Aneurysmal bone cyst of the coronoid process of the mandible: a case report

A rare case of aneurysmal bone cyst (ABC) located in the ramus of the mandible with involvement of the coronoid process is presented. The pressure of the slow growing tumor apparently caused severe resorption of the zigomatic arch. Treatment consisted of enucleation of the tumor via a pre-auricular access. A two year follow-up showed restoration of facial symmetry and partial regeneration of the coronoid process. To our knowledge this is the second published case of an ABC of the coronoid process of the mandible.     

Giant aneurysmal bone cyst of the mandible

The aneurysmal bone cyst is a type of pseudocysts of the jaw. It is a nonneoplastic lesion of the bone, characterized by replacement with fibro-osseous tissue containing blood-filled sinusoidal or cavernous spaces. The lesion remains a relatively uncommon finding in the facial bones, and the cause and pathogenesis are yet to be elucidated. Aneurysmal bone cyst was first described as a distinct clinical and pathologic entity by Jaffe and Lichtenstein in 1942. Aneurysmal bone cyst comprises 1.5% of all nonodontogenic cysts of the jaws and 1.9% of all aneurysmal bone cysts of skeleton. A rare case of giant aneurysmal bone cyst of mandible in a 10-year-old child is presented, which was managed by surgical curettage with a long-term follow-up.     

Unusual radiographic presentation of an aneurysmal bone cyst of the mandible

An 11-year-old girl was referred because of a painless firm swelling in the right posterior mandible that had started 2 months previously. A panoramic radiograph showed a nonspecific finding of a tiny discreet shadow following the lower border of the mandible, without any radiographic signs of radiolucency in the affected area or discontinuity of the lower border. However, multislice computed tomography (MSCT) findings were suggestive of an aneurysmal bone cyst, and histopathological findings revealed a diagnosis of aneurysmal bone cyst. Complete surgical excision followed by extensive cortical bone curettage was done, and no recurrence has been observed in the past 5 years. A differential diagnosis list is included, and extended with fibrous dysplasia according to the radiographic findings. To the best of our knowledge, this is the first case of a jaw aneurysmal bone cyst with unusual initial radiographic findings. Furthermore, a ground-glass appearance on MSCT scans suggested fibrous dysplasia. The present case highlights the need for accurate differential diagnosis of the lesion described to obtain the correct diagnosis in a timely manner and plan the appropriate treatment.     

Aneurysmal bone cyst of the mandible--a case report

Aneurysmal bone cysts originating in the craniofacial region have seldom been reported in Taiwan. A case of aneurysmal bone cyst arising in the right mandible of a 15-year-old Chinese boy was presented with both the roentgenographic and microscopic findings. In view of the high recurrent rate and the large destructive mandibular lesion, segmental resection with immediate bone grafting for reconstruction and a conscientious follow up regimen was employed. The etiology and pathogenesis of this interesting lesion remained unclear but several theories were reviewed and the differential diagnosis of this lesion was also discussed. Furthermore, immunoperoxidase staining for Factor VIII related antigen was performed to help differentiate between the aneurysmal bone cyst and a central hemangioma and then to elucidate the pathogenesis of the former.     

Aneurysmal bone cyst of the jaw: Case report

A bstract — A case report of aneurysmal bone cyst of the mandible in a twenty-four year old woman is presented. Although uncommon, such lesions should be considered in the differential diagnosis of radiolucent lesions of the jaws. The occurrence of this lesion in the jaws has not been previously reported in the Australian dental literature.     

Aneurysmal bone cyst of the jaws. Review of the literature and report of 2 cases

Strictly speaking, the aneurysmal bone cyst is not a true cyst. It is a lesion characterized by replacement of bone by fibro-osseous tissue containing blood-filled cavernous spaces. It is usually treated by surgical curettage, and access within the jaws may sometimes be difficult. We reviewed the world literature and found 63 cases of aneurysmal bone cysts involving the face, 22 reported in the maxilla, and 63 in the mandible. One was found in the zygomatic arch. Of the patients reported, 88% were younger than 30 years old; there was an equal sex distribution. Included in this report, are two cases of our own, one involving the maxilla and one the mandible.     

Aneurysmal bone cyst of the mandible

The case of a 48-year-old male patient with a slowly growing mass in the right molar region of the mandible is presented. The biopsy specimen showed an aneurysmal bone cyst. After radiation therapy failed to arrest the process, the patient was treated surgically via an external approach. Between the time of the initial presentation and the date of definitive surgery 9 months later, a dramatic change was noted in the roentgenographic pattern of the lesion, demonstrating early and late stages in the development of an aneurysmal bone cyst. There has been no recurrence in a 17-year follow-up period.     

Aneurysmal bone cyst of the maxilla--an association with tooth resorption.

