Aneurysmal bone cyst

Aneurysmal bone cysts are rare skeletal tumors that most commonly occur in the first two decades of life. They primarily develop about the knee but may arise in any portion of the axial or appendicular skeleton. Pathogenesis of these tumors remains controversial and may be vascular, traumatic, or genetic. Radiographic features include a dilated, radiolucent lesion typically located within the metaphyseal portion of the bone, with fluid-fluid levels visible on MRI. Histologic features include blood-filled lakes interposed between fibrous stromata. Differential diagnosis includes conditions such as telangiectatic osteosarcoma and giant cell tumor. The mainstay of treatment is curettage and bone graft, with or without adjuvant treatment. Other management options include cryotherapy, sclerotherapy, radionuclide ablation, and en bloc resection. The recurrence rate is low after appropriate treatment; however, more than one procedure may be required to completely eradicate the lesion.     

Aneurysmal bone cyst

Summary A typical case of aneurysmal bone cyst of thoracic vertebrae responding well to surgical extirpation has been reported. Relevant literature on the subject has been reviewed.

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Zusammenfassung Bericht über einen typischen Fall einer aneurysmatischen Knochenzyste eines Brustwirbelkörpers. Die Veränderung konnte chirurgisch entfernt werden. Die einschlägige Literatur wird dargestellt.

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Resumen Se presenta un caso típico de quiste oseo aneurismático de vértebras torácicas y que cursó bien después de la extirpación quirúrgica. La literatura más importante sobre este tema ha sido revisada.

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Résumé Un cas typique de kyste osseux anévrismal d'une vertèbre thoracique qui répond bien au traitement chirurgical a été rapporté. La littérature, qui est importante, a été revue.

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Riassunto Viene riportato un caso tipico di cisti ossea aneurismatica delle vertebre toraciche estirpata chirurgicamente con successo. La letteratura sull'argomento viene riportata e discussa.

     

Aneurysmal bone cyst

Summary Authors report on the results of treatment of 52 primary and 16 secondary aneurysmal bone cysts (ABC). ABC grow rapidly; 84% of them have already destroyed more than the half of the bone width at recognition. En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. Careful curettage and bone grafting still remains the surgical method of choice in the majority of cases, when the ABC is more destructive and affects the subchondral bone of the joints. Segmental resection is only indicated when removal of the affected bone does not influence the function of the extremity. Superselective embolization of the cyst was performed in seven cases with excellent results. This method is suggested for ABC in certain locations inaccessible to surgical intervention, e.g., the pelvis, or to avoid excessive bleeding in hypervascularized tumors. In one case, however, an incomplete rebuilding of the ABC could only be achieved by the administration of calcitonin. The 16 cases of secondary ABC were observed mostly in association with osteoblastomas, giant-cell tumors, and osteosarcomas. The incidence of the secondary ABC was 23% in the whole ABC group but not more than 2–4% among the osteosarcomas and giant-cell tumors. Secondary ABC may confuse the histological and clinical diagnoses and that, especially in cases of osteosarcoma, may have fatal consequences.     

Aneurysmal bone cyst

Summary Twenty cases of aneurysmal bone cyst were reviewed, with an average follow-up of 10.3 years. Twelve patients still had open growth plates at diagnosis, but all of them were fully grown at follow-up. The treatments performed were: resection of the cyst or of the whole affected bone, curettage, and curettage and bone grafting. Radiation therapy was a complementary treatment in three cases. Two patients relapsed, one that had been treated by curettage alone and one by curettage and bone grafting. Five patients showed skeletal deformities at follow-up. Two had lesions of the growth plate, most likely caused by radiation therapy, whereas in the other three growth had probably been impaired by surgical trauma.     

Aneurysmal bone cyst of the occipital bone

A 13 years boy presented with a painless hard and fixed swelling in occipital region for the last three months. Plain X-ray, CT scan and MRI showed an expansile multi loculated cystic lesion in occipital bone. Histopathological examination revealed it to be an aneurysmal bone cyst. Treatment of choice is surgery. However, radiotherapy may be helpful in incompletely excised lesions.     

