Diagnosis Of Aneurysmal Bone Cyst Research Articles

EXTENSE ANEURYSMAL BONE CYST WITH CENTRAL OSSIFYING FIBROMA OF THE MANDIBLE: A CASE REPORT

Aneurysmal bone cysts are benign osteolytic lesions that can occur alone or associated with other bone diseases. This report describes a case of an 84-year-old female patient, white, referred to a buccomaxillofacial service complaining of a 1-year history painless swelling in the mandible. Medical history revealed diabetes and hypertension, but no history of major trauma. Extraoral examination showed an increase of volume in the anterior mandible (parasymphysis and symphysis). Intraoral examination showed expansion of the buccolingual cortical bone covered by healthy mucosa. The swelling was firm and non-tender on palpation. Panoramic radiograph revealed a well-defined, radiolucent, and unilocular lesion with 7 cm diameter. Preoperative tests were within normal limits. Under general anesthesia, fine-needle aspiration was performed showing a reddish liquid; after complete removal of the lesion, microscopic evaluation confirmed the diagnosis of aneurysmal bone cyst associated with central ossifying fibroma. After 1 year of follow-up there is no recurrence.

Aneurysmal Bone Cyst of Clavicle in a Six-Year-Old Male Child

Aneurysmal Bone Cyst (ABCs) is a cystic expansile lesion which is usually found in solitary locations in the metaphysis of long bones. The most common locations of ABC are long bones of lower limbs. There is little knowledge about the presence of this tumor in Clavicle. Here we present a case of a six year old male child who presented with complaint of swelling in left shoulder for four months. There was a dilemma in the diagnosis of the swelling due to its unusual presentation and appearance. The Fine Needle Aspiration Cytology was also inconclusive. The diagnosis of ABC was made only by excision biopsy. The Clavicle regenerated to nearly normal anatomy at 15 weeks follow up period. The patient is asymptomatic now and is able to perform all daily activities without any restrictions. The uniqueness of this case lies in the fact that this is the first case where ABC has been reported in Clavicular region in young Asian male of less than 10 years age.
 Keywords: ABC, Bone tumor, Expansile lesion.

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.

Sacral aneurysmal bone cyst in a child presenting with radiculopathy

A13-year-old girl with complaints of difficulty in walking, left leg pain, and lower back pain of 1 month duration was admitted to our pediatric neurology department. Having the symptoms of lumbosacral radiculopathy, a magnetic resonance imaging (MRI) was ordered to exclude any herniated disc, spinal stenosis, or arthritic and degenerative changes of the facet joints. Lumbosacral MRI demonstrated a 4-cm×3.5cm×3.5-cm well-defined, expansile lesion of the left side of the sacral bone at the level of the S1–S2 vertebrae extending to the left sacroiliac joint (Figs. 1 and 2). The lesion was hypointense on T1WI and hyperintense on T2WI containing cysts with internal septations and characteristic fluidfluid levels representing blood of variable ages that was compatible with aneurysmal bone cyst (Fig. 2a and 2b). At the level of S1 and S2 the nerve roots at the left side were compressed by this expansile lesion. After contrast administration, we did not observe any enhancement or solid component distinctively. The left piriformis muscle had denervation-related muscle atrophy because of entrapment neuropathy of the piriformis nerve, originating in the sacral plexus and arising from the posterior division of the ventral rami of the first and second sacral nerve (Fig. 2c).An open bone biopsy confirmed the diagnosis of aneurysmal bone cyst which

Aneurysmal Bone Cysts of the Hand, Wrist, and Forearm

To determine the outcomes of surgical management of aneurysmal bone cysts (ABCs) in the hand, wrist, and forearm. The medical records of 11 patients undergoing surgical treatment of ABCs distal to the elbow from 1994 to 2011 with at least 12 months follow-up were reviewed retrospectively. Mean follow-up was 29 months (range, 13-56 months). There were 7 males and 4 females. Four lesions presented in the radius, 3 in the ulna, 2 in the metacarpals, and 2 in the phalanges. Ten patients underwent wide unroofing and intralesional curettage with 9 undergoing associated high-speed burring. Multiple chemical and thermal adjuvants were used. One patient underwent en bloc resection with reconstruction. There was 1 recurrence in a periphyseal lesion in a 2-year-old boy treated with curettage, burring, and adjuvant chemotherapy. Ten patients incorporated the bone graft and healed without further surgery. One patient required revision bone grafting. The diagnosis of ABC should remain in the differential diagnosis for cystic lesions in the upper extremity in pediatric and adult patients. Low recurrence has been obtained predominantly with intralesional curettage and high-speed burring with and without chemical and thermal adjuvant therapy. Appropriate healing has been obtained with both allograft and autograft reconstructions. Periarticular and periphyseal lesions remain challenging and provide the highest chance for incomplete resection and recurrence. Follow-up with plain radiographs did not lead to any delay in diagnosis of recurrence in any case.

