Aneurysmal bone cyst: a review of 26 cases

Twenty-six cases of aneurysmal bone cyst are reviewed to determine the frequency, preferred treatment and prognosis. Some observations are made as to the existence of aneurysmal bone cyst as a primary entity or a secondary manifestation of a more serious underlying condition. The difficulty of differentiating an aneurysmal bone cyst from a giant cell tumor of bone is acknowledged and certain similarities to unicameral bone cyst are noted, with reference to some intriguing hypotheses put forward in the literature.     

Aneurysmal bone cyst of the spine with familial incidence

STUDY DESIGN: A report of two cases of aneurysmal bone cysts of the spine occurring in a father and daughter. OBJECTIVE: To present an unusual finding of familial incidence of aneurysmal bone cyst and review the literature. SUMMARY OF BACKGROUND DATA: Aneurysmal bone cysts are benign, expanding, locally aggressive lesions. Up to 20% of cases involve the spine. The cause of primary aneurysmal bone cysts remains unclear. There have been three previous reports of a familial incidence supporting the importance of a hereditary component in the cause of aneurysmal bone cysts. METHODS: A 36-year-old man and a 7-year-old girl were diagnosed with aneurysmal bone cyst involving the spine by clinical manifestations, radiographic features, and histologic evaluation. RESULTS: The father remains recurrence- and symptom-free 6 years after primary resection. Five months after surgery, the daughter was found to have recurrent disease by magnetic resonance imaging and underwent a second procedure within 1 year of the primary resection. CONCLUSION: The occurrence of a primary aneurysmal bone cyst in two family members, occurring at adjacent vertebral levels, is suggestive of a hereditary component to the formation of primary aneurysmal bone cyst.     

Aneurysmal bone cyst in the first rib

Aneurysmal bone cyst is a benign tumor of the skeletal system that rarely occurs in ribs. We report two cases of aneurysmal bone cyst in the first rib. The first patient was a 21-year-old woman with an aneurysmal bone cyst in the left first rib that was resected with an L incision. The second patient was a 42-year-old man with an aneurysmal bone cyst in the right first rib that was resected with a posterolateral incision but recurred 1 year later. An en bloc resection was performed, without recurrence to date. We also review this disease with emphasis on the etiology, clinicopathology, and treatment approaches.     

Diagnosing aneurysmal and unicameral bone cysts with magnetic resonance imaging

The differential between aneurysmal bone cysts and unicameral bone cysts usually is clear clinically and radiographically. Occasionally there are cases in which the diagnosis is not clear. Because natural history and treatment are different, the ability to distinguish between these two entities before surgery is important. The authors reviewed, in a blinded fashion, the preoperative magnetic resonance images to investigate criteria that could be used to differentiate between the two lesions. All patients had operative or pathologic confirmation of an aneurysmal bone cyst or unicameral bone cyst. The authors analyzed the preoperative magnetic resonance images of 14 patients with diagnostically difficult bone cysts (eight children with unicameral bone cysts and six children with aneurysmal bone cysts) and correlated these findings with diagnosis after biopsy or cyst aspiration and contrast injection. The presence of a double density fluid level within the lesion strongly indicated that the lesion was an aneurysmal bone cyst, rather than a unicameral bone cyst. Other criteria that suggested the lesion was an aneurysmal bone cyst were the presence of septations within the lesion and signal characteristics of low intensity on T1 images and high intensity on T2 images. The authors identified a way of helping to differentiate between aneurysmal bone cysts and unicameral bone cysts on magnetic resonance images. Double density fluid level, septation, and low signal on T1 images and high signal on T2 images strongly suggest the bone cyst in question is an aneurysmal bone cyst, rather than a unicameral bone cyst. This may be helpful before surgery for the child who has a cystic lesion for which radiographic features do not allow a clear differentiation of unicameral bone cyst from aneurysmal bone cyst.     

Aneurysmal bone cysts of the occipital bone

Two cases of aneurysmal bone cysts are reported. Each patient presented with a palpable mass in the occipital region and signs of compression of structures in the posterior fossa. One of the cases is unique, in that the aneurysmal bone cyst was associated with an epidural hematoma in the posterior fossa. The pertinent literature is reviewed.     

Aneurysmal bone cyst of the sternum.

