Materiały źródłowe

• #1 Bone Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539849/

  A simple bone cyst is a solitary, benign, fluid-filled cyst that may be a single chamber or septated. […] An aneurysmal bone cyst is a locally destructive, rare, blood-filled, benign cystic bone tumor that involves the metaphysis of long bones in children and young adults. […] UBC seems to be a reactive bone lesion rather than a true bone tumor. It forms secondary to venous stasis in cancellous bone. Bone resorption occurs secondary to venous stasis, pressure buildup, and increased inflammatory mediators in cyst fluid. […] ABC is a locally aggressive indeterminate tumor. It was thought to be caused by intraosseous hemorrhage because of venous stasis and bone resorption due to the activation of osteoclasts. However, this is no longer the accepted theory for primary ABC. Approximately 70% of primary ABC lesions are associated with recurrent chromosomal translocations causing gene fusions between ubiquitin-specific peptidase 6 (USP6) and multiple genes.

• #2 Unicameral Bone Cyst – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470587/

  Unicameral bone cysts contain serosanguinous or serous fluid and are lined by a fibrous membrane. The precise etiology is unknown, but practitioners think they develop as a result of a bone growth defect, which results in the fluid filling this defect and ultimately thinning and expanding of the overlying bone. […] Researchers also suggest that they develop as a result of a venous obstruction within the bone. […] When in the active phase, the cysts tend to arise near the physis (growth plate) and maintain their growth potential; however, as the cysts become more latent, they begin to migrate away from the physis and can remain as a static bone defect or may gradually resolve over time.

• #3

  https://www.jposna.org/index.php/jposna/article/view/267

  Unicameral bone cyst (UBC) is a benign cystic lesion, most commonly diagnosed in the proximal aspects of the humerus and femur of growing children. Medullary venous obstruction is the leading pathogenesis theory, resulting in fluid accumulation, bone resorption, and cortical thinning. […] Most UBCs do not need treatment and are amenable to observation alone.

• #4

  https://journals.lww.com/clinorthop/fulltext/1991/05000/the_role_of_lysosomes_in_the_pathogenesis_of.10.aspx

  Unicameral bone cyst fluid possesses N-acetyl–D-glucosaminidase, -glucuronidase, PZ-pepti-dase, cathepsin D, acid phosphatase, N-acetyl–D galactosaminidase, and -galactosidase activities. […] The activities of lysosomal enzymes in the cyst fluid are, as a rule, higher than in the serum, whereas the total protein content is lower. […] The content of collagen degradation products in the cyst fluid is higher compared to the serum. […] The lack of coincidence of enzymatic spectra of the cyst fluid, wall tissues, and serum is suggestive of the diversity of ways of lysosomal enzyme enter the cyst cavity, i.e., blood, cyst fluid cells, and cyst cavity walls. […] The presence in the cyst cavity of extracellular lysosomal enzymes and collagen degradation products testifies to the permanent corrosion of the cyst cavity walls from the inside as well as to the increase in the osmotic pressure of the cyst fluid. […] Lysosome destruction should be regarded as an important pathogenetic factor that requires surgical or pharmacologic correction or both in the course of bone cyst management.

• #5 Analysis of the fluid contents of simple bone cyst in the mandible | Scientific Reports

  https://www.nature.com/articles/s41598-022-13264-4

  Consequently, studies have suggested that the SBC fluid content represents transudate (contains lower total protein than serum). […] This study reveals that fluid contents have substantially different concentrations of blood components, except for eosinophils and basophils. […] The internal fluid from the lesion had components similar to those found in the blood and serum, according to the laboratory analysis. […] The study aimed to report clinical, radiographic, surgical, and laboratory findings of 19 patients with SBC, with a particular focus on the components of the cyst liquid contents. […] This study reveals that fluid contents have substantially different concentrations of blood components, except for eosinophils and basophils.

• #6 Simple bone cyst | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/simple-bone-cyst?l

  Simple bone cysts (SBC) are common benign non-neoplastic lucent bone lesions seen mainly in childhood and typically remain asymptomatic. […] The etiology and pathogenesis are unknown. […] When uncomplicated by fracture the cysts contain clear serosanguineous fluid surrounded by a thin fibrous membranous lining. […] During the active phase, the cyst remains adjacent to the growth plate. As the lesion becomes inactive it migrates away from the growth plate (normal bone is formed between it and the growth plate) and it gradually resolves.

