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Cemento-osseous dysplasia (COD) is classified, by the World Health Organization as a benign fibro-osseous lesion related to the tooth and periapical area of the jaws and is considered as a benign reactive process appearing from the apical periodontium in close relation with the apices of teeth. Usually, it is asymptomatic, discovered accidentally, and affecting particularly middle-aged African women. There are four subtypes distinguished of the lesion: periapical (PCOD), focal (FCOD), florid (FLCOD) and familial florid cementoosseous dysplasia (FFLCOD). Pseudocysts found in the jaws go by various names, including solitary bone cyst, traumatic bone cyst, or simple bone cyst (SBC). These two pathologies have been reported separately; however, their co-occurrence remains rare and the first case of FLCOD with co-occurrence of SBC was reported by Melrose et al. in 1976 and later a few cases been reported in the literature. The aim of this report is to describe a case of a 46- year-old oriental female diagnosed with FLCOD with co-occurrence of SBC. Under local analgesia, a surgical exploration of the cyst was performed. In addition, a biopsy with a trephine was done in the region of missing right first mandibular molar. Based on the patient clinical, radiographic, and histological findings, a diagnosis of FLCOD was made in cooccurrence with a mandibular SBC. An examination of another female family member unveils a distinctive case, and the familial factor has been ruled out. No further treatment was planned and only follow-up was suggested. [ABSTRACT FROM AUTHOR]

Cemento-osseous dysplasia (COD) is classified, by the World Health Organization as a benign fibro-osseous lesion related to the tooth and periapical area of the jaws and is considered as a benign reactive process appearing from the apical periodontium in close relation with the apices of teeth. Usually, it is asymptomatic, discovered accidentally, and affecting particularly middle-aged African women. There are four subtypes distinguished of the lesion: periapical (PCOD), focal (FCOD), florid (FLCOD) and familial florid cemento-osseous dysplasia (FFLCOD). Pseudocysts found in the jaws go by various names, including solitary bone cyst, traumatic bone cyst, or simple bone cyst (SBC). These two pathologies have been reported separately; however, their co-occurrence remains rare and the first case of FLCOD with co-occurrence of SBC was reported by Melrose et al. in 1976 and later a few cases been reported in the literature. The aim of this report is to describe a case of a 46-year-old oriental female diagnosed with FLCOD with co-occurrence of SBC. Under local analgesia, a surgical exploration of the cyst was performed. In addition, a biopsy with a trephine was done in the region of missing right first mandibular molar. Based on the patient clinical, radiographic, and histological findings, a diagnosis of FLCOD was made in co-occurrence with a mandibular SBC. An examination of another female family member unveils a distinctive case, and the familial factor has been ruled out. No further treatment was planned and only follow-up was suggested.

Purpose: The aim of this study was to evaluate and compare different surgical treatment modalities for simple bone cysts (SBC) of the humerus regarding their effectiveness and recurrence rate. Methods: In this retrospective study, patients who received surgical treatment for previously untreated primary SBCs of the humerus were analyzed. Demographic data, cyst-specific as well as treatment-specific parameters, complications, treatment failures, and recurrence rates were collected and correlated with different treatment modalities. Observed procedures were categorized as open procedure (n=20) or osteosynthesis alone (n=3). For the open procedure group, four subgroups could be defined. Results: Twenty-three patients were included. The mean age at diagnosis was 11.6 ± 2.5 years, and the mean postoperative follow-up was 3.9 ± 2.6 years (range 1.0–10.3). After surgical intervention, a total of five (21.7%) patients showed at least one recurrence. Fracture occurred in three (13.0%) cases. The incidence of treatment failure was significantly higher in the curettage, allograft, adjuvants group, with five (83.3%) of six cases showing recurrence, than in the other subgroups (≤ 25.0%) including the osteosynthesis alone group (p=.024). For the open procedure group, the failure-free survival rates were 80.0% after two years and 50.4% after five years. For the three cases treated by osteosynthesis alone, no failures were observed. Conclusion: Open procedures showed similar failure rates except for the subgroup using curettage, allograft, and adjuvants which showed significantly higher treatment failure. Promising results were observed in the group which received solely osteosynthesis without cyst excision or filling, as no treatment failure was observed here. [ABSTRACT FROM AUTHOR]

Simple Bone Cysts (SBCs) are benign, fluid-filled lesions primarily located in the metaphysis of long bones in children and adolescents. Depending on the clinical situation, management is performed, but the ultimate goal is to minimise surgical complications. Hereby, the authors present a case report presents the management of a seven-year-old male with a pathological refracture of the subtrochanteric region of the right femur due to an SBC. The patient presented with pain, swelling, and inability to bear weight on the affected limb. Diagnostic evaluation revealed a fracture in the subtrochanteric region along with a lytic, expansile lesion at the fracture site. The patient had a history of a similar fracture three years prior. Treatment involved closed reduction and internal fixation with two Flexible Intramedullary Nails (FIN), followed by immobilisation with a unilateral hip spica cast for six weeks. Follow-up radiographs showed satisfactory fracture reduction and signs of resolution of the bone cyst. The patient demonstrated good functional outcomes and successful management of the pathological refracture. The present case report contributes to the existing literature on the management of pathological refractures in paediatric patients and highlights the effectiveness of FINs as a treatment option in such cases.