Aneurysmal bone cyst of the frontal bone

Aneurysmal bone cyst rarely affects the skull. We report two cases of aneurysmal bone cyst of the frontal bone. One of the cases is associated with pregnancy. The association of pregnancy with aneurysmal bone cyst and enlargement of the aneurysmal bone cyst during the pregnancy have been discussed.     

Aneurysmal bone cyst of the cuboid

Aneurysmal bone cyst was considered a variety of giant cell tumour up until 1942, when Jaffe and Lichtenstein isolated it and suggested it was an independent pathology in itself. Aneurysmal bone cyst of cuboid represents about 1% of all tumours and benign pseudotumoral lesions. Foot location of this type of condition is quite rare; its location in the cuboid bone is an exceptional occurrence. A review of the literature confirms its extreme rarity: we found only two cases.     

Aneurysmal bone cyst of the skull

A case of a 48-year-old woman with aneurysmal bone cyst of the skull is reported. By using estrogen, which is one of the chemical embolizing agents, the abnormal vascular shadow disappeared and clinical symptoms were improved. The significance of selective external carotid angiography in the diagnosis of this lesion is discussed and the benefit of this therapeutic method is argued.     

Aneurysmal bone cyst of the spine

The cases of twenty-two patients with an aneurysmal bone cyst of the spine above the sacrum were analyzed with regard to sex, age, site, symptoms, and radiographic findings. Four patients had extension of the lesion to the adjacent vertebra or rib, and twelve patients had neurological deficits. The primary treatment was either radiotherapy or surgery alone, or surgery and radiotherapy combined. No recurrences were found in patients who were treated with surgery alone or with surgery and radiotherapy, while three of the six patients who were treated with radiotherapy had a local recurrence, two of which were fatal. The patients with neurological deficits recovered after healing of the cyst.     

Aneurysmal bone cyst of the hand

Diagnosis of aneurysmal bone cyst in the hands is confused by rarity (2%) and overlapping characteristics of other lesions, especially benign osteoblastoma and giant-cell tumor. Pseudosinusoidal vascular channels create interfaces between liquid blood (maintained by fibrolysin) and connective tissue cells. The role of trauma is inexplicable.     

Aneurysmal bone cyst of the spine

Summary Long term follow up of three patients with aneurysmal bone cysts has allowed us to draw attention to features which facilitate diagnosis and determine adequate treatment. The lesion occurs usually under the age of twenty with a slight female predominance. Treatment consists in complete local excision. Failing this, curettage should be carried out, and this gives good results. The effectiveness of radiotherapy cannot be assessed from our series, but in our opinion it may not be necessary in every case and shoud be applied judiciously, as postradiation sarcomas have been reported. Special attention must be paid to the tendency for spontaneous regression and cure after incomplete removal, particularly in recurrent cases, with a view to avoiding more aggressive treatment than is necessary. Multi-location (vertebra and distant bone), endothelial proliferation, and obliteration of the lumen of the small blood vessels support the view that this is a vascular lesion.     

Aneurysmal bone cyst of the ischium

Summary The treatment of a patient with an aneurysmal bone cyst involving the pelvis by selective arterial embolism is described. After one year pain relief is complete and radiologically the lesion is healing with increased density of the cyst wall and intracystic trabecular bone formation.

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Résumé Présentation de l'évolution clinique et radiologique d'un cas de kyste osseux anévrysmal localisé au bassin, traité par embolisation artérielle sélective. Radiologiquement la lésion paraît stabilisée, avec densification des parois et apparition de travées d'os nouveau à l'intérieur du kyste.Avec un an de recul, les douleurs ont complètement disparu.

     

Aneurysmal bone cyst and solitary cyst of bone]

Results of treatment of 7 cases of aneurysmal bone cysts and 12 cases of solitary bone cysts in 19 patients treated in our Department between 1991 and 1996 are presented. Changes were found in the humerus, femur, tibia and fibula. Curettage or excision was the mode of treatment. Recurrence of the condition has been noted in 4 cases. Excision of the change and filling of the defect with autologous or homologous bone graft is more efficient than curettage alone.