A very rare case of aneurysmal bone cyst of the sternum is described. Aneurysmal bone cyst is a tumorlike bone lesion occumng commonly in the metaphysis of long bones and in the vertebrae. This report is one of the very few cases in the literature of aneurysmal bone cyst of the sternum. Total resection of the tumor and reconstruction of the sternal defect using autogenous fibula are presented     

Solid variant of aneurysmal bone cyst of the hamate

Solid variant of aneurysmal bone cyst is a variant of aneurysmal bone cyst in which the predominant histology is that of the solid material of a cystic aneurysmal bone cyst. In this article, we present a patient with solid variant of aneurysmal bone cyst of the hamate and discuss the differential diagnosis and current treatment for this lesion.     

Aneurysmal bone cyst of the zygomatic arch

Background: Aneurysmal bone cysts are rare vascular lesions that are most commonly found in the long bones. They are rare in the head and neck. Only two prior cases of aneurysmal bone cysts of the zygoma have been reported in the world literature. Results: We report a case of aneurysmal bone cyst arising in the zygomatic arch with intracranial extension treated with selective arterial embolization and complete excision via an infratemporal fossa approach. This is the first such case reported in the head and neck surgery literature. Conclusions: Selected cases of aneurysmal bone cyst may be safely treated with selective arterial embolization and complete resection.     

Aneurysmal bone cyst of the ethmoid

Although nearly 500 cases of aneurysmal bone cyst have been recorded in the English literature, involvement of the facial bone is uncommon. To our knowledge, this is the first case of extragnathic, facial aneurysmal bone cyst to be reported in the English literature. A left ethmoid aneurysmal bone cyst was found in a 20-year-old pregnant woman who had a 5-month history of progressive left periorbital swelling, left cystic nasal mass, progressive nasal obstruction, blurred vision, and occasional diplopia. The diagnostic evaluation included a sinus series, facial lamiograms, and an EMI scan. Needle aspirates taken frequently from the intranasal cyst consisted of a dark bloody fluid. The surgical procedure, using external rhinotomy approaches, pathologic findings, and a literature review are presented.     

The surgeon's procedure in dystrophic bone cysts in children]

The authors set apart childhood dystrophic cyst as a separate nosological unit. The underlying factor of the development of a bone cyst is dysplasia of vessels filling the bone-marrow canal and a concomitant dystrophic process in the surrounding bone tissue. The nonneoplastic nature of the cysts led to the search for sparing methods of treatment, namely, the puncture method. The administration of demineralized bone shavings during therapeutic puncture (after osteoperforation of the wall, scraping off the fibrous membrane) produces good results. The clinical material consists of 46 cases. There were 8 cases of aneurysmal bone cyst, 23 with active and 15 with passive bone cysts. In 44 cases treatment by two or three punctures led to recovery in 2-4 months. In 2 patients with aneurysmal bone cysts three punctures proved ineffective and an operative intervention was undertaken. It is concluded that treatment by puncture is indicated in dystrophic bone cysts. Operation is indicated in poor outcomes of puncture treatment in patients with aneurysmal bone cysts.     

Aneurysmal bone cyst of the rib.

Aneurysmal bone cysts are uncommon lesions, especially in the ribs. Four patients with aneurysmal bone cysts of the rib are presented and previously reported cases reviewed. A brief discussion of the clinical manifestations, pathology, aetiology, and current treatment of aneurysmal bone cyst is also included.     

Spontaneous healing of aneurysmal bone cysts. A report of two cases

Two cases of aneurysmal bone cyst in the pelvis which healed spontaneously are described. Spontaneous regression of aneurysmal bone cysts has not previously been well documented. Our experience with these two cases suggests that radical intervention is not always necessary.     

Radical surgery and vertebral body replacement in aneurysmal bone cysts of the spine

6 cases of aneurysmal bone cyst of the spine are presented. The clinical picture, diagnostic procedures and operative treatment will be discussed. Although aneurysmal bone cyst is a benign, non-neoplastic lesion its spreading tumor growth with destruction of important bony structures of the vertebral body, consecutive instability and cord compression presents a considerable menace to the mostly teenage-patient. Spinal computerized tomography is the diagnostic method of choice. The goal of surgical therapy of the aneurysmal bone cyst of the spine should include radical tumor excision in order to avoid recurrent tumor growth followed by vertebral body replacement and osteosynthetic stabilisation.     

