Aneurysmal Bone Cyst – Review

Original Article | Volume 6 | Issue 1 | JBST Jan-April 2020 | Page 17-20| DOI: 10.13107/jbst.2020.v06i01.009

Author: Nitin Shetty[1], Prateek Hegde[2], Hemant Singh[3], Ashish Gulia[4]

[1]Department of Radio-Diagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
[2]Department of Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India.

Address of Correspondence
Dr. Ashish Gulia
Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai – 400 012, India.
E- mail:

Background: Aneurysmal bone cyst (ABC) is a rare, benign, expansile lesion that produces blood-filled cavities inside the bone. The term, ‘Aneurysmal bone cyst’ was first time used by Jaffe and Lichtenstein in 1942 [1]. The name is a misnomer, as they are neither aneurysmal nor are, they truly cystic, as these lesions do not have an endothelial lined cyst wall. ABC is a disease of childhood or young adulthood with a median age of 13 years, with an incidence of 0.14 per 105 individuals with slight female preponderance [2].
Pathophysiology: ABC usually present as a solitary lesion either as a primary neoplasm (translocation driven) or a secondary lesion arising adjacent to previous bony lesions like giant cell tumours (GCT), osteoblastomas, chondroblastomas [3]. Few authors have proposed post traumatic hypothesis whereas others feel it could due to an hemodynamic disturbance especially venous impedance.
Primary ABCs: Primary ABC is one where it occurs in a bone without any previously known lesion. But now there has been identification of TRE17 also known as USP6 (ubiquitin-specific protease 6) gene on chromosome 17p13.Pathogenesis of some primary ABC involves transcriptional up-regulation of USP6 when there is the chromosomal translocation t(16;17)(q22;p13) which fuses the promoter region of the osteoblast cadherin 11 gene (CDH11) on chromosome 16q22 to the entire coding sequence of the ubiquitin protease USP6 gene on chromosome 17p13 [4].
Secondary ABCs: Approximately one third of the ABCs appear secondary to other pre-existing bone tumours, most commonly from GCT, which accounts for 19-39% of these cases [5]. Other common precursor lesions are chondroblastomas, chondromyxoid fibroma, fibrous dysplasia, osteoblastomas, haemangioendothelioma, angioma, fibroxanthoma (nonossifying fibroma), solitary bone cyst, fibrous histiocytoma, eosinophilic granuloma, radiation osteitis, osteosarcoma, trauma (including fracture), fibrosarcoma and even metastatic carcinoma [3, 5].
ABCs have been likened to a “blood-filled sponge”, composed of blood-filled, anastomosing, cavernomatous spaces, separated by a cyst like wall composed of fibroblasts, myofibroblasts, osteoclast like giant cells, osteoid and woven bone.
In approximately one third of cases, a characteristic reticulated lacy chondroid like material, described as a calcified matrix with a chondroid aura, is seen [6]. These are called as “solid aneurysmal bone cyst”. The term “solid aneurysmal bone cyst,” was coined by Sanerkin et al. in 1983 [7].


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16. Steffner RJ, Liao C, Stacy G, Atanda A, Attar S, Avedian R, et al. Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? J Bone Joint Surg Am. 2011;93(21):1221–1229.
17. Park HY, Yang SK, Sheppard WL, Hegde V, Zoller SD, Nelson SD, et al. Current management of aneurysmal bone cysts. Curr Rev Musculoskelet Med. 2016;9(4):435-444.
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19. Flont P, Kolacinska-Flont M, Niedzielski K. A comparison of cyst wall curettage and en bloc excision in the treatment of aneurysmal bone cysts. World J Surg Oncol.2013;11:109.
20. Elsayad K, Kriz J, Seegenschmiedt H, Imhoff D, Heyd R, Eich HT, et al.Radiotherapy for aneurysmal bone cysts: a rare indication. Strahlenther Onkol.2017;193(4):332-340.
21. Batisse F, Schmitt A, Vendeuvre T, Herbreteau D, Bonnard C. Aneurysmal bone cyst: A 19-case series managed by percutaneous sclerotherapy. Orthop Traumatol Surg Res.2016;102(2):213-216.
22. Varshney MK, Rastogi S, KhanSA, Trikha V. Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts? Clin Orthop Relat Res. 2010;468(6):1649-1659.
23. Falappa P, Fassari FM, Fanelli A, Genovese E, Ascani E, Crostelli M, et al. Aneurysmal bone cysts: treatment with direct percutaneous Ethibloc injection: long-term results. Cardiovasc Intervent Radiol.2002;25(4):282–290.
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34. Elsayad K, Kriz J, Seegenschmiedt H, Imhoff D, Heyd R, Eich HT, et al.Radiotherapy for aneurysmal bone cysts: a rare indication. Strahlenther Onkol.2017;193(4):332-340.
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How to Cite this article: Shetty N, Hegde P, Singh H, Gulia A. Aneurysmal Bone Cyst – Review. Journal of Bone and Soft Tissue Tumors January-April 2020;6(1): 17-20.

