Multifocal Unicameral Bone Cysts in a Middle-Aged Patient Treated with Three Different Methods: A Rare Case Report
Abstract
Background: Primarily diagnosed in the first two decades of life, unicameral bone cysts (UBCs) are benign cystic lesions of the bone. More than 90% of UBCs are located in the proximal femur or proximal humerus of skeletally immature patients, however in this case report we report a middle-aged patient with multiple lesions in unusual sites.
Case Report: A 42-year-old patient presented to our institute with multiple bony lesions in the right and left tibias, proximal radius, ulna, and the second metacarpus. The lesions were later pathologically proven to be UBCs. A multimodality treatment approach was selected including decompression-only, extended curettage, bone grafting, and prophylactic fixation based on the lesion size and anatomic location. All these methods proved to be effective with no disease relapse and complete radiographic obliteration of the cavities.
Conclusion: UBCs could occur in much older patients than generally believed and the proper method of treatment should be
individualized based on the lesion’s characteristics.
2. Noordin S, Allana S, Umer M, Jamil M, Hilal K, Uddin N. Unicameral bone cysts: Current concepts. Ann Med Surg (Lond). 2018;34:43-9. doi: 10.1016/j.amsu.2018.06.005. [PubMed: 30224948]. [PubMed Central: PMC6138978].
3. Liu Q, He H, Zeng H, Yuan Y, Wang Z, Tong X, et al. Active unicameral bone cysts: Control firstly, cure secondly. J Orthop Surg Res. 2019;14(1):275. doi: 10.1186/s13018-019-1326-3. [PubMed: 31455399]. [PubMed Central: PMC6712734].
4. 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. doi: 10.1001/Archsurg.1942.01210240043003.
5. Cohen J. Etiology of simple bone cyst. J Bone Joint Surg Am. 1970;52(7):1493-7. [PubMed: 5472904].
6. Boseker EH, Bickel WH, Dahlin DC. A clinicopathologic study of simple unicameral bone cysts. Surg Gynecol Obstet. 1968;127(3):550-60. [PubMed: 4874360].
7. Ji JH, Hwang WH, Lee YS, Kim JO. A rare case of multiple and huge simple bone cysts in Wilson's disease. J Orthop Surg (Hong Kong). 2019;27(2):2309499019843141. doi: 10.1177/2309499019843141. [PubMed: 31035865].
8. Farr S, Balaco IMS, Martinez-Alvarez S, Hahne J, Bae DS. Current trends and variations in the treatment of unicameral bone cysts of the humerus: A survey of EPOS and POSNA members. J Pediatr Orthop. 2020;40(1):e68-e76. doi: 10.1097/BPO.0000000000001376. [PubMed: 30925579].
9. Pretell-Mazzini J, Murphy RF, Kushare I, Dormans JP. Unicameral bone cysts: General characteristics and management controversies. J Am Acad Orthop Surg. 2014;22(5):295-303. doi: 10.5435/JAAOS-22-05-295. [PubMed: 24788445].
10. Ramirez A, Abril JC, Touza A. Unicameral bone cyst: radiographic assessment of venous outflow by cystography as a prognostic index. J Pediatr Orthop B. 2012;21(6):489-94. doi: 10.1097/BPB.0b013e328355e5ba. [PubMed: 22751482].
11. Pizem J, Sekoranja D, Zupan A, Bostjancic E, Matjasic A, Mavcic B, et al. FUS-NFATC2 or EWSR1-NFATC2 fusions are present in a large proportion of simple bone cysts. Am J Surg Pathol. 2020;44(12):1623-34. doi: 10.1097/PAS.0000000000001584. [PubMed: 32991339].
12. Hung YP, Fisch AS, Diaz-Perez JA, Iafrate AJ, Lennerz JK, Nardi V, et al. Identification of EWSR1-NFATC2 fusion in simple bone cysts. Histopathology. 2021;78(6):849-56. doi: 10.1111/his.14314. [PubMed: 33316098].
13. Baig R, Eady JL. Unicameral (simple) bone cysts. South Med J. 2006;99(9):966-76. doi: 10.1097/01.smj.0000235498.40200.36. [PubMed: 17004531].
14. Scaglietti O, Marchetti PG, Bartolozzi P. The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up. J Bone Joint Surg Br. 1979;61- B(2):200-4. doi: 10.1302/0301-620X.61B2.438272. [PubMed: 438272].
15. Sung AD, Anderson ME, Zurakowski D, Hornicek FJ, Gebhardt MC. Unicameral bone cyst: a retrospective study of three surgical treatments. Clin Orthop Relat Res. 2008;466(10):2519- 26. doi: 10.1007/s11999-008-0407-0. [PubMed: 18679761]. [PubMed Central: PMC2584314].
16. Jamshidi K, Mirkazemi M, Izanloo A, Mirzaei A. Locking plate and fibular strut-graft augmentation in the reconstruction of unicameral bone cyst of proximal femur in the paediatric population. Int Orthop. 2018;42(1):169-74. doi: 10.1007/s00264- 017-3648-2. [PubMed: 28963665].
17. Ahn JI, Park JS. Pathological fractures secondary to unicameral bone cysts. Int Orthop. 1994;18(1):20-2. doi: 10.1007/BF00180173. [PubMed: 8021063].
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Issue | Vol 8, No 2 (2022) | |
Section | Case Report | |
DOI | https://doi.org/10.18502/jost.v8i2.9313 | |
Keywords | ||
Case Reports Cysts Bone Cysts |
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