Clinical manifestations, a symptomatic complex of tumors of bone tissue, consists of three main signs:
- The presence or absence of severe pain.
- The actual tumor, which can be palpated, first determine its density and the expected size.
- The presence or absence of violations of the functions of the extremities and motor activity in general.
Symptoms of a cyst of a bone depend on the type of tumor, the rate of its development, localization and the ability to spread to surrounding tissues, structures.
Both simple solitary bone cyst (CCK) and aneurysmal have common etiopathogenetic causes, however their symptoms are different in the same way as radiographic visual indices. Common symptoms of bone cysts are related to such manifestations and symptoms:
- The cyst will debut with clinical manifestations on the background of the child's general health.
- The bony cyst begins to show up with painful sensations in the fall, sudden movements.
- The cyst can provoke a pathological fracture in the area in which pain is periodically felt.
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Cyst in foot bones
The bony cyst of the lower extremity is most often diagnosed in children aged 9 to 14 years and is defined as fibrous osteitis of the hip or tibia. In 50% of cases, the first clinical symptom that can not be overlooked is a pathological fracture. Radiographically, the cyst in the leg bone is confirmed in the form of a picture showing a characteristic expansion of the bone tissue with a distinctly visible resorption zone in the middle. The pathological focus has clear boundaries, especially if there is no reaction from the periosteal (periosteal). The bony cyst of the leg refers to benign tumorous neoplasms and a favorable outcome in 99% of cases. The destruction of bone tissue develops spontaneously, the process begins with transient pain and minor swelling in the developmental region of the cyst.
Symptoms of leg cysts can be as follows:
- Transient pain in the cyst area for a long time.
- Violation of the supporting function of the leg, pain when walking.
- It is possible to rotate the leg outward with a pathological fracture.
- In the area of fracture, edema is always observed.
- With a fracture, the axial load on the leg provokes severe pain.
- Palpation of the fracture zone causes painful sensations.
- The symptom of the "stitched heel" is missing.
In clinical orthopedic practice, cases of spontaneous bone repair are not uncommon for 2-3 years. However, if the cyst is accompanied by a pathological fracture, a cystic cavity remains at the site of bone fusion, which is prone to recurrent development. Nevertheless, surgeons note a paradoxical phenomenon: a fracture can accelerate the fibrous restoration of bone tissue, as it helps to reduce the size of the cyst cavity. Often it is a pathological fracture that is a kind of therapy for cystic education proper, and trauma is treated as standard, like all other types of fractures. With this development, the cysts of the leg bone require dynamic observation, in which the main method of examination is X-ray. With a favorable course of the restoration process, the pictures show a slow but steady obliteration of the cyst cavity. In more complex cases, when bone destruction progresses, the cyst is scraped. Further, symptomatic treatment is prescribed, including with the help of injection steroids. Timely treatment of the cyst of bone tissue of the lower extremity allows avoiding recurrent fractures and pathological shortening of the leg as a result of deformation of bone tissue.
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Cyst of the talus
Astragalus seu talus, talus bone is part of the ankle joint structure, which also includes the tibia. The cyst of the talus is most often diagnosed in young people, less often in children under 14 years old, which distinguishes this pathology from many other cysts of bone tissue. It is well known that CCM and ACC are typical diseases associated with dysplasia of the bone growth zone, which develops in childhood. However, the specificity of the talus bone lies in the fact that it is almost completely responsible for the process of walking and assumes the entire weight of a person in motion. Thus, this bone, often undergoing a load, becomes a rather vulnerable zone, especially in the presence of osteopathology or calcium deficiency in the bone.
The talus bone transfers the load to the heel, the middle zone of the foot, so often its pathologies manifest themselves in the bones of these zones.
Clinical signs of talus cyst:
- The onset of cyst development is hidden.
- The active cyst of the talus manifests itself in the form of aggravated pains that become intense during prolonged walking or running.
- The cyst of the talus can provoke a fracture of the ankle.
As a rule, such a tumor is defined as benign, but it must be removed as early as possible in order to prevent pathological fractures.