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Editorial IMSOS Issue January – April 2020

Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 21 | DOI: 10.13107/jbst.2020.v06i01.010

Author: Dr. Yogesh Panchwagh[1] , Dr. Ashish Gulia[2] & Dr. Ashok Shyam[3, 4]

1. Orthopaedic Oncology Clinic, Pune, India,
2. Orthopedic Oncology Services, Department of Surgical Oncology,
Tata Memorial Hospital, Mumbai,
3. Indian Orthopaedic Research Group, Thane, India,
4. Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India.

Address of Correspondence:
Dr. Yogesh Panchwagh.
Orthopaedic Oncology Clinic, 101, Vasant plot 29, Bharat Kunj
Society -2, Erandwana, Pune – 38, India.

We are pleased to bring you the IMSOS issue for 2020. JBST is the official publication of the Indian musculoskeletal oncology society (IMSOS). This is the second consecutive year that we are publishing a special IMSOS issue, which typically coincides with the IMSOS annual conference in early March.

Since the last year, JBST editorial board has 2 IMSOS life members selected as IMSOS representatives. Dr. Akshay Tiwari and Dr. Dominic Putthoor are the current IMSOS representatives on the JBST editorial board. Both have a vast experience of treating bone and soft tissue tumors and bring along considerable credibility to the work published in the issue.

IMSOS annual conference this year is being held at Bengaluru. The organising secretary Dr. Suman Byregowda and his team have put up an exceptional scientific program. The current IMSOS issue being released online to coincide with the annual conference promises to add to the academic value that IMSOS had aimed at. The conference is being held on the background of the Covid 19 scare that is looking to grip India. Hopefully the great academic content, warm hospitality and gracious hosts will not let the scare dampen the fervor and camaraderie.

JBST wishes IMSOS 2020 the very best.

How to Cite this article: Panchwagh Y, Gulia A, Shyam A. Editorial IMSOS Issue January – April 2020. Journal of Bone and Soft Tissue Tumors January-April 2020; 6(1):1.

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Facilitating Timely Access to Highly Specialized Surgery for Children with Extremity Bone and Soft-Tissue Sarcomas in North and Central India

Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 2-4 | DOI: 10.13107/jbst.2020.v06i01.005

Author: Rashmi Kumari [1], Akshay Tiwari [2], Ishita Maji [1], Haresh Gupta [1], Poonam Bagai [1], Mohini
Daljeet Singh [3], Ramandeep Singh Arora [1]

1. Quality Care, Research and Impact Division, Cankids…Kidscan, New Delhi, India,
2. Max Institute of Cancer Care, , Max Super Speciality Hospital, Saket, Delhi, India,
3. Founder CEO, Max India Foundation, Delhi, India.

Address of Correspondence
Dr. Ramandeep Singh Arora,
Department of Musculoskeletal Oncology, Max Institute of Cancer Care, Max Super
Speciality Hospital, Saket, New Delhi – 110 017, India.


Background: Optimal management of bone and soft-tissue sarcomas (BSTSs) of the extremity in low- and middle-income countries like India remains a challenge due to the paucity of surgical expertise and other resource limitations. In this study, we aimed to develop a multiple stakeholder model where children with extremity BSTS in North and Central India can access specialized surgery without experiencing cost and delays.
Materials and Methods: The model brought together four stakeholders and developed a pathway of identifying eligible patients, facilitating timely referral, providing specialized surgery, and sharing the cost. Services were offered for 1 year (2018–2019) under this model.
Results: Sixteen non-metastatic patients (69% osteosarcoma, 18% soft-tissue sarcoma, and 13% Ewing sarcoma) from five hospitals received specialized extremity BSTS surgery under this model. About 69% had limb salvage surgeries, 19% rotationplasty, and 12% amputation. Surgery was done at a median interval of 16.9 weeks (range 7.3–33.6 weeks) from the date of diagnosis. None of the patients abandoned treatment. The total cost for the facilitation of the surgery, supportive care and social support for the entire cohort was INR 38.7 lakh (USD 54,180) with
an average of INR 2.8 lakh per patient (USD 3920). The patient had to bear no cost toward the surgery.
Conclusions: In this study, we developed a model systematically bringing together four stakeholders and identifying eligible patients, facilitating timely referral, providing specialized surgery at zero cost to the patient, and ensuring completion of treatment and follow-up. Our next goal is to increase the capacity of this model by amplifying its scope and replicating it in other parts of India.
Keywords: Child, Health services accessibility, India, Sarcoma.

