Nanda Saurav Narayan, Tripathi Sanjay, Shiraz Shaikh Muzammil, Warrier Sudhir
Resident, Department of Orthopaedics & Trauma, Lilavati Hospital and Research Centre Mumbai, Maharashtra, India.
Consultant Orthopaedic Hand Surgeon, Lilavati Hospital and Research Centre Mumbai, Maharashtra, India.
J Orthop Case Rep. 2018 Mar-Apr;8(2):9-12. doi: 10.13107/jocr.2250-0685.1024.
Aneurysmal bone cysts of the hand are rare, and only few cases are reported in scientific literature. We report a case of aneurysmal bone cyst of 3rd metacarpal treated at our tertiary care hospital, Mumbai.
A 13-year-old young female presented with pain and progressive increase in swelling over the dorsum of the right hand for 7-months. There was pain and tenderness over 3rd metacarpal. There was painful restriction of movement at the metacarpophalangeal joints. Serial radiographic evaluation of the hand from May 2009 to October 2010 showed multilocular expansile lytic lesion with ballooning of 3rd metacarpal with increasing size. The patient was managed surgically with bone grafting. Histopathology section suggested fibrous septa enclosing hemorrhagic cystic space. Septa contained bony chips, spindle cell, inflammatory cell, and few scattered osteoclast. Diagnosis of aneurysmal bone cyst of 3rd metacarpal was made. The patient was followed up after 5 years with good radiological healing with pain-free and good range of motion, good grip strength without any recurrence.
Aneurysmal bone cyst is a rare, rapidly growing, and destructive benign bone tumor. Many treatment modalities have been reported in literature including radiation, curettage and bone grafting, cryotherapy, and excision. However, controversy exists in the literature regarding optimal treatment. Due to its rarity in the hand, no evidence-based treatment regimen has been established. The patient can be managed surgically with bone grafting with good radiological healing with pain-free and good range of motion, good grip strength without any recurrence.
手部动脉瘤样骨囊肿较为罕见，科学文献中仅有少数病例报道。我们报告一例在孟买我们的三级医疗中心治疗的第三掌骨动脉瘤样骨囊肿病例。
一名13岁年轻女性因右手背疼痛和肿胀进行性加重7个月前来就诊。第三掌骨处有疼痛和压痛。掌指关节活动时有疼痛性受限。2009年5月至2010年10月对手部进行的系列影像学评估显示，第三掌骨出现多房性膨胀性溶骨性病变，且病变大小不断增大。患者接受了骨移植手术治疗。组织病理学切片显示纤维间隔包绕出血性囊性腔隙。间隔内含有骨碎片、梭形细胞、炎性细胞及少数散在的破骨细胞。诊断为第三掌骨动脉瘤样骨囊肿。患者在5年后接受随访，影像学愈合良好，无痛，活动范围良好，握力良好，无任何复发。
动脉瘤样骨囊肿是一种罕见、生长迅速且具有破坏性的良性骨肿瘤。文献中报道了多种治疗方式，包括放疗、刮除及骨移植、冷冻治疗和切除。然而，关于最佳治疗方法，文献中存在争议。由于其在手部罕见，尚未确立基于证据的治疗方案。患者可通过骨移植手术治疗，获得良好的影像学愈合，无痛，活动范围良好，握力良好，无任何复发。