From aneurysmal bone cyst to telangiectatic osteosarcoma with metastasis in inguinal lymph nodes: Case report

Aneurysmal bone cyst is a benign bone lesion composed of blood filled cystic cavities lined by fibrous septa. Its malignant transformation of is a rare event. We report a case of a lesion in the second metatarsal bone in a 29-year-old male, presented as a slight swelling of the right foot. After the curettage had been done, the diagnosis of aneurysmal bone cyst was made but the recurrence occurred 4 years later. The biopsy of the recurrent tumor showed compact neoplastic tissue consistent with diagnosis of giant cell tumor with malignancy. The malignant component was recognized as a high grade sarcoma with osteoid production. A tumor mass with the whole II metatarsal bone was extirpated and a resected part of fibula was transplanted. A year later, another recurrence occurred, an amputation was performed and a teleangiectatic osteosarcoma with ingvinal lymph nodes metastases was diagnosed. No other tumor mass was confirmed, either clinically or by imaging techniques at the time of his third operation. He died 4 months later with multiple pulmonary metastases. We emphasize the importance of team work in order to achieve the accurate diagnosis, highlighting careful radiological examinations, good sampling and awareness of unusual cases in bone tumor pathology.

Quiste óseo aneurismático en cóndilo mandibular: reporte de caso

Se reporta el caso de una paciente mujer de 14 años de edad que presentaba una lesión asintomática de apariencia tumoral ubicada en la zona de la articulación témporo mandibular derecha. Durante la apertura bucal había desviación de la mandíbula hacia el mismo lado. El estudio imaginológico mediante radiografía panorámica, tomografía espiral multicorte y angiografía, fue determinante para plantear el diagnóstico de Quiste Óseo Aneurismático. Este es un tipo de pseudoquiste de los maxilares. Se discuten los aspectos clínicos, imaginológicos, anátomo-patológicos y el tratamiento de esta entidad. De la revisión de la literatura se concluye que es una lesión muy rara a nivel del cóndilo, no tiene una apariencia radiográfica patognomónica y puede confundirse con varias otras entidades que ocurren en esta zona anatómica. El estudio imaginológico cuidadoso y la punción aspiración fueron elementos importantes para el diagnóstico y por lo tanto para el correcto tratamiento.

Assessment of 120 Maxillofacial Aneurysmal Bone Cysts: A Nationwide Quest to Understand This Enigma

Compared with other maxillofacial lesions, oral and maxillofacial (OM) aneurysmal bone cysts (ABCs) are rare, and most studies have been case reports. Because the features or radiographic findings of 1 case could not be representative of the whole, conclusions cannot be drawn and data analyses will not be feasible. Our aim was to assess and describe the clinical and histopathologic characteristics of a large sample of subjects with ABCs. To our knowledge, the present case series of OM ABCs is the largest ever reported. To address our research purpose, we designed and implemented a retrospective case series. A multicenter retrospective cohort study of patient charts dated from 1967 to 2013 (46 years) at 10 major universities in 8 cities was undertaken to assess OM ABCs nationwide. Subjects were included if they had documented chart data and definitive histopathologic slides confirming the diagnosis and treatment of ABC. They were excluded if their histopathologic slides did not confirm the diagnosis of an ABC. Data were collected, and special forms were completed. Variables such as age, gender, site (ie, maxilla, mandible, anterior, posterior), histologic type (ie, solid, mixed, vascular), signs, symptoms, radiographic features (ie, radiolucency, unicystic or multilocular), and outcomes (ie, treatment modal, recurrence, complications) of the lesion were evaluated and documented by OM surgeons and confirmed by OM pathologists for assurance. Data analyses were performed using Statistical Package for Social Sciences, version 20, software (SPSS, Chicago, IL) (P < .05). We assessed the medical records and histopathologic slides of 120 patients diagnosed and treated for OM ABCs nationwide. Of these patients, 69 were male (57.5%) and 51 were female (42.5%), with no predilection found. The key findings were as follows. The mean age of occurrence was 20.7 ± 2.5 years (range 4 to 78), and occurrence was significantly greater in the first 2 decades of life (P < .001). The incidence was 2.6 cases/year. ABCs were significantly more common in the mandible (P < .05) and posterior areas (P < .05). The most common histopathologic type was the mixed type (P < .05). Firm swelling was the most common clinical presentation (P < .05); all cases were radiolucent and commonly unilateral (P < .05). Most were treated by excision and curettage. Recurrence was reported in 11 patients (9.2%) during the follow-up period (1 to 45 years). The present retrospective cohort found ABCs with a variable presentation, disease course, and histopathologic type, with no gender predilection. ABCs were significantly more common in childhood and adolescence and in the mandible and posterior areas of the jaws. Of the cases reviewed, 90% were treated by excision and curettage. ABCs had a relatively low recurrence rate (<10%), precluding the need to perform aggressive surgery primarily.

