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Soft tissue aneurysmal bone cyst is a rare entity, with about 20 cases reported in literature, only 3 of which are in patients over 40 years of age. We present a case of a 41 year old Latin American female who presented for evaluation of atraumatic chest pain with radiation to the left shoulder. Her initial workup was negative, including radiographic imaging of the chest and left shoulder. 4 months later, she presented to her orthopedic surgeon with a palpable mass and mild left shoulder pain. Radiographs acquired at that time demonstrated a 7.0 × 5.5 × 6.7 cm mass with rim calcification in the region of the upper triceps muscle. Subsequent CT imaging showed central areas of hypodensity and thin septations, a few of which were calcified. MR evaluation showed hemorrhagic cystic spaces with multiple fluid-fluid levels and enhancing septations. Surgical biopsy was performed and pathology was preliminarily interpreted as cystic myositis ossificans, however on final review the diagnosis of soft tissue aneurysmal bone cyst was made. The lesion was then surgically excised and no evidence of recurrence was seen on a 3 year post-op radiograph. Following description of our case, we conduct a literature review of the imaging characteristics, diagnosis, and treatment of soft tissue aneurysmal bone cyst.

The perivertebral space extends from the skull base to the mediastinum and is delineated by the deep layer of the deep cervical fascia. The different tissue types, including muscles, bones, nerves, and vascular structures, give rise to the various disorders that can be seen in this space. This article defines the anatomy of the perivertebral space, guides lesion localization, discusses different disease processes arising within this space, and reviews the best imaging approaches., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Aneurysmal bone cyst is a benign pseudocystic osseous lesion characterized by a fibrous connective tissue stroma with cellular fibrous tissue, multinucleated giant cells, and large blood-filled spaces with no endothelial lining. The entity is uncommon in facial bones, and it rarely involves the mandibular condyle. Resection of the lesion is the most accepted treatment. The present case is the 11th reported case of aneurysmal bone cyst of the mandibular condyle in the existing literature and the first where, rather than using conventional extra oral approach, sagittal split ramus osteotomy was used to excise the lesion successfully with no recurrence after 3 years of follow-up.

Introduction: Aneurysmal bone cysts are benign tumours that usually present in childhood. Aggressive forms have been described, which are often treated with surgery that entails major resection and reconstruction. Polidocanol sclerotherapy has recently been reported to have excellent results and promises to replace operative treatments, but its efficacy in the case of aggressive aneurysmal bone cysts has not been documented., Case Presentation: An 18-year-old woman from Sweden presented with pain in her shoulder and a rapidly progressing cystic bone lesion. The differential diagnosis was a rare, aggressive form of aneurysmal bone cyst or a sarcoma of the proximal humerus. She was successfully treated using sequential percutaneous injections of polidocanol after exclusion of malignancy., Conclusions: Management of aggressive aneurysmal bone cysts has thus far relied on open surgery. We propose that non-operative treatment with polidocanol is efficient even in the aggressive form of the aneurysmal bone cyst.

