Metachronous aneurysmal bone cysts with involvement of the humerus and the thoracic vertebrae

Metachronous aneurysmal bone cysts are rare. We report on a 32-year-old man who presented with an aneurysmal bone cyst of the thoracic spine 15 years subsequent to diagnosis of aneurysmal bone cyst of the humerus.     

Giant-cell tumor of bone and aneurysmal bone cyst

A correlated histologic and radiographic study of nine giant-cell tumors, six aneurysmal bone cysts, and one combined lesion is presented. Clinical findings and plain radiographic appearances were found to overlap. Angiographically, the giant-cell tumors were richly vascularized, with a marked intratumoral contrast uptake, occasional irregular tumor vessles, a prominent peritumoral arterial net-work, and early draining veins. Microscopic examination revealed fine, capillary-like and somewhat larger, angulated, sinusoid vessels, and occasional small, bloodfilled cysts within the tumor. Conspicuous arteries, veins, and capillaries surrounded the tumor. The aneurysmal bone cysts at angiography were predominantly avascular in the interior, surrounded by a thin hyperemic zone in the peritumoral tissue, with sometimes early filling of veins. Microscopically, the aneurysmal bone cysts showed large, anastomosing, bloodfilled vascular channels, and a moderate number of capillaries within the solid, fibrous areas and the granulation tissue. It is concluded that angiography, particularly with a subtraction technique, may be a valuable diagnostic method in the pre-operative differentiation of giant-cell tumors from aneurysmal bone cysts.     

Intralesional Ethibloc Injections in Bone Cysts

Benign bone cysts (aneurysmal and unicameral) often require treatment to prevent pathological fractures. Percutaneous injections are less invasive than surgery. We describe the different percutaneous treatments available: local injection of steroids, calcitonin, or bone marrow in unicameral bone cysts, and Ethibloc(R)(Ethicon, Ethnor Laboratories, Nevilly Sur Seine, France) injection in both unicameral or aneurysmal bone cysts. Within the tumor, histologic modifications usually occur after these injections, due to the fibrogenic properties of the agent. Therefore, we emphasize the necessity of obtaining an histologic proof before any injection, especially in aneurysmal bone cysts.     

原发性与继发性动脉瘤样骨囊肿CT表现

目的评价CT对诊断与鉴别原发性与继发性动脉瘤样骨囊肿的价值。方法回顾性分析9例经手术病理证实原发性与继发性动脉瘤样骨囊肿的CT征象,并进行献复习。结果9例患中骨皮质缺损征象出现率(67％)高于“液一液平面”出现率(44％)。继发性动脉瘤样骨囊肿骨嵴明显粗大,可构成分房。9例病灶内呈不均匀软组织密度,增强后强化明显。结论CT检查有助于动脉瘤样骨囊肿早期定性诊断,并有助于鉴别原发性与继发性病灶。     

Fluid-fluid level: a nonspecific finding in tumors of bone and soft tissue

Fluid-fluid levels have commonly been reported to occur in aneurysmal bone cysts but have also been seen in telangiectatic osteosarcoma, chondroblastoma, and giant cell tumor of bone. The authors reviewed their experience with nine bone and three soft-tissue tumors that showed fluid-fluid levels on computed tomographic or magnetic resonance images. The bone tumors included fibrous dysplasia, simple bone cyst, recurrent malignant fibrous histiocytoma of bone, two classical osteosarcomas, and four aneurysmal bone cysts. The soft-tissue tumors included soft-tissue hemangioma and two synovial sarcomas. Except for aneurysmal bone cysts, these types of tumors have not been reported to be associated with fluid-fluid levels. Radiologic-pathologic correlation was available in seven patients; in all seven, the fluid-fluid levels indicated prior hemorrhage. The authors conclude that the presence of fluid-fluid levels in bone or soft-tissue tumors cannot be considered diagnostic of any particular tumor.     

Aneurysmal bone cyst of the orbit

Aneurysmal bone cysts of the skull are rare, and orbital involvement of these cysts is even less frequent. We present CT, MR imaging, and histopathologic findings of an aneurysmal bone cyst of the orbit in a 13-year-old female adolescent. The tumor mainly involved the frontal bone. MR imaging findings of the aneurysmal bone cyst of the skull were highly suggestive of the diagnosis.     