Objective To analyze the clinical presentations, radiographic features, operative findings, and pathological characteristics of one patients with unilateral maxillary and mandibular simple bone cysts (SBC), and to enhance the clinicians’ recognition and treatment of this condition. Methods The clinical data, radiographic features, operative findings, pathological characteristics, clinical diagnosis, and treatment of a case with right-sided maxillary and mandibular SBC were collected,and the relevant literatures were reviewed. Results The patient, an 11-year-old male, presented with a clearly demarcated low-density image within the right maxillary and mandibular bones on panoramic tomography. There was no history of trauma, no subjective symptoms or facial asymmetry before treatment, and no positive signs of the specialist examination. The patient was diagnosed with right-sided maxillary and mandibular SBC based on the operative exploration and pathological diagnosis. The patient received the conventional curettage treatment and recovered well postoperatively without significant discomfort. A 6-month follow-up results showed good intraoral wound healing without swelling. The cone beam computed tomography (CBCT) results showed a smaller bone cavity with visible new bone trabeculae, indicating good osteogenesis. The patient was currently the under regular follow-up. Conclusion Unilateral maxillary and mandibular SBC do not present with characteristic clinical signs and radiographic features, which can be easily confused with the common maxillofacial diseases. A definitive diagnosis should be made by combining radiographic examination with surgical and pathological findings. [ABSTRACT FROM AUTHOR]

Simple bone cysts (SBCs) are nonneoplastic intraosseous cavities without an epithelial lining, surrounded by bony walls and either empty or containing liquid and/or connective tissue: they were first described in 1929 as a distinct entity of disease. The characteristic that distinguishes SBCs from true cysts is the absence of epithelial lining, that allow us to regard SBCs as pseudocysts.In the literature, SBCs have been referred to as solitary bone cysts, idiopathic bone cysts, unicameral cysts, traumatic bone cysts, hemorrhagic bone cysts, primary bone cysts, and extravasation cysts.The pathogenesis of SBC remains uncertains. Radiographically, SBCs usually present as isolated unilocular radiolucencies with well-defined borders. When SBC extends to the interdental bone, the characteristic radiographic “scalloping effect” can be observed. The differential diagnosis includes apical periodontitis, odontogenic keratocyst, central giant cell granuloma, ameloblastoma, odontogenic myxoma, and central and neurogenic neoplasms.Surgery (curettage) is the gold standard treatment as it allows both diagnosis and treatment by generation of a blood clot in the vacant cavity of SBCs: bone usually regenerates progressively within 6–12 months. Recurrence rate is almost negligible.The aim of the present article is to present and discuss the diagnosis and management of a case of SBC.

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Simple bone cysts (SBCs) are benign cavitary lesions that most commonly affect adolescent males in the first 2 decades of life. They are mainly asymptomatic but can manifest with pain or pathological fractures. Despite numerous proposed methods for managing calcaneal SBCs, the optimal approach toward these lesions remains controversial. Herein, we report a case of a 16-year-old girl with a calcaneal SBC. On local examination, tenderness was the only noteworthy sign. In an outpatient setting, under conscious sedation, 2 interosseous needles were simultaneously inserted into the cyst under the guidance of CT fluoroscopy. Without aspiration, a radiopaque bone cement mixture was injected into the cyst from 1 needle until serosanguineous fluid efflux from the second needle ceased. Over a 2-year follow-up period, the patient recovered without any complications. This novel technique has the potential to be used as a feasible and minimally invasive approach in the management of symptomatic unicameral calcaneal bone cysts.

Here, a 36-year-old female patient with inflammatory sacroiliitis and simple bone cyst of the ipsilateral iliac bone is presented. Simple bone cysts occur in the developing skeleton, usually asymptomatic; however, they are benign lytic bone lesions that can cause pathological fractures. The prevalence of simple bone cysts in the whole body has been reported as 0.30/100000. Only 2% of these rare cysts are found in the pelvis, and according to our knowledge, it is the first case in which iliac simple bone cyst is seen together with sacroiliitis on the same side.

Aims: Simple Bone Cysts (SBCs) predominantly occur in long bones and 59% harbour NFATC2 rearrangements. Jaw SBC is rare and was previously referred to as traumatic bone cyst. It can rarely occur in association with cemento‐osseous dysplasia (COD). To determine whether jaw SBCs represent the same entity as SBC of the long bones, or if they have a different molecular signature, we collected 48 jaw SBC cases of 47 patients to assess NFATC2 rearrangement. Methods and results: Out of the 48 cases, 36 could be used for fluorescence in‐situ hybridization (FISH), of which nine (two of which associated with COD) were successful using an NFATC2 split probe. The remaining cases failed to show adequate FISH signals. All nine cases lacked NFATC2 rearrangement and five of these showed no detectable gene fusions using Archer FusionPlex. Conclusion: In our study, NFATC2 rearrangement is absent in solitary jaw SBC (n = 7) and COD‐associated SBC (n = 2). Our findings suggest that SBC presenting in the jaw is molecularly different from SBC in long bones. Future molecular studies may confirm the absence of clonal molecular aberrations in SBC of the jaw which would support a non‐neoplastic, reactive origin. [ABSTRACT FROM AUTHOR]

Simple bone cysts (SBCs) and intraosseous lipoma (IOL) of the calcaneus are rare tumor entities that are primarily diagnosed due to unspecific heel pain, incidental findings, or rarely due to pathological fractures. Compared to traditional open tumor resections, endoscopic resection of these benign tumors aims to minimize surgical morbidity and maximize surgical efficiency without compromising safety. Grafting is regularly performed to reduce the risk of recurrence and stimulate osseous consolidation of the lytic lesion. As the incidence is low and treatment strategies are heterogeneous, there is no clear consensus for the treatment of simple cysts or intraosseous lipomas of the calcaneus. The objectives of this study are (a) to present medium to long-term results after endoscopic resection and grafting with allogenic cancellous bone or bioresorbable hydroxyapatite and calcium sulfate cement, and (b) to add further evidence to the discussion of whether calcaneal SBC and IOL are the same entity at different developmental stages. Between 2012 and 2019, a total of 25 benign bone tumors consisting of 17 SBCs and 8 IOLs were treated by A.T. with endoscopic resection and grafting, comprising the largest cohort to date. For grafting, 12 patients received allogenic cancellous bone (group A) and 13 patients received injectable bone substitute (group B). Pre- and postoperative imaging using plain X-rays and MRI was retrospectively analyzed with a mean follow-up time of 24.5 months to assess tumor size, osseous consolidation (modified Neer classification), and tumor recurrence. A retrospective chart analysis focusing on adverse intra- and perioperative events and other complications associated with the surgical procedure was performed using the modified Clavien–Dindo classification (CD1-3). A total of 12/13 cases with allogenic bone grafting showed a Neer Type 1 osseous healing of the tumorous lesion after endoscopic resection, whereas only 5/11 cases with injectable bone substitute showed sufficient healing (types 1 and 2). There were three recurrent cysts (Neer 4) and two persistent cysts (Neer 3) after using injectable bone substitute. Two CD1 complications were observed in group A (prolonged wound drainage, sural neuritis) and eight complications were observed in group B (6× CD1, 2× CD3). At least two IOLs diagnosed preoperatively using MRI were ultimately identified as SBCs upon histopathologic examination. Allogenic cancellous bone grafting after endoscopic resection of calcaneal SBC or IOL showed a very low rate of complications and no tumor recurrence in our series. On the other hand, depending on the material used, injectable bone substitute showed a high rate of "white-out" (excessive drainage), resulting in multiple complications such as prolonged wound healing, insufficient permanent defect filling, recurrence, and revision surgery. Over time, calcaneal SBC may transform into IOL, exhibiting distinct features of both entities simultaneously during ossoscopy and histopathological analysis. [ABSTRACT FROM AUTHOR]

Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features. [ABSTRACT FROM AUTHOR]

Cemento‐osseous dysplasia (COD) is a non‐neoplastic, usually asymptomatic condition characterized by the presence of amorphous cement‐like calcifications located exclusively in the tooth‐bearing regions of the jawbone. Simple bone cysts (SBCs) of the jaws are benign intraosseous cavities, empty or filled with serous, serohematic, or blood fluid. They are characterized by the absence of an epithelial lining. COD and SBCs are two distinct lesions of the jaws that have long been described separately in the literature; however, their co‐occurrence remains rare and only a few cases have been reported illustrating this relationship. This association can be considered as a distinct entity since it presents specific epidemiological, clinical, and radiological data. The aim of this article was to report a new case of association between COD and SBC by illustrating a florid COD formation in mandibular SBC detected in a 31‐year‐old patient followed over a period of 11 years. [ABSTRACT FROM AUTHOR]

Here we report a rare case of a 46-year-old female with multiple simple bone cysts (SBC) with recurrence as noted by the appearance of new lesions during a routine follow-up. The patient visited a dental clinic for a toothache in 2008, and panoramic radiography revealed mixed radiolucent-radiodense lesions with well-defined borders in the mandibular first and second molar sites bilaterally. An intra-oral examination performed at our institute in July 2019 revealed no apparent swelling on either side of the mandible and no gingival or oral mucosa abnormalities. Panoramic radiography revealed radiolucent lesions with well-defined borders in the bilateral mandibular molar region. Biopsy was performed under local anesthesia and no evidence of an epithelial lining was found in the specimens obtained from either side of the jaw, suggesting a diagnosis of SBC; therefore, curettage was performed in the surrounding bone. One year post-surgery, a new lesion was observed in the left upper first molar region; consequently, curettage was performed. Histopathological examination once again suggested SBC. Six months later, relapse was observed on the right side of the mandible. Curettage was performed in September 2021, and there has been no evidence of recurrence and no clinical symptoms. Based on this case, we concluded that it is essential to counsel patients on the necessity of periodic follow-up with imaging and raise awareness regarding the risk of recurrence of SBC. [ABSTRACT FROM AUTHOR]

Here, a 36-year-old female patient with inflammatory sacroiliitis and simple bone cyst of the ipsilateral iliac bone is presented. Simple bone cysts occur in the developing skeleton, usually asymptomatic; however, they are benign lytic bone lesions that can cause pathological fractures. The prevalence of simple bone cysts in the whole body has been reported as 0.30/100000. Only 2% of these rare cysts are found in the pelvis, and according to our knowledge, it is the first case in which iliac simple bone cyst is seen together with sacroiliitis on the same side. [ABSTRACT FROM AUTHOR]

Abstract Cemento‐osseous dysplasia (COD) is a non‐neoplastic, usually asymptomatic condition characterized by the presence of amorphous cement‐like calcifications located exclusively in the tooth‐bearing regions of the jawbone. Simple bone cysts (SBCs) of the jaws are benign intraosseous cavities, empty or filled with serous, serohematic, or blood fluid. They are characterized by the absence of an epithelial lining. COD and SBCs are two distinct lesions of the jaws that have long been described separately in the literature; however, their co‐occurrence remains rare and only a few cases have been reported illustrating this relationship. This association can be considered as a distinct entity since it presents specific epidemiological, clinical, and radiological data. The aim of this article was to report a new case of association between COD and SBC by illustrating a florid COD formation in mandibular SBC detected in a 31‐year‐old patient followed over a period of 11 years.

In the last decade, new tumor entities have been described, including EWSR1/FUS::NFATC2-rearranged neoplasms of different biologic behavior. To gain further insights into the behavior of these tumors, we analyzed a spectrum of EWSR1/FUS::NFATC2-rearranged neoplasms and discuss their key diagnostic and molecular features in relation to their prognosis. We report five patients with EWSR1/FUS::NFATC2-rearranged neoplasms, including one simple bone cyst (SBC), two complex cystic bone lesions lacking morphological characteristics of SBC, and two sarcomas. In three cases, fluorescence in situ hybridization (FISH) and in all cases copy number variation (CNV) profiling and fusion analyses were performed. All patients were male, three cystic lesions occurred in children (aged 10, 14, and 17 years), and two sarcomas in adults (69 and 39 years). Fusion analysis revealed two FUS::NFATC2 rearrangements in two cystic lesions and three EWSR1::NFATC2 rearrangements in one complex cystic lesion and two sarcomas. EWSR1 FISH revealed tumor cells with break-apart signal without amplification in one complex cystic lesion and EWSR1 amplification in both sarcomas was documented. CNV analysis showed simple karyotypes in all cystic lesions, while more complex karyotypes were found in NFATC2-rearranged sarcomas. Our study supports and expands previously reported molecular findings of EWSR1/FUS::NFATC2-rearranged neoplasms. The study highlights the importance of combining radiology and morphologic features with molecular aberrations. The use of additional molecular methods, such as CNV and FISH in the routine diagnostic workup, can be crucial in providing a correct diagnosis and avoiding overtreatment. [ABSTRACT FROM AUTHOR]