Background: To decrease the recurrence rate after intralesional curettage for aneurysmal bone cysts, different adjuvant treatments have been recommended. Liquid nitrogen spray and argon beam coagulation have provided the lowest recurrence rates, but unlike the high-speed burr, these adjuvants are not always available in operating rooms., Questions/purposes: We asked: (1) Is high-speed burring alone sufficient as an adjuvant to curettage with respect to recurrence rates? (2) What is the complication rate from this technique? (3) What are the risk factors for local recurrence?, Methods: A retrospective review of the database of the University Musculoskeletal Tumor Unit and the private files of the senior author (EHW) for a period of 19 years (1993-2011) was performed to identify all patients histologically diagnosed with primary aneurysmal bone cyst. During that period, patients with aneurysmal bone cysts were treated with intralesional curettage, burring, and bone grafting if the lesions showed an adequate cortical wall or a wall with thinned out portions which could be reconstructed with bone grafting. Based on those indications, we treated 54 patients for this condition. Of those, 18 were treated using approaches other than burring because they did not meet the defined indications, and an additional five patients were lost to followup before 2 years, leaving 31 patients for analysis, all of whom were followed up for at least 2 years (mean, 7 years; range, 2-18 years)., Results: Of these 31 patients, one had a recurrence (3.2%). Complications using this approach occurred in three patients (9.7%), and included growth plate deformity (1) and genu varus (2) secondary to collapse of the reconstructed condyle. With only one recurrence, we cannot answer what the risk factors might be for recurrence; however, the one patient with recurrence presented with a large lesion and a pathologic fracture., Conclusions: Curettage, burring, and bone grafting compare favorably in the literature with other approaches for aneurysmal bone cysts, such as cryotherapy and argon-beam coagulation. We conclude that high-speed burring alone as an adjuvant to intralesional curettage is a reasonable approach to achieving a low recurrence rate for aneurysmal bone cysts., Level of Evidence: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Objectives: Use of titanium prostheses for reconstructing chest wall defects following major chest wall resections is rapidly increasing in popularity. Previously, complications including prosthesis fracture have been reported for the system secured to the rib ends using clips following chest wall reconstruction and pectus excavatum repair. By contrast, fracture failure in titanium systems fastening the plate to the rib with locking screws through predrilled holes has not been previously reported, possibly owing to differences in the design and material of the system., Methods: We report an index case of plate fracture in the latter design following rib reconstruction and discuss the pathophysiology and relative risks behind such fractures., Results: Fracture of titanium plate occurred after chest impact during sport at 25 months following initial plate implantation. Surgical excision was performed because of persistent pain and cough., Conclusions: Fracture failure can occur in those systems fastening the plate to the rib with locking-screws, and patients, particularly those engaged in contact sports or occupations with chest impact risks, should be informed of this possibility during consent, as surgical removal is most likely required following implant fracture failur., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: Endolymphatic sac tumors (ELSTs) are rare, slow-growing tumors of the petrous bone. Despite the typical localisation, their radiological diagnosis can be challenging due to the variety of other tumors potentially showing similar features., Case Report: We present a 16-year-old child with progressive hearing loss, vertigo, and tinnitus who had a large petrous bone lesion showing imaging features of both ELSTs and aneurysmal bone cysts (ABCs). The patient underwent preoperative embolization of the tumor-supplying vessels and subsequently a subtotal resection. Histological examination revealed an ELST., Conclusion: Despite the rarity of petrous bone ABCs, they should be considered as a differential diagnostic alternative of ELSTs due to their similar imaging appearance.

Aneurysmal bone cyst (ABC) is a benign tumor of bone presenting as a cystic, expansile lesion in both the axial and appendicular skeleton. Axial lesions demand special consideration, because treatment-related morbidity can be devastating. In similar lesions, such as giant cell tumor of bone (GCTB), the receptor-activator of nuclear kappaB ligand (RANKL)-receptor-activator of nuclear kappaB (RANK) signaling axis is essential to tumor progression. Although ABC and GCTB are distinct entities, they both contain abundant multinucleated giant cells and are osteolytic characteristically. We hypothesize that ABCs express both RANKL and RANK similarly in a cell-type specific manner, and that targeted RANKL therapy will mitigate ABC tumor progression. Cellular expression of RANKL and RANK was determined in freshly harvested ABC samples using laser confocal microscopy. A consistent cell-type-specific pattern was observed: fibroblastlike stromal cells expressed RANKL strongly whereas monocyte/macrophage precursor and multinucleated giant cells expressed RANK. Relative RANKL expression was determined by quantitative real-time polymerase chain reaction in ABC and GCTB tissue samples; no difference in relative expression was observed (P > 0.05). In addition, we review the case of a 5-year-old boy with a large, aggressive sacral ABC. After 3 months of targeted RANKL inhibition with denosumab, magnetic resonance imaging demonstrated tumor shrinkage, bone reconstitution, and healing of a pathologic fracture. Ambulation, and bowel and bladder function were restored at 6 months. Denosumab treatment was well tolerated. Post hoc analysis demonstrated strong RANKL expression in the pretreatment tumor sample. These findings demonstrate that RANKL-RANK signal activation is essential to ABC tumor progression. RANKL-targeted therapy may be an effective alternative to surgery in select ABC presentations., (Copyright © 2014 Mosby, Inc. All rights reserved.)

