Vol 1 | Issue 2 | Oct-Dec 2015 | page: 20-25 | Mohammed Al Sobeai [1], Wazzan Al Juhani [2].
Authors : Mohammed Al Sobeai [1], Wazzan Al Juhani [2].
[1] Fellow at Department of Orthopaedics, McGill University, Montreal, Canada.
[2] Consultant at Department of Surgery, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Address of Correspondence
Dr. Dr Mohammed Al Sobeai
2000 Claremont Avenue, Apartment 301 Montreal, QCH3Z 2P8.
Email:- alsobeai@hotmail.com
Abstract
Introduction: Introduction: An aneurysmal bone cyst (ABC) is an enigmatic lesion that can involve any bone. Pelvic ABC is a challenging lesion that is sometimes difficult to manage surgically.
Case Report: We present a case of ABC involving the right ilium and supra-acetabular area. Surgical resection was performed after embolization, to reduce intraoperative bleeding, and was followed by acetabular reconstruction.
Conclusion: Pelvic ABC is a challenging tumor. Management depend on size of the lesion and stability in addition to clinical presentation. Small lesions can be treated conservatively. Large lesions affecting pelvic mechanical stability should be treated with surgical resection and reconstruction.
Keywords: Aneurysmal bone cyst, Pelvis, benign tumor.
Introduction
The ABC lesion has been reported in the orthopedic literature for more than 60 years; it was first described in 1942 by Jaffe and Lichtenstein [1]. It represents almost 1% of primary bone lesions [2-4]. ABCs are primary lesions in 70% of cases and in 30% arise from an eosinophilic granuloma, a simple bone cyst, a chondroblastoma, a giant-cell tumor (GCT), or an osteosarcoma [5-8]. Pelvic ABCs are intractable tumors because they may affect acetabular or sacral stability and are usually challenging surgically.
Case report
A 24-year-old female presented to the orthopedic oncology clinic with right hip pain associated with a mass. The mass was large but had been growing slowly over 6 months. The patient has no referred pain and was still walking. On examination, she had a large mass fixed to her pelvis over the right side (Fig. 1).
Plain radiography showed a large lytic lesion involving the right innominate bone with ill-defined margins in some areas and extending to the right acetabular dome (Fig. 2). A pelvis MRI (Fig. 3A, B) showed multiple fluid-fluid levels, indicating primary versus secondary ABC. A systemic investigation to rule out distant disease was normal. A biopsy was performed initially percutaneously with a core needle. Our pathologist could not identify any malignant cells and saw mainly hemorrhagic cysts. Then, the patient underwent an open biopsy to provide more tissue.
The pathologist confirmed the diagnosis of primary ABC. After diagnosis, surgery was planned. Embolization was performed 24 h before resection. In the operating room, a skin incision was created from the middle of the iliac crest to the anterior superior iliac spine (ASIS) and down to the pubic rami (Fig. 1). Another line extended from ASIS to the greater trochanter. Muscles were dissected around the mass from the outer to the inner side of the ilium. The neurovascular bundle was identified and protected at the femoral canal (Fig. 4). The mass was too large to be removed en bloc and was released in pieces (Fig. 5). Part of the mass extended to the dome of acetabulum, which was reconstructed with a bone graft, calcium carbonate based. A drain was placed and closure was achieved in layers. Histopathology slides were shown in (Figs 6 and 7). Post-operative radiography taken on the first day postoperatively is shown in (Fig 8).
The patient started to mobilize with full weight-bearing the next day and was discharged to home after a few days with no postoperative complications. She was seen in the clinic at 2 weeks for a wound check and removal of sutures and then at 6 weeks, 3 months, and 6 months. Radiographs are shown in (Fig 9).
The last clinical visit was at one year postoperatively and the patient is mobilizing well with no hip or pelvic pain.