Introduction: Unicameral Bone Cysts (UBC) are benign fluid filled lesions at metaphyseal regions of long bones of immature skeleton. Several treatment options exist but none have proven to be the best. Curettage helps to remove the cyst membrane responsible for lysis of bone and fibular grafting with plate osteosynthesis which gives adequate stability to the fracture and promotes healing of the UBC of proximal humerus with pathological fracture. Aim: To assess functional outcome, pain relief, healing of the cyst and recurrence of lesion with curettage and fibular bone grafting with proximal humerus plating in UBC of proximal humerus with pathological fracture. Materials and Methods: This was a retrospective study done using the medical records of 10 patients with UBC of proximal humerus with pathological fracture treated with curettage and fibular grafting and plate osteosynthesis at Nizams Institute of Medical Sciences, Hyderabad, Telangana, India, between January 2018 to December 2021. Patients were studied for functional outcome by Musculoskeletal Tumour Society (MSTS) score before surgery and one year after surgery. Healing of the cysts was evaluated by using a modified classification system by Chang et al., and pain relief was evaluated with pre and postoperative Visual Analogue Scale (VAS). Paired t-tests were used to compare the MSTS scores and VAS scores. Results: MSTS score increased significantly after surgery from 11.6±2.06 to 27.3±1.6, p<0.0001. Cysts have healed completely in seven cases, partially in three cases and recurrence was seen in three cases at the end of one year. Mean VAS scores decreased significantly from 7.60±0.97 to 1.40±0.97 after the surgery. Among three cases with recurrence of UBC, two cases were diagnosed at eight months and one case at 12 months after surgery. Conclusion: Treatment of UBC of proximal humerus with pathological fracture by curettage, fibular grafting and plate osteosynthesis gives good functional outcome and cyst healing rate. It is a safe and effective procedure without any complications. [ABSTRACT FROM AUTHOR]

Introduction: Unicameral Bone Cysts (UBC) are benign fluid filled lesions at metaphyseal regions of long bones of immature skeleton. Several treatment options exist but none have proven to be the best. Curettage helps to remove the cyst membrane responsible for lysis of bone and fibular grafting with plate osteosynthesis which gives adequate stability to the fracture and promotes healing of the UBC of proximal humerus with pathological fracture. Aim: To assess functional outcome, pain relief, healing of the cyst and recurrence of lesion with curettage and fibular bone grafting with proximal humerus plating in UBC of proximal humerus with pathological fracture. Materials and Methods: This was a retrospective study done using the medical records of 10 patients with UBC of proximal humerus with pathological fracture treated with curettage and fibular grafting and plate osteosynthesis at Nizams Institute of Medical Sciences, Hyderabad, Telangana, India, between January 2018 to December 2021. Patients were studied for functional outcome by Musculoskeletal Tumour Society (MSTS) score before surgery and one year after surgery. Healing of the cysts was evaluated by using a modified classification system by Chang et al., and pain relief was evaluated with pre and postoperative Visual Analogue Scale (VAS). Paired t-tests were used to compare the MSTS scores and VAS scores. Results: Mean age of the study group was 15.6±2.3 years with range of 11-19 years. The MSTS score increased significantly after surgery from 11.6±2.06 to 27.3±1.6, p

Purpose: Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out.Objective: We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation.Methods: In this retrospective study, we included 30 children (median age 10.5 years; range 1.1-17.8 years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87 months (range 24-156 months). We evaluated the healing of lesions according to Capanna's classification and rated functional outcomes according to Merle d'Aubigné and Postel score.Results: Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5 months (range 3-7 months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d'Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15-17 points) and only 1 (3.3%) patient had a fair result (14 points).Conclusion: Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children.Level Of Evidence: Therapeutic, retrospective comparative study-Level III. [ABSTRACT FROM AUTHOR]

Solitary Bone Cyst (SBC) are the bony cysts which lack epithelial lining. They are also known as simple bone cysts or pseudocyst. This fluid filled lesions, lies in an intact bony wall. These lesions are not a common clinical finding and are frequently discovered by chance in radiographs during routine examinations. The aetiopathogenesis has not been studied in depth, and the management remains controversial. When presented in oral cavity, the most common site of occurrence is body of mandible with 75% occurrence among jaw bones while prevalence in maxilla is only 1% in the jaw bone. In this case report, solitary bone cyst is presented in a 12-year-old male patient, who came with chief complaint of bony enlargement on buccal aspect of maxilla in the posterior region. The lesion presented as a painless swelling for three months gradually increasing in size. The patient was treated with surgical excision and there was no sign of regional recurrence at three months of postoperative follow-up. In this paper, the authors presented a rare case report of solitary bone cyst in maxilla in a paediatric patient.

Objective:Steroid injections represent one of the simple treatment alternatives for simple bone cysts (SBC). The aim of this study was to evaluate the results of local steroid injections in the treatment of SBC.Methods:Seventeen patients (11 males, 6 females; mean age 12.4 years; range=2 to 39 years) with SBC were treated with injection of methylprednisolone acetate (MPA) with the use of the two-needle technique. The cysts were localized in the proximal humerus (n=6), the calcaneus (one patient had bilateral lesions) (n=2), proximal femur (n=7) and the tibia (n=2). Pathological fractures occurred in three patients before steroid injection. These three patients with pathological fractures were treated with injection of MPA after fractures healed. Each patient received a maximum of four injections at eight week intervals, each consisting of 40-160 mg of MPA. The patients were followed up with plain radiographs obtained in the first month, third month, sixth month, and at the end of a year. After the first year, patients were followed up with plain radiographs once a year. The mean follow-up duration was twenty two months (range=3 to 48 months). Cyst healing was assessed according to the modified Neer classification.Results:Treatment with MPA resulted in complete recovery in ten cysts (55%) and recovery with residual lesions in three cysts (17%). Three cysts (17%) did not respond to steroid treatment and two patients (11%) developed recurrence. The results were satisfactory (72%) in patients with complete recovery and partial recovery with residual lesions, and unsatisfactory in five patients (28%). The patients with recurrence were treated with curettage and grafting or cementation. No procedure-related complications were encountered.Conclusion:Our findings suggest that, the treatment with local steroid injection in SBC provides satisfactory results, thus this treatment with low morbidity can be applied to these patients before aggressive treatment.