Giant cell bone tumors are the most common precursor lesions of aneurysmal bone cysts (ABCs) developing secondarily. In giant cell bone tumors containing an explicit ABC component, the observation of the solid component of the giant cell bone tumor plays a critical role in the separation of the primary ABC. In general, ABC cases together with giant cell tumors in the bone are diagnosed histopathologically. The combination of giant cell bone tumor with superposed ABC and that of painful scoliosis with backache is rarely seen in children. In this case study, we discussed the diagnosis and the treatment of a giant cell tumor and superposed an ABC present in the fifth lumbar spine in a pediatric patient admitted to our clinic with a complaint of acute scoliotic back pain.

Background: Distal radius fractures (DRF) are often referred to as osteoporosis indicator fractures as their incidence increases from age 45. In the group of young adults, distal radius fractures normally result from high-energy trauma. Wrist fractures in young patients without adequate trauma thus raise suspicion of a pathologic fracture. In this report we present the case of a fractured unicameral bone cyst (UBC) at the distal radius in a young adult.To the author's best knowledge, this is the first detailed report in an UBC at the distal radius causing a pathologic DRF in an adult patient., Case Presentation: A 25-year-old otherwise healthy male presented to our Emergency Department after a simple fall on his right outstretched hand. Extended diagnostics revealed a pathologic, dorsally displaced, intra-articular distal radius fracture secondary to a unicameral bone cyst occupying almost the whole metaphysis of the distal radius. To stabilize the fracture, a combined dorsal and volar approach was used for open reduction and internal fixation. A tissue specimen for histopathological examination was gathered and the lesion was filled with an autologous bone graft harvested from the ipsilateral femur using a reamer-irrigator-aspirator (RIA) system. Following one revision surgery due to an intra-articular step-off, the patient recovered without further complications., Conclusions: Pathologic fractures in young patients caused by unicameral bone cysts require extended diagnostics and adequate treatment. A single step surgical treatment is reasonable if fracture and bone cyst are treated appropriately. Arthroscopically assisted fracture repair may be considered in intra-articular fractures or whenever co-pathologies of the carpus are suspected.

Giant cell tumor of bone is a benign, locally aggressive neoplasm that is composed of sheets of neoplastic mononuclear cells interspersed amongst non-neoplastic, uniformly distributed, osteoclast-like giant cells. They represent approximately 4-5% of primary bone tumors. Rarely, bone tumors have been noted to produce human chorionic gonadotropin, a finding most often reported in osteosarcoma. We present the case of a young woman who presented with a low-level human chorionic gonadotropin level which, after resection of her recurrent giant cell tumor of bone with secondary aneurysmal bone cyst-like change, became undetectable in her blood. Furthermore, cells within the aneurysmal bone cyst component were immunohistochemically positive for β-human chorionic gonadotropin. This is the first report of such a finding in the literature.

