Pain Around Elbow: Not Always Tennis Elbow!

Elbow is a well-known body part of muscular strains and overuse syndromes. Patients presented to the orthopedic department with elbow pain or swelling often diagnosed with benign conditions such as tennis elbow, golfer’s elbow, or olecranon bursitis. It must be kept in mind that several tumoral conditions can be seen around the elbow and the patient must be carefully evaluated. In this study, we aimed to demonstrate rare cases of bone or soft tissue tumors around the elbow. Between 2004 and 2017, patients with a symptom of elbow pain or swelling are included in the study. Finally, the study consists of 53 patients. 20 patients were male and 33 were female. The mean age of the patients was 42.94 ± 15.3. There were 9 bone tumors, 16 soft tissue tumors, 9 non-classified benign cystic lesions, 3 metastasis, and 16 cases were non-tumoral conditions. 7 of 9 bone tumors were benign. The solitary bone cyst was the most common bone tumor seen around the elbow. 2 malignant bone tumor cases were diagnosed as Ewing Sarcoma and metastatic bone disease. Among the 16 soft tissue tumors, schwannomas are the most presented cases in the tumor council followed by lipoma (6 cases). Even in a multidisciplinary bone and soft tissue tumor council, almost one-third of the elbow pain patients were non-tumoral and the most commonly seen condition was myositis ossificans (6 cases), followed by infection or bursitis (5 cases). Elbow pain is commonly seen and evaluated by every orthopedic surgeon on outpatient’s clinic. It must be kept in mind that tumoral conditions around the elbow are rarely seen but deserve further examination in the presence of chronic pain.

QUISTE ÓSEO SIMPLE EN EL CALCÁNEO: REPORTE DE UN CASO.

Bone tumors are pathologies resulting from modifications in the bone structure and its content, they can present as benign or malignant, primitive or metastatic tumor lesions, depending on various factors: age of presentation, location, growth rate, periosteal reaction and infiltration to neighboring structures. The publications show that small, asymptomatic and small bone cysts do not require treatment, up to 25% are spontaneous resolution after a pathological fracture; while larger cysts with thin bark require some type of intervention.The case of a 17-year-old female patient is presented, who presents for presenting moderate intensity pain in the left heel that intensifies on ambulation, with a time of 2 months of evolution, after a blunt trauma in this region. On physical examination, pain from the pressure digit and active-passive mobilization maneuvers were evidenced on the external lateral aspect at the calcaneus level of the left foot. A simple lateral radiograph of the left calcaneus was performed, showing a 3 by 3 cm circular lytic lesion involving the anteroinferior region of the calcaneus.In conclusion, simple or solitary bone cyst is a benign pathology that, although it does not endanger the person’s life, can seriously affect the functionality of the foot. Currently, there is no standardized treatment for the management of this pathology, current surgical techniques, especially curettage and bone autograft are very promising.

Aspectos clínicos e histológicos para o diagnóstico do cisto ósseo simples: relato de caso