1. AroraRS. Epidemiology of cancers in children. In: GuptaP, MenonPS, RamjiA, LodhaR, editors. PG Textbook of Pediatric. 2015. p. 2416-20.
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10. PapyanR, TamamyanG, DanielyanS, TananyanA, MuradyanA, SaabR. Identifying barriers to treatment of childhood rhabdomyosarcoma in resource-limited settings: A literature review.Pediatr Blood Cancer 2019;66:e27708. 11. HowardSC, PedrosaM, LinsM, PedrosaA, PuiCH, RibeiroRC, et al. Establishment of a pediatric oncology program and outcomes of childhood a c u t e l y m p h o b l a s t i c l e u k e m i a i n a r e s o u r c e – p o o r area.JAMA2004;291:2471-5.
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13. IsraelsT, PaintsilV, NyirendaD, KouyaF, MbahAfungchwi G, HesselingP, et al. Improved outcome at end of treatment in the c o l l a b o r a t i v e w i l m s t u m o u r A f r i c a p r o j e c t . P e d i a t r B l o o d Cancer2018;65:e26945.


How to Cite this article: Kumari R, Tiwari A, Maji I, Gupta H, Bagai P, Singh MD, Arora RS | Facilitating Timely Access to Highly Specialized Surgery for Children with Extremity Bone and Soft-Tissue Sarcomas in North and Central India | Journal of Bone and Soft Tissue Tumors | January-April 2020; 6(1): 2-4.

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An Interesting Reconstruction Option after Resection for a Distal Fibular Osteosarcoma: A Case Report

Case Report | Volume 6 | Issue 1 | JBST  Jan-April 2020 | Page 13-16 | DOI: 10.13107/jbst.2020.v06i01.008

Author:  Manish Pruthi [1], Jagandeep Singh Virk [2], Lokesh Garg [1], Sumit Goyal [4], Anila Sharma [3]

1. Department of Orthopaedic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi,Delhi, India,
2. Department of Orthopaedic Oncology, Paras Hospitals, Panchkula,Haryana, India,
3. Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India,
4. Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi,India

Address of Correspondence
Dr. Jagandeep Singh Virk,
Department of Orthopaedic Oncology, Paras Hospitals, Panchkula,Haryana, India.


Fibula is an expandable bone in the body, but tumors arising from the distal part which require a wide resection of the distal fibular part require some form of reconstruction for preventing lateral ankle instability. Many methods involving either bony or soft tissue reconstruction techniques have been described in literature, but consensus regarding which one is optimal for a good oncological and functional outcome is lacking. In this case report, we make use of a biological soft tissue technique involving use of peroneus brevis autograft reconstruction for providing lateral ankle support for a patient suffering from distal fibular osteosarcoma who underwent resection of the distal fibula. The patient went on to have an excellent functional outcome. This technique, although reported in literature, is in the form of only a few cases with a limited follow-up with none reported from the Indian subcontinent.
Keywords: Fibula, Sarcomas, Limb salvage, Reconstruction.


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11. JonesRB, IshikawaSN, RichardsonEG, MurphyGA. Effect of distal fibular resection on ankle laxity.Foot Ankle Int2001;22:590-3.
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14. deGauzy JS, KanyJ, CahuzacJP. Distal fibular reconstruction with pedicled vascularized fibular head graft: A case report.J PediatrOrthop B2002;11:176-80.
15. EgerW, SchörleC, ZeilerG. Giant cell tumor of the distal fibula: Fifteenyear result after en bloc resection and fibula reconstruction.Arch Orthop Trauma Surg2004;124:56-9.
16. PickeringR. Arthrodesis of ankle, knee, and hip. In: PickeringRM, editors. Campbell’s Operative Orthopaedics. 10th ed. St Louis, MO, USA: Mosby; 2003.
17. SaridisAG, MegasPD, GeorgiouCS, DiamantakisGM, TyllianakisME. Dual-fibular reconstruction of a massive tibial defect after Ewing’s sarcoma resection in a pediatric patient with a vascular variation.J PediatrOrthop2011;31:297-302.
18. VaseenonT, SaengsinJ, KamintaA, PattamapaspongN, SettakornJ, PruksakornD.Ankle ligament reconstruction after wide resection of the osteosarcoma of the distal fibula: A case report.BMC Res Notes2017;10:769.


How to Cite this article: Pruthi M, Virk J D, Garg L, Goyal S, Sharma A | An Interesting Reconstruction Option after Resection for a Distal Fibular Osteosarcoma: A Case Report | Journal of Bone and Soft Tissue Tumors | January-April 2020; 6(1): 13-16.