Discussion
This case is a rare condition where large lesion in the pelvis where stability is affected and needed reconstruction with bone graft. The lesion was large and involving the acetabulum. Mechanical stability was an issue and reconstruction with bone graft was done. We have chosen this approach as literature was supporting this technique in similar lesions involving the acetabulum. The pathophysiology of ABC remains unclear. The name is merely descriptive and no genetic or neoplastic cause has been identified [10]. Many theories have been proposed, including vascular, traumatic, and genetic etiologies. Campanachi and Lichtenstein believed in vascular theory and described the pathophysiology as a local vascular disturbance and hemorrhage [11-14]. Ratcliffe and Grimmer described the formation of ABC at the proximal metaphysis of a tibia fracture and considered that ABC occurred secondarily to vascular disturbances initiated by a fracture [15]. A third theory of ABC pathophysiology is the genetic theory. The genetic theory indicates that primary ABC is neoplastic rather than reactive. Oliveira reported a genetic translocation, t(16,17) which was absent in secondary ABC [16]. Extensive studies of the role of insulin-like growth factor-I in bone tissue have suggested that it plays a role in the pathogenesis of GCT and ABC [17]. Familial cases of ABC have been reported, supporting the genetic and neoplastic theories[11, 18-24]. Malignant transformation has been reported, mainly after radiotherapy of an ABC or initially misdiagnosed telangectatic osteosarcoma. However, few cases have developed into malignancies without a history of previous radiotherapy [11, 21, 25, 26]. Histological examinations of ABC reveal multiple cavities and of various sizes, filled with blood and/or proteinaceous material. These cavities are lined with endothelial and smooth muscle cells. The septa consist of several cell types, including spindle cells, inflammatory cells, and some giant cells. Osteoid formation, which is seen in ABC, is not seen in GCT tumors. 5 – 10 % of ABC are atypically solid in nature with little or no cystic formation [10, 11, 13,14, 27].
Literature Review
Review of literature revealed 25 articles discussed the pelvic aneurysmal bone cyst. Articles that reported different body parts including the pelvis were excluded. 25 reports and series were identified. Around 59 males and 55 females are reported with different parts of the pelvis involved. Age was ranging from 18 months to 64 years old. Management was studied in all cases and discussed below.
Clinical Presentation
ABC can occur at ages from 1 to 59 years, with a peak at 12‑13 years. It also affects males more than females. Usually, ABC presents with pain and swelling secondary to the expansile mass. Secondary symptoms, such as fever, weight loss, nausea, and vomiting, that typically occur with malignancies are not common [10]. Pelvic ABC has several unique characteristics, including proximity of the tumor to the neurovascular bundle and acetabulum, making it more difficult to approach and reconstruct, intraoperative bleeding, and that pelvic ABC tend to be large and highly vascular [11, 28-30]. Usually, they present with pain in the low back, groin, or thigh, commonly associated with a limp. Sacral lesions can present with radicular symptoms and may be similar to spinal disc disease due to encasement of the cauda equina or nerve roots [11, 30, 31].
Imaging
Imaging of pelvic ABC is important in diagnosis [32]. Combining conventional radiography with MRI increases the sensitivity and specificity of the diagnosis [32]. Similar lesions that can be misdiagnosed are GCTs and telangectatc osteosarcoma. Typically, ABC is seen on plain radiographs as an eccentric expansile lesion involving the metaphysis. Usually, it is contained within a thin shell of cortex. Thick nodular enhancement at the rim of the tissue on MRI and CT is suggestive of telangectatic osteosarcoma rather than ABC. These nodularities are secondary to osteoid mineralization, due to sarcomatous cells [33].
Epiphyseal ABC should raise the suspicion of a lesion secondary to benign or malignant lesions. However, there are few reported cases of epiphyseal primary ABC in the literature [11, 34, 35]. Dabska and Buraczewski described four radiological phases of the disease (Table 1) [10]. Computed tomography and MRI usually show multiple fluid levels in multiloculated lesion. This is not a pathognomonic sign of ABC, because it may also be seen in telangectatic osteosarcoma, GCT, chondroblastoma, secondary ABC, fracture through a simple cyst, and even conventional osteosarcoma post-chemotherapy [36].
Treatment
Spontaneous resolution of ABC may occur through thrombosis and fibrosis after no or partial treatment. Malghem et al. reported three cases with spontaneous resolution and suggested conservative management of ABC when there is no risk of fracture or stability issues [11, 37, 38].
Embolization
Embolization of pelvic ABC is recommended before curettage and bone graft, especially if the ABC is large. Extensive intraoperative bleeding may occur if the tumor is opened, due to loss of the tamponade effect of a closed compartment [39]. However, some believe that ABC can be treated effectively without surgery. Rossi et al. reported a success rate of 94% without surgery. The need to repeat embolization was more frequent in patients younger than 16 years old and with lesions of more than 5 cm in diameter [40].