• #7 Simple Bone Cyst (Unicameral) : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/bones/simple-bone-cyst-unicameral/

  – a membrane lined cavity containing a clear yellow fluid. – lesions remain asymptomatic unless complicated by fracture. – they enlarge during skeletal growth and become inactive, or latent, after skeletal maturity. – cyst arises adjacent to growth plate may grow to fill most of metaphysis; – bone may be slightly expanded w/ thin cortical shell; – it will continue to enlarge during observation; – may cause pathologic fracture; – cysts cease to expand; – become increasingly separated from growth plate (more than 1-2 cm); – have thicker bony wall than active lesions; – may show evidence of healing or ossification – less likely to result in frx; – when cyst becomes latent, epiphysis grows away from the lesion; – active cyst have a mesothelial membrane lining thin margin of bone; – inner wall of bone adjacent to membrane may be lined by osteoclasts; – between membrane osteoclasts is a layer of areolar tissue containing fibroblastic and multinucleated giant cells; – goal of treatment is prevention of pathologic fracture; – conventional teaching is that the cyst will heal and resolve if a fracture occurs thru the cyst; – this has been called into question w/ some estimates that cyst healing occurs in less than 10% fractures; – recurrence is high for active cysts (50%) low for latent cysts (10%); – healing response to intralesional steroids was unpredictable and was incomplete even after multiple injections; – failure in wt bearing bones was high; – authors questioned whether the results of the treatment were a result from multiple drill holes rather from the steroid; – Simple bone cyst. Treatment by trepanation and studies on bone resorptive factors in cyst fluid with a theory of its pathogenesis. […] – Pathological fractures secondary to unicameral bone cysts. […] – Epiphyseal involvement of simple bone cysts.

• #8 Aneurysmal bone cyst – Wikipedia

  https://en.wikipedia.org/wiki/Aneurysmal_bone_cyst

  Aneurysmal bone cyst has been widely regarded a reactive process of uncertain cause since its initial description by Jaffe and Lichtenstein in 1942. […] Many hypotheses have been proposed to explain the cause and pathogenesis of aneurysmal bone cyst, and until very recently the most commonly accepted idea was that aneurysmal bone cyst was the consequence of an increased venous pressure and resultant dilation and rupture of the local vascular network. […] However, studies by Panoutsakopoulus et al. and Oliveira et al. uncovered the clonal neoplastic nature of aneurysmal bone cyst. […] Primary cause has been regarded arteriovenous fistula within bone. […] The lesion may arise de novo or may arise secondarily within a pre-existing bone tumor, because the abnormal bone causes changes in hemodynamics. […] Aneurysmal bone cysts may be intraosseous, staying inside of the bone marrow. Or they may be extraosseous, developing on the surface of the bone, and extending into the marrow. […] According to Buraczewski and Dabska, the development of the aneurysmal bone cyst follows three stages.

• #9 Aneurysmal Bone Cyst: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1254784-overview

  The true pathophysiology of ABCs is unknown. […] Different theories about several vascular malformations exist; these include arteriovenous fistulas (AVFs) and venous blockage. The vascular lesions then cause increased pressure, expansion, erosion, and resorption of the surrounding bone. The malformation is also believed to cause local hemorrhage that initiates the formation of reactive osteolytic tissue. Findings from a study in which manometric pressures within the ABCs were measured supported the theory of altered hemodynamics. […] Most primary ABCs demonstrate a t(16;17)(q22;p13) fusion of the TRE17/CDH11-USP6 oncogene. This fusion leads to increased cellular cadherin-11 activity that seems to arrest osteoblastic maturation in a more primitive state. […] This process may be the neoplastic driving force behind primary ABCs as opposed to secondary ABCs, which seem to occur reactively as a result of another underlying disease process.

