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Three cases of aneurysmal bone cyst of the skull are reported. The localization in the base of the skull (two cases) is extremely rare and simulates a space-occupying intracerebral lesion. The clinical and microscopic findings, and their significance for the differential diagnosis from malignant brain tumors, are described.
A 21-year-old woman who presented with a voluminous aneurysmal bone cyst in the distal left fibula was treated with en-bloc resection. After 30 months of follow-up, the stability and range of motion of the left ankle were similar to that of the contralateral ankle.
A case of aneurysmal bone cyst of the thoracic spine treated with serial particulate embolization responded with involution of soft-tissue and cystic components and diffuse ossification of the mass. Reappearance of foci of bony rarefaction or cystic change at 4-year follow-up indicates the need for continued surveillance.
A rare case of chondromyxoid fibroma of the scapula in a 21-year-old man is presented. This case is of interest because of its unusual site and association of aneurysmal bone cyst. Although chondromyxoid fibroma is uncommon bone tumor of the scapula, it should be considered in the differential diagnosis of expansile osteolytic lesion of the scapula.
Review of 17 computed tomographic (CT) scans of aneurysmal bone cysts revealed fluid levels in six of the lesions; the fluid shifted after repositioning of two patients. Visibility of fluid levels did not correlate with the type of fluid found within the lesions. Detection of fluid levels depended partly on a period of immobilization before CT and on viewing the images with sufficiently narrow window settings.
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.
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 should 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. Multilocation (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.
The clinical radiologic, and histopathologic findings of an extremely large traumatic bone cyst have been described. The review of literature, theories of origin, and management of the traumatic cyst have been briefly discussed.
Preoperative radiological evaluation with magnetic resonance imaging and computed tomography was valuable in planning the surgical management of a destructive lesion of the posterior elements of the thoracic spine that was causing spinal cord compression in an 18-year-old woman. Preoperative recognition of bilateral involvement of the pedicles in addition to the laminae and spinous process led to use of prophylactic segmental stabilization of the spine with Luque rods after successful excision of an aneurysmal bone cyst. This case provides an example of the usefulness of computed tomographic scanning and magnetic resonance imaging in assessing the distribution and location of vertebral tumor and its potential effect on spinal stability. The efficacy of combining radical excision with stabilization for treatment of aneurysmal bone cysts of the spine is emphasized.
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Aneurysmal bone cyst (ABC) of the spine can cause acute spinal cord compression in young patients. We report the CT and MRI findings in a histology-proven case of spinal ABC presenting with sudden paraplegia. Typical features of a spinal ABC at the thoracic level with considerable extension into the posterior epidural space and cord compression were demonstrated. Special note was made of the disproportionately large longitudinal extent of the epidural component of the lesion. Associated vertebral collapse was absent. A fracture of the overlying cortex had probably allowed the lesion to decompress and track along the epidural space without significantly jeopardizing integrity of the osseous structures. This case illustrates a less frequently recognised mechanism of acute spinal cord compression by ABC.