Aneurysmal Bone Cysts

(ABCs)
Dr. Ted Scriven
Sept 8, 2008

ABCs
Classified as a benign boney lesion
More specifically, benign-aggressive
Benign-aggressive = marked bone
destruction, soft tissue extension or
pathologic fractures

Etiology
Specific translocation @ 17p13
Can arise de novo, or be associated with
another primary:
GCT, chondroblastoma, UBC, osteoblastoma,
fibrous dysplasia, nonossifying fibroma,
chondromyxoid fibroma, osteosarcoma

Etiology
Result from local circulatory abnormality:
Increased venous pressure
Local hemorrhage
Osteolysis
More bleeding
Source of bleeding = capilliaries in cyst membrane
Hemorrhage progresses to destructive lesion

Clinical Picture
Age: often < 20
Gender: F > M (slight)
Location:
metaphysis or metadiaphysis of long bones
(prox humerus, distal femur, prox tibia)
Occasionally iluim or lumbar vertebrae (15
20%)

Clinical Picture

Mild pain or swelling

May have neuro deficits with spinal lesions
Duration = weeks years
Symptoms may worsen with pregnancy
(more blood volume)

Investigations
Start with thorough Hx & PE
Xray:
Radiolucent destructive cyst, expands
surrounding cortex Soap-Bubbles
Often eccentric, can be central or
subperiosteal
Elevated periosteum

Thin shell

Investigations
Bone Scan:
Diffuse or peripheral tracer uptake
Central area of decreased uptake

Angiography:
Accumulation of contrast throughout +/hypervascularity of periphery
Absence of viable afferent or efferent vessels

Investigations
CT
Helps deliniate lesion in areas
of complex boney anatomy

MRI
Multiloculated cavities, fluid
levels, +/- associated soft
tissue mass
Helps to differentiate between
ABC & UBC

DDx

UBC
Chondromyxoid Fibroma
Chondroblastoma
GCT
Osteoblastoma
Talengiectatic Osteosarcoma

Pathology
Gross:
Cavitary w/ blood filled spaces
Surrounded by thin layer of bone & raised
periosteum

Pathology
Micro:
Hemorrhagic tissue with spaces separated by cellular
stroma

No endothelial lining or smooth muscle only lining is

compressed fibroblasts
ALWAYS be sure to examine entire speciman and
surrounding area (association with other primaries!!)

Treatment
Curettage & Bone Grafting
Caution: lesion prone to heavy bleeding!
Tourniquet
Pre-op embolization

+/- local adjuvent tx for cavity sterilization:

Phenol, liquid nitrogen, argon

Ressection:
If area is expendable (fibula, metatarsal, etc)

Radiation:
Not routinely used d/t potential for malignant
transformation

Prognosis
If primary:
Usually a favourable prognosis
Recurrence:
Rate after curettage = 14 34%
Usually within 6/12, rare after 2 yrs
More common in age < 15 yo, centrally located
lesions, and when contents not all removed

If associated with another primary:

Classification, treatment and prognosis based
on the other (primary) lesion