Background: Primary aneurysmal bone cysts (ABCs) are benign, expansile bone lesions commonly treated with aggressive curettage with or without adjuvants such as cryotherapy, methacrylate cement, or phenol. It has been reported that occasionally these lesions heal spontaneously or after a pathologic fracture, and we observed that some ABCs treated at our center healed after biopsy alone. Because of this, we introduced a novel biopsy technique we call "curopsy," which is a percutaneous limited curettage at the time of biopsy, obtaining the lining membrane from various quadrants of the cyst leading to consolidation (curopsy = biopsy with intention to cure)., Questions/purposes: We asked whether (1) a curopsy results in comparable likelihood of healing of the ABC compared with more aggressive approaches involving curettage, (2) the two approaches differ in terms of the likelihood of recurrence after treatment, and (3) the two approaches differ in terms of complications after surgery., Methods: Between January 1, 1999 and June 30, 2012, 221 patients with a diagnosis of primary ABC were registered in our oncology database. Patients presenting with a pathologic fracture and those seeking a second opinion were excluded. One hundred ninety patients were included in the study. One hundred two (54%) were treated with curopsy and 88 (46%) were treated with curettage after a core needle biopsy. Complete followups were available for 88% (90 of 102) and 93% (80 of 88) of patients in those groups, respectively. During that period, a curopsy was performed for all patients with benign bone lesions with imaging suggestive of classic primary ABCs and for whom the core needle biopsy simply showed blood with no solid component. Curettage after a core needle biopsy was reserved for histologically confirmed primary ABCs, lesions with impending fractures, large lesions, if the ABC was thought to be a secondary disorder, and patients for whom the curopsy failed. All patients were followed up until consolidation of the lesion (mean, 9.6 weeks, range, 3-25 weeks, 95% CI, 8.32-10.9 for curopsy; mean, 11.4 weeks, range, 8-32 weeks, 95% CI, 10.6-12.3 for curettage). The median followup for all patients was 14 months (range, 6-36 months)., Results: Of the 102 patients who had curopsy and observation, 83 (81%) required no additional treatment and the lesion resolved. Of the 88 patients who underwent curettage (with or without adjuvant therapy) after core needle biopsy, the success rate was 90% (79 of 88). Local recurrences in both groups (curopsy or curettage) were treated successfully with additional curettage in all but one case. Curopsy in comparison to curettage provided a mean shorter healing time (9.6 versus 11.4, p = 0.01) but there was a higher local recurrence and need for additional intervention rate (18.6% versus 10.2%, p = 0.04). There were no differences in the complications between the treatment groups., Conclusions: A curopsy is a novel biopsy technique that was successful in resolving ABCs in 81% of the patients in our study. Curopsy, as a biopsy technique, for ABCs needs consideration as it potentially minimizes the number of patients needing a second procedure (a core needle biopsy being the first) as is the current practice. Furthermore, it does not disadvantage the patient or surgeon should additional intervention be needed in the form of curettage with or without adjuvants., Level of Evidence: Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Chondroblastoma is a benign tumor that typically arises in the epiphysis of a long bone. There have been only 2 reported cases of chondroblastoma involving the capitate. This is the first report of chondroblastoma with secondary aneurysmal bone cyst involving the capitate. A 33-year-old man presented with a 3-year history of pain and swelling of the right wrist. Radiography as well as computed tomography showed a radiolucent area and no matrix calcification within the capitate. Magnetic resonance imaging revealed a homogeneous signal that was low on T1-weighted images and high on T2-weighted images and showed only slight enhancement. On the basis of imaging findings, the authors chose excisional biopsy. The bone tumor in the capitate was explored through a dorsal approach by dividing the extensor tendons. After repeated curettages, bone graft substitute using allograft bone was packed into the capitate. Histologically, the authors diagnosed this tumor as a chondroblastoma with a secondary aneurysmal bone cyst. At the final 2-year follow-up, there was evidence of bone union, full range of motion, and recovery and no evidence of recurrence. Although the recurrence of chondroblastoma is occasionally reported, the principal treatment is intralesional curettage and bone graft. High-speed burring, phenol, bone cement, and cryosurgery have been reported to reduce local recurrence. Complete excision of the carpal bone seems to be overtreatment., (Copyright 2014, SLACK Incorporated.)

A 90-year-old woman presented with headache and diplopia, and a mass in the nasal cavity and paranasal sinuses was found on CT scan. The patient underwent examination under anaesthesia showing a mass arising from the ethmoid, apparently from the nasal septum. Biopsies taken showed an aneurysmal bone cyst. The patient opted against surgery and has been managed conservatively. A second CT scan 4 years later showed significant increase in size.

Alongside histomorphology and immunohistochemistry, molecular pathology is now established as one of the cornerstones in the tissue diagnosis of bone tumours. We describe the principal molecular pathological techniques employed, and each of the bone tumour entities where their identified characteristic molecular pathological changes can be detected to support and confirm the suspected histological diagnosis. Tumours discussed include fibrous dysplasia, classical and subtype osteosarcomas, central and surface cartilaginous tumours, Ewing's sarcoma, vascular tumours, aneurysmal bone cyst, chordoma, myoepithelioma, and angiomatoid fibrous histiocytoma. This is a rapidly evolving field with discoveries occurring every few months, and some of the newer entities (the Ewing's-like sarcomas), which are principally identified by their molecular pathology characteristics, are discussed., (© 2013 John Wiley & Sons Ltd.)

Cystic spinal lesions with characteristic patterns, such as the presence of haematic fluid-fluid levels (H-FFL), have been associated with many tumoral lineages, more frequently with aneurysmal bone cyst (ABC) and exceptionally with metastasis. We present the case of a 60-year-old man with the finding of a sacral cystic bone lesion with H-FFL, with initial suspicion of ABC and confirmed diagnosis of metastasis. The case presented is, to our knowledge, the second case published of spinal cystic bone metastasis with H-FFL pattern with unknown primary tumour at the time of diagnosis and the only one that received resective surgical treatment, achieving pulmonary and metastatic disease control with good quality of life after 1 year of follow up., (Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.)