Florid cemento-osseous dysplasia (FCOD) can rarely be associated with bone lesions, including simple bone cysts (SBCs). Only a few cases showing the co-occurrence of these two distinct entities have been reported in the literature. This article reports two new cases of SBCs within FCOD. The first case involves a 37-year-old Black female with a large radiolucent lesion around the apex of the right third mandibular molar, accompanied by multiple cemento-osseous lesions around the mandibular teeth. Surgical exploration revealed an empty bone cavity, confirming the diagnosis of an SBC. Curettage of the bone walls was performed to stimulate healing, with promising results observed at the nine-month follow-up. The second case concerns a 44-year-old Black female presenting with a radiolucent lesion at the site of extraction of the left third mandibular molar and a slightly painful radiolucent/radio-opaque lesion in the apical region of the right first mandibular molar. Surgical exploration confirmed an SBC in the region of the left third mandibular molar and a bone biopsy was made. Histopathological analysis confirmed FCOD. Curettage of the bone wall was again used to promote healing through increased bleeding. At the 30-month follow-up, new dysplastic lesions had appeared, the initial SBC had healed completely, and a new SBC seemed to have developed in the apical region of the left second mandibular premolar. These cases highlight the importance of considering SBCs in the differential diagnosis of well-defined radiolucent lesions and demonstrate that surgical intervention for SBC-associated FCOD can yield favorable outcomes. From these cases, we learn the critical need for accurate diagnosis to avoid unnecessary treatments and the value of regular follow-up to monitor for recurrence or new lesions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rollin et al.)

Simple bone cysts (SBCs) are the most common osteolytic lesions in children, often leading to pathological fractures of non-weight-bearing bones. These benign tumors primarily arise in the proximal humerus, femur, or calcaneus. The cystic cavity is filled with serous or serosanguineous fluid and lined by a thin fibrovascular connective tissue membrane. The etiological factors include disturbances in bone growth, local venous obstruction, synovial origin disorders, and genetic predispositions. SBCs are most frequently observed in individuals from birth to 20 years of age. The report presented a case of a 12-year-old male patient who was admitted to the hospital with a history of a mass on his left upper arm. The mass had an acute onset and gradually progressed to its current size over three to four weeks, after which it became nonprogressive. The patient had been healthy until the age of four, after which he experienced frequent fractures of the left arm following trivial trauma. Multiple traumas led to the gradual formation of a diffuse mass over the upper part of the humerus. Radiological imaging modalities, such as X-ray and magnetic resonance imaging, are crucial in diagnosing bone cysts and evaluating their clinical conditions. Treatment can involve the injection of bone marrow or steroids into the cyst to facilitate the healing process., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sahu et al.)

In the last decade, new tumor entities have been described, including EWSR1/FUS::NFATC2-rearranged neoplasms of different biologic behavior. To gain further insights into the behavior of these tumors, we analyzed a spectrum of EWSR1/FUS::NFATC2-rearranged neoplasms and discuss their key diagnostic and molecular features in relation to their prognosis. We report five patients with EWSR1/FUS::NFATC2-rearranged neoplasms, including one simple bone cyst (SBC), two complex cystic bone lesions lacking morphological characteristics of SBC, and two sarcomas. In three cases, fluorescence in situ hybridization (FISH) and in all cases copy number variation (CNV) profiling and fusion analyses were performed. All patients were male, three cystic lesions occurred in children (aged 10, 14, and 17 years), and two sarcomas in adults (69 and 39 years). Fusion analysis revealed two FUS::NFATC2 rearrangements in two cystic lesions and three EWSR1::NFATC2 rearrangements in one complex cystic lesion and two sarcomas. EWSR1 FISH revealed tumor cells with break-apart signal without amplification in one complex cystic lesion and EWSR1 amplification in both sarcomas was documented. CNV analysis showed simple karyotypes in all cystic lesions, while more complex karyotypes were found in NFATC2-rearranged sarcomas. Our study supports and expands previously reported molecular findings of EWSR1/FUS::NFATC2-rearranged neoplasms. The study highlights the importance of combining radiology and morphologic features with molecular aberrations. The use of additional molecular methods, such as CNV and FISH in the routine diagnostic workup, can be crucial in providing a correct diagnosis and avoiding overtreatment.

Background: Presentation of benign lesions with a pathological fracture may be confusing to general orthopedic surgeons regarding missing a fracture in a pathological bone, the need for special care for these lesions, and the potential for healing of these fractures. The objective of this work was to evaluate the clinical and radiological outcomes of the treatment of patients with stages 1 and 2 Enneking benign bone-tumors presented with pathological fractures.Methods: This retrospective study included 66 patients who presented with a pathological fracture through stage 1 or 2 Enneking benign bone lesions and were received at the emergency unit of the orthopedic department between 2014 and 2018. Demographic data and patient's evaluation were collected. Lesion-size (length, width, and depth) was calculated from the X-ray. Surgical intervention was planned in 28 patients. The indication for surgery was either fracture fixation or curettage of the lesion with or without augmentation. There were no repeated surgeries or local recurrences. The filling of the cavity was classified according to modified Neer's classification.Results: Sixty-six patients, 45 males, and 21 females were included. Forty-two affections were right while 24 were left. The mean age was 14.9 ± 8.6 (range, 3-40) years. The most common radiological diagnoses were simple bone-cysts 43.9% (n = 29), followed by non-ossifying fibroma 27.3% (n =18). The mean length of the lesions was 4.4 ± 2.6 (range, 1 - 12) cm, width was 1.6 ± 0.8 (range, 0.3- 4.5) cm, and depth was 1.8 ± 0.9 (range, 0.3 - 5) cm. The mean follow-up was 24.15 ± 18.7 months. Minor complications occurred in 7 patients (10.6%). Fifty-four out of 65 lesions (83%) showed either almost complete or partial filling of the lesions. There was no significant difference regarding the filling of the lesions according to the modified Neer's classification between those who were treated conservatively and those who underwent surgical intervention P-value = 0.783.Conclusion: Careful diagnosis of a pathological fracture through stages 1 and 2 Enneking benign bone tumors is essential before initiating treatment. These fractures have good potential for bone healing and a low incidence of complications even with conservative treatment. Special surgical care of the lesion is not mandatory in all situations and should be individualized.Level Of Evidence: Level III, retrospective. [ABSTRACT FROM AUTHOR]

