Publication:

Endoscopy assisted extended curettage in a rare case of aneurysmal bone cyst involving the 2nd metatarsal of a child

Aneurysmal bone cysts account for only 1% of all bone tumours and of these only a handful of reported cases occur in the foot. They can mimic other bone tumours on imaging studies, thus making histological diagnosis mandatory. Aneurysmal bone cyst of a metatarsal is very rare especially in children and only few cases have been reported in the literature. We report the novel management option for a rare case of an Aneurysmal bone cyst localized to the second metatarsal in a 5 years old boy who presented with limping, local pain, and minimal swelling in his left foot. Tissue diagnosis was confirmed on the basis of needle biopsy. Surgery was in the form of extended curettage using an endoscope with a high-speed burr and cautery. The remnant cavity was filled up with artificial bone graft. Histopathology analysis of the resected tissue was consistent with Aneurysmal bone cyst. There was complete healing at final follow-up at 2 years. Endoscopy assisted extended curettage appears to be an ideal treatment option as it provides a perfect visualisation of the interior of the entire cyst and use of cautery and burr more accurately under direct vision which potentially leaves only a minimal scope for recurrence. Use of artificial bone grafts instead of conventional autogenous bone grafts to reduce graft site morbidity in children and stimulate local foreign body reaction for enhancing residual tumour cell kill if any and also to promote bony sclerosis for healing.