Primary aneurysmal bone cyst (ABC) in the hands is rare. It occurs more commonly in metacarpal bones and involvement of carpal bones is very uncommon. We report the third case of ABC in the capitate, its clinical presentation, imaging findings and treatment.

Aneurysmal bone cyst of the foot is extremely rare and the involvement of medial cuneiform has never been reported in the literature. In this report, we describe a 15-year-old boy who presented with a 6-month history of pain and swelling in his left foot. Radiograph demonstrated a lytic lesion in the medial cuneiform extending on to the middle cuneiform, the navicular bone and the base of the first metatarsal. En bloc resection of the lesion was performed using a dorsal longitudinal incision along the first ray. Tricortical iliac crest graft was harvested and shaped to fill the defect. Two drill holes were made and the tibialis anterior tendon was attached to the graft. Prepared, morcellised allograft was placed along the junction of autograft and host bone. At 1-year follow-up, the patient was pain free, the medial arch of the foot was maintained and the graft had united with the host bone.

Introduction: Spinal bone metastases may be lytic or sclerotic lesions. Sometimes aneurismal bone cyst (ABC)-like areas (also called "secondary ABC") can be found in giant-cell tumors, osteoblastomas and chondroblastomas but are rare in metastatic tumors., Case Report: A retrospective study on 518 patients surgically treated for metastatic lesions of the spine from 1995 to 2012 was performed to evaluate the radiographic presentation. We propose a case report of a metastatic lesion associated with imaging features suggestive of aneurismal bone cyst. The patient was treated by intralesional surgery, after embolization of the lesion., Conclusions: Fluid-fluid levels detected on imaging can be found in bone metastases and may be similar to a primary aneurismal bone cyst. Embolization of metastastic tumor was useful to help the surgeon.

Diagnostic problems attending intraosseous and parosteal pseudoneoplastic lesions can be radiographic, or histological, or both. Proliferations in this category may contain cellular fibro-osseous or chondro-osseous tissues that are difficult to separate microscopically from those seen in various true neoplasms of the bones. This review considers the clinicopathologic features of fibrous dysplasia, benign fibro-osseous lesions of the jawbones, osteofibrous dysplasia, metaphyseal fibrous defect, giant-cell reparative granuloma, "brown tumor" of hyperparathyroidism, synovial chondrometaplasia, aneurysmal bone cyst, tumefactive chronic osteomyelitis, proliferative Paget disease, and polyvinylpyrrolidone storage disease of bone., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Epithelioid and epithelial neoplasms of bone are rare. They include different epithelioid variants of vascular lesions, osteoblastoma, chondroblastoma and most importantly metastatic carcinoma. Up to now, only few cases of epithelioid osteosarcoma were described. In this case the authors report a 53-year-old patient presented with a medical history of chronic shoulder pain for 3 years. Magnetic resonance imaging (MRI and computed tomography (CT) showed a destructive, partially calcified osseous lesion of the scapula with expansion into the surrounding soft tissue, suggestive of a primary bone tumor. Histologically, the tumor consisted of epithelioid cells with expression of cytokeratine and the lesion was primarily diagnosed as metastatic carcinoma. With regard to the MRI morphology untypical for metastatic disease the histopathologic slides were re-evaluated and detection of tumor osteoid led to the diagnosis of epithelioid osteosarcoma. Chemotherapy was initiated, however follow-up imaging studies showed rapidly progressive disease of both primary tumor and lung metastases. In conclusion, epithelioid neoplasms of the bone are extremetumourly rare and must be distinguished from metastatic carcinoma. Despite the presence of cytokeratine positive cells a thorough histological evaluation is mandatory and osteoid detection is essential in order to establish the correct diagnosis and further treatment. Key words: osteosarcoma, epithelioid, aneurysmal bone cyst, chondrosarcoma, pathology, immunohistochemistry.