Aneurysmal bone cyst of the mandible: Report of a case with a review of the literature

Aneurysmal bone cyst (ABC), is a rare benign osteolytic bone neoplasm of bone tissue characterized by several sponge-like blood or serum filled, generally non-endothelialized spaces of various diameters that can contain osteoid tissue and osteoclast-like giant cells. In this article, we describe a case of ABC in the mandibular corpus region with clinical, radiological and pathological findings and review the literature concerning the case. A 23-year-old male patient attended to our clinic with the complaint of a mild-pain on the left posterior lower jaw since two months. The superior margin of the lesion was extending between the apical third parts of the roots of the teeth 35-38. Cone beam computed tomography (CBCT) was performed. CBCT Slices revealed an expansile lesion with hydraulic-appearing outer margins above the mandibular canal. Excisional surgical treatment was performed after raising a mucoperiosteal flap and finalized with curette of lesion under local anesthesia. Diagnosis of aneurysmal bone cyst was confirmed by histopathological evaluation. The patient was pain free after six months follow-up, and panoramic radiography showed no evidence of recurrence. The ABC is most common in those regions of the skeleton where there is a relatively high venous pressure and high marrow content. Clinical presentation of the ABC varies from a small, indolent, asymptomatic lesion to rapidly growing, expansile, destructive lesion causing pain, swelling, deformity, neurologic symptoms, pathologic fracture, and perforation of the cortex. As the radiologic and clinical presentation of ABC is extremely variable, histopathologic examination is placed a great emphasis on for the diagnosis.

Serial endovascular embolization as stand-alone treatment of a sacral aneurysmal bone cyst

Aneurysmal bone cysts (ABCs) are destructive cystic lesions of the bone and are common in children. They are expansile in nature and, therefore, may become symptomatic. These have traditionally been treated surgically; but recently, endovascular embolization has shown promise as a stand-alone therapy. The authors describe a case of an ABC highlighting the effectiveness and efficiency of endovascular treatment. A 16-year-old boy was referred for a 4-month history of radiating back pain and urinary hesitancy. Findings from his neurological examination were normal, but he had problems ambulating because of pain. Magnetic resonance imaging and CT scanning showed a cystic mass in the sacrum; a biopsy was performed and diagnosis of ABC was confirmed. Treatment options were then discussed with the family. The patient underwent 2 endovascular embolizations in approximately 1 month: Onyx 18 was involved in the first session, and N-butyl cyanoacrylate glue was used in the second session. After the first treatment, the patient experienced a dramatic decrease in pain and concomitant improvement in function. The patient went from being mildly symptomatic after the first treatment to completely asymptomatic after the second treatment. Clinical and radiographic follow-up obtained at 2, 6, and 18 months after initial treatment revealed the patient to be asymptomatic with progressive ossification. Endovascular treatment can be effective in treating symptomatic cases of ABC in which surgery would carry significant risk. Selective arterial embolization can promote sclerosis and result in an immediate and significant decrease in pain.

A giant aneurysmal bone cyst of the rib: Case report

An aneurysmal bone cyst (ABC) is a benign tumor of the skeletal system, which most frequently occurs in long bones. An ABC arising from the rib is extremely rare and it is difficult to distinguish from other types of rib tumors. The present study describes an unusual case of a large ABC in the rib of a 17-year-old male. The entity is discussed with particular emphasis on the clinicopathological features, differential diagnosis and treatment. Due to difficulties in the pre-operative diagnosis, a possible diagnosis of ABC should be made aware when confronting an expansile rib mass. An en bloc resection of the mass and the affected portion of the rib is mandatory to obtain a satisfactory outcome.