The aneurysmal bone cyst is an uncommon lesion of the jaws. Cases involving the maxilla have been reported infrequently. Despite uncertainty as to the aetiology of the aneurysmal bone cyst, it is regarded as a benign lesion. Conservative surgical treatment with regular postoperative follow-up is recommended. The case described here presented with tooth mobility resulting from extensive root resorption. A review of the literature reveals that significant root resorption is not a commonly reported feature of aneurysmal bone cysts. For the present case we interpret the evidence as supporting a diagnosis of idiopathic root resorption complicated by the formation of a aneurysmal bone cyst.     

Aneurysmal bone cysts of the jaws: a case report and review of the literature.

A case of aneurysmal bone cyst of the mandible in a 21-year-old female has been presented, and the pertinent literature reviewed. Conservative surgery in the treatment of this type of jaw lesion is recommended.     

Pathologic fracture of the mandible associated with simultaneous occurrence of an odontogenic keratocyst and traumatic bone cyst

A case is presented which involved a pathologic fracture of the mandible associated with a large radiolucent lesion extending from the parasymphysis to the coronoid notch. The osseous defect was found to involve two separate lesions, identified histologically as a traumatic bone cyst in the anterior portion and an odontogenic keratocyst in the posterior aspect. The clinical course and treatment are discussed.     

Extensive aneurysmal bone cyst of the mandible

The aneurysmal bone cyst (ABC) is a rare benign lesion with an incidence of approximately 1% to 2% of bone tumors mainly in patients of 10 to 20 years of age and requires an operative procedure involving complete removal.We present a rare case of a large ABC in the angle and ramus of the mandible of a 14-year-old boy. The lesion had first been seen by a pediatrician 3 months before and turned out to be causing both a large and rapidly increasing swelling of the right face. Histology revealed a solid ABC, located in the angle and ramus of the mandible with cortical perforation and extrusion of the neighboring structures. A segmental resection of the mandible and soft-tissue excision of the lesion was performed. The mandible was primarily reconstructed by microvascular free-fibula transfer.The ABC did not show specific clinical or radiologic signs based on varying clinical examinations. The diagnosis was thus challenging, and other malignant tumors that can occur in the maxillofacial field had to be considered. Aneurysmal bone cysts mainly occur in patients 10 to 20 years old, so it is of clinical significance for pediatricians and pediatric dentists, who may well be the first to see such patients. This case report shows an ABC unusual in both its clinical findings and the therapy necessary. This article gives a conclusive review of diagnosis, pathogenesis, and treatment options.     

Aneurysmal bone cyst of the mandible: a case report

The case of a 6-year-old boy with a rapid growing mass in the right angle of the mandible that clinically and radiographically resembled a malignant lesion is presented. The biopsy specimen showed an aneurysmal bone cyst. The patient was treated surgically via extraoral approach including immediate mandibular reconstruction with with iliac crest bone. The literature is briefly reviewed.     

Aneurysmal bone cyst--a lesion in the mandibular ramus

The aneurysmal bone cyst occurs predominantly in the long bones and vertebral column although lesions have been seen in the clavicle, ribs, innominate bone, skull and bones of the hands and feet (Shafer et al., 1974). A case is reported of such a lesion presenting in the ascending ramus of the mandible.     

Aneurysmal bone cyst of the jaws. Report of a case associated with fibrous dysplasia and review of the literature

A case of aneurysmal bone cyst (ABC) of the mandible, recurring for the third time and arising in conjunction with fibrous dysplasia, is reported. A comprehensive review of the literature and analysis of over 50 cases of ABC of the jaws yielded the following results: ABCs of the jaws constitute 1.5 % of all non-odontogenic and non-epithelial cysts of the jaws, and 1.9 % of all ABCs of the skeleton. The mandible was affected in 55 % of the cases, the maxilla in 45 % of the patients. Females represented 53 % of the patients and males the remaining 47 %. Seventy-four percent of the ABCs occurred in patients 20 years old and younger. This lesion is regarded as non-neoplastic and as most likely secondary to a pre-existing bone lesion. Our review established that 21 % of the reported cases in the jaws had developed in association with various primary lesions of bone, including fibro-osseous lesions. The primary bone lesion initiates an osseous, arteriovenous fistula which, through its hemodynamic forces, creates a secondary reactive lesion, that is an aneurysmal bone cyst. We also established a recurrence rate of 26 %, based upon previously reported cases as well as our own. The treatment of choice is surgical curettage with cryosurgery and immediate packing with bone chips.     

Differential diagnosis in a case of brown tumor caused by primary hyperparathyroidism

Fibrous-cystic osteitis is a bone metabolic disorder related to hyperparathyroidism. This pathological condition shows a bone catabolism enhancement, due to increased level of PTH. Brown tumour is a uni- or multi-focal bone lesion, which represents the terminal stage of the hyperparathyroidism-dependent bone pathology. This focal lesion is not a real neoplasm showing itself as a cellular reparative process, mainly interesting the jaws, specially the mandible. Because of the similar radiological features (cyst-like radiolucency) showed by other lesions, the diagnosis can be difficult. Histology cannot guarantee a certain diagnosis, some lesions, such as giant cell tumour, giant cell granuloma, aneurysmal bone cyst and cherubism, show a similar macroscopical and microscopical features. Differential diagnosis is possible only by comparative evaluation of clinical, radiological and biochemical evidences. Personal experience with a patient affected by maxillary expansive lesion previously diagnosed as GCT is reported. Radiological examinations showed another cyst-like lesion involving the mandible. Clinical history and multifocality of lesions were suggestive for the presence of a systemic disease, laboratory data allowed a primary hyperparathyroidism diagnosis. Parathyroid scintigraphy was performed and detected a parathyroid adenoma. In first instance the patient underwent to surgical operation on the jaws in order to stop the rapid progression of bone lesions, and then another operation for the removal of parathyroid adenoma was performed.     

