Aneurysmal bone cyst on the carpus of an African collared dove (Streptopelia roseogrisea).
Key words: aneurysmal bone cyst, avian, Columbiformes, African collared dove, Streptopelia roseogrisea
An adult female African collared dove (Streptopelia roseogrisea) was presented for examination of a mass on the left wing. The bird was of unknown age but had been in the owner's possession for 6 years. It was housed with 3 other doves in a free-flight aviary and was offered a commercial seed-mix diet, bread, and, occasionally, bakery products. According to the owner, the mass had been present for 2 months, but the size had dramatically increased over the previous 2 weeks. The bird did not show any signs of pain or difficulty flying. It had laid eggs 2 days before the examination.
On physical examination, a soft mass (1 x 1 x 0.25 cm) was present on the medial aspect of the left carpus. The mass was yellow and nonulcerated, and appeared adherent to deeper structures (Fig 1). The carpus could be flexed and extended as normal. The body condition score was optimal (3/ 5). No other abnormalities were detected on examination. Primary differential diagnoses were neoplasia (eg, osteoma, osteosarcoma, giant cell tumor, fibroma, fibrosarcoma, hemangioma, hemangiosarcoma, chondroma, chondrosarcoma), (1,2) inflammation (eg, osteomyelitis, granuloma, xanthoma), or a bone cyst. Radiographic examination of the left wing revealed a cavitary radiolucent lesion (Fig 2). This lesion was well demarcated, surrounded by a thin bony wall, and confined to the metaphysis of the alular bone. No soft tissue swelling or periosteal reaction was associated with the lesion. Based on these observations, an expansile bone cyst or osteochondromatosis were suspected.
The bird was anesthetized with isoflurane (Baxter, Maurepas Cedex, France) in oxygen administered by face mask, and the mass was surgically prepared and aspirated with a 25-gauge needle under ultrasonographic guidance. The content of the mass appeared cystic and hypoechoic. A serohemorrhagic fluid was aspirated. Moderate hemorrhage after the aspirate was stopped by compression. Cytologic examination of the aspirate revealed an inflammatory or degenerative lesion with blood contamination, with low numbers of erythrocytes, heterophils, and lymphocytes, and without any evidence of neoplasia.
[FIGURE 1 OMITTED]
Surgical excision of the mass or amputation of the wing in case of malignant neoplasia as options were discussed with the owner. Both the anesthetic risks and the risk of necrosis of the distal part of the wing if the vascularization were damaged were discussed. Initially, surgery was declined, and meloxicam (Boehringer Ingelheim, Paris, France; 2 mg/kg PO q12h 1 week per month) was prescribed to prevent osteoarthritis and pain, as recommended for columbiform birds. (3) After 1 week, the mass had increased by approximately one-third in size and extended to the lateral part of the carpus. The owner decided to proceed with surgery.
[FIGURE 2 OMITTED]
[FIGURE 3 OMITTED]
The dove was anesthetized with isoflurane administered by face mask. Butorphanol (0.5 mg/ kg IM once; Dolorex Merck, Frankfurter, Darmstadt, Germany) and cephalexin (30 mg/kg IM once) were administered into the pectoral muscles. The bird was intubated with a 1-mm endotracheal tube, monitored with a Microstream sidestream capnometer (NPB-75, Nellcor Puritan Bennett, Pleasanton, CA, USA) and an electrocardiogram, and placed on a warm pad. An intraosseous catheter was inserted into the right ulna and lactated Ringer's solution was delivered at 1 mL/h during the surgery. An elliptical skin incision was made over the mass, and the subcutis was bluntly dissected free from the underlying mass. Cotton-tipped swabs were used to ensure hemostasis. The deep bone was adherent to the mass, and it was decided to remove the part of the alular bone involved in the mass. The skin was partially closed with a synthetic absorbable suture (Vicryl 4-0, Ethicon, Auneau, France). In the central part of
the wound, it was not possible to close the skin, which was attached to the underlying tissues. A figure-of-eight bandage was put on the left wing. The recovery was uneventful. The postoperative radiograph revealed a complete resection of the alular bone. The owner was instructed to cage rest the bird until reexamination. Meloxicam (2 mg/kg PO q24h x5 days) and cephalexin (30 mg/kg PO q12h x l0 days) were given for postoperative treatment.
At reexamination 3 days after surgery, the figure-of-eight bandage was replaced by a light wound dressing. At 7 days after surgery, the wound was healing well. A healthy granulation tissue bed had developed, but epithelialization was still incomplete. On reexamination 1 month after surgery, the wound had healed completely. The bird maintained a good condition and constant weight after surgery. There was no recurrence of the lesion during the following year.
[FIGURE 4 OMITTED]
On histologic examination, the mass appeared as a well-circumscribed subcutaneous cavitary lesion filled with erythrocytes and thrombocytes admixed with a large amount of fibrin (clotted blood). The periphery was devoid of endothelial or epithelial lining (pseudocyst) and consisted of siderophages, reactive spindle cells (fibroblasts), multinucleated giant cells (osteoclasts), and bony spicules. Signs of bone resorption (Howship lacunae with osteoclasts) and new bone formation (multifocal deposition of osteoid) were observed. No cytonuclear atypia or atypical mitoses were observed (Figs 3 and 4). Differential diagnoses were a chronic hematoma or an aneurysmal bone cyst. Although several sections were examined, no underlying neoplastic lesion could be found. Based on the clinical presentation, the radiographic results, and previous descriptions of aneurysmal bone cysts in birds, (2) the diagnosis was aneurysmal bone cyst.
