Aneurysmal bone cyst

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Aneurysmal bone cyst_table_infobox_0

Aneurysmal bone cystAneurysmal bone cyst_header_cell_0_0_0
SpecialtyAneurysmal bone cyst_header_cell_0_1_0 Rheumatology Q4761773?uselang=en#P1995Aneurysmal bone cyst_cell_0_1_1

Aneurysmal bone cyst, abbreviated ABC, is an osteolytic bone neoplasm characterized by several sponge-like blood or serum filled, generally non-endothelialized spaces of various diameters. Aneurysmal bone cyst_sentence_0

The term is a misnomer, as the lesion is neither an aneurysm nor a cyst. Aneurysmal bone cyst_sentence_1

Signs and symptoms Aneurysmal bone cyst_section_0

The afflicted may have relatively small amounts of pain that will quickly increase in severity over a time period of 6–12 weeks. Aneurysmal bone cyst_sentence_2

The skin temperature around the bone may increase, a bony swelling may be evident, and movement may be restricted in adjacent joints. Aneurysmal bone cyst_sentence_3

Spinal lesions may cause quadriplegia and patients with skull lesions may have headaches. Aneurysmal bone cyst_sentence_4

Sites Aneurysmal bone cyst_section_1

Commonly affected sites are metaphyses of vertebra, flat bones, femur and tibia. Aneurysmal bone cyst_sentence_5

Approximate percentages by sites are as shown: Aneurysmal bone cyst_sentence_6

Aneurysmal bone cyst_unordered_list_0

  • Skull and mandible (4%)Aneurysmal bone cyst_item_0_0
  • Spine (16%)Aneurysmal bone cyst_item_0_1
  • Clavicle and ribs (5%)Aneurysmal bone cyst_item_0_2
  • Upper extremity (21%)Aneurysmal bone cyst_item_0_3
  • Pelvis and sacrum (12%)Aneurysmal bone cyst_item_0_4
  • Femur (13%)Aneurysmal bone cyst_item_0_5
  • Lower leg (24%)Aneurysmal bone cyst_item_0_6
  • Foot (3%)Aneurysmal bone cyst_item_0_7

Causes Aneurysmal bone cyst_section_2

Aneurysmal bone cyst has been widely regarded a reactive process of uncertain cause since its initial description by Jaffe and Lichtenstein in 1942. Aneurysmal bone cyst_sentence_7

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. Aneurysmal bone cyst_sentence_8

However, studies by Panoutsakopoulus et al. Aneurysmal bone cyst_sentence_9

and Oliveira et al. Aneurysmal bone cyst_sentence_10

uncovered the clonal neoplastic nature of aneurysmal bone cyst. Aneurysmal bone cyst_sentence_11

Primary cause has been regarded arteriovenous fistula within bone. Aneurysmal bone cyst_sentence_12

The lesion may arise de novo or may arise secondarily within a pre-existing bone tumor, because the abnormal bone causes changes in hemodynamics. Aneurysmal bone cyst_sentence_13

An aneurysmal bone cyst can arise from a pre-existing chondroblastoma, a chondromyxoid fibroma, an osteoblastoma, a giant cell tumor, or fibrous dysplasia. Aneurysmal bone cyst_sentence_14

A giant cell tumor is the most common cause, occurring in 19% to 39% of cases. Aneurysmal bone cyst_sentence_15

Less frequently, it results from some malignant tumors, such as osteosarcoma, chondrosarcoma, and hemangioendothelioma. Aneurysmal bone cyst_sentence_16

Pathology Aneurysmal bone cyst_section_3

Histologically, they are classified in two variants. Aneurysmal bone cyst_sentence_17

Aneurysmal bone cyst_unordered_list_1

  • The classic (or standard) form (95%) has blood filled clefts among bony trabeculae. Osteoid tissue is found in stromal matrix.Aneurysmal bone cyst_item_1_8
  • The solid form (5%) shows fibroblastic proliferation, osteoid production and degenerated calcifying fibromyxoid elements.Aneurysmal bone cyst_item_1_9

According to Buraczewski and Dabska, the development of the aneurysmal bone cyst follows three stages. Aneurysmal bone cyst_sentence_18

Aneurysmal bone cyst_table_general_1

StageAneurysmal bone cyst_header_cell_1_0_0 DescriptionAneurysmal bone cyst_header_cell_1_0_1
Initial phase (I)Aneurysmal bone cyst_cell_1_1_0 Osteolysis without peculiar findingsAneurysmal bone cyst_cell_1_1_1
Growth phase (II)Aneurysmal bone cyst_cell_1_2_0 Aneurysmal bone cyst_cell_1_2_1
Stabilization phase (III)Aneurysmal bone cyst_cell_1_3_0 Fully developed radiological patternAneurysmal bone cyst_cell_1_3_1

They can also be associated with a TRE17/USP6 translocation. Aneurysmal bone cyst_sentence_19

Aneurysmal bone cysts may be intraosseous, staying inside of the bone marrow. Aneurysmal bone cyst_sentence_20

Or they may be extraosseous, developing on the surface of the bone, and extending into the marrow. Aneurysmal bone cyst_sentence_21

A radiograph will reveal a soap bubble appearance. Aneurysmal bone cyst_sentence_22

Diagnosis Aneurysmal bone cyst_section_4

On a radiograph, well-defined, expansile, lytic lesion is observed. Aneurysmal bone cyst_sentence_23

Expansion of cortex gives the lesion a balloon-like appearance. Aneurysmal bone cyst_sentence_24

Larger lesions may appear septated Aneurysmal bone cyst_sentence_25

Differential diagnosis Aneurysmal bone cyst_section_5

Following conditions are excluded before diagnosis can be confirmed: Aneurysmal bone cyst_sentence_26

Aneurysmal bone cyst_unordered_list_2

  • Unicameral bone cystAneurysmal bone cyst_item_2_10
  • Giant cell tumorAneurysmal bone cyst_item_2_11
  • Telangiectatic osteosarcomaAneurysmal bone cyst_item_2_12
  • Secondary aneurysmal bone cystAneurysmal bone cyst_item_2_13

Treatment Aneurysmal bone cyst_section_6

Curettage is performed on some patients, and is sufficient for inactive lesions. Aneurysmal bone cyst_sentence_27

The recurrence rate with curettage is significant in active lesions, and marginal resection has been advised. Aneurysmal bone cyst_sentence_28

Liquid nitrogen, phenol, methyl methacrylate are considered for use to kill cells at margins of resected cyst. Aneurysmal bone cyst_sentence_29

Prognosis Aneurysmal bone cyst_section_7

Recurrence rate of solid form of tumour is lower than classic form. Aneurysmal bone cyst_sentence_30

Epidemiology Aneurysmal bone cyst_section_8

It is common in age group of 10–30 years. Aneurysmal bone cyst_sentence_31

It is second most common tumor of spine and most common benign tumor of pelvis in pediatric population. Aneurysmal bone cyst_sentence_32

Incidence is slightly more in males than females (1.3:1). Aneurysmal bone cyst_sentence_33

Additional images Aneurysmal bone cyst_section_9

Aneurysmal bone cyst_unordered_list_3

  • Aneurysmal bone cyst_item_3_14
  • Aneurysmal bone cyst_item_3_15

See also Aneurysmal bone cyst_section_10

Aneurysmal bone cyst_unordered_list_4

Credits to the contents of this page go to the authors of the corresponding Wikipedia page: bone cyst.