Aneurysmal bone cyst of the zygomatic arch.

A case is described of an aneurysmal bone cyst which, because of its normal anatomical location, caused considerable difficulties in diagnosis and clinical management. The literature concerning aneurysmal bone cysts of the jaw is reviewed and the pathogenesis of this rare but interesting lesion is briefly discussed.     

Aneurysmal bone cyst of the mandible

Aneurysmal bone cyst is a multilocular cystlike lesion in the bone which is filled with blood. In 1942, Jaffe and Lichtenstein¹ separated a cystic lesion containing numerous pools of blood from other cysts, and in 1950 Lichtenstein² proposed the name “aneurysmal bone cyst” for this entity. He stated that the aneurysmal bone cyst usually occurred in vertebrae, clavicle, rib, and limb bones and produced eccentric bone expansion with numerous pools of blood. The histologic findings showed that spongy bone and marrow were replaced by a fibrous tissue in which hemorrhage, giant cell reaction, and reparative new bone formation were observed.Lichtenstein³ reported statistically that vertebrae and limb bones were commonly affected, constituting about 60% of the total number of cases. Studies by Biesecker et al⁴ and Ruiter et al⁵ showed almost the same result. The aneurysmal bone cyst rarely affects the craniofacial bones. Biesecker reported only two cases in the mandible in 66 cases, and Ruiter reported one case in the maxilla in 105 cases. Daugherty⁶ mentioned that only 2% of these lesions were in the facial bones.     

Aneurysmal bone cyst of the jaws. (II). Pathogenesis

The pathogenesis of the aneurysmal bone cyst is the subject of much controversy. This study was undertaken to test the hypothesis that the aneurysmal bone cyst is a secondary phenomenon which occurs in a primary lesion of bone. Histological material from 303 bone lesions was studied for evidence of development of aneurysmal bone cyst. Microcysts and blood-filled spaces, similar to those seen in aneurysmal bone cysts, were observed in 15 of 54 central giant cell granulomas studied (28%). The frequency was lower (10%) in 49 cases of fibrous dysplasia and very low in ossifying and cementifying fibromas. 1 of 7 cases of Paget's disease of bone showed large blood spaces. It is postulated that the initiating process of the aneurysmal bone cyst is the microcyst, which forms as a result of intercellular oedema in a primary lesion with loose, unsupported stroma. Rupture of vessels into the microcysts introduces blood under haemodynamic pressure. With little resistance provided by the stroma, the blood spaces resorb the surrounding bone and lift the periosteum, which produces a thin shell of new bone. Similar histological features were observed in 6 of 42 fibrosarcomas examined (14%) and in 8 of a series of 75 osteosarcomas (11%). While many of these lesions did not present with clinical similarity to the aneurysmal bone cyst, it is postulated that this type of case may account for the so-called malignant aneurysmal bone cyst occasionally reported.     

Soft tissue aneurysmal bone cyst of the mandible: Report of a case

We report the case of a 17-year-old boy with a soft tissue aneurysmal bone cyst (STABC) located in the posterior aspect of the right mandible. Conventional radiography revealed no positive findings. On the computed tomography scan, the lesion appeared to have a non-uniform intralesional density. Magnetic resonance imaging revealed an abnormal soft tissue masses with cystic component in the superficial part of right mandibular body and angle with intact cortex. Following histopathological examination, fibro-histiocytic proliferation, blood-filled spaces and multinucleated giant cells were seen and the lesion was diagnosed as a STABC. The mass together with underlying bone and periosteum on its periphery was surgically resected under general anesthesia. Thirty-six months after surgery the patient was assessed at outpatient clinic and found no sign of recurrence This may be only the first reported case of the mandible in the English literature of this extremely rare benign tumor occurring in soft tissue.     

颌面部动脉瘤样骨囊肿的诊断与治疗:附2例报道

目的:探讨颌面部动脉瘤样骨囊肿的临床诊断与治疗方法.方法:回顾分析2例发生于上、下颌骨的动脉瘤样骨囊肿病例,结合相关文献进行讨论.结果:2例患者均采用手术治疗.术后颌面部外形和功能恢复良好.随访la无复发.结论:发生于颌面部的动脉瘤样骨囊肿非常少见,确诊依赖于术后病理,手术治疗为其有效的治疗手段.