Chondroblastoma of the patella is rare. Aneurysmal bone cysts, which develop from a prior lesion such as a chondroblastoma, are seldom seen in the patella. The authors report a case of a 36-year-old man who presented with 2 years of right knee pain without calor, erythema, pain on palpation, or abnormal range of motion. Radiological studies suggested aneurysmal bone cyst. The lesion was excised with curettage and the residual cavity filled with autogenous bone graft. Histopathology revealed chondroblastoma associated with a secondary aneurysmal bone cyst. In the follow-up period, the patient demonstrated normal joint activities with no pain. Normal configuration of the patella and bone union were shown on plain radiographs. The authors present a review of the literature of all cases of patellar chondroblastoma with aneurysmal bone cyst. This case is the 14th report of aneurysmal bone cyst arising in a chondroblastoma of the patella. According to the literature, computed tomography and magnetic resonance imaging are useful in the study of these lesions. The pathologic diagnosis is based on the presence of chondroblastoma and aneurysmal bone cyst. Treatment of this lesion includes patellectomy, curettage alone, and curettage with bone grafting. Despite the risk of recurrence of this lesion in the patella, the authors first recommend curettage followed by filling the cavity with bone graft. To protect the anterior tension of the patella intraoperatively, the bone window should be made at the medial edge of the patella to perform the curettage and bone grafting.

The authors describe a case of giant cell tumor (GCT) with secondary aneurysmal bone cyst (ABC) in a 44-year-old man with chronic, intermittent knee pain. A unique feature is the presentation of GCT with an ossified extraosseous soft tissue mass. Radiograph demonstrates a multiloculated lytic lesion in the distal meta-epiphyseal region of the femur with an adjacent extraosseous soft tissue mass. The soft tissue mass was partially ossified along its margin and internal septa. MRI demonstrates a multiloculated lesion in the distal femur with multiple fluid-fluid levels and cortical penetration of the lesion. Both the intraosseous lesion and extraosseous soft tissue mass have similar MR signal characteristics. At surgery, the intraosseous component was found to be contiguous with the extraosseous soft tissue mass through a cortical perforation. To the best of our knowledge, this is the first case report of GCT with aneurysmal bone cyst initially presenting with an extraosseous soft tissue mass.

Aneurysmal cysts of bone are rare non-neoplastic, locally aggressive lesion of bone with propensity for rapid growth, affecting mainly the long bones and spine. It rarely occurs in the head and neck region and within the head and neck mandible (especially the molar areas) is common. Aneurysmal cyst of bone involving the maxilla in the first decade of life is even rarer. We report a case of giant aneurysmal bone cyst of maxilla in eight-year-old male with ectopic molar tooth within the cyst. Is endoscopic excision possible? Endoscopic excision of the cyst was done successfully and no recurrence was noted even after 1 year of follow up., (Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

We present a case report of a 33-year-old woman with back pain for several months which was resistant to medical treatment. Thoracolumbar MRI and multidetector CT showed an aneurysmal bone cyst intersecting the body and pedicles of L5. Minimally invasive treatment was performed with percutaneous injection of osteoconductive cement (Cerament) to induce sclerosis and bone remodeling of the bone cyst lesion with an analgesic effect. Before treatment, spinal angiography was performed to exclude arterial afferents. No bone biopsy was done. Under general anesthesia and fluoroscopic guidance, a first vertebroplasty was performed by a bilateral transpedicular approach using the osteoconductive cement followed 2 months later by a second treatment with CT-fluoro-guided direct injection of Cerament. No complications occurred during the procedure. At 4 and 6 months follow-up the MRI/CT showed sclerotic bone remodeling of the walls of the aneurysmal cyst with clinical improvement.

Aneurysmal bone cysts (ABC) are benign neoplasms frequently occurring in the long tubular bones. It is very rare in temporal bone. We report a case of ABC of the left temporal bone in an 8-year-old Asian boy who presented clinically with swelling over the left temporal region for 5 months. CT and MRI features were suggestive of ABC. Surgical resection was performed and on follow-up the patient was doing well. CT and MRI are the imaging modalities for proper evaluation of ABC, aiding to diagnosis and helpful in treatment planning.

We describe a case of an aneurysmal bone cyst originating from the zygomatic arch, which, according to the literature, is an extremely rare location. In the preoperative diagnosis the characteristic radiological signs of the high-quality computed tomography and magnetic resonance examinations were the cornerstones. Treatment was successful total excision. Careful diagnostic workup and multidisciplinary approach (head and neck surgeon, radiologist, and pathologist) should be utilized to successfully diagnose and to treat this rare pathology., (© 2013.)

