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Year : 2012  |  Volume : 8  |  Issue : 1  |  Page : 103-105

Radiologic and pathologic correlation of aneurysmal bone cysts at unusual sites

1 Department of Radio Diagnosis, Era's Lucknow Medical College, Lucknow, India
2 Department of Pathology, SRL Religare Private Limited, Lucknow, India
3 Department of Pathology, S.G. Post Graduate Institute of Medical Sciences, Lucknow, India

Date of Web Publication19-Apr-2012

Correspondence Address:
Deepika Upadhyay
Department of Pathology, S. G. Post Graduate Institute of Medical Sciences, Rae Bareli Road, SGPGI Campus, MRA-A63, Lucknow
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.95183

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 > Abstract 

Aneurysmal bone cyst (ABC) is a benign solitary lesion. It usually occurs in the long bones but uncommonly in the calcaneum, mandible, femur and clavicle. Its frequency of occurrence in skull and mandible is 4%, clavicle and ribs is 5%, femur is 13% and foot is 3%. Only a few cases of ABC of these unusual sites have been reported till date. Here we report four cases of ABC at unusual sites namely the calcaneum, mandible, femur and clavicle diagnosed primarily on the basis of different imaging modalities and later confirmed on histopathology.

Keywords: Aneurysmal bone cyst, clavicle, computed tomography, femur, histopathology, mandible, MRI, multiloculated cyst, unusual sites, calcaneum

How to cite this article:
Parashari UC, Khanduri S, Upadhyay D, Bhadury S, Singhal S. Radiologic and pathologic correlation of aneurysmal bone cysts at unusual sites. J Can Res Ther 2012;8:103-5

How to cite this URL:
Parashari UC, Khanduri S, Upadhyay D, Bhadury S, Singhal S. Radiologic and pathologic correlation of aneurysmal bone cysts at unusual sites. J Can Res Ther [serial online] 2012 [cited 2020 Jul 9];8:103-5. Available from: http://www.cancerjournal.net/text.asp?2012/8/1/103/95183

 > Introduction Top

Aneurysmal bone cyst (ABC) is a solitary expansile cystic and erosive lesion of bone that most often manifests in individuals during their second decade of life. The most common location is the metaphysis of lower extremity long bones. ABC of the calcaneum, mandible, clavicle and femur are uncommon entities.

 > Case Reports Top

We present a case series comprising of four cases in the second decade of their lives where in the pathology involves four different sites of the body. Case 1 was a 19-years-old male, a case of ABC of the calcaneum [Figure 1]. Case 2 was a 16-years-old female, a case of ABC of the clavicle [Figure 2]. Case 3 was a 19-years-old female, a case of ABC of the femur [Figure 3]. Case 4 was an 11-years-old female, a case of ABC of the mandible [Figure 4]. The patients presented with painful swelling at the involved site which gradually increased with time and was associated with restricted movement at the corresponding joint. There was no history of any trauma. Clinical examination revealed tender bony swelling at the involved site with no neurological deficit. Patients further underwent different modalities of imaging namely X-ray, CT and MRI which showed an expansile multicystic lesion of the respective bone. Histological examination was conducted from the biopsy of the involved bone seeing which final diagnosis of ABC was made. The patients were planned for bone curettage and grafting or bone resection as the treatment. The patients when followed after a period of six months to one year were asymptomatic and doing fine. Clinical features, imaging findings, histological correlation and treatment of all four cases are summarized in [Table 1].
Figure 1: Axial CT images of both foot in bone (a) and soft tissue window (b) showing an expansile, multiloculated lytic lesion of left calcaneum with thin septations. Focal breach of cortex is noted on medial aspect. Histopathological of the cyst shows stroma comprising of proliferating fibroblasts, histiocytes and multinucleated giant cells (c)

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Figure 2: Axial CT image of the lower chest and neck (a) showing a large well defined, rounded expansile, multi-septate hypodense lesion in the medial two-third of the left clavicle. Fluid– fl uid levels are seen
within the mass. Histopathology of open biopsy of the cyst reveals cystic vascular spaces, without endothelial lining, separated by fi brous septa and thin strands of bone

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Figure 3: Axial CT images of the hip joints (a and b) showing a moderate size expansile lesion in upper end of right femur involving neck extending in head with pathological fracture of right femoral neck. 3D reconstruction with shaded surface display (c) shows lobulated multiseptated lesion in right upper metadiaphyseal region of right femur extending in epiphysis (head). Histopathological image (3d) shows cavernous blood fi lled spaces lacking endothelial lining and separated by fibrous stroma with infl ammatory infi ltrate, giant cells and strands of bone