To screen the radiomic features of simple bone cysts of the jaws and explore the potential application of radiomics in pre-operative diagnosis of jaw simple bone cysts. The investigators designed and implemented a case–control study. 19 patients with simple bone cysts who were admitted to the Department of Maxillofacial Surgery, Sun Yat-sen University Affiliated Stomatology Hospital from 2013 to 2019 were included in this study. Their clinical data and cone-beam computed tomography (CBCT) images were examined. The control group consisted of patients with odontogenic keratocyst. CBCT imaging features were analyzed and compared between the patient and control groups. Overall, 10,323 image features were extracted through feature analysis. A subset of 25 radiomic features obtained after feature selection were analyzed further. These 25 features were significantly different between the 2 groups (p < 0.05). The absolute value of correlation coefficient was 0.487–0.775. Gray-level co-occurrence matrix (GLCM) contrast, neighborhood gray tone difference matrix (NGTDM) contrast, and GLCM variance were the features with the highest correlation coefficients. Pre-operative radiomics analysis showed the differences between simple bone cysts and odontogenic keratocysts, can help to diagnose simple bone cysts. Three specific texture features—GLCM contrast, NGTDM contrast, and GLCM variance—may be the characteristic imaging features of simple bone cysts of the jaw. [ABSTRACT FROM AUTHOR]

Aneurysmal (ABC) and simple bone cysts (SBC) have been traditionally distinguished by radiological and histopathological features. However, there is some radiological and histopathological overlap between ABC and SBC. ABC is characterised by USP6 fusions while, recently, NFATC2 fusions have been found in a large proportion of SBC. Identifying these fusions may assist in confirming the diagnosis of either ABC or SBC. To elaborate the potential benefit of molecular testing, we report a prospective series of 19 consecutive bone cysts with comprehensive radiological, histopathological and molecular diagnostics. Integrating radiological, histopathological and molecular findings, 11 cysts were diagnosed as SBC and 8 as ABC. Radiologically, 6 of 11 SBC and 6 of 8 ABC were diagnosed as ABC. Fibrin-like collagen deposits were identified in 8 of 11 (73%) SBC and 3 of 8 (38%) ABC. Nodular fasciitis-like areas were identified in 6 of 8 (75%) ABC and in 7 of 11 (64%) SBC. A USP6 fusion was identified in all 8 ABC, including a novel RBM5-USP6 fusion. An NFATC2 fusion was found in 7 of 11 SBC (FUS-NFATC2 fusion in 5 and EWSR1-NFATC2 in 2 cases). There is radiological and histopathological overlap between SBC and ABC in a significant proportion of cases. A diagnosis of ABC is frequently suggested radiologically in SBC, and fibrin-like deposits, thought to be specific for SBC, may be found in some ABC. Molecular testing may significantly improve diagnostic accuracy in bone cysts. [ABSTRACT FROM AUTHOR]

This review of the literature aims to compare the etiology, the pathogenesis, the clinical diagnostics and the relevant treatment options of two different types of cystic bone lesions: the solitary bone cyst (SBC) and the aneurysmal bone cyst (ABC). Whereas the clinical symptoms and the radiographic appearance can be similar, the diagnostic pathway and the treatment options are clearly different.The solitary bone cyst (SBC) represents a tumor-like bone lesion, occurring most frequently in the humerus and femur in children and adolescents. Pain caused by intercurrent pathological fractures is often the first symptom, and up to 87% of the cysts are associated with pathological fractures. In the majority of cases SBCs can be treated conservatively, especially in the upper extremity. However, if a fracture is completely dislocated, joint affecting, unstable or open, surgical treatment is necessary. Pain under weight bearing or regaining the ability to mobilize after fracture timely can necessitate surgical treatment in SBCs affecting the lower extremity. Spontaneous resolution can be seen in rare cases.The aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor that occurs in childhood and early adulthood. It usually affects the metaphysis of long bones but can also occur in the spine or the pelvis. ABC can be primary but also secondary to other bone pathologies. The diagnosis has to be confirmed by biopsy and histopathological examinations. With cytogenetic studies and the detection of specific translocations of the ubiquitin-specific protease (USP) 6 gene primary ABCs can be differentiated from secondary ABCs and other bone lesions. Among various modalities of treatment i.e. en bloc resection, intralesional curettage with adjuvants, embolization or the systemic application of denosumab, intralesional sclerotherapy using polidocanol is an effective and minimally invasive treatment of primary ABCs.

Abstract Background A traumatic bone cyst is an uncommon nonneoplastic lesion of the jaws that is considered as a “pseudocyst” because of the lack of an epithelial lining. This lesion is particularly asymptomatic and therefore is diagnosed by routine dental radiographic examination as a unilocular radiolucency with scalloped borders, mainly in the posterior mandibular region. The exact etiopathogenesis of the lesion remains uncertain, though it is often associated with trauma. Case presentation We report three Persian cases of traumatic bone cyst with different clinical and radiographic features, and we present a review of the literature to further discuss diagnostic and treatment challenges. Only one of the three patients reported a history of trauma, and despite the usual signs and symptoms of the lesion, extension of the defect to the ramus, swelling of the lingual cortex, and their unusual presence in the anterior mandible were noted in these patients. Conclusions Because features of this cyst can be varied, careful history taking and radiographic evaluation alongside the clinical signs and symptoms have a very significant role in definitive diagnosis, appropriate treatment, and accurate assessment of prognosis.