Imaging study of ossifying fibroma with associated aneurysmal bone cyst in the paranasal sinus

Objective

To determine the CT and MR imaging features of ossifying fibroma with aneurysmal bone cyst of the paranasal sinus.

Materials and methods

We retrospectively reviewed 15 patients with histopathology-proven ossifying fibromas with aneurysmal bone cysts in the paranasal sinus. All 15 patients underwent CT and MR imaging. The following imaging features were reviewed: location, shape, margin, CT findings, and MR imaging appearances and time-intensity curve of dynamic contrast-enhanced MR imaging.

Results

Ossifying fibromas occurred in the maxillary sinus in one patient, sphenoid sinus in 2, frontal sinus in 3, frontoethmoid sinuses in 3, and ethmoid sinus in 6 patients. Ossifying fibromas showed an elliptic-shape and aneurysmal bone cysts revealed a multicystic appearance, with well-demarcated margins. On unenhanced CT, ossifying fibromas appeared isodense to gray matter with scattered calcifications in nine, ground-glass appearance in 6 patients and aneurysmal bone cysts showed mixed density. Ossifying fibromas appeared isointense to gray matter in 12 and slightly hypointense in three patients on T1-weighted images, and isointense in 4 and hypointense in eleven patients on T2-weighted images, with moderate or marked enhancement after administration of contrast material. The time-intensity curves of eight ossifying fibromas exhibited a rapidly enhancing and rapid washout pattern. The intracystic components of aneurysmal bone cysts showed heterogeneous signal intensity on MR images, with fluid–fluid levels identified clearly by T2-weighted images, without enhancement. The periphery and septa of aneurysmal bone cysts appeared isointense on MR images, with marked enhancement.

Conclusions

Fluid–fluid levels within an elliptic-shape mass with scattered calcifications or ground-glass appearance is highly suggestive of this complicated entity in the paranasal sinus.     

Case report 748

A case of chondroblastoma associated with an aneurysmal bone cyst has been described. The radiographic appearance of the lesion understandably reflects the combined features of both tumors. Up to one-half of all cases of aneurysmal bone cysts are found in association with other tumors, benign or malignant, and up to 15% of chondroblastomas are combined with an aneurysmal bone cyst (4).     

Aneurysmal bone cyst of the temporal bone

Aneurysmal bone cysts are benign fibrosseous lesions of the bone that are rarely detected in the temporal bone. Seventeen cases of aneurysmal bone cysts with histological confirmation involving the temporal bone were reported in the literature. We report a case of left temporal aneurysmal bone cyst in a 52-year-old male with the clinical findings of periauricular painful swelling, decreased hearing, and facial paralysis. A magnetic resonance image of the patient showed a well-circumscribed multi-loculated expansile lesion of the left temporal bone during the first admission to the hospital. The lesion recurred 1 year after the subtotal resection with a more solid appearance. In addition, we review the literature for these rare lesions.     

Regression of aneurysmal bone cyst following open biopsy

Aneurysmal bone cysts are well described but relatively rare bone lesions. Histological diagnosis is usually obtained before definitive treatment. We report a patient with aneurysmal bone cyst regression after excisional biopsy and prior to preoperative embolization. This was also a patient with the William syndrome. This has not previously been reported, nor is there any known association between aneurysmal bone cyst and the William syndrome.     

Direct Ethibloc injection in benign bone cysts: preliminary report on four patients

Benign bone cysts often require treatment in order to prevent pathological fracture. We report preliminary experience with percutaneous injection of Ethibloc in four children (8–15 years old) presenting with benign bone cysts: two were aneurysmal bone cysts, two were unicameral bone cysts. All the patients were followed up for 12–18 months. Healing was satisfactory in all cases and no complications occurred.     

Treatment of an aneurysmal bone cyst of the spine by radionuclide ablation

We report the nonoperative treatment of a recurrent, multilevel spinal aneurysmal bone cyst by injection of 32P chromic phosphate colloid into the cyst. The patient was then followed up with serial CT examinations, which showed stabilization and progressive ossification within the lesion. The rationale, alternatives, and possible contraindications to radionuclide ablation of spinal aneurysmal bone cysts are discussed.     

