Solid Variant Of Aneurysmal Bone Cyst (S-ABC) of Thoracic Spine
|IJOCP | November 2015 | Volume 2015 | Issue 2015 | Page 120
Conference: 28th Annual Conference of Association of Spine Surgeons of India 2015, Pune. , India [Click for Full details]
Authors: Pravin Padalkar, Varun Joshi, Saurabh Tanver
Authors Affiliatoins: MGM Institute of Health Sciences.
Address of correspondence: Pravin P Padalkar Center for Orthopaedic Superspecialities & spine Surgery, 105, Neel Enclave, Sec 09, Khanda Colony, New Panvel, Navi Mumbai 410206
Background – The solid variant of aneurysmal bone cyst is rare, accounting for 3.4% to 7.5% of all aneurysmal bone cysts. The diagnosis is difficult to secure radiographically before biopsy or surgery. There is a distinct solid variant of aneurysmal bone cyst, first described by Sanerkin et al. in 1983. This solid variant may be easily misdiagnosed as a spindle cell tumor, especially osteosarcoma.
Material & Methods:
Case Study: A 16-year-old man presented to us with sudden onset of weakness in both lower limbs leading to paraplegia. A rectal examination showed good rectal tone and no perineal anesthesia. The post-void residual volume of urine was negligible. His premedical history was unremarkable. Laboratory findings were all within normal limits. Plain radiograph revealed collapse of D5 vertebrae, expansile osteolytic lesion occupying T5 destroying the lamina and pedicle & left transverse process and rib head. MRI revealed a large hypointense lesion on T1- weighted images with homogenous enhancement & mixed low-signal intensity with scattered high-signal intensity areas on T2-weighted MRI. Attempt to establish preoperative tissue diagnosis couldn’t be done due to non fesibility at our institute & urgency of decompression
Our patient was taken to the operating room with an initial plan of total en-block spondylectomy of T5. Intraoperatively, histology favoured (S-ABC) variant rather than GCT. Thus, initial plan was revised to palliative surgery decompression without resecting body en block via posterolateral approach. Post-operatively, our patient was neurologically intact.
Depending on the proliferative component, the solid variant of aneurysmal bone cyst may be histologically misdiagnosed for other benign , malignant and tumor like lesions of the bone. The pathological differential diagnosis includes solitary bone cyst, hemangioma, osteosarcoma, giant cell tumor, and chondroblastoma. At 16 months after surgery, our patient remains neurologically intact with resolution of his chest and back pain.There was reconstituation of diseases of vertebral body with new bone formation & healing.
Whether an aggressive surgical approach results in a better outcome and recurrencerate than a more conservative one (for example, curettage alone) remains to be seen in longer-term follow-up, and is the subject of future studies. This discussion concludes that ABC should be kept as a differential diagnosis for tumour of spine. Intra-operative frozen section may be useful to determine aggression of surgery.
|How to Cite this Abstract|
|Padalkar P, Joshi V, Tanver S. Bipedicular Fixation of affected Vertebare in thoracolumbar Brust Fractures. International Journal of Conference Proceedings November 2015;(2015):120|