The cyst is visualized as a subchondral neoplasm with clear contours. The tumor does not extend to the joint, but can limit its mobility.
The localization of the cyst in the talus is considered not very favorable due to frequent recurrences of the pathology, even with a carefully performed operation. A high risk of complications is associated with a specific anatomical structure of the talus and its intensive blood supply. Disturbance of blood flow, both at the time of a pathological fracture, and during an unavoidable operation in adult patients, can lead to avascular necrosis and even to disability of the patient. In addition, the talus bone is surrounded by other bone tissues - heel, scaphoid, bone of the ankle, so determining the exact location of the cyst or fracture, and rapid access is very difficult. Operation pop about cyst astragalus seu talus is considered one of the most difficult among all operational techniques for the removal of bone cysts, the process of graft survival is also complex. Time recovery, rehabilitation after surgery on the talus can last for 2-3 years. In 5-10% of cases, treatment results in disability of the patient, mainly this refers to patients older than 45 years.
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Cyst of metatarsal bone
Metatarsus, metatarsal bone, is a combination of five small tubular bones, rather short and brittle compared to other bones of the foot. Each of the five parts of the metatarsal bone in turn consists of the base, body and head, the most prominent forward, the long one - this is the second metatarsal bone, the shortest and strongest - the first. It is in them that the bone cyst is most often formed, although according to statistics such tumor formations in these parts of the foot are rarely diagnosed early and, rather, they are confused with other bone diseases. The structure of the metatarsal bones is very similar to the metacarpal, but still visually look narrower and squeezed laterally, although for all their fragility they successfully amortize our gait, they help withstand static body weight loads.
Diagnosis of the metatarsal cyst is very difficult due to various reasons:
- Rare cases of the disease and the absence of statistically, clinically confirmed information about such pathologies.
- Similarity of symptoms of cyst metatarsus and other tumor-like formations in this zone.
- Frequent pathological fractures of the metatarsal bone in the presence of osteopathy.
- Absence of unified diagnostic differential criteria.
Errors in the examination and diagnosis of the CCM or ACC of the metatarsal zone are quite common and are one of the reasons for the high incidence of disability in patients. In addition, there are descriptions of the malignancy of the metatarsus bone cyst, when a neglected process or recurrence of a spontaneous fracture leads to malignancy of the tumor. Diagnosis should be thorough and include in addition to collecting anamnesis and a standard X-ray examination, even CT, ultrasound, scintigraphy, histology. Conservative treatment of cysts of metatarsals does not bring any result, therefore it is most often operated on. The only way to avoid surgery can be an uncomplicated fracture, after which the cyst collapses and disappears. But such cases can be only in a few patients, mainly in the age of 12 years. Treatment of adult patients is much more complicated and traumatic. The cyst is resected, the bone defect is filled with aaloplastic material.
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Cyst on the bones of the hand
Manus - the upper limb, the hand consists of such anatomical parts:
- Angulum membri superioris is a shoulder girdle, which in turn consists of such structural parts:
- Articulatio acromioclavicularis - acromioclavicular joint.
- Humerus - humerus.
- Ulna - a pair of ulnar bone.
- Radius is the twin radius.
- The wrist, consisting of 8 bones.
- Scaphoid, trihedral, semilunar, pea-bones - proximal level.
- Trapezoidal, capitate, hook-shaped bones - distal level of the hand.
- Pasty, consisting of 5 bones.
- The fingers are the bones of the phalanx.
The cyst of the arm bones is predominantly localized in the humerus, much less often cystic dysplasia is noted in the forearm or in the bones of the hand. This is due to the fact that the CCM and ACC prefer to form in the metaphyseal sections of the tubular long bones, small and short bone structures simply do not have the necessary width of the cavity for the development of tumors and are not able to intensively and rapidly elongate during the period of intensive growth of a person - childhood and adolescence. Clinical cases of diagnosis of solitary cysts in the distal phalanges of the fingers of adult patients, described in the medical literature can be considered a rarity and most likely, such definitions are erroneous. Quite often, bone cysts are difficult to separate from similar osteoblastoclast or similar chondrames. Precise diagnosis and differentiation is possible only with CT or MRI, which is not always available to patients.