Current treatments of primary aneurysmal bone cysts

The management of aneurysmal bone cyst depends on the age of the patient, the location, extent, aggressiveness and the size of the lesion. In the light of their experience and a review of the literature of 1256 aneurysmal bone cysts, the authors analyzed various treatment modalities. Inactive lesions can heal with biopsy or curettage alone. In active or aggressive lesions, elective treatment usually consists of curettage, whether associated or not with bone grafting and local adjuvants. Aneurysmal bone cyst in young children do not seem more aggressive than in older children. In pelvic locations, the emergence of a few cases of spontaneous healing (even in active or aggressive lesions) encourages the adoption of clinical and radiological supervision for some months after biopsy when possible. In some cases, the localization and extent of the cyst are such that operative treatment is extremely hazardous. Selective arterial embolization has made a considerable contribution towards the therapeutic solution of such cases. For some authors, direct percutaneous Ethibloc injection can be recommended as the first-choice treatment except in spinal lesions. Nevertheless, the complications encountered in some series after percutaneous embolization of aneurysmal bone cyst with Ethibloc should encourage the use of Ethibloc injection not as an initial treatment but as a reliable alternative to surgery.     

Unicameral and aneurysmal bone cysts

One hundred and seventy-eight cases of unicameral bone cysts (UBC) treated with curettage and bone grafting were compared to 141 cases treated with cortisone injections. The end results were comparable in the two groups. Local recurrence risk factors in the surgical group were active cyst and previous operations. In the other group they were multilocation of the cyst, active cyst, and size of cyst. A new radiographic classification of aneurysmal bone cyst (ABC) is proposed in a report of 198 cases of ABC. The treatment of choice in ABC is surgical and the type (curettage, curettage plus phenole or cryosurgery, resection or hemiresection) is selected on the basis of the radiographic aspect and the rate of growth of the cyst. Radiotherapy is only indicated in inoperable ABC cases.     

儿童跟骨动脉瘤样骨囊肿:病例报告及文献分析

[目的]跟骨动脉瘤样骨囊肿是一种少见病，本文报告了1例儿童跟骨动脉瘤样骨囊肿患者。[方法]本文结合文献回顾性分析了跟骨动脉瘤样骨囊肿患儿的临床、影像学及组织病理学表现。[结果]肿物累及右侧跟骨，经肿物刮除术和植骨术后恢复良好。组织病理学检查确诊为右侧跟骨动脉瘤样骨囊肿。随访2年无复发。[结论]跟骨动脉瘤样骨囊肿是一种少见病，对于单纯的动脉瘤样骨囊肿，肿物刮除术和植骨术是有效的治疗方法。     

Aneurysmal bone cyst of the rib: a case report

An aneurysmal bone cyst involving the rib is very rare. Forty-four cases have been reported in the literature. Primary neoplasms of the ribs are uncommon and malignant tumours are significantly more common than benign tumours in this location. The condition is a rare benign, progressive bone tumour. The aetiology and natural history are unknown. The Authors report the case of a 38-year-old man with an aneurysmal bone cyst of the right 6th rib, treated by en-bloc resection. The patient has been followed up now for ten years with no signs of recurrence.     

Secondary aneurysmal bone cyst of the patella

Aneurysmal bone cyst accounts for 1% of primary bone tumors and is one of the benign tumor-like lesions. Patellar involvement is quite rare. Its development on the basis of any previous lesion such as chondroblastoma is called secondary aneurysmal bone cyst. A 26-year-old male patient presented with right knee pain of three-year history. Physical examination showed a firm, immobile swelling at the anterior aspect of the right knee, without increase in temperature or redness of the skin. There was no pain on palpation and joint range of motion was normal. Radiological studies were suggestive of an aneurysmal bone cyst. At surgery, the cystic lesion was removed via curettage and the residual cavity was filled with an autogenous bone graft taken from the iliac wing. The histopathologic diagnosis was secondary aneurysmal bone cyst in association with chondroblastoma. During a 1.5-year follow-up, the patient had no complaint and no recurrence was observed.     

Aneurysmal bone cyst involving the hand: a review and report of two cases.

Two cases of aneurysmal bone cyst occurred in the hand. One involved the distal phalanx and followed a crushing injury to the tip of the finger; amputation of the part resulted in cure. The other involved almost all of the first metacarpal and was resected and replaced by an iliac bone graft. The appearance of an aneurysmal bone cyst in roentgenograms and after angiography usually is not diagnostic, although benign, progressive growth and potential for recurrence require complete removal.