Aims: Simple bone cysts are benign intramedullary tumours primarily involving the long bones in skeletally immature individuals. Several mechanisms have been proposed for their pathogenesis. Although the diagnosis is typically straightforward, the interpretation can be problematic, because of superimposed fracture causing them to resemble aneurysmal bone cysts and other tumours. EWSR1–NFATC2 or FUS–NFATC2 fusions, which are characteristic of a subset of aggressive round cell sarcomas, have been recently detected in simple bone cysts. The aim of this study was to examine the clinicopathological and molecular features in a series of simple bone cysts. Methods and results: Using RNA‐based next‐generation sequencing and/or fluorescence in‐situ hybridisation, we investigated the presence of EWSR1 or FUS rearrangements in nine simple bone cysts. The patients were five females and four males, aged 3–23 years (median, 14 years); the tumours ranged from 19 mm to 160 mm (median, 46 mm) in size, and involved the femur (n = 3), humerus (n = 2), fibula (n = 2), tibia (n = 1), and iliac wing (n =1). We identified three cases with EWSR1–NFATC2 fusion (showing identical breakpoints to those in EWSR1–NFATC2 sarcomas) and one additional case with FUS rearrangement. Unlike in EWSR1–NFATC2 sarcomas, immunohistochemical expression of NKX3.1 and NKX2.2 was absent in two simple bone cysts tested. Conclusions: More than 40% of simple bone cysts harbour genetic alterations confirming that they are neoplastic, investigation of EWSR1 and/or FUS rearrangement may help to distinguish simple bone cysts from mimics, and NFATC2 rearrangement is not pathognomonic of malignancy. [ABSTRACT FROM AUTHOR]

Purpose: Fatty or part-fatty intraosseous lesions are occasionally encountered while imaging the skeletal system. A number of case reports have proposed involution of calcaneal bone cysts to intraosseous lipomas, but this has never been proven. This paper sets out to prove that simple bone cysts (SBCs) can involute to fatty lesions indistinguishable from intraosseous lipomas. Materials and methods: The pathology and PACS databases at 2 specialist orthopedic hospitals were retrospectively interrogated for all cases of intraosseous lipomas or SBCs with cross-sectional imaging follow-up for SBCs and precursor or follow-up imaging for intraosseous lipomas, in the time period from August 2007 to December 2016. For intraosseous lipoma cases, these were only included if change in imaging appearances was observed. Results: There was no case of change in the appearance in intraosseous lipomas. Six cases of SBC with cross-sectional imaging follow-up were identified in one participating hospital and none in the other. The 6 cases were comprised of 4 male and 2 female patients. Two were located in the proximal humerus, one in the proximal tibia, and 3 in the os calcis. All cases demonstrated filling in of the cystic lesion with fat from the periphery, in 2 cases complete filling in, and in 4 cases partial fatty conversion. Conclusion: SBCs can heal with fatty conversion of the cystic cavity, with partly cystic remnants. It is proposed that at least part of the so-called intraosseous lipomas are healed simple bone cysts. [ABSTRACT FROM AUTHOR]

Solitary Bone Cyst (SBC) are the bony cysts which lack epithelial lining. They are also known as simple bone cysts or pseudocyst. This fluid filled lesions, lies in an intact bony wall. These lesions are not a common clinical finding and are frequently discovered by chance in radiographs during routine examinations. The aetiopathogenesis has not been studied in depth, and the management remains controversial. When presented in oral cavity, the most common site of occurrence is body of mandible with 75% occurrence among jaw bones while prevalence in maxilla is only 1% in the jaw bone. In this case report, solitary bone cyst is presented in a 12-year-old male patient, who came with chief complaint of bony enlargement on buccal aspect of maxilla in the posterior region. The lesion presented as a painless swelling for three months gradually increasing in size. The patient was treated with surgical excision and there was no sign of regional recurrence at three months of postoperative follow-up. In this paper, the authors presented a rare case report of solitary bone cyst in maxilla in a paediatric patient. [ABSTRACT FROM AUTHOR]

Abstract Background Although a simple bone cyst carries the risk of pathological fractures, it rarely causes severe deformity. Here we report a case of severe femoral deformity after multiple pathological fractures due to simple bone cysts, and consider the reason for the progression of malunion despite multiple previous treatments. Finally, we propose a treatment option for malunion correction. Case presentation A 9-year, 7-month-old Japanese girl was referred to our facility with obvious deformity of her right femur, caused by multiple simple bone cyst-related pathological fractures. The deformity included bowing of approximately 90° and an internal rotation of 60° in the middle third of the femoral shaft. To correct this deformity, we excised the lesion, thus shortening the femur, then corrected the alignment and applied an Ilizarov fixator to extend the bone. At present, 3 years after surgery, the deformity has not recurred and our patient is living without any limitations in daily activities or regular exercise. Conclusions When a long bone is in a prolonged state of deformation, the deformity not only progresses as the bone grows, but the soft tissues remain unbalanced and treatment becomes increasingly difficult. To prevent increasing bone deformity and fragility, the deformity should be corrected as quickly as possible using intramedullary nailing or other fixation techniques. We believe that our shortening-distraction method is effective for the treatment of severe deformity with unbalanced soft tissues.

Background: Simple bone cysts are benign lesions with fluid content, commonly occur in the proximal femur and humerus and rarely occur in the calcaneus. Calcaneal bone cysts are usually asymptomatic, diagnosed incidentally on radiographs and rarely susceptible to pathological fractures, but it may present with heel pain. The site of the cysts is usually the neutral triangle of the calcaneus. Plain radiograph, CT, MRI and histopathology examinations are the diagnostic tools for simple bone cyst (SBC) in calcaneus. Objective: To evaluate the results of using autogenous bone graft in surgical treatment of simple bone cysts in calcaneus. Patients and Method: A prospective study held between February 2019 and February 2020, where 12 patients included with simple bone cyst in the calcaneus managed by curettage and autogenous bone graft were admitted to Orthopedic Department at Zagazig University Hospitals and followed up for 6 to 12 months. Results: Age of the patients ranged from 5 to 30 years with mean age of 15.8 years. 8 [66.7%] patients were male and 4 [33.3%] patients were female. All of the patients had heel pain and two of them [16.7%] had pathological fractures. 10 patients [83.3%] had complete healing of the cyst while 2 patients [16.7%] of them healed with defect and all of the studied cases [100%] had complete clinical resolution. The observed complications during the follow-up period were superficial infection on one [8.3%] patient and delayed wound healing on another [8.3%] patient. Conclusion: Curettage and autogenous bone graft is an effective successful method for treating SBC in the calcaneus. [ABSTRACT FROM AUTHOR]