Objective: To emphasize the importance of early detection, recognition, appropriate investigation, accurate diagnosis, proper referral, and treatment of an aneurysmal bone cyst (ABC) presenting as chronic low back pain (LBP) in a chiropractic office., Clinical Features: A 21-year-old female student presented to the chiropractic office with a 2-year history of severe and progressive LBP. The patient described the LBP as an aching type of pain that was more pronounced during activity and exercises. She also reported weight loss and increased fatigue., Intervention and Outcome: A detailed clinical, physical, and imaging evaluation was performed. A well-defined, expansile, and lytic bone lesion with the appearance of a possible ABC was detected; it involved the left inferior half and posterolateral aspect of the vertebral body of L3., Results: Treatment consisted of an L3 hemivertebrectomy resection en bloc and a vertebral fusion from L2 to L4 with tricortical iliac crest graft. After surgery and recovery, LBP was relieved and the bone lesion did not recur., Conclusion: Although uncommon, ABC is an important lesion that can affect the spine. Healthcare providers must be aware that the cause of LBP may extend beyond musculoskeletal dysfunction. It is important to identify an ABC and refer the patient for appropriate evaluation and care.

Background: Aneurysmal bone cyst (ABC) has a recurrence rate of between 12% and 71% without en bloc resection or amputation. There is no percutaneous ABC treatment drug regimen demonstrating consistent evidence of bone healing with recurrence of < 12%. Doxycycline has properties that may make it appropriate for percutaneous treatment., Questions/purposes: We therefore asked: (1) Is there reduction in ABC lytic cyst volume with injectable doxycycline? (2) Is it associated with thickening of involved bony cortex? (3) Is the recurrence rate after percutaneous treatment < 12%?, Methods: We retrospectively reviewed 20 patients who underwent percutaneous treatment of ABCs with doxycycline from 2006 to 2010. The mean age was 10 years (range, 3-18 years). There were 21 treatment locations: humerus (six), spine (five), clavicle (two), fibula (one), femur (two), ulna (two), tibia (two), and scapula (one). Twenty patients completed treatment involving 118 treatment sessions (two to 14 sessions per patient). Treatment response was evaluated radiographically by measuring the lytic component and thickness of involved cortex. Recurrence was indicated by new areas of lytic destruction after completion of treatment. The minimum followup was 24 months (mean, 38 months)., Results: Twenty of 20 patients demonstrated reduction in lytic destruction and bony healing. All patients demonstrated cortical thickening. One patient demonstrated recurrent minimal lytic destruction after 20 months of observation., Conclusions: In this series, patients undergoing percutaneous doxycycline treatment of ABCs demonstrated a healing response and a recurrence rate of 5% at more than 24 months.

Giant cell tumors of the jaw (GCTJ) are common in the long bones but rare in the craniofacial region, with only 1% of cases occurring in the latter; they account for approximately 3% to 5% of all primary bone tumors and 15% to 20% of all benign bone tumors. The biologic behavior of central giant cell lesions of the jaws ranges from quiescent to aggressive with destructive expansion, and the clinical behavior of GCTJ of the jaws is variable and difficult to predict. A number of tumors that occur in the jaws contain giant cells but are not true benign giant cell tumors. These include aneurysmal bone cyst, cherubism, simple bone cyst, osteoid osteoma, giant cell granuloma reparative, and tumor of hyperparathyroidism. This article reports a patient study of giant cell extended lesion in the left mandible from dental canine element to mandibular angle. The patient underwent excision of neoplasm and reconstruction of the mandible with an autologous bone graft of the iliac crest, but dentition was preserved over the resected area. No complications were detected, and 8 months postoperative control revealed excellent aesthetic and functional recuperation. This case is presented because of the following: (1) GCTJ is an infrequent tumor; (2) uncommon clinical presentation, severe deformity; (3) excessive size and jaw deformity; (4) fast growing; and (5) surgical treatment with preservation of the dentition in affected area.

A 16-year-old girl was admitted with insidious onset, gradually progressive spastic sensori-motor paraparesis, with a sensory level at D10 dermatome without bowel or bladder involvement for the last 2 months following trivial trauma on the lower back. MRI of the spine showed a low-to-intermediate signal intensity, heterogeneous mass with multiple fluid levels. A diagnosis of aneurysmal bone cyst was made. A D8-D9 laminectomy with near total excision of mass was performed. Histopathology of the mass showed cyst cavity filled with haemorrhage surrounded by bony trabeculae confirming the diagnosis. Following excision the patient had excellent recovery. We report this case owing to its rarity and to emphasise the importance of surgery if there is cord compression.

