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aneurysmal bone cysts abc s

ABC's. Classified as a benign boney lesionMore specifically,

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aneurysmal bone cysts abc s

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    1. Aneurysmal Bone Cysts(ABC’s) Dr. Ted Scriven Sept 8, 2008

    2. ABC’s Classified as a benign boney lesion More specifically, “benign-aggressive” Benign-aggressive = marked bone destruction, soft tissue extension or pathologic fractures

    3. 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

    4. 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

    5. 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%)

    6. Clinical Picture Mild pain or swelling May have neuro deficits with spinal lesions Duration = weeks ? years Symptoms may worsen with pregnancy (more blood volume)

    7. Investigations Start with thorough Hx & PE Xray: Radiolucent destructive cyst, expands surrounding cortex ? “Soap-Bubbles” Often eccentric, can be central or subperiosteal

    8. 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

    9. 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

    10. DDx UBC Chondromyxoid Fibroma Chondroblastoma GCT Osteoblastoma Talengiectatic Osteosarcoma

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

    12. 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!!)

    13. 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

    14. 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

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