Aneurysmal bone cyst and osteoblastoma: an extremely rare combination in the pediatric spine
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CASE REPORT
Aneurysmal bone cyst and osteoblastoma: an extremely rare combination in the pediatric spine F. A. Lazaro1 · R. G. Remondino1 · L. Piantoni1 · C. A. Tello1 · E. Galaretto1 · I. A. Francheri Wilson1 · M. A. Noel1 Received: 21 April 2020 / Accepted: 3 October 2020 © Scoliosis Research Society 2020
Abstract Study design Case report. Objective To report the clinical and imaging findings of a patient with the extremely rare association of aneurysmal bone cyst and osteoblastoma in the cervical spine. Background data summary To our knowledge, only three cases have been reported in the published literature in children under 16 years of age with this condition in the cervical spine. Methods The patient’s history, physical examination, imaging findings, and management with a complete 4-year medical history, surgical intervention and radiological follow-up are reported. Results A 4-year 11-month-old boy was diagnosed with aneurysmal bone cyst in association of osteoblastoma and was treated with CT-guided intralesional injection calcitonin and methylprednisolone. During the course of intralesional therapy, a pathological fracture of C2 was produced. Subsequently, a widened intralesional excision and instrumented fusion from occiput to cervical spine (C0–C4) was performed. Conclusion The association of aneurysmal bone cyst and osteoblastoma in spine is extremely rare. Although both are benign lesions, in the cervical location, complete removal of the tumors is challenging. Wide resection with reconstruction of the segments for stability associated with adjuvant treatment with calcitonin and corticosteroids provides a good option. Keywords Aneurysmal bone cyst · Osteoblastoma · Instrumented fusion · Benign lesions
Introduction An aneurysmal bone cyst (ABC) is a benign pseudotumor lesion, that regarding the location, extension, and soft tissue involvement, may behave particularly aggressively. The lesion accounts for between 8 and 30% of primary tumors of the spine, mainly the lumbar and thoracic segments [1]. On rare occasions, the lesion occurs in combination (secondary ABCs) with benign (giant-cell tumor, osteoblastoma, etc.) or malignant (osteosarcoma) tumors. ABC is characterized by a presentation in the second decade of life in the majority of the cases and a slight male preponderance [2]. Osteoblastoma is a primary tumor of the spine mainly involving the posterior vertebral elements. Incidence is low * F. A. Lazaro [email protected] 1
Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, CABA, Buenos Aires, Argentina
and the tumor, generally, occurs in the second decade of life and more frequently in boys, similar to the ABC. The cervical vertebrae are affected in around 20–40% of the cases [3]. It may have locally aggressive behavior involving bone, peritumoral nerve and vascular structures. We present a patient with a relatively rare association of ABC and osteoblastoma treated with a combination of surgical interventio
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