during the 5th injection of polidocanol, showing proper placement of the needle and signs of sclerosis (a), and graphical reconstruction of a computed tomography scan of the proximal humerus, 18 months after the last treatment, showing consolidation of the lesion (b).

Mentions: An 18-year-old woman from Sweden was admitted to our institution due to a painful mass in her left shoulder, discovered 2 months ago, and impairment in range-of-motion (ROM). An ultrasound examination by the admitting primary care physician revealed a vascularized tumour. During physical examination, a palpable mass was present in close proximity to her deltoid muscle. A plain X-ray examination of her left humerus showed an osteolytic lesion (Figure 1a) and magnetic resonance imaging (MRI) revealed a 5.5cm tumour which had a discrete soft tissue component (Figure 1b). Fine needle aspiration biopsy was inconclusive, most suggestive of myositis ossificans. Overall, telangiectatic osteosarcoma could not be excluded, a fact that led us to an open biopsy. The pathology report verified the diagnosis of ABC, without any evidence of malignancy. A repeat MRI, approximately 6 weeks after the first scan, however, showed a clear progression of both the intraosseous and the extraosseous components of the tumour, raising again the suspicion of sarcoma (Figure 2). This led to a second open biopsy, and the second pathology report was also consistent with an ABC. The diagnosis of an unusually aggressive ABC was set, and polidocanol sclerotherapy was initiated. She received six consecutive injections of 240mg of polidocanol under general anaesthesia and fluoroscopic guidance at approximately 3-week time intervals (Figure 3a), until symptoms subsided and convincing radiological findings of healing of the lesion were observed. She had no symptoms at follow-up 3 months after the last injection, and her shoulder ROM was normalized. She remains symptom-free 1.5 years after the last injection, and there is radiologic consolidation of the lesion (Figure 3b).Figure 1


Treatment of an aggressive aneurysmal bone cyst with percutaneous injection of polidocanol: a case report.

Brosjö O, Tsagozis P - J Med Case Rep (2014)

Fluoroscopy picture taken during the 5th injection of polidocanol, showing proper placement of the needle and signs of sclerosis (a), and graphical reconstruction of a computed tomography scan of the proximal humerus, 18 months after the last treatment, showing consolidation of the lesion (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307636&req=5

Fig3: Fluoroscopy picture taken during the 5th injection of polidocanol, showing proper placement of the needle and signs of sclerosis (a), and graphical reconstruction of a computed tomography scan of the proximal humerus, 18 months after the last treatment, showing consolidation of the lesion (b).
Mentions: An 18-year-old woman from Sweden was admitted to our institution due to a painful mass in her left shoulder, discovered 2 months ago, and impairment in range-of-motion (ROM). An ultrasound examination by the admitting primary care physician revealed a vascularized tumour. During physical examination, a palpable mass was present in close proximity to her deltoid muscle. A plain X-ray examination of her left humerus showed an osteolytic lesion (Figure 1a) and magnetic resonance imaging (MRI) revealed a 5.5cm tumour which had a discrete soft tissue component (Figure 1b). Fine needle aspiration biopsy was inconclusive, most suggestive of myositis ossificans. Overall, telangiectatic osteosarcoma could not be excluded, a fact that led us to an open biopsy. The pathology report verified the diagnosis of ABC, without any evidence of malignancy. A repeat MRI, approximately 6 weeks after the first scan, however, showed a clear progression of both the intraosseous and the extraosseous components of the tumour, raising again the suspicion of sarcoma (Figure 2). This led to a second open biopsy, and the second pathology report was also consistent with an ABC. The diagnosis of an unusually aggressive ABC was set, and polidocanol sclerotherapy was initiated. She received six consecutive injections of 240mg of polidocanol under general anaesthesia and fluoroscopic guidance at approximately 3-week time intervals (Figure 3a), until symptoms subsided and convincing radiological findings of healing of the lesion were observed. She had no symptoms at follow-up 3 months after the last injection, and her shoulder ROM was normalized. She remains symptom-free 1.5 years after the last injection, and there is radiologic consolidation of the lesion (Figure 3b).Figure 1

Bottom Line: Polidocanol sclerotherapy has recently been reported to have excellent results and promises to replace operative treatments, but its efficacy in the case of aggressive aneurysmal bone cysts has not been documented.An 18-year-old woman from Sweden presented with pain in her shoulder and a rapidly progressing cystic bone lesion.She was successfully treated using sequential percutaneous injections of polidocanol after exclusion of malignancy.

View Article: PubMed Central - PubMed

Affiliation: Section of Orthopaedics, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm S-17176, Sweden. tsagozis@gmail.com.

ABSTRACT

Introduction: Aneurysmal bone cysts are benign tumours that usually present in childhood. Aggressive forms have been described, which are often treated with surgery that entails major resection and reconstruction. Polidocanol sclerotherapy has recently been reported to have excellent results and promises to replace operative treatments, but its efficacy in the case of aggressive aneurysmal bone cysts has not been documented.

Case presentation: An 18-year-old woman from Sweden presented with pain in her shoulder and a rapidly progressing cystic bone lesion. The differential diagnosis was a rare, aggressive form of aneurysmal bone cyst or a sarcoma of the proximal humerus. She was successfully treated using sequential percutaneous injections of polidocanol after exclusion of malignancy.

Conclusions: Management of aggressive aneurysmal bone cysts has thus far relied on open surgery. We propose that non-operative treatment with polidocanol is efficient even in the aggressive form of the aneurysmal bone cyst.

Show MeSH
Related in: MedlinePlus