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In three patients an aneurysmal bone cyst occurring in a metacarpal was treated by excising the involved bone and substituting bone grafts. There was no evidence of recurrence in 1, 3, and 8 years of follow-up. In two patients with open epiphyses, growth of the metacarpal was not impaired.
Recently, clonal chromosome abnormalities have been identified in the mural spindle cells in aneurysmal bone cysts (ABCs), but the nature of the cystic spaces is unclear. Endothelial injury has been suggested as a mechanism of aneurysmal formation in these lesions, but few studies have surveyed vascular markers in ABCs. We stained 25 primary aneurysmal bone cysts with a variety of antibodies that stain vessels. Antibody to factor 8 stained the edge of ABC cavities in almost all cases, and antibodies to VEGF-C, GLUT-1, and smooth muscle actin stained the edge of the cavities in approximately half the cases. Antibodies to D2-40 and CD34 also stained the edge of the cavities in some cases. These results suggest that the cavities in ABCs are related to vasculature and support the theory that vascular injury may be important in the pathogenesis of ABCs.
Key findings that aid in the diagnosis of an aneurysmal bone cyst are: 1) typically the patients are young individuals less than 20 years old; 2) an expansile bone lesion is bordered by a thin, low signal intensity rim mass; 3) the lesion is inhomogenously increased in signal on T2-weighted images; and 4) multiple fluid-fluid levels are seen with the mass on T2-weighted magnetic resonance imaging scans.
A case of aneurysmal bone cyst of the thoracic spine is described. The value of the various imaging procedures in diagnosis of this benign bone lesion and its pathogenesis are discussed.
We report the first case, in a 4-month-old girl, of an aneurysmal bone cyst secondary to infantile cartilaginous hamartoma of the rib. Infantile cartilaginous hamartoma of the rib (benign mesenchymoma) is a large, expansile tumour that is characterised by cartilaginous, vascular and primitive-appearing stromal and mesenchymal elements. Most cases are diagnosed at less than 1 year of age and may even be congenital. Aneurysmal bone cyst may be a secondary lesion to pre-existing tumours such as giant cell tumours, osteoblastomas, angiomas and chondroblastomas. This unique case is presented with radiological and pathological findings.
Successful treatment of two cases of aneurysmal bone cyst by cobalt 60 gamma radiation using low doses over prolonged periods (1400 rad in seven weeks and 1600 rad in eight months) is reported. Follow-up of four to ten years duration does not reveal any recurrence or complications. The merit of low dose, prolonged interval irradiation over surgery is discussed. This technique is recommended for aneurysmal bone cysts in children, especially at inaccessible sites.
Probable cause of fracture in a Paint gelding was a congenital bone defect involving the extensor process area of the right and left forelimb distal phalanges. Radiographically and histologically, subchondral bone cysts at the fracture lines were suspected. These cysts were thought to have developed in association with abnormal ossification centers at the extensor process areas of the third phalanx. Partial avulsion of weak extensor processes would then occur from natural forces exerted on these weakened bony prominences via the common digital extensor tendon. Support for osteochondrosis as a cause of this bone cyst formation was seen in histologic examination of fragments removed. Within the bony trabeculae, a dysplastic focus of cartilage with mineralized plaques and osseous tissues was observed. Findings supported a diagnosis of osteochondrosis, to the extent that the disease is presently understood in horses. Surgical correction by fragment removal was performed to circumvent progression of degenerative joint disease, which was evident as partial cartilage erosion of the distal dorsal articular surface of the second phalanx and fracture fragments. Recovery from surgery was rapid, and several months after surgery, the horse was sound for pleasure riding.
PURPOSE OF THE STUDY: Diaphyseal aneurysmal bone cyst is very rare. We report a case in a 20-year-old female. PATIENT AND METHOD: The clinical signs developed rapidly, within one month. The lesion was first curetted and grafted with cortico-cancellous bone. Recurrence was observed 6 months later. Complete excision and reconstruction with a free fibular vascularized grafted enabled healing. DISCUSSION: The pathogenesis of aneurysmal bone cysts is debated. We hypothesize that it is due to the opposed direction of periosteal and medullary blood circulation. This could explain the relative rarity of diaphyseal localizations compared with metaphyseal localizations.
We report the long-term results with ten patients with simple bone cysts with special retrospective reference to the radiographic evidence of healing after hole drilling. Cortical thickening was initially observed within 3 months, and minimal new bone formation around Kirschner wires left in situ was observed within 4 months. New bone formation gradually progressed from the cyst wall and around the wire. Consolidation of a cyst cavity was uniformly observed 6-7 months after drilling. In several patients residual cysts were seen between the wire and cortical shell. In younger patients, a cystic cavity reappeared after extraction of the wire, although complete radiographic healing had been observed. These findings suggest that a Kirschner wire plays an important role in preventing relapse of simple bone cysts after hole drilling.
Two series of 20 patients each with unicameral bone cysts were compared, one treated before 1975 by curettage and bone grafting and the other treated after 1975 with methylprednisolone acetate (MPA) injections. At follow-up, the majority of patients were at the end of skeletal growth. In the MPA-treated series, the average age of the patients at diagnosis was 9.1 years, whereas the average age at follow-up was 16.7 years. The average follow-up interval was 7 years. The steroid-treated series had better radiographic final results than the surgically treated series, with a lower recurrence rate. The number of MPA injections required to heal the lesion ranged from one to six, with 70% of the patients requiring a maximum of three injections. Steroid injection treatment should be preferred to surgical treatment for the better final results, for the virtual absence of complications, and for the greater simplicity of execution and postoperative care.