In humans, aneurysmal bone cysts are expansile lesions that consist of anastomotic cavernous spaces filled with unclotted blood, fibrous tissues, and, usually, osseous components. (4) However, in psittacine birds, they have been described as lesions composed of immature fibrous bone and osseous trabeculae with intense osteoclastic activity and containing a central cavity filled with fibrin and packed erythrocytes (clotted blood). (2) Hence, despite a similar name, aneurysmal bone cysts in birds may differ morphologically and pathogenetically from those of humans. Aneurysmal bone cysts have no endothelial lining and, therefore, should be considered as pseudocysts rather than cysts. This criterion is useful to differentiate them from vascular tumors. (5) Aneurysmal bone cysts are benign and nonneoplastic, and, although they may be associated with locally aggressive growth, metastasis does not occur. (6,7) However, if left untreated, they may destroy a large part of the bone in which they originate and may also compress surrounding soft tissue and adjacent bone. (5,6)
Aneurysmal bone cysts have been reported in humans, (7,8) dogs, (9-14) cats, (6) horses, (4) cows, (15) and psittacine birds. (2) To the best of our knowledge, this is the first report of an aneurysmal bone cyst in a columbiform bird. In birds, bone cysts have been reported on the radius of an umbrella cockatoo (Cacatua alba), on the cranium of a cockatiel (Nymphicus hollandicus), and on the distal third of the metacarpus of a cockatiel. (2)
The pathogenesis of this uncommon lesion remains unclear. It may result from trauma or a tumor-induced abnormal vascularization process of the bone marrow. (8-10) In humans, a third of aneurysmal bone cysts are associated with preexisting bone lesions. (8) Primary lesions include giant cell tumors, fibrous and osseous neoplasia, metastatic carcinomas, eosinophilic granuloma, radiation osteitis, and traumatic fractures. (8) However, aneurysmal bone cysts in humans and in dogs are usually benign. (12,16) In dogs, the condition is rare, and the prognosis is good to guarded, depending on the predisposing factors. (2,14) In dogs, osteosarcomas have been reported as a primary lesion associated with aneurysmal bone cysts. (14) A hereditary predisposition also has been suspected in Doberman pinschers. (12) Female doves can be very territorial when nesting, and they may defend their nesting site by striking with the carpus of a wing and flipping the wings while crouching in the nest. (17) The location of this aneurysmal bone cyst might be explained by repeated trauma due to this behavior during previous nestings by this dove. Such lesions, therefore, might be prevented by avoiding stressing doves during their breeding cycle.
Treatment options include irradiation, curettage, curettage augmented by the use of a high-speed burr, cauterization, and bone marrow injections. (13) In addition to the classic treatment options, adjuvants have been advised due to the risk of recurrence. These adjuvants include cryotherapy, polymethylmethacrylate filling of the defect, and ablation by alcohol injections. In humans, curettage of the cyst and transplantation of a bone graft have been used. Resection of the bone is advised when it is located in an expendable bone, such as the fibula, rib, (13) or the alula in the present case. In a study of humans treated for aneurysmal bone cysts, recurrence occurred in 30.5% of all cases and in 34.2% of those treated by curettage. (18) Amputation has not been associated with any recurrence. (18) Cementing the lesion with polymethylmethacrylate has been reported to be more effective than curettage and bone grafting alone: in 1 study, the local recurrence rate after curettage and cementation was 17% and, after curettage and bone graft, was 37%. (19) In the case we describe, amputation of the alular bone was elected because of the limited role of this bone during flight in companion birds.
Acknowledgments: We thank Professor Jean-Jacques Fontaine, DESVP-AP, Dipl ECVP, Department of Anatomic Pathology, Ecole Nationale Veterinaire d'Alfort, France, for assistance with this case.
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Claire Grosset, DVM, Edouard Reyes-Gomez, DVM, DESVP-AP, Dipl ECVP, Joanna Hedley, BVMS, CertZooMed, MRCVS, and Fouzia Stambouli, DVM
From the Exotic Pets Unit (Grosset) and the Department of Imaging (Stambouli), Ecole Nationale Veterinaire d'Alfort, Maisons-Alfort, 7 avenue du General de Gaulle, Cedex, 94700 France; the Department of Embryology, Histology, and Anatomical Pathology, Universite Paris-Est, Cite Descartes, Champs-sur-Marne, Marne-la-Vallee, Cedex 77454, France and the Department of Embryology, Histology, and Anatomical Pathology, Ecole Nationale Vetarinaire d'Alfort, Maisons-Alfort, 7 avenue du General de Gaulle, Cedex, 94700 France (Reyes-Gomez); and the Royal (Dick) School of Veterinary Studies, University of Edinburgh, Old College South Bridge, Edinburgh EH8 9YL, UK (Hedley). Present address (Grosset): Resident in Companion Avian and Exotic Pet Medicine, University of California, Davis, 1 Shields Ave, Davis, CA 95616, USA.
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|Title Annotation:||Clinical Reports|
|Author:||Grosset, Claire; Reyes-Gomez, Edouard; Hedley, Joanna; Stambouli, Fouzia|
|Publication:||Journal of Avian Medicine and Surgery|
|Article Type:||Clinical report|
|Date:||Mar 1, 2012|
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