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Aneurysmal Bone Cyst

Aneurysmal bone cyst
Objectives
  1. Describe the symptoms associated with aneurysmal bone cyst
  2. Describe the radiographic and imaging features of aneurysmal bone cyst, including staging by the Musculoskeletal Tumor Society
  3. Discuss the etiology of aneurysmal bone cyst
  4. Define and discuss "secondary aneurysmal bone cyst"
  5. Discuss the natural history of aneurysmal bone cyst
  6. Discuss the treatment of aneurysmal bone cyst

Discussion points
  1. Why is pathologic fractures less common with aneurysmal bone cyst than unicameral bone cyst?
  2. Is aneurysmal bone cyst a true primary lesion of bone?

Discussion
Aneurysmal bone cyst is a confusing lesion. It most often appears in teenagers. Most of the lesions involve long bones, but the spine is affected in up to 30% of lesions. The pelvis is the most commonly affected long bone. Although the lesion has been reported in the spine of a father and daughter, there is no identifiable hereditary component. The cyst is more aggressive than unicameral bone cyst, usually with a less distinct border that can penetrate the cortex. The periosteum is usually intact, and often produces a thin shell of bone. So-called secondary aneurysmal bone cysts are actually a cystic part of a giant cell tumor, chondroblastoma, osteoblastoma, of osteosarcoma. The diffential diagnosis includes these entities. This is obviously a tricky situation, so a careful work-up by a qualified surgeon, working with a competent radiologist and pathologist, is essential. Since the lesion tends to be painful, pathologic fracture as a presenting symptom is less common than with unicameral bone cyst. CT findings can be of help in differentiating the 2 entities, the layering of fluid in aneurysmal cysts tends to be in 2 layers. Ultrasound has also been recommended. The natural history of aneurysmal bone cyst is continued progression rather than spontaneous healing as seen with a unicameral cyst. Recurrence is common following curettage. In an effort to reduce recurrence, a number of surgical methods have been employed, including curettage with a high speed burr, cryotherapy with liquid nitrogen, or phenol, also reported is saucerization of the lesion with autologous bone marrow. No modality is presently accepted as superior. Lesions of the spine can be challenging, to preserve function and stability, while still eradicating the lesion. Aneurysmal bone cyst in young children appears to be especially aggressive.

References
  1. Aboulafia AJ, Kennon RE, Jelinek JS. Benign bone tumors of childhood. J Am Acad Orthop Surg 1999; 7: 377-88.
  2. Casadei R, Ruggieri P, Moscato M, Ferraro A, Picci P. Aneurysmal bone cyst and giant cell tumor of the foot. Foot & Ankle International 1996; 17( 8): 487-95.
  3. DiCaprio MR, Murphy MJ, Camp RL. Aneurysmal bone cyst of the spine with familial incidence. Spine 2000; 25( 12): 1589-92.
  4. Freiberg AA, Loder RT, Heidelberger KP, Hensinger RN. Aneurysmal bone cysts in young children. Journal of Pediatric Orthopedics 1994; 14( 1): 86-91.
  5. Gibbs CP, Jr., Hefele MC, Peabody TD, Montag AG, Aithal V, Simon MA. Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr. Journal of Bone & Joint Surgery -American Volume 1999; 81( 12): 1671-8.
  6. Gomez J, Pinar A, Vallcanera A, Moreno A, Cortina H. Sonographic findings in aneurysmal bone cyst in children: correlation with computed tomography findings. Journal of Clinical Ultrasound 1998; 26( 2): 59-64.
  7. Hemmadi SS, Cole WG. Treatment of aneurysmal bone cysts with saucerization and bone marrow injection in children. Journal of Pediatric Orthopedics 1999; 19( 4): 540-2.
  8. Kransdorf MJ, Sweet DE. Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging. AJR. American Journal of Roentgenology 1995; 164( 3): 573-80.
  9. Leithner A, Windhager R, Lang S, Haas OA, Kainberger F, Kotz R. Aneurysmal bone cyst. A population based epidemiologic study and literature review. Clinical Orthopaedics & Related Research 1999( 363): 176-9.
  10. Marcove RC, Sheth DS, Takemoto S, Healey JH. The treatment of aneurysmal bone cyst. Clinical Orthopaedics & Related Research 1995( 311): 157-63.
  11. Ozaki T, Halm H, Hillmann A, Blasius S, Winkelmann W. Aneurysmal bone cysts of the spine. Archives of Orthopaedic & Trauma Surgery 1999; 119( 3-4): 159-62.
  12. Papagelopoulos PJ, Currier BL, Shaughnessy WJ, Sim FH, Ebsersold MJ, Bond JR, et al. Aneurysmal bone cyst of the spine. Management and outcome. Spine 1998; 23( 5): 621-8.
  13. Power RA, Robbins PD, Wood DJ. Aneurysmal bone cyst in monozygotic twins: a case report. Journal of Bone & Joint Surgery -British Volume 1996; 78( 2): 323-4.

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