The clinical, angiographic and histological aspects of 20 cases of aneurysmal bone cyst suggest that angiography is a valuable aid in the diagnosis of a cyst, differentiating it from other cystic bone lesions. Angiographic information also has a certain bearing on the origin of the lesion. It was demonstrated that other, benign, lesions may exist adjacent to the cyst or prior to it; in most cases, however, the cyst appears in a bone which is otherwise normal. The failure to differentiate between aneurysmal bone cyst and giant cell tumor in relation to sex, age, localizaiton, morphology, and clinical course (e.g. tendency of recurrence and malignant transformation) may be responsible for confusion in the literature on these lesions. Good results of treatment are achievable by resection en bloc and by resection, or curettage with bone grafting. Curettage alone is inadequate. Only two recurrences (10%) were recorded in the present series during the average follow-up period of 4.5 years.
BACKGROUND AND METHODS: Of the 200 cases of ABC in the Rizzoli Institute files, 15 had solid features on both gross and histologic examination. Inasmuch as fibrous proliferation with giant cell and bone production along with fibromyxoid areas and small aneurysmal spaces were found in the solid parts of the aneurysmal bone cyst, a grossly solid and radiographically osteolytic bone lesion with these microscopic features was called a solid aneurysmal bone cyst. Some authors call the same lesion extragnathic giant cell reparative granuloma. RESULTS: Sixty percent of the patients were female. The metaphysis was the preferred location in the long bones (8/11). Radiographic appearance was not specific, and sometimes a malignant lesion was very difficult to rule out. In seven patients, the lesion was considered radiographically "aggressive." Intralesional excision (curettage) in 12 patients and marginal resection in 3 patients with diaphyseal location was effective in controlling the lesion. No recurrence was detected after a mean follow-up of 59 months. CONCLUSIONS: High proliferative activity of the benign-appearing proliferative spindle cells, often with fairly abundant mitoses, associated with benign giant cells and immature bone production are the features of this pseudosarcomatous hyperplastic lesion. It is sometimes is mistaken for a malignant tumor.
In this report, the management of an aneurysmal bone cyst in the cervicothoracic region of an 8-year-old girl is described. Aneurysmal bone cyst is a histologically benign lesion that is often extremely vascular. In the spine, it can cause extensive bone destruction and compress neural structures. Because this lesion may involve all parts of a vertebra, full delineation of the lesion before its excision is important in planning the surgical approach. The value of preoperative embolization to reduce tumor vascularity, allowing total excision, and the improved radiological evaluation of this lesion with computed tomographic scanning are demonstrated.
Aneurysmal bone cyst (ABC) is a non-neoplastic expansile bone lesion that is common in the long bones; only 2% occurs in the head and neck. We present a case of ABC in a 23-year-old male and describe the clinical and radiological features, histopathology and treatment. Magnetic resonance imaging (MRI) demonstrated multiple internal septations, cysts with fluid-fluid levels of varying intensity, and an intact rim of low-intensity signal completely surrounding the lesion. The tumor was removed by enucleation with resection of the lateral nasal cavity. Histopathologic diagnosis was ABC and fibrous dysplasia. We suggest that MRI is very useful for the diagnosis of ABC. ABC is thought to follow other lesions, and thus when treating ABC, it is important to determine whether any pre-existing lesion has preceded or not; in particular, if the lesion site is in the head and neck region.
Cytogenetic analysis was performed on samples from ten patients diagnosed with aneurysmal bone cyst. Six of the patients were male and four were female, with ages ranging from 7 to 24 years. Results were obtained in eight of the cases; all were karyotypically normal.
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.
The simple bone cyst (sbc) is generally regarded as a tumourous bone lesion, to be classified with the bone tumours. It is a non-malignant disease which, however, affects adolescents in the immediate area of the epiphysis, so that disturbances of growth and deformities cannot always be avoided. The commonest localisation is stated to be at the proximal humerus, followed by the femur. The authors shell out small sbc, filling the defect with autologous spongiosa, but treat recurrences and extensive cyst formation by means of limb-preserving resection. Procedure followed, e.g. at the humerus; resection of the tumour en bloc, formation of a groove in the head of the humerus, into which an autologous tibia graft is driven, after this has been fitted into the distal humerus after Lexer, where the transplant is fixed by 2 AO screws, or by boring the graft into the marrow canal of the distal humerus, without using extraneous material for osteosynthesis. Postoperative stabilisation is effected in a thoracic abduction plaster for an average of about 12 weeks. A review of the results of treatment in 26 patients with sbc of the humerus showed a recurrence rate of 55% after curettage and filling with spongiosa, against 7% following resection. Complete removal of the cyst by resection can thus be taken to be the most reliable prophylaxis against recurrence in the upper arm. In certain cases, we also perform a subtotal resection of the proximal femur. Of these patients, 22 were followed up:(ABSTRACT TRUNCATED AT 250 WORDS)
The aneurysmal bone cyst is an enigmatic and misnamed lesion displaying variable etiopathogenic and histologic characteristics. The aneurysmal bone cyst may appear as a primary lesion or as a secondary lesion associated with other pathologic entities. This article presents a probable self-limiting lesion that provides an opportunity to present an approach to classifying aneurysmal bone lesions.