Radiographically, the bony cyst looks like a light area of rounded shape in the bone metaphysis, the tumor has clear boundaries, inclusions are usually absent, the cortical layer is significantly reduced, often swollen. Histological analysis of the wall of the formation shows a weakly vascularized connective tissue with signs of hemorrhage with an aneurysm cyst or without them in the determination of a solitary cyst.
The process of development of the cyst in the arm bones is always accompanied by focal destruction, bone resorption. Gradually increasing, the cyst is shifted toward the diaphysis without touching the shoulder joint, without causing a change in the periosteum and any signs of inflammation in general.
The symptomatology of cystic education in the upper limb is nonspecific, the patient can feel periodic discomfort with rotational movements of the hand, lifting his arm up while doing sports. The tumor is rarely manifested by visual signs, only a large cyst may look like an obvious swelling.
The most typical symptom, more accurately evidence of the neglect of the process, is a pathological fracture. Most often, the fracture is localized in the forearm, it can be triggered both by physical activity (lifting of gravity), and falling, bruise. A pathological fracture or fracture of the bone quickly fuses, with this the cyst cavity decreases, it disappears.
Diagnosis of the cyst on the bones of the hand using X-rays, osteoscintigraphy, computed tomography and ultrasound. Treatment with timely diagnosis and a small amount of cyst is done conservatively, by immobilizing the upper limb and puncturing. In the absence of positive dynamics for 1.5-2 months, the cyst is surgically removed. Also, the operation is indicated if, after a pathological fracture, the cyst does not decrease. It must be removed in order to avoid a recurrent fracture of the arm.
The prognosis of cysts in the arm bones of children is generally favorable, the specificity of the child's organism is that the abilities for self-correction and reparation at this age are very high. In adults, the process of recovery, rehabilitation of the hand lasts much longer, damage to the muscle tissue during surgery can provoke some limitations in the functions of the upper limb. In addition, there is a risk of rejection of the bone implant inserted into the resection defect. To fully implant the alloplastic material or autograft, it takes from 1.5 to 3 years.
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Solitary cyst of bone
In the last century, a solitary simple cyst was considered the final stage in the formation of a giant-cell bone tumor. Currently, the solitary cyst of the bone according to ICD-10 is considered an independent nosological unit. The disease most often affects children and adolescents, it is not accidental that it is also called a juvenile bone cyst.
Cysta ossea solitaria or a solitary cyst of the bone is diagnosed more often than an aneurysmal tumor. In 65-70% of the solitary cyst is detected in childhood in boys and looks like a benign single-chambered formation localized mainly in the humeral girdle or in the hip bones. The symptoms of a simple bone cyst are non-specific, often the manifestation of a clinical sign and the reason for going to the doctor becomes a pathological fracture. Statistically, among patients with solitary bone cyst (CCM), boys aged 9 to 15 years predominate. In adult patients, a solitary cyst is not found, thus, the established diagnosis of CCM in individuals over the age of 40 can be considered an error due to insufficient differentiation of benign bone tumors.
Localization and symptomatology of a solitary cyst bone:
- The predominant zone of CCM development are tubular long bones - the zone of the shoulder girdle, femurs. Localization of a simple cyst in small short bones is not typical and requires careful differentiation from the chondroma, sarcoma, ganglion.
- The CCM is asymptomatic for a long period, sometimes up to 10 years.
- Indirect signs of the development of a solitary cyst may be transient pain in the area of the tumor.
- In the developmental area of the cyst, if it increases to 3-5 centimeters or more, a slight visible swelling is possible.
- A characteristic feature of the large cyst formed is a pathological spontaneous fracture, uncomplicated by displacement.
- At a primary examination and palpation, the cyst is felt as a painless seal.
- Pressing on the wall of the tumor causes the deflection of the destroyed bone segment.
- The volume of movement of the cyst is not limited, except for the femur cyst that provokes intermittent claudication.
