Zusammenfassung
Hintergrund
Knochenzysten sind gutartige tumorähnliche Knochenläsionen, welche einen flüssigkeits- und z. T. zellgefüllten Hohlraum im Knochen darstellen. Sie können solitär, in seltenen Fällen auch multipel im Skelettsystem vorkommen.
Fragestellung
In diesem Beitrag werden die Diagnostik, das radiologische Erscheinungsbild und die Therapie der wichtigsten benignen zystischen Knochenläsionen, wie solitäre Knochenzysten, aneurysmatische Knochenzysten, intraossäre Ganglien, Epidermiszysten und subchondrale Zysten vorgestellt und deren Differenzialdiagnostik zu zystoiden Formationen und Tumoren mit zystischen Anteilen erörtert.
Methode
Es erfolgte eine selektive Literaturrecherche unter Berücksichtigung eigener Erfahrungen.
Ergebnisse
Solche „tumor-like lesions“ können radiologisch wie Knochentumoren imponieren, zeigen jedoch kein autonomes reizunabhängiges Wachstum und können sich auch spontan vollständig zurückbilden. Zumeist ist eine offene Biopsie zur Diagnosesicherung notwendig. Bedarf es in manchen Fällen keiner chirurgischen Intervention („Do-not-touch-“ oder „Leave-me-alone“-Läsionen), stehen in vielen Fällen die Prävention und die Behandlung pathologischer Frakturen sowie die Rezidivprophylaxe im Vordergrund.
Schlussfolgerung
Zystische Knochenläsionen gehören zu den häufigsten nichttraumatischen Knochenveränderungen. Bei differenzialdiagnostischer Unklarheit ist die Histologiegewinnung wegweisend. Im Falle einer chirurgischen Intervention besteht aktuell der Trend zur multimodalen Therapie, wobei die exakte Kürettage zumeist die Grundlage bildet.
Abstract
Background
Bone cysts are benign tumor-like lesions which often present as a fluid-containing cavity in the bone. They can occur in the skeletal bone as solitary or sometimes multiple bone lesions.
Objectives
This review discusses the diagnostics, radiological appearance and therapeutic strategies of the most important benign cystic bone lesions, such as simple bone cysts, aneurysmal bone cysts, intraosseous ganglia, epidermoid cysts and subchondral cysts. The differential diagnoses with respect to cystoid formations and tumors with cystic components are discussed.
Method
A selective literature search was performed taking own experiences into consideration.
Results
These tumor-like lesions can have the radiological appearance of bone tumors but show no autonomic, stimulus-independent growth and can resolve spontaneously. In the majority of cases open biopsy is necessary to confirm the diagnosis. In some cases no surgical intervention is necessary (e.g. do not touch and leave me alone lesions), whereas in other cases the focus of treatment is on the prevention and therapy of pathological fractures as well as prevention of recurrence.
Conclusion
Cystic bone formations are among the most commonly occurring non-traumatic bone lesions. To eliminate differential diagnostic unclarity, histological investigation of biopsy material is essential. In terms of surgical intervention there exists a trend towards multimodal therapy mostly based on a meticulous curretage.
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Interessenkonflikt. K.-D. Schaser, C. Hipfl, P. Schwabe, S. Märdian und I. Melcher geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Hipfl, C., Schwabe, P., Märdian, S. et al. Benigne zystische Knochenläsionen. Unfallchirurg 117, 892–904 (2014). https://doi.org/10.1007/s00113-014-2579-2
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DOI: https://doi.org/10.1007/s00113-014-2579-2