Aneurysmal bone cyst
Aneurysmal bone cyst | |
---|---|
Other names | Not recommended: Giant cell reparative granuloma of small bone, giant cell lesion of small bones |
Differential diagnosis | Telangiectatic osteosarcoma[1] |
Treatment | Surgery[2] |
Prognosis | 20-70% recur after curettage.[1] |
Frequency | Rare,[3] ~0.15 cases per one million per year.[1] 80% age <20 years.[1] M=F[1] |
Aneurysmal bone cyst (ABC) is a
The cause is unknown.
Treatment is usually by curettage, bone grafting or surgically removing the part of bone.[2] 20–30% may recur, usually in the first couple of years after treatment, particularly in children.[2]
It is rare.[3] The incidence is around 0.15 cases per one million per year.[1] Aneurysmal bone cyst was first described by Jaffe and Lichtenstein in 1942.[5][6]
Signs and symptoms
The afflicted may have relatively small amounts of pain that will quickly increase in severity over a time period of 6–12 weeks. The skin temperature around the bone may increase, a bony swelling may be evident, and movement may be restricted in adjacent joints.[7]
Spinal
Sites
Commonly affected sites are
]- Skull and mandible (4%)
- Spine (16%)
- Clavicle and ribs (5%)
- Upper extremity (21%)
- Pelvis and sacrum (12%)
- Femur (13%)
- Lower leg (24%)
- Foot (3%)
Causes
Aneurysmal bone cyst has been widely regarded a reactive process of uncertain cause since its initial description by Jaffe and Lichtenstein in 1942. Many hypotheses have been proposed to explain the cause and pathogenesis of aneurysmal bone cyst, and until very recently the most commonly accepted idea was that aneurysmal bone cyst was the consequence of an increased venous pressure and resultant dilation and rupture of the local vascular network. However, studies by Panoutsakopoulus et al. and Oliveira et al. uncovered the clonal neoplastic nature of aneurysmal bone cyst. Primary cause has been regarded arteriovenous fistula within bone.[9]
The lesion may arise de novo or may arise secondarily within a pre-existing bone tumor, because the abnormal bone causes changes in
]Pathology
Histologically, they are classified in two variants.[citation needed]
- The classic (or standard) form (95%) has blood filled clefts among bony trabeculae. Osteoid tissue is found in stromal matrix.
- The solid form (5%) shows fibroblastic proliferation, osteoid production and degenerated calcifying fibromyxoid elements.
According to Buraczewski and Dabska, the development of the aneurysmal bone cyst follows three stages.[5]
Stage | Description |
---|---|
Initial phase (I) | Osteolysis without peculiar findings |
Growth phase (II) |
|
Stabilization phase (III) | Fully developed radiological pattern |
They can also be associated with a TRE17/USP6 translocation.[10]
Aneurysmal bone cysts may be intraosseous, staying inside of the bone marrow. Or they may be extraosseous, developing on the surface of the bone, and extending into the marrow. A radiograph will reveal a soap bubble appearance.[citation needed]
Diagnosis
Differential diagnosis
Following conditions are excluded before diagnosis can be confirmed:[12]
- Unicameral bone cyst
- Giant cell tumor
- Telangiectatic osteosarcoma
- Secondary aneurysmal bone cyst
Treatment
Curettage is performed on some people,[13] and is sufficient for inactive lesions. The recurrence rate with curettage is significant in active lesions, and marginal resection has been advised. Liquid nitrogen, phenol, methyl methacrylate are considered for use to kill cells at margins of resected cyst.[9]
Prognosis
20–70% recur after curettage.[1]
Epidemiology
It is rare.
Additional images
-
High magnification micrograph of an aneurysmal bone cyst
-
Intermediate magnification micrograph of an aneurysmal bone cyst
See also
- Simple bone cyst(SBC)
- Giant cell tumor of bone
- Traumatic bone cyst
References
- ^ ISBN 978-92-832-4503-2.
- ^ a b c "Bone tumours. What are Bone Tumours?". patient.info. Archived from the original on 24 April 2021. Retrieved 24 April 2021.
- ^ PMID 31476792.
- ^ Stevens, Kyle J.; Stevens, James A. (5 September 2020). "Aneurysmal Bone Cysts". StatPearls. StatPearls Publishing.
- ^ ISBN 9783540266310.
- PMID 19920289.
- PMID 22118925.
- ISBN 9780323013420.
- ^ ISBN 9783540699644.
- PMID 20418905.
- ^ ISBN 9241545550.
- ISBN 9781416045809.
- PMID 16170183. Archived from the originalon 2013-04-15.