Bisphosphonates
One case of a sacral ABC was reported by Simm in 2013 after a failed embolization because no supplying vessel was identified. The patient was then administered zoledronic acid at 0.04 mg/kg. After seven injections at 4-month intervals, the tumor resolved, as confirmed by MRI [41].
Sclerotherapy
Polidocanol shows excellent results with ABCs. Additionally, it is safe and causes only transient inflammatory reactions when it leaks into surrounding tissues. Brosjo et al. found that it was effective in ABC, especially ABC of the pelvis. All six pelvic and sacral ABCs treated with sclerotherapy healed without complications[42]. Varshney et al. reported a disturbance of growth in 4% of cases treated with polidocanol. However, only 21% healed after the first injection. The remaining patients required repeated injections[43]. Ehibloc has also been used in the treatment of ABC. However, this agent has been abandoned because of the many complications reported[11, 19, 44-48].
Steroid and bone graft injections
Steroid injections are not common practice in ABC. Unlike the unicameral bone cyst, Scaglietti reported that ABC responded poorly to steroid injections; all 12 of their cases then underwent curettage and bone graft [49]. Bone graft is a minimally invasive procedure performed through a small incision. Demineralized bone matrix (DBM) mixed with bone marrow is injected into the lesion. it stimulates healing of the lesion without removal of the lesion contents. Docquier and colleagues published their experience with DBM in 2005 [50].
Curettage and bone graft versus en bloc resection
Treatment strategies depend on the size of the lesion and the part of the pelvis and sacrum involved. Lesions < 5 cm can be treated with curettage and bone graft and rarely require reconstruction. However, lesions > 5 cm that involve the cortex and affect the integrity of acetabulum and sacrum require more aggressive treatment: that is, excision and reconstruction. A structural autograft or allograft can be used to rebuild the structural integrity [51].
Adjuvant therapy
The available adjuvant therapies can reduce recurrence and improve outcome. Phenol is well known but cannot be used in sacral lesions near nerve roots because it may damage the nerves[30] Marcove and Peeters reported good experience in cryosurgery with liquid nitrogen [11, 52, 53]. Combining cryosurgery and curettage will reduce the need for major reconstruction [54]. Adjuvant radiotherapy is not an option for ABC, except in cases where surgery is not possible. Post-operative sarcoma is a potentially devastating complication that prevents the use of this option [42]. Other possible complications include growth arrest with secondary deformities and gonadal arrest [55, 56].
Complications
Pelvic ABC may be complicated with pathological fractures that make reconstruction challenging. Acetabular fracture, protrusion acetabuli, destruction of the sacroiliac joint, and sacral nerve compression are the possible complications [28].
Conclusion
Pelvic ABC is a challenging tumor because of its location. An appropriate approach is essential to confirm the diagnosis and to rule out other malignant conditions that will prevent problems in management. Conservative management can be offered for small lesions and those that do not affect stability. In large lesions or where stability is an issue, surgery is necessary and reconstruction will facilitate resumption of normal functioning.
Clinical Message
Pelvic ABC is a challenging tumor because of its location. An appropriate diagnostic approach is essential to confirm the diagnosis and to rule out other malignant conditions. Conservative management options can be offered for small lesions and those that do not affect stability. In large lesions or where stability is an issue, surgery is necessary and reconstruction will facilitate resumption of normal functioning.
References
1. Jaffe HL, Lichtenstein L. Solitary unicameral bone cyst: With emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Archives of Surgery. 1942;44(6):1004-25.
2. Freiberg AA, Loder RT, Heidelberger KP, Hensinger RN. Aneurysmal Bone Cysts in Young Children. Journal of Pediatric Orthopaedics. 1994;14(1):86-91.
3. Aneurysmal Bone Cysts. Radiology. 1955;64(1):56-65.
4. Leithner A, Windhager R, Lang S, Haas OA, Kainberger F, Kotz R. Aneurysmal Bone Cyst: A Population Based Epidemiologic Study and Literature Review. Clinical Orthopaedics and Related Research. 1999;363:176-9.
5. Campanacci M CC, Donati U, Bertoni F. Aneurysmal bone cyst
(a study of 127 cases, 72 with long term follow-up). Ital J Orthop Traumatol. 1976;2:341–53.
