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Aneurysmal Bone Cyst of the Proximal Femur in a Pediatric Patient: A Case Report

Medicine and Health

Aneurysmal Bone Cyst of the Proximal Femur in a Pediatric Patient: A Case Report

Sowinski and E. Al

This intriguing case report by Sowinski et al. details the diagnosis and innovative treatment of an aneurysmal bone cyst in a six-year-old boy, shedding light on the critical importance of thorough evaluation and multidisciplinary management in pediatric lower extremity pain.

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Playback language: English
Introduction
Aneurysmal bone cysts (ABCs) are rare, benign bone tumors characterized by expansive, hemorrhagic lesions. They predominantly affect the pediatric population, typically during the second decade of life. ABCs are often located in the metaphysis of long bones and present radiographically as eccentric, radiolucent, expansile lesions. While the genetic basis involves a USP6 oncogene rearrangement, ABCs can also be secondary to other bone lesions. Differential diagnosis is crucial, particularly from telangiectatic osteosarcoma, necessitating biopsy. Treatment typically involves wide resection, potentially with osteosynthesis and bone grafting to address fracture or bone fragility. This case report examines a pediatric patient with an ABC of the proximal femur, highlighting the diagnostic and therapeutic challenges involved.
Literature Review
The literature review cites several studies relevant to the diagnosis and management of pediatric lower extremity pain and bone tumors. One study examined the diagnostic utility of lower extremity radiographs in young children with gait disturbances, revealing that in most cases (96%), initial radiographs appeared normal, and symptoms often resolved spontaneously. Another study investigated the natural history of benign bone tumors in asymptomatic children, finding an 18.9% prevalence. These studies underscore the challenge of differentiating between self-limiting conditions and more serious pathology, emphasizing the need for careful clinical evaluation. Further, guidelines for musculoskeletal imaging in children with bone masses recommend radiographs of the entire affected bone and urgent consultation with surgical specialists or oncologists for suspicious lesions. The importance of considering referred pain, particularly hip pain manifesting as knee pain, is also highlighted in the literature.
Methodology
This is a case report describing the diagnosis and treatment of a single pediatric patient with an aneurysmal bone cyst (ABC) of the proximal femur complicated by a pathologic fracture. The methodology involved a retrospective review of the patient's clinical presentation, radiographic findings, surgical intervention, and pathology results. The patient's clinical history, including the onset and progression of pain, and the impact on ambulation, were documented. Initial radiographs revealed the lesion, prompting further imaging (MRI) and consultation with pediatric orthopedic surgery. The surgical procedure included open reduction and internal fixation of the fracture, curettage of the cyst, and filling of the cavity with an injectable inductive graft and crushed cancellous bone. Post-operative care involved physical and occupational therapy. The final diagnosis was confirmed by histopathological examination of the biopsy specimen. The literature review summarized existing studies related to the presentation, diagnosis, and treatment of ABCs and pediatric lower extremity pain.
Key Findings
A six-year-old male presented with left leg pain that progressed to an inability to bear weight. Initial radiographs showed an ill-defined lytic lesion in the proximal left femur with a suspected pathologic fracture. MRI confirmed a multiloculated expansile lesion consistent with an ABC. Orthopedic surgery performed open reduction and internal fixation to stabilize the fracture, followed by curettage of the cyst and bone grafting. Pathology confirmed the diagnosis of an aneurysmal bone cyst. Post-operative recovery involved physical and occupational therapy, and the patient regained ambulation with assistance.
Discussion
This case highlights the diagnostic challenges in evaluating pediatric patients with lower extremity pain. The initial radiograph of the knee was unremarkable, while subsequent radiographs of the hip revealed a concerning lesion. This underscores the importance of considering referred pain and performing imaging studies of the entire affected bone rather than just focusing on the site of reported pain. The multidisciplinary approach involving the pediatrician, orthopedic surgeon, and pathologist was crucial for accurate diagnosis and effective management. The successful treatment with surgical intervention and bone grafting showcases the importance of timely intervention in such cases.
Conclusion
This case report emphasizes the importance of comprehensive evaluation of children presenting with lower extremity pain and gait disturbances. While many cases resolve spontaneously, suspicious findings on imaging, particularly those suggesting a bone lesion, necessitate further investigation and referral to specialists. Early diagnosis and appropriate surgical management are essential for effective treatment of ABCs to prevent complications and ensure optimal functional outcomes. Further research into the long-term outcomes of various treatment strategies for ABCs in the pediatric population would be beneficial.
Limitations
This study is limited by its nature as a single case report. The findings cannot be generalized to the broader population of children with ABCs. Furthermore, long-term follow-up data on the patient's functional outcome are not yet available, limiting the ability to fully assess the long-term success of the treatment strategy. More extensive research with larger cohorts is required to establish more definitive conclusions about diagnosis and management.
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