. The solitary bone cyst develops within the clinical stages:
- Active development of the cyst causes a thickening of the bone visible on the X-ray, can provoke a pathological fracture, immobilization of the damaged joint. The active stage lasts from six months to one year.
- Passive stage of development of the cyst begins with the moment of displacement of the tumor in the center of the bone, while the cyst significantly decreases in size, falls off. This stage can also be asymptomatic and last from 6 to 8 months.
- The stage of bone restoration starts from the moment of the termination of the growth of the bone system, after 1.5-2 years from the beginning of the active stage. Nevertheless, destructive bone lesions remain and can still be a provoking factor of a pathological fracture. Fracture in turn helps to close the cavity of the cyst and compensatory replacement mechanism of filling the cavity with bone tissue.
The juvenile solitary cyst of the bone is most often treated with a conservative method and immobilization of the affected area. If this method does not yield results and the disease progresses, the cyst is surgically removed, resection is performed within intact tissues with obligatory allo or autoplasty.
Treatment of patients older than 16-18 years is 90% surgical, since the detection of a cyst at this age indicates its long development and significant bone destruction, which is a huge risk of multiple recurrent fractures.
Aneurysmal cyst of bone
ACC or an aneurysmal cyst of bone in surgical practice is rare, but the complexity of its treatment is not due to individual diagnoses, but rather to the end of the unspecified etiology. In addition, ACC is most often detected in the spine, which in itself indicates the severity of the disease and the risk of complications from the spinal cord. Aneurysmal cyst of a large size or a multi-chamber tumor localized in the bone tissue of the vertebra, can cause paresis and paralysis, and also tends to malignant.
AAC is a significant, extensive lesion of bone tissue, the cyst looks like a multi-chamber, less often a single chamber cavity filled with blood exudate, the walls may be with small parts of the bone. Until the middle of the last century an aneurysmal tumor was not isolated as an independent disease and was considered a variety of osteoblastoklastomy. Today ACC is diagnosed as a benign tumor, burdened with multiple complications when localized in the spine.
The specificity of an aneurysmal cyst development is that it is very aggressive, unlike a solitary tumor. Rapid growth and increase in its size sometimes resembles a malignant process, but AAC very rarely maligns and is successfully successfully operated with timely detection. Most often AAC is diagnosed in children during intensive growth - 6 to 15-16 years, according to some information aneurysmal tumors predominate in girls, although this information is contradictory and not confirmed by reliable statistics. The favorite location of the AAK is the cervical and thoracic spine, sometimes it forms in the bones of the hip joint, in the lumbar region and extremely rarely in the calcaneus. AAC of large sizes can capture several vertebrae at once - up to 5, which is complicated by paralysis, including irreversible ones.
Symptoms of AAC - aneurysmal bone tumor:
- The onset can occur without clinical signs, asymptomatic.
- As the child's cysts increase, the aching aching pain in the area of bone damage is disturbed.
- The pain is aggravated by physical exertion, stress, can disturb at night.
- In the zone of cyst formation, the swelling is clearly visible.
- The cyst, located near the joint, limits the volume of its movements.
- Aneurysmal tumor in the femur causes lameness, disrupts the supporting function.
- A large cyst provokes paresis and partial paralysis, which debuts at first sight for no apparent objective reason.
- To provoke the acceleration of the development of a cyst may be injuries or bruises.
AAC can have such forms of development:
- Central AAK - localization at the center of the bone.
- Eccentric AAC - an enlarging cyst captures nearby tissues.
Uncomplicated aneurysmal bone tumor can be closed independently after a pathological fracture, however such cases are very rare, most often AAC has to operate. The most difficult are operations to remove the cyst on the vertebra, since the surgeon works with a very vulnerable and dangerous zone - the vertebral column and multiple nerve endings. After removal of AAC, a very long recovery period, rehabilitation measures are required, in addition aneurysmal cysts are prone to recurrence even in the case of a carefully performed operation. The risk of recurrence is very high, according to statistics, 50-55% of patients who have been through surgical treatment again get to the surgeon. The only way to reduce the risk of recurrence can be permanent medical supervision and a regular examination of the bone system.
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