Aneurysmal bone cyst: Rarity in mandible and its ambiguity with Central giant cell granuloma

The aneurysmal bone cyst is an uncommon lesion which has been found in most bones of the skeleton, although the majority occur in the long bones and in the spine. It was first described as a distinct clinical entity by Jaffe and Lichenstein in 1942 to describe the ­characteristic blow-out of the bone seen in the radiographs of the lesion. In the past, the lesion has been classified as an atypical giant cell tumor or benign bone cyst. We report a case of an aneurysmal bone cyst in an 18-year-old patient who reported with the chief complaint of swelling on the right side of the face since 4 months. It was non-tender, non-fluctuant, and hard in consistency. Radiographic examination revealed a large, expansile, multilocular lesion suggestive of benign odontogenic tumor. Complete enucleation was carried out and the final histopathologic diagnosis of aneurysmal bone cyst was given.

Aneurysmal bone cyst of the mandible managed by conservative surgical therapy with preoperative embolization

A 9-year-old girl visited our hospital, complaining of a rapid-growing and rigid swelling on the left posterior mandibular area. Panoramic radiograph showed a moderately defined multilocular honeycomb appearance involving the left mandibular body. CT scan revealed an expansile, multilocular osteolytic lesion and multiple fluid levels within cystic spaces. Bone scan demonstrated increased radiotracer uptake and angiography showed a highly vascularized lesion. The lesion was suspected as aneurysmal bone cyst (ABC) and preoperative embolization was performed, which minimize the extent of operation and the surgical complication. The lesion was treated by surgical curettage and lateral decortication with repositioning. No additional treatment such as a surgical reconstruction or bone graft was needed. Early diagnosis of ABC is very important and appropriate treatment should be performed considering several factors such as age, surgical complication, and possibility of recurrence.

Pelvic aneurysmal bone cyst.

This paper describes an extremely rare case of a huge aneurysmal bone cyst (ABC) in the pelvis, occurring in the patient’s 5th decade of life. The patient presented with a history of painless huge pelvic mass for 10 years. Plain radiograph and computed tomography showed huge expansile lytic lesion arising from the right iliac bone. A biopsy was performed and histology confirmed diagnosis of aneurysmal bone cyst. Unfortunately, the patient succumbed to profuse bleeding from the tumour.

Aneurysmal bone cyst of thoracic spine mimicking spinal tuberculosis

A 22-year-old female presented to our services with back pain and paraparesis for 11 months. She was earlier diagnosed with tuberculosis of spine, and antitubercular chemotherapy was started. However her condition had worsened. Plain and contrast-enhanced computed tomography scans of the thorax and magnetic resonance imaging of the thoracic spine showed heterogenous, lytic, expansile lesion involving third thoracic vertebra with epidural extension and large bilateral paraspinal and mediastinal components. Multiple variably sized loculations with fluid-fluid levels were seen within the lesion. These imaging findings suggestive of aneurysmal bone cyst of thoracic spine were compared with the findings seen 11 months earlier, which were mistaken for spinal tuberculosis. Histopathology confirmed the diagnosis of aneurysmal bone cyst. The imaging features, diagnostic challenges and the lessons learned have been briefly discussed.

Sakrumda Tekrarlayan Büyük Anevrizmal Kemik Kisti: Pediyatrik Bir Vakada Total Çıkarılabilirliğinin Tartışılması

Aneurysmal bone cyst (ABC) is a locally agressive tumor-like lesion of the bone. Sacral location is rare. Currently recommended treatment for a benign ABC lesion is complete intralesional curettage with or without selective arterial embolization and attempt to salvage unilateral sacral 2-5 roots. A 14-year-old girl presented with severe pain and a large mass in her lower lumbosacral region. Imaging studies demonstrated a destructive lesion, arising from the second sacral vertebral level, extending posteriorly and bilaterally into the gluteal muscles, and anteriorly into the pelvis. Open biopsy established the diagnosis of ABC. Marginal extra-capsular resection via a combined anterior and posterior approach, and postoperative radiation therapy were performed. The patient was pain-free, and no evidence of local recurrence was detected at the 84-month follow up postoperatively. Marginal extra-capsular resection and adjuvant radiotherapy are thought to be effective for the treatment of this large ABC of the sacrum.

