Aneurysmal Bone Cyst

ANEURYSMAL BONE CYST
DL/SM
Aneurysmal Bone Cyst (ABC)

Benign solitary, expansile & erosive lesion of
bone
Aetiology

Unknown, but thought to be a reactive
process secondary to trauma or vascular
disturbance
Primary ABC's
Lesions are secondary to increased venous
pressure -> haemorrhage -> osteolysis
This osteolysis can in turn promote more
haemorrhage causing amplification of cyst

Pathophysiology
primary and secondary forms
primary ABC:
translocation of gene
secondary ABC:
translocation has not been identified

Associated conditions
associated with other tumors

giant cell tumor
chondroblastoma
fibrous dysplasia
chondromyxoid fibroma
Prognosis
Good
local recurrence in up to 25% and more common
in children with open physes

Incidence

1% of benign bone lesions
Most frequent in children (85% cases <20 yrs)
F:M = 2:1
ABC's can be found in any bone in body
location
25% in spine
20% in long bones (distal femur, proximal tibia)
usually in metaphysis
posterior elements of pelvis

Pathology

Macroscopical
ABC is like a blood filled sponge with a thin periosteal
membrane
Soft, fibrous walls separate spaces filled with friable
blood clot
Microscopical
Cystic spaces filled with blood
Fibrous septa have immature woven bone trabeculae
as well as macrophages filled with haemosiderin,
fibroblasts, capillaries & giant cells
Histology
Characteristic findings
cavernous space
blood-filled
spaces without
endothelial lining
cavity lining
numerous benign giant
cells
spindle cells
thin strands of woven
(new) bone present

HISTOLOGICAL FINDING
Clinical

Swelling, tenderness & pain
Occasionally limited range of motion due to
joint obstruction
Spinal lesions can cause neurological
symptoms secondary to cord compression
Pathological # rare due to eccentric location of
lesion
Radiographic features

Osteolytic lesion placed eccentrically in
metaphysis
Expansile nature of lesion often reflected by
"blow-out" or "soap bubble" appearance
Periosteum elevated
'Pencil-in-cup' appearance

Aneurysmal bone cyst. Expansile cystic tumour, always on the metaphyseal
side of the physis

CT scan
Can help delineate lesions in pelvis or spine
where plain film may be inadequate
Can narrow differential diagnosis of ABC by
demonstrating multiple fluid-fluid levels

MRI
Fluid-fluid level visible on T2-weighted MRI
scan
Double-density fluid level and intralesional
septation

Treatment

Most lesions can be treated with curettage &
application of a high-speed burr
Marginal excision or wide excision with bone
grafting preferable
In theses cases, packing with
methylmethacrylate may be more effective

THANK YOU
A 6-year-old male presents with pain and
swelling in his proximal tibia after twisting his
knee. AP and lateral radiographs are shown in
Figures A and B. Figure C shows a sagittal section
from an MRI, and Figure D shows the high-
power histology specimen from biopsy. What is
the most likely diagnosis?
FIGURES:

1. Unicameral bone cyst

2. Aneurysmal bone cyst

3. Chondrosarcoma

4. Giant cell tumor

5. Non ossifying fibroma
Preffered response : 2
DISCUSSION: The radiographs, MRI, and histology specimen are most consistent with the diagnosis of an
aneurysmal bone cyst.

Aneurysmal bone cysts are rare skeletal tumors that occur most frequently in people <20 years old.
Pathogenesis remains uncertain, but may be vascular, traumatic, or genetic. Differential diagnosis includes a
giant cell tumor, unicameral bone cyst, and telangiectatic osteosarcoma. Treatment consists of curettage and
bone grafting with or without adjuvant treatments such as sclerotherapy, cryotherapy, or radionuclide ablation.

Figures A and B show an expansile, eccentric, lucent lesion in the proximal tibia with evidence of a pathologic
fracture. Figure C is an MRI showing multiple fluid-fluid levels on T2 imaging confirming a diagnosis of an
aneurysmal bone cyst (ABC). Figure D shows the low-power view of an aneurysmal bone cyst with "lakes of
blood" and a benign fibrocystic lining.

Incorrect Answers:
Answer 1: Unicameral bone cysts (UBC) are serous filled bone lesions that occur most commonly in the
proximal humerus. Unlike UBCs, long bone ABCs are *eccentric* lesions seen in the metaphysis, and can
expand to a diameter greater than that of the physis.
Answer 3: Age, radiographs, MRI and histology are not consistent with a diagnosis of chondrosarcoma.
Answer 4: While there are giant cells on the high-power biopsy specimen, the cavernous spaces filled with
blood and MRI findings of fluid-fluid levels make ABC the more correct diagnosis.
Answer 5: While non-ossifying fibroma is common in this age bracket, radiographs would most likely show a
"bubbly" lytic lesion surrounded by a sclerotic rim and histology would show fibroblastic spindle cells in a
storiform pattern.

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