6. Cottalorda J, Kohler R, Sales de Gauzy J, Chotel F, Mazda K, Lefort G, et al. Epidemiology of aneurysmal bone cyst in children: a multicenter study and literature review. Journal of Pediatric Orthopaedics B. 2004;13(6):389-94.
7. Primary and Secondary Aneurysmal Bone Cyst: A Radiological Study of 75 Cases. Radiology. 1978;126(1):75-83.
8. McGough III RL, Yasko AW. Techniques in pelvic resection. Operative Techniques in Orthopaedics. 2004;14(4):259-66.
9. Dabska M, Buraczewski J. Aneurysmal bone cyst. Pathology, clinical course and radiologic appearances. Cancer. 1969;23(2):371-89.
10. Campanacci M BF, Bacchini P:. Aneurysmal bone cysts. vienna, Austria: Springer; 1990.
11. Lichtenstein L. Aneurysmal bone cyst. A pathological entity commonly mistaken for giant-cell tumor and occasionally for hemangioma and osteogenic sarcoma. Cancer. 1950;3(2):279-89.
12. Rapp TB, Ward JP, Alaia MJ. Aneurysmal Bone Cyst. Journal of the American Academy of Orthopaedic Surgeons. 2012;20(4):233-41.
13. Ratcliffe PJ, Grimer RJ. Aneurysmal bone cyst arising after tibial fracture. A case report1993 1993-08-01 00:00:00. 1225-7 p.
14. Oliveira AM, Perez-Atayde AR, Inwards CY, Medeiros F, Derr V, Hsi B-L, et al. USP6 and CDH11 Oncogenes Identify the Neoplastic Cell in Primary Aneurysmal Bone Cysts and Are Absent in So-Called Secondary Aneurysmal Bone Cysts. The American Journal of Pathology. 2004;165(5):1773-80.
15. Leithner A, Lang S, Windhager R, Leithner K, Karlic H, Kotz R, et al. Expression of Insulin-Like Growth Factor-I (IGF-I) in Aneurysmal Bone Cyst. Mod Pathol. 0000;14(11):1100-4.
16. Ginsburg LD. Congenital Aneurysmal Bone Cyst. Radiology. 1974;110(1):175-6.
17. Cottalorda J, Bourelle S. Modern concepts of primary aneurysmal bone cyst. Arch Orthop Trauma Surg. 2007;127(2):105-14.
18. DiCaprio MR, Murphy MJ, Camp RL. Aneurysmal Bone Cyst of the Spine With Familial Incidence. Spine. 2000;25(12):1589-92.
19. G V. Familial incidence in two cases of aneurysmal bone cysts. Ital J Orthop Traumatol. 1981;7:251-3.
20. Leithner A, Machacek F, Haas OA, Lang S, Ritschl P, Radl R, et al. Aneurysmal bone cyst: a hereditary disease? Journal of Pediatric Orthopaedics B. 2004;13(3):214-7.
21. Leithner A, Windhager R, Kainberger F, Lang S. A case of aneurysmal bone cyst in father and son. European Journal of Radiology. 1998;29(1):28-30.
22. Power RA, Robbins PD, Wood DJ. ANEURYSMAL BONE CYST IN MONOZYGOTIC TWINS: A CASE REPORT. Journal of Bone & Joint Surgery, British Volume. 1996;78-B(2):323-4.
23. Aho H, Aho A, Einola S. Aneurysmal bone cyst, a study of ultrastructure and malignant transformation. Virchows Arch A Path Anat and Histol. 1982;395(2):169-79.
24. Brindley GW, Greene JFJ, Frankel LS. CASE REPORTS: Malignant Transformation of Aneurysmal Bone Cysts. Clinical Orthopaedics and Related Research. 2005;438:282-7 10.1097/01.blo.0000176553.27976.b3.
25. Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer. 1992;69(12):2921-31.
26. Cottalorda J, Chotel F, Kohler R, Gauzy JSd, Louahem D, Lefort G, et al. Aneurysmal Bone Cysts of the Pelvis in Children: A Multicenter Study and Literature Review. Journal of Pediatric Orthopaedics. 2005;25(4):471-5 10.1097/01.bpo.0000158002.30800.8f.
27. Dick HM, Bigliani LU, Michelsen WJ, Johnston AD, Stinchfield FE. Adjuvant Arterial Embolization in the Treatment of Benign Primary Bone Tumors in Children. Clinical Orthopaedics and Related Research. 1979;139:133-41.