• #10 Aneurysmal bone cyst: a review

  https://www.jpatholtm.org/journal/view.php?number=17061

  Aneurysmal bone cyst (ABC) is a benign locally destructive bone neoplasm composed of multi-loculated blood-filled cystic spaces. […] About two-third of primary ABCs have a rearrangement of the USP6 gene, which is not present in the ABC-like changes that occur secondary to other primary bone tumors (i.e., secondary ABC). […] Historically, it was thought that an ABC develops as the result of an underlying vascular event; increased venous blood flow; or a reaction to prior trauma. However, in light of the recent molecular findings of the recurrent rearrangement involving the USP6 gene (chr.17p13.2 locus). ABC is now considered a neoplasm rather than a reactive lesion. […] Recurrent rearrangements of the short arm of chromosome 17 (p13.2) have been found in approximately 63% of cases of ABC.

• #11 Aneurysmal bone cyst: a review

  https://www.jpatholtm.org/journal/view.php?number=17061

  As a result, the gene induces the production of matrix metalloproteinase activity via nuclear factor-kB. […] The most common fusion partner for the USP6 gene is CDH11 (about 30%); however, other genes such as TRAP150 (THRAP3), ZNF9 (CNBP), OMD, COL1A1, RUNX2, PAFAH1B1, CTNNB1, SEC31A, E1F1, FOSL2, STAT3, USP9X, ASAP1, FAT1, SAR1A, TNC, SPARC have been reported. […] Rearrangement of the USP6 gene can be detected by fluorescence in-situ hybridization or fusion panel analysis such as targeted RNA sequencing. […] This common finding suggests that these neoplasms might belong to a spectrum of disease processes that can best be referred to as USP6-associated neoplasms.

• #12

  https://link.springer.com/article/10.1007/s00247-022-05396-6

  Due to these unique cytogenetic findings, fluorescent in situ hybridization (FISH) and next generation sequence (NGS) are useful tools in differentiating ABC from other primary bone lesions with ABC changes, which typically lack USP6 rearrangements. […] Several classifications have been proposed based on natural history, activity and morphological appearance of ABC. […] In 1969, Dabska and Buraczewski were the first to reference the natural history of ABC by dividing the progression into four phases: (1) the initial osteolytic phase in which the cortices of the bone are involved with subtle periosteal reaction; (2) the growth phase characterized by progressive bone destruction with poor demarcation of the borders and no septations seen on radiographs, (3) the stabilization phase that leads to the typical ABC appearance of a well-defined, expansile lesion with sclerotic borders and internal septations and (4) the healing phase characterized by progressive ossification of the lesion.

• #13 Aneurysmal Bone Cyst (ABC) | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/aneurysmal-bone-cyst-(abc)

  Aneurysmal bone cyst (ABC) is a benign and non-neoplastic reactive bone lesion with multiple blood-filled cavities. Histologically, it is a cavernous vascular tumor that can range from a few millimeters to 1-2 cm in diameter with intralesional communicating cavitations. The cavity spaces are separated by fibrous septa made of spindle cells, inflammatory cells, and giant cells. […] Histologically, an ABC with a higher proportion of cellular tissue relative to the amount of osteoid and fibrillary content is a prognostic indicator of recurrence. In addition, the presence of higher mitotic indices is a risk factor for an increased recurrence rate. […] Malignant transformation from ABC to fibroblastic osteosarcoma and telangiectatic osteosarcoma has been reported.

• #14

  https://journals.lww.com/neur/fulltext/2002/50040/aneurysmal_bone_cyst_of_the_temporal_bone___a_case.18.aspx

  Aneurysmal bone cyst is a rare and benign lesion of the skull with obscure pathogenesis. […] Trauma has been put forward as an important etiological factor. […] Lichtenstein suggested that it could result from local circulatory disturbance, because of sudden vascular occlusion of venous drainage of that segment of bone or development of an arterio-venous shunt. This results in progressive blood spaces in the medulla, which lead to gradual distension of the bone with atrophy. […] Pathologically, these cysts contain multiple fluid filled cavities separated by multiple septa lined by mutinucleated giant cells. These large spaces filled with blood do not have an endothelial lining, but are rather delimited by cells with the morphology, ultrastructural and immunohistochemical features of fibroblasts, myofibroblasts and histiocytes.