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Local Recurrences of Giant Cell Tumor of Bones after Extended Surgical Curettage – A Retrospective Cohort Study

Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 9-12 | DOI: 10.13107/jbst.2020.v06i01.007

Author: Dominic K Puthur [1], Dijoe Davis [1], N Sanjay [1]

1. Department of Orthopaedics, Amala Institute of Medical Sciences, Thrissur, Kerala, India.

Address of Correspondence
Dr. Dijoe Davis,
Department of Orthopaedics, Amala Institute of Medical Sciences,
Cloud Nine, Kollannur Villas, Jasmin Road, Near Water Tank Street
Nehrunagar, Kuriachira P.O, Thrissur – 680 006, Kerala, India.


Introduction: Giant cell tumor of bone (GCTB) is a locally aggressive tumor well known for recurrence after surgical treatment. Local recurrence rate ranged from 10 to 25%. The objectives of this study are to find out the incidence of recurrence in GCT after extended surgical curettage, factors affecting recurrence, and also to find the best modality of treatment available for the recurred GCT.
Materials and Methods: It was a retrospective cohort study of 225 patients diagnosed and treated by extended surgical curettage in the Orthopaedic Department of a Tertiary Care Hospital in South India, between January 2003 and December 2017. Patients were followed up clinically and radiologically for diagnosis of recurrence. Factors affecting the recurrence were analyzed. These recurrent cases were further followed up. IBM SPSS v23 was used for data analysis such as age, gender, site of lesion and side, and material used to fill the defect after curettage. Descriptive statistics was elaborated in the form of means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Fisher’s exact test is used for comparison.
Results: Recurrence was found in 27 patients of 225 cases of GCTB treated by extended surgical curettage. These include 9 of 135 cases initially treated by extended curettage and bone cement and 18 of 88 cases initially treated by curettage and bone graft. Recurrence was found to be more common in males than females.
Conclusions: Local recurrence is significantly lower in patients treated by cementation following extended surgical curettage than bone graft which makes bone cement as a better filling material with regard to recurrence.
Keywords: Giant cell tumor, Curettage, Bone cement, Bone graft, South India.


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How to Cite this article: Puthur D K, Davis D, Sanjay N | Local Recurrences of Giant Cell Tumor of Bones After Extended Surgical Curettage– A Retrospective Cohort Study | Journal of Bone and Soft Tissue Tumors | Jan-Apr 2020; 6(1): 9-12.

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Factors Predicting Massive Blood Loss in Patients Undergoing Pelvic Resection: A Tertiary Referral Center Experience from North India

Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 5-8 | DOI: 10.13107/jbst.2020.v06i01.006

Author: Devansh Goyal [1], Venkatesan Sampath Kumar [1], Roshan Banjara [1], Abdul Majeed [1],
R Namith [1], Shah Alam Khan [1]

1. Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Address of Correspondence
Dr. Venkatesan Sampath Kumar,
Department of Orthopaedics, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi – 110 029, India.


Background: Pelvic resections are challenging procedures with significant risk of morbidity, especially massive blood loss. Risk factors for massive blood loss are understudied due to the rarity of such procedures.
Materials and Methods: A cross-sectional study was performed on pelvic resections performed between January 2018 and October 2019. Intraoperative and perioperative data were collected from prospectively collected database and hospital medical records. Patients were divided into two groups– Group 1 with intraoperative blood loss <2 L and Group 2 with blood loss 2 L or more. Demographic data, tumor characteristics, surgical procedure, and perioperative outcomes were studied between the two groups. Patients in whom only soft-tissue resections were performed and those who did not have complete data were excluded from the study.
Results: Of the 27 patients identified, 2 had soft-tissue recurrence resections only and 4 had incomplete data and were excluded from the study. Of the remaining 21 patients, 8 were classified into Group 1 and 13 into Group 2. On studying the various characteristics, tumor type, tumor volume, type of pelvic resection, and duration of procedure were significantly different between the two groups. Although wound complications, 30-day mortality, and read missions were higher in Group 2, this difference was not statistically significant.
Conclusion: Massive blood loss was more common in chondrosarcoma patients, with tumor volume more than 300 cc and the duration of procedure more than 4 h with resection involving the acetabulum and pubis (Type I/II/III and Type I/II/III/IV).
Keywords: Blood loss, Pelvic resections, Perioperative morbidity, Pelvic tumor surgery, Tumor volume.


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How to Cite this article:  Goyal D, Kumar VS, Banjara R, Majeed A, Namith R, Khan SA | Factors Predicting Massive Blood Loss in Patients Undergoing Pelvic Resection: A Tertiary Referral Center Experience from North India | Journal of Bone and Soft Tissue Tumors | January-April 2020; 6(1): 5-8.

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