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Figure 4: Axial (a), sagittal (b) and coronal (c) T2WIs showing a welldefined expansile lesion in the inferior part of right ramus of mandible with thinning of the cortical bone. The lesion has multi-cysts with air fluid levels displaying heterogeneously hyperintense signals. In axial (d) and sagittal (e) T1WIs, lesion is isointense with multiple fluid– fluid levels with few hyperintense signals. Histopathology (f) reveals vascular
space separated by stroma lacking endothelial lining and containing fi broblasts, chronic inflammatory cells and numerous histiocytic giant cells

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Table 1: Summary of clinical features, imaging findings, histological correlation and treatment of all four cases

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 > Discussion Top

WHO defines ABC as a benign tumor like expanding osteolytic lesion consisting of blood-filled spaces separated by connective tissue septa containing trabeculae or osteoid tissue and occasional osteoclastic giant cells. The term ABC was coined by Jaffe and Lichtenstein in 1942 to describe its radiographic appearance. [1]

ABC is a lesion with a unique clinical, radiological and diagnostic finding. [2] Researchers believe that ABCs are a result of a vascular malformation within the bone, though the ultimate cause of the malformation is still under debate. [3]

The male-to-female ratio is 1.2:1 and the location is usually metaphyseal end of the long bones. Diaphyseal lesions are seen in only 8% of cases. Extension into the epiphysis is even rarer. [4] ABCs are usually seen in the long bones and lumbar spine. The most common site of involvement is the metaphyseal region of the knee. To the best of our knowledge, most of the cases of clavicle reported till date had involved either the lateral end or the middle segment of the clavicle. In our case, the medial end of clavicle is involved which is a rare finding. Struthers and Shear concluded that ABC of mandible can occur secondary to a pre-existing lesion and central giant cell granuloma to be the most common of these lesions. [5] Only 95 cases have been reported without any history of trauma by Tillman et al. [6]

Clinically, ABC often presents with painful swelling, although some remain asymptomatic. Even though there are many typical radiographic, CT, and MRI findings to diagnose ABC, an open biopsy for histological examination is performed to confirm diagnosis. [7] There are various methods of treatment, which include curettage, wide excision, arterial embolization. Surgical curettage is sufficient to treat most ABCs of the feet, including the calcaneum. [8]

ABCs show a favorable outcome with an overall cure rate of 90-95%. [9] The incidence of recurrence has been noted to vary between 59% in cases who have been treated with intralesional excision and about 0% in cases who have been treated by resection. [10]

 > References Top

1.Murphey MD, Andrews CL, Flemming DJ, Temple HT, Smith WS, Smirniotopoulos JG. From the archives of the AFIP. Primary tumors of the spine: Radiologic pathologic correlation. Radiographics 1996;16:1131-58.  Back to cited text no. 1
2.Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop 1986;204:25-36.  Back to cited text no. 2
3.Cottalorda J, Bourelle S. Modern concepts of primary aneurysmal bone cyst. Arch Orthop Trauma Surg 2007;127:105-14.  Back to cited text no. 3
4.Levine SM, Lambiase RE, Pethprapa CN. Cortical lesions of the tibia: Characteristics appearances at conventional radiography. Radiographics 2003;23:157-77.  Back to cited text no. 4
5.Gadre KS, Zubairy RA. Aneurysmal bone cyst of the mandibular condyle: Report of a case. J Oral Maxillofac Surg 2000;58:439-43.   Back to cited text no. 5
6.Pelo S, Gasparini G, Boniello R, Moro A, Amoroso PF. Aneurysmal bone cyst located in the mandibular condyle. Head Face Med 2009;5:8.  Back to cited text no. 6
7.Unni KK, Inwards YC. Conditions that normally simulate primary neoplasms of the bone. In: Unni KK, Inwards YC, editors. Dahlin's Bone Tumors. 6 th ed. Philadelphia: Lippincott Williams and Wilkins; 2010. p. 305-80.  Back to cited text no. 7
8.Chowdhry M, Chandrasekar CR, Mohammed R, Grimer RJ. Curettage of aneurysmal bone cysts of the feet. Foot Ankle Int 2010;31:131-5.  Back to cited text no. 8
9.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. J Bone Joint Surg Am 1999;81:1671-8.  Back to cited text no. 9
10.Schreuder HW, Veth RP, Pruszczynski M, Lemmens JA, Koops HS, Molenaar WM. Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting. J Bone Joint Surg Br 1997;79:20-5.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1]

This article has been cited by
1 Aneurysmal bone cyst of the mandible: A case report
Shina Mohd Ariffin,Noraini Nun Nahar Yunus
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