• #15 Internet Scientific Publications

  https://ispub.com/IJNS/9/1/1462

  Aneurysmal bone cyst is a rare and benign lesion of the skull with obscure pathogenesis. […] Aneurysmal bone cyst is a benign, non-neoplastic lesion that presents most frequently under the age of 20 years. […] The incidence of aneurysmal bone cyst in the skull varies from 3 to 6% of all aneurysm bone cysts. […] Trauma has been put forward as an important etiological factor. […] Lichtenstein suggested that it could result from local circulatory disturbance, because of sudden vascular occlusion of venous drainage of that segment of bone or development of an arterio-venous shunt. […] Pathologically, these cysts contain multiple fluid filled cavities separated by multiple septa lined by multinucleated giant cells. […] Aneurysmal additional feature of a peculiar degenerated calcifying fibromyxoid tissue reported by Rosai. […] The risk of recurrence is increased with an increase of mitotic figures.

• #16 Expression of Insulin-Like Growth Factor-I (IGF-I) in Aneurysmal Bone Cyst | Modern Pathology

  https://www.nature.com/articles/3880443

  The effects of insulin-like growth factor-I on bone tissue and its role in bone development have been extensively investigated, but there is little information on its role in the pathogenesis of aneurysmal bone cyst. […] the findings of this study suggest that insulin-like growth factor-I may play a role in the pathogenesis of aneurysmal bone cyst. […] the results of this study indicate that locally produced IGF-I might play a role in the development and growth and of ABC. […] the involvement of IGF-I in the pathogenesis of ABC might explain the coincidence of these conditions with ABC. […] the data presented in this study demonstrate that IGF-I is overexpressed in ABC, indicating a possible role of the IGF-I-system in the pathogenesis and growth of this lesion. […] the exact mechanisms of the growth of ABC, the role of multinucleate giant cells, and the true nature of this entity remain unclear.

• #17 Traumatic bone cyst of the mandible: a review of 26 cases | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-traumatic-bone-cyst-mandible-review-S1808869415300045

  The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws. […] A higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts. […] Although traumatic bone cysts were described at the beginning of the 20th century, the pathogenesis remains unclear and speculative. The most accepted version at present is the traumatic-hemorrhagic theory, which suggests that lesions develop if intramedullary clots due to trauma do not undergo lysis or resolution. This theory explains why traumatic bone cysts occur more often in young individuals (an age at which trauma occurs more often) and also explain the presence of blood within the cavity at the time of surgical exploration.

• #18 Traumatic bone cyst of the mandible: a review of 26 cases | Brazilian Journal of Otorhinolaryngology

  https://www.bjorl.org/en-traumatic-bone-cyst-mandible-review-articulo-S1808869415300045

  The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws. […] A higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts. […] Although traumatic bone cysts were described at the beginning of the 20th century, the pathogenesis remains unclear and speculative. The most accepted version at present is the traumatic-hemorrhagic theory, which suggests that lesions develop if intramedullary clots due to trauma do not undergo lysis or resolution. This theory explains why traumatic bone cysts occur more often in young individuals (an age at which trauma occurs more often) and also explain the presence of blood within the cavity at the time of surgical exploration.

• #19 Traumatic bone cyst of the mandible: a review of 26 cases | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-traumatic-bone-cyst-mandible-review-S1808869415300045

  This opens the possibility that microtrauma of teeth and the alveolar ridge are involved in the pathogenesis of traumatic bone cysts. […] The trauma-hemorrhage theory may be an explanation because the mandible, which has more cortical bone, repairs itself more slowly compared to the maxilla. […] A higher prevalence of cases in the mandible and in young individuals, infrequent histories of trauma, and a paucity of lesions with serous-bloody content reflect a need to debate the true pathogenesis of traumatic bone cysts.