Alphabet soup: GCT, ABC, SBC, ETC

Identify the imaging appearance of giant cell tumor, aneu-rismal bone cyst, simple bone cyst and subchondral bone cyst. Recognize the relationships between these lesions. Recognize how the radiologie images reflect the underlying patho-physiology. Giant cell tumor is a common benign lesion that is most common in long bone, originating in the metaphysis and extending to the end of the bone. Giant cell tumor is rare in children (2% of cases). Aneurysmal bone cyst is the resuit of a hemorrhagic pathophysiology and may be primary or secondary. Simple bone cysts are typically central, metaphyseal and occur most frequently in children. Subchondral degenerative cysts are common, typically juxtaarticular and often not “cystic”. This session is a review of these relatively common lesions, emphasizing radiographie-pathologie corrélation, and how the radiographs and imaging studies reflect the underlying pathophysiology. More importantly, this session explains how these lesions do and do not interrelate, specifically addressing the “fact and fiction” associated with the diagnosis of aneurysmal bone cyst (ABC) and the conflicting views of this diagnosis.

Aneurysmal Bone Cyst of the Fifth Metacarpal

Aneurysmal bone cyst is a rare, rapidly growing, and destructive benign bone tumor that even more rarely involves the bones of the hand. Various treatment options for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. Due to its rarity in the hand, no evidence-based treatment regimen has been established. A 21-year-old man presented with a history of pain and local swelling over his fifth metacarpal of 5 months' duration. Physical and radiographic examination of the hand was consistent with aneurysmal bone cyst. After biopsy, pathologic examination confirmed the diagnosis of aneurysmal bone cyst. En-block resection of the tumor and autologous bicortical strut graft fixation with Kirschner wires was performed. The hand was immobilized in a short arm cast for 3 weeks after the patient received 3 weeks of physiotherapy. Kirschner wires were removed 6 weeks postoperatively. Excellent clinical and functional results were obtained with no recurrence after 3 years of follow-up with en-block resection and reconstruction with iliac crest graft. Radiographic examination demonstrated the osseous integration of the graft with no signs of recurrence. Although treatment should be planned individually according to lesion site and size and to patient age, we suggest en-block resection to prevent recurrence and secondary surgical interventions particularly in cases with no articular involvement.

Argon Beam Coagulation as Adjuvant Treatment after Curettage of Aneurysmal Bone Cysts: A Preliminary Study

The optimal treatment of aneurysmal bone cysts remains an area of debate. Curettage, with or without adjuvant therapy, has been advocated for tumors in most locations. To evaluate argon beam coagulation as adjuvant therapy to curettage, we retrospectively analyzed the complication and recurrence rates in 40 consecutive patients with a diagnosis of aneurysmal bone cyst. For our analysis of recurrence, we excluded six of the 40 patients who were lost to followup or had less than 18 months followup; five patients treated with resection also were excluded. Of the remaining 29 patients, 17 were treated with curettage and argon beam coagulation and 12 were treated with curettage with or without phenol. None of the 17 patients treated with curettage and argon beam coagulation had a recurrence, whereas four patients treated without argon beam coagulation had recurrences. There were no differences between patients treated with or without argon beam coagulation regarding frequencies of intraoperative complications, neurovascular injury, or bone graft incorporation. Argon beam coagulation seems to offer favorable control rates when compared with curettage with or without phenol. No complications have been experienced thus far with its use. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Secondary Aneurysmal Bone Cyst in Fibrous Dysplasia of the Proximal Femur

Fibrous dysplasia of bone is a congenital skeletal disorder characterized by proliferation of spindle cells inside an intramedullary collagenous stroma and by formation of metaplastic bone. An aneurysmal bone cyst is a lesion of unknown etiology. Macroscopically it appears like a blood-filled cavity that expands the affected bone. Histologically, fibrous septa are bordered by macrophages, giant cells, inflammatory cells, and areas of bone production. Hemorrhagic areas can rise into fibrous dysplasia. The lesion appears as an aggressive and destructive process that is difficult to diagnose properly. A 29-year-old woman presented with a 2-year history of left inguinal and lumbar pain. She reported increased pain after physical activity. Magnetic resonance imaging of the left femur (without intravenous gadolinium) showed a mass extending 14 cm along the femoral metaphysis. This lesion involved cortical bone that was broken in the posteromedial site. Computed tomography confirmed the osteostructural lytic alteration that "blows up" the proximal femur metaphysis. A trochar biopsy allowed the diagnosis of aneurysmal bone cyst on fibrous dysplasia, excluding malignancy. The lesion was treated with curettage and local adjuvants and filled with bone grafts. Internal fixation with a sliding screw plate was also performed. Radiographs at 1 year postoperatively showed good consolidation of the grafts and absence of local recurrence. The patient achieved active and passive mobilization of the left hip with no pain.