Aneurysmal bone cyst

An aneurysmal bone cyst (ABC) is a benign expansile tumour-like bone lesion of uncertain
aetiology, composed of numerous blood filled channels.
Epidemiology
Aneurysmal bone cysts are primarily seen in children and adolescents, with 80% occurring in
the patients less than 20 years of age
8
.
Clinical presentation
atients may present with pain, which may be of insidious onset or abrupt due to pathological
fracture, with a palpable lump or with restricted mo!ement.
Pathology
A"#s consist of blood-filled spaces of !ariable si$e that are separated by connecti!e tissue
containing trabeculae of bone or osteoid tissue and osteoclast giant cells. %hey are not lined
by endothelium. &'A# is usually non-diagnostic and is dominated by fresh blood
(
.
Although often primary, up to a third
))
of A"#s are secondary to an underlying lesion
*e.g chondroblastoma, fibrous dysplasia, giant cell tumour *+#%,
-
, osteosarcoma,.
A !ariant of A"#s is the giant cell reparati!e granuloma which is usually seen in the tubular
bones of the hands and feet as well as in the craniofacial skeleton. .ccasionally they are also
seen in appendicular long bones where they are known as solid aneurysmal bone cysts.
/istologically these two entities are identical
0
.
Location
%hey are typically eccentrically located in the metaphysis of long bones, ad1acent to an
unfused growth plate. Although they ha!e been described in most bones, the most common
locations are
-,8
long bones 2 30 - 00% 2 typically of the metaphysis
o lower limb 2 -0%
tibia and fibula 2 2-%, especially proximal tibia
femur 2 )4%, especially proximally
o upper limb 2 20%
spine 2 20 - 40%
o especially posterior elements, with extension into !ertebral body in -0% of
cases
8

sacrum
Radiographic features
Plain film and CT
lain films demonstrate sharply defined, expansile osteolytic lesions, with thin sclerotic
margins. #% will demonstrate these findings to a greater degree, and is also better at
assessing cortical breach and extension into soft tissues.
Additionally, #% can demonstrate fluid fluid le!els, which are harder to appreciate than on
567 and re8uire !iewing with narrow window width
4
.
Bone scan
9oughnut sign 2 increased uptake peripherally with a photopenic centre.
MR
567 is able to demonstrate the characteristic fluid-fluid le!els ex8uisitely as well as identify
the presence of a solid component suggesting the the A"# is secondary.
%he cysts are of !ariable signal, with surrounding rim of low %) and %2 signal. &ocal areas of
high %) and %2 signal
8
are also seen presumably representing areas of blood of !ariable age
*see ageing blood on 567,.
7t is important to remember that the presence of fluid-fluid le!els, although characteristic of
A"# is by no means uni8ue to it, and is also seen in both benign and malignant lesions *e.g.
giant cell tumours *+#%,, chondroblastoma, simple bone cysts and telangiectatic
osteosarcomas,.
Treatment and prognosis
%raditionally these lesions ha!e been treated operati!ely *curettage and bone grafting, with a
recurrence rate of between )) and 4)%. ercutaneous treatment with fibrosing agents has
also been performed, either in isolation as a precursor to surgical excision
),3
.
!ifferential diagnosis
%he differential diagnosis depends on the modality.
.n plain films *and to a lesser degree #%, the diagnosis includes most of the lesions included
in the mnemonic &:+'.5A;/7#.
.n 567 the differential is much shorter, especially when age, location and plain film
appearance is taken into account. %he main differential includes both lesions that intrinsically
ha!e fluid-fluid le!els *thus see fluid-fluid le!el containing bone lesions, and those from
which an A"# may arise *chondroblastoma, fibrous dysplasia, giant cell tumour
*+#%,
-
, osteosarcoma,.
CT OF WRIST