• #20 Traumatic bone cyst of the mandible: a review of 26 cases | Brazilian Journal of Otorhinolaryngology

  https://www.bjorl.org/en-traumatic-bone-cyst-mandible-review-articulo-S1808869415300045

  This opens the possibility that microtrauma of teeth and the alveolar ridge are involved in the pathogenesis of traumatic bone cysts. […] The trauma-hemorrhage theory may be an explanation because the mandible, which has more cortical bone, repairs itself more slowly compared to the maxilla. […] A final diagnosis of a traumatic bone cyst is almost invariably made at the time of surgery; the material available for histology is usually sparse because of the difficulty in removing the thin connective tissue membrane. […] We also believe this hypothesis is speculative.

• #21 An unusual case of proximal humeral simple bone cyst in an adult from secondary cystic change | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/s12957-017-1166-8

  Simple bone cysts (SBC) have been documented to occur in adults with closed physeal plates, most commonly affecting the calcaneus in this patient subset. […] Although the lesion seems to be dysplastic or reactive rather than a true tumor. […] Theories being proposed include local disturbances in bone growth, pressure effects due to blocked fluid drainage, local venous obstruction, nitric oxide, increased lysosomal enzyme activity, prostaglandins, oxygen free radicals, disorders of synovial origin, and genetic causes. […] Cases of SBC following trauma have been observed, theorized to be forming consequently from intraosseous hemorrhage when mechanisms of bone organization and repair fail. […] The recognition that SBC can occur in the adult, which is atypical, may possibly indicate a different pathogenesis.

• #22 An unusual case of proximal humeral simple bone cyst in an adult from secondary cystic change | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/s12957-017-1166-8

  More so, the observation that most adult patients have calcaneally located SBC lends the suggestion that in this subset of patients, association to trauma could be the likely etiology. […] The calcaneus endures concentration of forces through the heel, possibly developing intraosseous hematoma that subsequently liquefies to become SBC. […] We believe this report may add basis to suggest that in adults, and separate from younger patients, SBC presents a trauma-hemorrhage etiopathogenesis. […] The authors hypothesize that a different etiopathogenesis could be serving as the basis for SBC formation in the adult bone, particularly a trauma-associated one. […] The initial radiographic features could actually be the picture of a posttraumatic medullary hematoma that subsequently liquefied later on to appear as a cyst 3 years later.

• #23 An unusual case of proximal humeral simple bone cyst in an adult from secondary cystic change | World Journal of Surgical Oncology | Full Text

  https://wjso.biomedcentral.com/articles/10.1186/s12957-017-1166-8

  With supporting evidence for a trauma-hemorrhage theory underlying SBC formation in the adult bone, surgical strategies, whenever necessary, may possibly be downstaged to minimally invasive ones. […] The authors hereby conclude that their case provides support to a possible association to trauma of solitary bone cysts occurring in the adult population and suggest this subset of patients may require a different treatment approach from that for juvenile simple bone cysts.

• #24 Osteosarcoma at the site of a previously treated simple bone cyst – Li – Translational Cancer Research

  https://tcr.amegroups.org/article/view/11066/html

  Rarely sarcomas develop in previous bone cysts, especially in simple bone cysts. […] The underlying mechanisms are still unclear, with the possibility of a second primary osteosarcoma at the same site or malignant transformation of the previous UBC. […] The pathogenesis for the malignancy formation is still controversial. In some view, the malignant tumors arose due to malignant transformation of the previous bone cysts. […] Several possible mechanisms existed to explain the development of the subsequent osteosarcoma. Firstly, the osteosarcoma may be a second primary tumor that arise de novo at the same site of the previous SBC. […] It may be possible that the grafted bone promoted the development of the osteosarcoma. […] Secondly, the osteosarcoma may develop from malignant transformation of the SBC.

• #25 Osteosarcoma at the site of a previously treated simple bone cyst – Li – Translational Cancer Research

  https://tcr.amegroups.org/article/view/11066/html

  The reparative microenvironments and changing growth factors after the initial curettage and bone-grafting may also influence the metabolism of the residual SBC cell components and contribute to the malignant tumor occurrence. […] However, we still cannot totally rule out the possibility that the initial lesion contained osteosarcoma from the beginning, and the SBC was secondary to the malignant lesion. […] It would very unusual that a SBC occurred as a secondary lesion of an osteosarcoma, and it is hard to explain that why a SBC not an ABC was secondary to the osteosarcoma if the bone cyst was a secondary lesion. […] The underlying mechanisms are still nuclear and needed to be further clarified with more cases to be reported in the future.