Fibro-osseous and cystic tumors are some of the more common tumors encountered in bone pathology. Although there is significant histologic overlap, fibro-osseous tumors of bone have distinct clinical, radiologic and pathogenetic features. Similarly, cystic lesions have characteristic radiologic and pathologic features that help distinguish them from tumor of bone that can have secondarily cystic components. More recently, specific genetic abnormalities have been identified in a subset of fibro-osseous and cystic tumors, such as fibrous dysplasia and aneurysmal bone cyst. Herein we discuss the clinical, radiologic, pathologic and genetic features of fibro-osseous and cystic tumors of bone. [ABSTRACT FROM AUTHOR]

Introduction Simple bone cysts (SBCs) are common in children and adolescents. The risk of refracture and the probability of spontaneous healing in SBCs are mainly dependent on the activity of the cyst and can be quantified with the Cyst-Index. Avoiding pathological fractures is the primary goal. Our study presents a comparison of two different bioresorbable bone graft substitutes (BGSs) in the minimally-invasive treatment of SBC in the active stage by percutaneous cyst aspiration and injection. Methods Between 2006 and 2017, 38 patients (aged two to 37 years; mean age 12.4 (sd 5.6)) were treated with percutaneous cyst aspiration and refilled with bioresorbable BGSs in three hospitals. The cysts of 21 patients (11 humerus, five femur, four calcaneus, one fibula) were refilled with porous beta- tricalcium phosphate (PB-TP group) (ChronOS Inject) and of 17 patients (nine humerus, six femur, one calcaneus, one fibula) with hydroxyapatite/calcium sulphate (H/CS group) (CERAMENT|BONE VOID FILLER). There were 13 (62%) preceding fractures in the PB-TP group and eight (47%) in the H/CS group. The follow-up of all patients was at least two years. During follow-up, radiological healing (modified Neer classification), activity level, refracture rates, recurrence rates, resorption period and complications were analyzed. Results In all, 21 patients treated with PB-TP group experienced 27 operations (one refracture, three recurrences and one persistent cyst). A total of 17 patients treated with H/CS experienced 20 operations (one refracture and one 1 Department of Pediatric Orthopedics, University Children's Hospital Basel, Basel, Switzerland 2 Cantonal Hospital Aarau, Aarau, Switzerland 3 Cantonal Hospital Bellinzona, Bellinzona, Switzerland Correspondence should be sent to Andreas Krieg, University Children's Hospital, Switzerland, Spitalstrasse 33, CH-4053, Basel. E-mail: andreas.krieg@ukbb.ch recurrence). After six weeks, 95% in the PB-TP group returned to unrestricted activity with one refracture in the femur due to insufficient biomechanical stability and all returned to unrestricted activity in the H/CS group. Partial or complete radiological response was observed in 81% after 13 months (sd 3.4). Three recurrences (14%) occurred in the PB-TP group and one recurrence (6%) occurred in the H/CS group. The refracture rates were similar in both groups; one (5%) in the PBTP group and one (6%) in the H/CS group. All H/CS treated cysts showed completed resorption after two years, whilst in PB-TP treated cysts no resorption occurred in five cases (25%) (p = 0.031). Two (10%) wound infections occurred in the PBTP group and no infections occurred in the H/CS group. Conclusion Both PB-TP and H/CS can provide stability and prevent refracture in patients with single bone cysts at the upper extremity or the foot. For the proximal femur, additional stabilization is necessary, due to the weight-bearing and associated high refracture rate. The H/CS bone graft substitute has a better resorption rate than the PB-TP graft. [ABSTRACT FROM AUTHOR]

Objective: Steroid injections represent one of the simple treatment alternatives for simple bone cysts (SBC). The aim of this study was to evaluate the results of local steroid injections in the treatment of SBC. Methods: Seventeen patients (11 males, 6 females; mean age 12.4 years; range=2 to 39 years) with SBC were treated with injection of methylprednisolone acetate (MPA) with the use of the two-needle technique. The cysts were localized in the proximal humerus (n=6), the calcaneus (one patient had bilateral lesions) (n=2), proximal femur (n=7) and the tibia (n=2). Pathological fractures occurred in three patients before steroid injection. These three patients with pathological fractures were treated with injection of MPA after fractures healed. Each patient received a maximum of four injections at eight week intervals, each consisting of 40-160 mg of MPA. The patients were followed up with plain radiographs obtained in the first month, third month, sixth month, and at the end of a year. After the first year, patients were followed up with plain radiographs once a year. The mean follow-up duration was twenty two months (range=3 to 48 months). Cyst healing was assessed according to the modified Neer classification. Results: Treatment with MPA resulted in complete recovery in ten cysts (55%) and recovery with residual lesions in three cysts (17%). Three cysts (17%) did not respond to steroid treatment and two patients (11%) developed recurrence. The results were satisfactory (72%) in patients with complete recovery and partial recovery with residual lesions, and unsatisfactory in five patients (28%). The patients with recurrence were treated with curettage and grafting or cementation. No procedure-related complications were encountered. Conclusion: Our findings suggest that, the treatment with local steroid injection in SBC provides satisfactory results, thus this treatment with low morbidity can be applied to these patients before aggressive treatment. [ABSTRACT FROM AUTHOR]

Objective: This case raises awareness for healthcare practitioners who may not suspect a simple bone cyst (SBC) in a pediatric athlete with a high risk of pathological fracture. Case summary: SBC's are often considered as asymptomatic lesions which are commonly found incidentally on plain film radiographs. Presented here is a case of a 14-year-old competitive synchronized swimmer with a SBC in the proximal humerus with no MRI evidence of soft tissue pathology or pathological fracture, presenting clinically with refractory posterior shoulder pain. Summary: Early detection of a SBC in a pediatric athlete is essential so an interdisciplinary care approach can be employed to ensure the appropriate management in those where there is high risk of pathological fracture. Clinicians should be aware of the risk factors for the development of a pathological fracture, and for other potential complications that may arise thereafter in those with a SBC. [ABSTRACT FROM AUTHOR]