Aneurysmal Bone Cyst (ABC)
- solitary expansile lesion located in metaphysis of long bones, flat bones & vertebrae
- presents in 2nd decade
- cysts filled with blood
Signs & Symptoms:
- pain with tenderness & swelling at the site of the lesion
Xrays:
- expansile eccentric lesion surrounded by a thinned cortex with periosteal new bone formation
- CT/MRI - characteristic ‘fluid-fluid’ level
- beware of telangiectatic osteosarcoma - has fluid-fluid levels but far more aggressive looking
Histology:
- blood spaces separated by cellular septa lacking an endothelial cell lining & containing a variety of cells such as fibroblasts, multinucleated giant cells & histiocytes & metaplastic bone
- large solid cellular areas may be seen
Treatment:
- excision, curettage & bone grafting
- cryosurgery or chemical ablation may be used
1 response so far ↓
1 orthonet // Sep 9, 2006 at 1:43 pm
The treatment approach will vary depending of the location and aggressiveness of the lesion. A slow growing, indolent ABC has been observed to regress spontaneously. Selective embolectomy of nutrient vessels and percutaneous injection of a fibrosing agent are newer treatment modalities. Percutaneous injection of methylmethacrylate was used successfully by Herve Deramond for an aggressive ABC lesion in the second cervical vertebra.
Most lesions can be treated with currettage and application of a high-speed burr. Local recurrence rates vary widely, with one recent report having 4 recurrences in 40 patients (Gibbs JBJS Am 1999 Dec;81(12):1671-8). Recurrence was statistically related to young age and open growth plates, and may be less likely following wide excision than following intralesional treatment by currettage. If a recurrence is detected, a thorough examination of the original radiographs and pathology specimens should be performed to insure that the primary lesion, if any, is discovered, since this may radically alter the treatment plan. Once the precise diagnosis is known, local recurrences may be retreated by appropriate methods. Wide resection and limb-sparing reconstructions are necessary to prevent progressively destructive recurrence. Curettage and bone graft can be complicated by profuse bleeding from the lesion. If bleeding is a concern, preoperative selective embolization can be used. Radiation has been used in some cases where operative treatment is not possible, but this adds the additional risk of malignancy.
From http://bonetumor.org/tumors/pages/page151.html
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