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Review
. 2016 Dec;9(4):435-444.
doi: 10.1007/s12178-016-9371-6.

Current management of aneurysmal bone cysts

Howard Y Park  1 , Sara K Yang  2 , William L Sheppard  1 , Vishal Hegde  1 , Stephen D Zoller  1 , Scott D Nelson  3 , Noah Federman  2 , Nicholas M Bernthal  4
Affiliations
Review

Current management of aneurysmal bone cysts

Howard Y Park et al. Curr Rev Musculoskelet Med. 2016 Dec.

Abstract

Aneurysmal bone cysts (ABCs) are benign bone lesions arising predominantly in the pediatric population that can cause local pain, swelling, and pathologic fracture. Primary lesions, which constitute roughly two thirds of all ABCs, are thought to be neoplastic in nature, with one third of ABCs arising secondary to other tumors. Diagnosis is made with various imaging modalities, which exhibit characteristic features such as "fluid-fluid levels," although biopsy is critical, as telangiectatic osteosarcoma cannot be excluded based on imaging alone. Currently, the standard of care and most widely employed treatment is intralesional curettage. However, tumor recurrence with curettage alone is common and has driven some to propose a multitude of adjuvants with varying efficacy and risk profiles. Historically, therapies such as en bloc resection or radiation therapy were utilized as an alternative to decrease the recurrence rate, but these therapies imposed high morbidity. As a result, modern techniques now seek to simultaneously reduce morbidity and recurrence, the pursuit of which has produced preliminary study into minimally invasive percutaneous treatments and medical management.

Keywords: Aneurysmal bone cyst; Benign bone tumor; Pediatric tumor.

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Conflict of interest statement

Howard Y. Park, Sara K. Yang, William L. Sheppard, Vishal Hegde, Stephen D. Zoller, Scott D. Nelson, and Noah Federman declare that they have no conflict of interest. Nicholas M Bernthal reports personal fees from Onkos and grants from NIH, OREF, POSNA, and MTF outside of the submitted work. Human and animal rights and informed consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
a–f Aneurysmal bone cyst of the distal femur metaphysis. a AP knee X-ray with large, eccentrically located expansile lesion at the distal femur metaphysis with thin cortical borders and trabeculations. b Lateral knee X-ray with similar findings to a. c MRI knee, axial cross-sectional image revealing multiple, clear fluid-fluid levels and peri-lesional edema. d MRI knee, coronal cross-sectional image revealing expansile lesion abutting and displacing surrounding soft tissue. e Low power histology of ABC showing unlined, undulating cyst wall containing scattered giant cells. f Higher power histology of ABC showing mineralizing osteoid within a wall/septation
Fig. 2
Fig. 2
a, b Aneurysmal bone cyst of the proximal humerus. a AP X-ray humerus revealing a large, expansile lesion centered about the proximal humerus metaphysis with clear trabeculations and borders of thin cortical bone. b MRI proximal humerus, axial cross-sectional image revealing clear fluid-fluid levels within an expansile mass
Fig. 3
Fig. 3
a, b Aneurysmal bone cyst of the thoracic spine and rib. a MRI thoracic spine, sagittal cross-sectional image revealing well-circumscribed expansile lesion projected anterior and posteriorly with fluid-fluid levels. b MRI thoracic spine, axial cross-sectional image revealing findings similar to a
Fig. 4
Fig. 4
a–e Telangiectatic osteosarcoma of the tibia. a, b AP and lateral X-ray of the tibia revealing lytic lesion with adjacent soft tissue shadow. c, d MRI of the tibia, cross-sectional axial and coronal images revealing cyst-like fluid collections, one area of discernable fluid-fluid level anteriorly, as well as solid components near the bone within an uncircumscribed lesion that invades the tissue to the subcutaneous level. e High power histology of TOS showing anaplastic, malignant tumor cells among fibroblast and giant cells
See this image and copyright information in PMC

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