28. Papagelopoulos PJ, Choudhury SN, Frassica FJ, Bond JR, Unni KK, Sim FH. Treatment of Aneurysmal Bone Cysts of the Pelvis and Sacrum2001 2001-11-01 00:00:00. 1674-81 p.
29. Capanna R, Van Horn JR, Biagini R, Ruggieri P. Aneurysmal bone cyst of the sacrum. Skeletal Radiol. 1989;18(2):109-13.
30. Mahnken A, Nolte-Ernsting C, Wildberger J, Heussen N, Adam G, Wirtz D, et al. Aneurysmal bone cyst: value of MR imaging and conventional radiography. Eur Radiol. 2003;13(5):1118-24.
31. Murphey MD, Jaovisidha Sw, Temple HT, Gannon FH, Jelinek JS, Malawer MM. Telangiectatic Osteosarcoma: Radiologic-Pathologic Comparison. Radiology. 2003;229(2):545-53.
32. Chan G, Arkader A, Kleposki R, Dormans J. Case Report: Primary Aneurysmal Bone Cyst of the Epiphysis. Clin Orthop Relat Res. 2010;468(4):1168-72.
33. Kerimoglu S, Çitlak A, Kerimoglu G, Turgutalp H. Primary aneurysmal bone cyst of the distal tibial epiphysis: a case report. Journal of Pediatric Orthopaedics B. 2014;23(3):266-9 10.1097/BPB.0000000000000014.
34. Malghem J, Maldague B, Esselinckx W, Noel H, De Nayer P, Vincent A. Spontaneous healing of aneurysmal bone cysts. A report of three cases. Journal of Bone & Joint Surgery, British Volume. 1989;71-B(4):645-50.
35. McQueen M, Chalmers J, Smith G. Spontaneous healing of aneurysmal bone cysts. A report of two cases. Journal of Bone & Joint Surgery, British Volume. 1985;67-B(2):310-2.
36. J. Wathiong PB, I. Samson, G. Maleux. Selective Arterial Embolization in the Treatment of an Aneurysmal Bone Cyst of the Pelvis. Journal Belge de Radiologie – Belgisch Tijdschrift voor Radiologie 2003;86:325-8.
37. Rossi G, Rimondi E, Bartalena T, Gerardi A, Alberghini M, Staals E, et al. Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate. Skeletal Radiol. 2010;39(2):161-7.
38. Simm PJ, O’Sullivan M, Zacharin MR. Successful Treatment of a Sacral Aneurysmal Bone Cyst With Zoledronic Acid. Journal of Pediatric Orthopaedics. 2013;33(5):e61-e4 10.1097/BPO.0b013e318285c3a7.
39. Brosjö O, Pechon P, Hesla A, Tsagozis P, Bauer H. Sclerotherapy with polidocanol for treatment of aneurysmal bone cysts. Acta Orthopaedica. 2013;84(5):502-5.
40. Varshney M, Rastogi S, Khan S, Trikha V. Is Sclerotherapy Better than Intralesional Excision for Treating Aneurysmal Bone Cysts? Clin Orthop Relat Res. 2010;468(6):1649-59.
41. Topouchian V, Mazda K, Hamze B, Laredo J-D, Penneçot G-F. Aneurysmal Bone Cysts in Children: Complications of Fibrosing Agent Injection. Radiology. 2004;232(2):522-6.
42. Guibaud L, Herbreteau D, Dubois J, Stempfle N, Bérard J, Pracros JP, et al. Aneurysmal bone cysts: percutaneous embolization with an alcoholic solution of zein–series of 18 cases. Radiology. 1998;208(2):369-73.
43. Mascard E, Adamsbaum C. Direct Ethibloc Injection of Aneurysmal Bone Cysts. Radiology. 2005;236(3):1111-.
44. 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. CVIR. 2002;25(4):282-90.
45. Peraud A, Drake JM, Armstrong D, Hedden D, Babyn P, Wilson G. Fatal Ethibloc Embolization of Vertebrobasilar System following Percutaneous Injection into Aneurysmal Bone Cyst of the Second Cervical Vertebra. American Journal of Neuroradiology. 2004;25(6):1116-20.
46. SCAGLIETTI O, MARCHETTI PG, BARTOLOZZI P. Final Results Obtained in the Treatment of Bone Cysts with Methylprednisolone Acetate (Depo-Medrol) and a Discussion of Results Achieved in Other Bone Lesions. Clinical Orthopaedics and Related Research. 1982;165:33-42.