Introdução: O cisto ósseo simples é uma lesão benigna intra-óssea considerada um pseudocisto, de etiologia incerta, crescimento lento, radiograficamente radiolúcida e de tratamento simples. Porém, pode fazer diagnóstico diferencial com outras lesões mais agressivas, e a ausência ou tênue presença de uma cápsula cística prejudica seu diagnóstico histopatológico. Objetivo: discutir os detalhes dos achados clínicos, radiográficos, histopatológicos e cirúrgicos para o cisto ósseo simples, bem como, o acompanhamento e o desfecho de um caso em corpo mandibular. Material e Método: Estudo descritivo de relato de caso. Resultados: foi realizada exploração cirúrgica e ostectomia periférica em lesão mandibular radiolúcida, observando-se no trans-cirúrgico discreta presença de material intralesional enviado para análise histopatológica. Conclusão: apesar do tratamento ser simples, o diagnóstico do cisto ósseo simples continua sendo um desafio, onde a exploração cirúrgica é o método mais preciso de diagnóstico e tratamento, mas a avaliação histopatológica é indispensável para exclusão de outras patologias.Descritores: Cistos Ósseos; Mandíbula; Diagnóstico.ReferênciasWorld Health Organization (WHO). Classification of tumours – Pathology and Genetics of Head and Neck Tumours. 3rd edition. Lyon: IARC Press; 2005.Main DM. Epithelial jaw cysts: 10 years of the WHO Classification. J Oral Pathol. 1985;14(1):1-7.Rushton MA. Solitary bone cysts in the mandible. Br Dent J. 1946;81(2):37-49.Seehra J, Horner K, Sloan P. The unusual cyst: solitary bone cyst of the jaws. Dent Update. 2009;36(8):502-8.Chell M, Idle M, Green J. Case report: an unusual finding of a solitary bone cyst in a patient with a fractured mandible. Dent Update. 2015; 42(10):977-78.Wong-Romo G, Carrillo-Terán E, Ángeles-Varela E. Solitary mandibular bone cyst. Case report and literature review. Rev Odont Mex. 2016;20(2):e112-19.Andrade EL, Cerqueira LS, Rebouças DS, Ferreira TG, Marchionni AMT. Cisto ósseo simples: relato de caso. Rev cir traumatol buco-maxilo-fac. 2016;16(2):36-9.Horne RP, Meara DJ, Granite EL. Idiopathic bone cavities of the mandible: an update on recurrence rates and case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117(2):e71-3.Resnick CM, Dentino KM, Garza R, Padwa BL. A management strategy for idiopathic bone cavities of the jaws. J Oral Maxillofac Surg. 2016;74(6):1153-58.Rivero ERC, Daltoé FP, Mello FW, de Souza CECP, Grando LJ. Aspiration and cytological evaluation of idiopathic bone cavities of the jaw. Tissue Cell. 2017;49(3):435-39.MacDonald-Jankowski DS. Traumatic bone cysts in the jaws of a Hong Kong Chinese population. Clin Radiol.1995;(50):787-91.Chrcanovic BR, Gomez RS. Idiopathic bone cavity of the jaws: an updated analysis of the cases reported in the literature. Int J Oral Maxillofac Surg. 2019;48(7):886-94.Harnet JC, Lombardi T, Klewansky P, Rieger J, Tempe MH, Clavert JM. Solitary bone cyst of the jaws: a review of the etiopathogenic hypotheses. J Oral Maxillofac Surg. 2008; 66(11):2345-48.Silveira HA, Cardoso CL, Pexe M, Araujo RZ, Condezo AB, Curi MM. Simple bone cyst in a 7-year-old child. RGO Rev Gauch Odontol. 2017;65(1):83-6.Ankha MEA, Nascimento R, Raldi F, Moraes M, Ribeiro Z, Santos L. Traumatic bone cyst and congenital muscular torticollis: association or a chance? Rev Esp Cir Oral Maxilofac. 2017;39(1):28-49.Ishimoto S, Tanaka S, Maatsishita Y, Kogo M. Mandibular simple bone cyst in a patient with first and second branchial arch syndrome. J Oral Maxillofac Surg Med Pathol. 2017;29(6):538-41.Saia G, Fusetti S, Emanuelli E, Ferronato G, Procopio O. Intraoral endoscopic enucleation of a solitary bone cyst of the mandibular condyle. Int J Oral Maxillofac Surg. 2012;41(3):317-20Bai XF, Hu ZP, Xu Z, Wushou A. Solitary bone cyst of the zygomatic bone. J Oral Maxillofac Surg Med Pathol. 2015;27(2):213-15.Suei Y, Taguchi A, Tanimoto K. Simple bone cyst of the jaws: Evaluation of treatment outcome by review of 132 cases. J Oral Maxillofac Surg. 2007;65(5):918-23.Mathew R, Omami G, Gianoli D, Lurie A. Unusual cone-beam computerized tomography presentation of traumatic (simple) bone cyst: case report and radiographic analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(3):410-13.

Surgical treatment of solitary bone cysts in children by parietal resection with plastic reconstruction with bone replacement materials

Objective. The study objective is to assess the effectiveness of bone cysts treatment by parietal resection of a bone cyst with plastic reconstruction with bone replacement materials.Methods: We have analyzed surgical treatment of 13 patients aged from 6 to 16 years with the diagnosis “solitary bone cyst”. As bone replacement material we used “Osteomatriks” (9 cases), (2 cases) and Chronos (2 cases). Surgical operations were performed in the active stage of cyst in eight patients and in the passive stage – five patients. To assess the results of treatment we used radiological criteria C.S. Neer et al. (1973).Results: Recovery was registered in 11 cases, residual cavity – in 1 case, relapse – in 1 case.Conclusions: Parietal resection with plastic reconstruction with bone replacement materials is a quite effective method of treatment of solitary cysts in children. In this case “Osteomatriks” can be an alternative to more expensive and less available materials.

Continuous Surgical Decompression for Solitary Bone Cyst of the Jaw in a Teenage Patient

Background. A solitary bone cyst or simple bone cyst is a nonneoplastic osseous lesion, with no epithelial lining, also considered as a pseudocyst. These lesions, with an intact bony wall and fluid-filled, are frequently discovered by chance in radiological studies. The etiopathogenesis has not been studied in depth, and the management remains controversial. Case Presentation. We present a clinical case of a 15-year-old boy who underwent an orthopantomography to assess the development and position of the third molars during a routine postorthodontic check-up. By chance, the X-ray identified an asymptomatic radiolucent image in the left jaw, measuring 12.0 mm×17.8 mm and compatible with a solitary bone cyst involving teeth 35 and 36. We describe our technique for performing minimally invasive decompression of the lesion using a microperforated catheter. We describe the entire course of the follow-up, both clinical and radiological, until complete cure. Conclusions. This straightforward continuous decompression technique poses no problems for the patient, has a low risk of sequelae, and is clearly cost-effective. In view of the highly satisfactory evolution, whenever possible, we favor this minimally invasive technique for the treatment of solitary bone cysts in the jaw.