• #26 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0

  Solitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. The lack of a clear pathoetiology has impeded the development of treatment strategies. […] Numerous hypotheses have been proposed to explain the pathogenesis of SBC, e.g. bone resorptive properties of the cyst lining, vascular obstruction, increase in intracavitary osseous pressure, inflammation or traumatic causes. […] The objective of therapy is to prevent a pathologic fracture or re-fracture, promote cyst healing, and to avoid cyst recurrence. […] The cyst volume found to be related to healing rate. If the cyst volume was 84.3 cm3 the healing rate for the SBC was significantly reduced in comparison of all the groups.

• #27 Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1012-0

  The cyst index at diagnosis showed a significant relation to the healing rate. […] The failure rate was significantly higher in patients with an active bone cyst, independent from treatment and location. […] The first treatment choice was not successful in 37 patients, and all patients underwent an invasive intervention. […] The combination of intramedullary nailing and a course of steroid injection showed the best clinical result and is our preferred treatment option in the case of non obliteration of the cyst or in weight bearing long-bones. […] Curettage and disruption of the cyst lining combined with bone grafting has been considered as the gold standard for many years. […] In our study, patients initially treated by curettage with a combined bone grafting (group IV) no recurrence was observed. […] We believe that the invasiveness of the procedure must be contrasted by the need for repeated treatment (e.g. steroids).

• #28 Investigating Factors Influencing the Risk of Recurrence of Simple Bone Cysts: Retrospective Analyses of 41 Cases – Istanbul Medical Journal

  https://istanbulmedicaljournal.org/articles/investigating-factors-influencing-the-risk-of-recurrence-of-simple-bone-cysts-retrospective-analyses-of-41-cases/doi/imj.galenos.2024.23245

  Recurrence is a major challenge in the treatment of solitary bone cysts (SBC). […] The exact cause and pathogenesis of SBC remain unknown; venous obstruction, synovial tissue in the metaphysis, and delayed metaphyseal ossification have been hypothesized. […] Younger age was the only significant factor associated with increased risk of recurrence. […] In the present series, younger age at surgery was clinically significant in the recurrence group (p=0.02). […] It is important to inform the family that the risk of recurrence will be high at a young age and when the SBC is large.

• #29

  https://link.springer.com/article/10.1007/s00247-022-05396-6

  The traditional treatment of ABC has been intralesional curettage with or without bone grafting, which is sometimes enhanced with adjuvant techniques, such as cauterization, phenol, argon bean coagulation and cryotherapy. […] Despite these techniques, local disease recurrence is relatively high. […] Over the past three decades, less invasive treatments using image-guided sclerotherapy with intralesional injection of various substances, such alcohol, polidocanol, doxycycline and calcitonin mixed with steroids, among others, have become an alternative to surgery. […] Denosumab, a monoclonal antibody, has recently been used to treat ABC in an injectable form with promising results also in select cases and difficult locations based on the fact that ABCs belong to the osteoclastic, giant cell-rich tumors.

• #30 Expansive unicameral bone cyst occupying the distal tibia: A case report | The Foot and Ankle Online Journal

  http://faoj.org/2020/09/30/expansive-unicameral-bone-cyst-occupying-the-distal-tibia-a-case-report/

  Unicameral bone cysts (UBC) are relatively uncommon benign bone tumors found mostly in the metaphysis of long bones, such as the humerus or femur with a male to female ratio of 3:1. […] In 1876, Virchow first described these lesions as cystic structures caused by abnormalities in local circulation. […] Multiple theories have been postulated for the pathogenesis of unicameral bone cysts. Blockage in the venous drainage is the most favored mechanism which occurs in rapidly growing and remodeling cancellous bone. This increased pressure may lead to the resorption of bone. Others have postulated that there could be a disturbance in bone growth, intramedullary hemorrhages secondary to trauma that do not completely resolve, degenerative phase of benign tumor, and osteomyelitis. […] Cyst fluid analysis has shown increased levels of prostaglandin e2, IL1 beta, and proteolytic enzymes which could lead to bone resorption and cyst formation.

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