47. Docquier P-L, Delloye C. Treatment of Aneurysmal Bone Cysts by Introduction of Demineralized Bone and Autogenous Bone Marrow2005 2005-10-01 00:00:00. 2253-8 p.
48. Agarwal A GP, Khan SA et al. Large aneurysmal bone cyst of iliac bone in a female child: a case report. Journal of Orthopedic Surgery and Research. 2010;5-24.
49. Erkan Yıldırım SE, İsmail Kırbaş, Ahmet Fevzi Özgür, Tolga Akkaya, Elif Karadeli Treatment of pelvic aneurysmal bone cysts in two children: selective arterial embolization as an adjunct to curettage and bone grafting. Diagnostic and Interventional Radiology. 2007;13(1):49-52.
50. Marcove RC, Sheth DS, Takemoto S, Healey JH. The Treatment of Aneurysmal Bone Cyst. Clinical Orthopaedics and Related Research. 1995;311:157-63.
51. Peeters SP, Van der Geest ICM, de Rooy JWJ, Veth RPH, Schreuder HWB. Aneurysmal bone cyst: The role of cryosurgery as local adjuvant treatment. Journal of Surgical Oncology. 2009;100(8):719-24.
52. Veth R, Schreuder B, van Beem H, Pruszczynski M, de Rooy J. Cryosurgery in aggressive, benign, and low-grade malignant bone tumours. The Lancet Oncology.6(1):25-34.
53. Capanna R, Bertoni F, Bettelli G, Present D, Biaginil R, Ruggieri P, et al. Aneurysmal bone cysts of the pelvis. Arch Orth Traum Surg. 1986;105(5):279-84.
54. lkattah R, Foulk B. A Suspected Pelvic Aneurysmal Bone Cyst in Pregnancy. Case Reports in Obstetrics and Gynecology. 2013;2013:4.
55. Samura H, Shiraishi M, Tokashiki H, Nosato E, Miyazato H, Muto Y. An extraosseous aneurysmal cyst in the pelvic cavity: report of a case. Clin Imaging. 2000;24(2):68-71.
56. Issa AA, Amr SS, Swaiss AM. Aneurysmal bone cyst of the ilium associated with pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1986;23(3–4):243-8.
57. Cisneros AJ, Gomez CH, Benedicto FC, Cisneros MJ, Bascuñana FL. Aneurysmal bone cyst of the ischium. International Orthopaedics (SICOT). 1985;9(1):49-54.
58. Nayak A, Kulkarni S, Kulkarni A, Natesh K, Bami M. Aneurysmal Bone Cyst of the Pubis: A Case Report. Journal of Clinical and Diagnostic Research : JCDR. 2013;7(8):1740-2.
59. GARNJOBST W, HOPKINS R. Aneurysmal Bone Cyst of Pubis1967 1967-07-01 00:00:00. 971-5 p.
60. Abdul Q. Khan YSS, Ambareesh Parameshwar, Mohd K. Anwar-Sherwani. Aneurysmal bone cyst of pubis. A rare presentation. Saudi Medical Journal. 2010;31(3).
61. Sharifah MIA NHM, Suraya A, Tan SP. Pelvic Aneurysmal Bone Cyst. Biomed Imaging Interv J 2011;7(4):e24.
62. Honl M, Westphal F, Carrero V, Morlock M, Schwieger K, Hille E, et al. Pelvic Girdle Reconstruction Based on Spinal Fusion and Ischial Screw Fixation in a Case of Aneurysmal Bone Cyst. Sarcoma. 2003;7(3-4):177-82.
63. J. Wathiong PB, I. Samson, G. Maleux,. Selective Arterial Embolization in the Treatment of an Aneurysmal Bone Cyst of the Pelvis. JBR – BTR. 2003;86:325-8.
64. Rossi G MA, Papagelopoulos P, Rimondi E, Ruggieri P. Successful Treatment of Aggressive Aneurysmal Bone Cyst of the Pelvis With Serial Embolization. ORTHOPEDICS. 2012;35:e963-e8.
| How to Cite this Article: Al Sobeai M, Al Juhani W. Pelvic Aneurysmal Bone Cyst: Case report and Literature Review. International Journal of Surgical Cases 2015 Oct-Dec;1(2): 20-25. |