Scintigraphy of aneurysmal bone cysts

Bone scintigrams of 25 aneurysmal bone cysts showed abnormal activity in every case. In 22 cases, the activity was correlated with the true pathologic extent of the lesions; only three exhibited a false-positive extended pattern of uptake beyond the true tumor margins. Sixteen scintigrams (64%) revealed increased uptake, chiefly around the periphery of the lesions, with less activity in their centers. This feature could not be explained simply by the cystic nature of the lesions, since aneurysmal bone cysts may contain considerable fibrous tissue septa containing trabeculae of reactive new bone. However, there was no correlation between any specific anatomic or histologic pattern and the intensity and pattern of abnormal scintigraphic activity.     

Treatment of pelvic aneurysmal bone cysts in two children: selective arterial embolization as an adjunct to curettage and bone grafting

Treatment options of aneurysmal bone cysts include complete resection, curettage, curettage with bone grafting, selective arterial embolization (as a primary treatment or preoperative adjuvant therapy), and percutaneous injection of fibrosing agent. Treatment in pelvic locations is difficult because of the relative inaccessibility of the lesions, the proximity of the lesions to neurovascular structures, and the vulnerability of the acetabulum. Herein, we present 2 pediatric cases of pelvic aneurysmal bone cysts successfully treated with curettage with bone grafting following preoperative selective arterial embolization.     

Aneurysmal bone cyst of the temporal bone

Summary Aneurysmal bone cysts occurring within the calvarium are uncommon. The following case report describes the radiological and pathological findings of a temporal bone aneurysmal bone cyst with intra- and extracranial manifestations. The pertinent literature is reviewed.     

Sacral cysts with exophytic components

Sacral cysts are rare lesions. Two cases are presented, an aneurysmal bone cyst and a simple cyst. Simple cysts have not previously been described in the sacrum. Both cysts were asymptomatic, had similar radiographic appearances, and displayed significant exophytic components.     

Therapeutic embolization of aneurysmal bone cyst

Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications.     

Intracortical and subperiosteal aneurysmal bone cysts: a report of three cases

 Aneurysmal bone cyst of the long bones in a purely intracortical or subperiosteal location is unusual. Three such cases are reported, and the radiographic and pathologic differential diagnoses are discussed.Those subperiosteal or intracortical aneurysmal bone cysts with radiographic features similar to the intramedullary variety should suggest the same diagnosis. However, the radiographic features may be less specific, so that a diagnosis of aneurysmal bone cyst must be entertained when considering a subperiosteal or intracortical lytic lesion.     

Fluid-fluid levels in benign neurogenic tumors.

We report two cases of cystic lesions in the head and neck, one a cystic schwannoma and the other a neurofibroma, both of which showed fluid-fluid levels on MR images. The differential diagnosis of fluid-fluid levels in the head and neck region should include cystic hygromas, aneurysmal bone cysts, soft-tissue cavernous hemangiomas, and simple bone cysts.     

Percutaneous Ethibloc injection in aneurysmal bone cysts

Objective. To investigate whether the injection of Ethibloc into aneurysmal bone cysts can be an effective treatment modality. Design and patients.Ethibloc is an alcoholic solution of zein (corn protein) which has thrombogenic and fibrogenic properties. Ten patients with aneurysmal bone cysts were treated with CT-guided percutaneous injection of Ethibloc into the cyst cavity. Ethibloc injection was the primary treatment in five patients. Four patients had recurrence following previous curettage and bone grafting and one patient had not responded to injection into the lesion of autologous iliac crest bone marrow aspirate. Three patients needed a second injection. The median follow-up was 27 (6–60) months. Results and conclusion.Symptoms were relieved in all patients. At imaging, seven patients had resolution of the lesion and three had partial response at the most recent follow-up. Complications consisted of a local transitory inflammatory reaction in two patients and an aseptic abscess in one patient. This relatively simple, minimally invasive procedure makes an operation unnecessary by stopping the expansion of the cyst and inducing endosteal new bone formation. This technique may be used as the primary management of aneurysmal bone cysts excluding spinal lesions. Received: 19 July 1999 Revision requested: 20 September 1999 Revision received: 9 November 1999 Accepted: 6 December 1999