Aneurysmal bone cyst is a benign and locally destructive bone lesion usually seen in the younger population. Its etiology is unknown. Its yearly incidence rate has been reported to be 0.14/100,000, comprising 1% of all bone tumors. It may develop primarily or arise from primary bone tumors. Hemorrhagic fluid content with a septated appearance is the characteristic feature of aneurysmal bone cyst. It is most commonly seen in the metaphysis of the long bones. In rare cases, the cyst is located in the skull. Primary treatment is surgical excision, and the recurrence rate after treatment is 10 to 30%. Based on a review of the current literature, there have been no previous reports of aneurysmal bone cyst located in the middle turbinate. We report a case of aneurysmal bone cyst with an atypical location and discuss the treatment of the patient with endoscopic surgery in light of relevant literature.

Introduction: This study aimed to evaluate radiological findings in patients with chondroblastoma (CB) in tubular and non-tubular bones (NTBs)., Methods: We retrospectively reviewed the medical records of patients with CB. Data collected included patients' gender and age, type, size and location of bone involved, and imaging findings regarding border, lobulation, calcification, trabeculation, cortical expansion and destruction, periosteal reaction, soft tissue component and fractures. Magnetic resonance imaging and/or multidetector computed tomography were used to determine the presence of any internal cystic space or secondary aneurysmal bone cyst that may have affected the radiological appearance of CB., Results: All 31 lesions (18 tubular bones, 13 NTBs) exhibited geographic bone destruction and did not involve the adjacent joints. Univariate analysis showed that NTB lesions were found in older patients and were associated with thin trabeculation (p < 0.01) and well-defined margins (p < 0.05), whereas tubular bone lesions correlated with thick trabeculation and partially ill-defined margins. On multivariate analysis, age and type of bone involvement were significantly correlated. An increase in age by one year reduced the risk of having tubular bone involvement by about 27% when compared with NTBs (p = 0.011). Thin trabeculation was also significantly correlated with NTB lesions., Conclusion: Age was the most significant parameter, as increased age was found to reduce the risk of tubular bone involvement. Patients with NTB lesions were significantly older than those with tubular bone lesions. Based on imaging alone, thin trabeculation showed significant correlation with CB occurring in NTBs on both univariate and multivariate analyses.

Introduction: Despite numerous descriptive publications, the nature, character, differential diagnosis and optimal treatment of aneurysmal bone cysts (ABCs), remain obscure. The authors report a case of the solid variant of aneurysmal bone cyst (S-ABC) occurring in the posterior components and body of C7 vertebra focusing on the differential diagnosis and surgical treatment rationale., Case Report: Right shoulder and neck pain were the presenting symptoms of 9-year-old boy. Torticollis developed later on but no neurological deficit was found. Imaging revealed an osteolytic lesion with significant extraosseous extension. Although diagnosis favoured an ABC, imaging studies did not provide clear diagnostic criteria. CT guided biopsy performed preoperatively was also not directly diagnostic. Given that differential diagnoses included S-ABC but also giant cell tumor (GCT) of bone, decision was made to proceed with a staged, back and front, complete resection of the affected bony elements of C7. Preoperative spinal angiography showed supply to the tumor from the right ascending and deep cervical artery territories. Particle embolization was not performed due to the presence of ipsilateral supply to the anterior spinal artery at the C6 level and contralateral supply at the C7 level. Intraoperatively, histology taken from posterior elements, although again not clearly diagnostic, favoured S-ABC variant rather than GCT. Thus, initial plan was revised and anterior surgery was postponed as the extent of the dissection would have been dependent on the presumed diagnosis. The final histological report confirmed the diagnosis of an S-ABC. In view of this, it was decided to embolize the lesion to avoid a second stage anterior surgery. At embolization, repeat spinal angiography showed reduced tumor blush following the surgery. Distal branches of the deep cervical artery were occluded with platinum coils (avoiding the risks associated with the use of particles or liquid embolic agents). No further procedure was planned., Conclusion: Imaging and histological pattern of this specific type of ABC, differential diagnosis from GCT and the surgical protocol followed with the patient consist of an interesting case of revising the initial plan, according to the upcoming histological reports.

Background: Osteoblastomas and aneurysmal bone cysts each comprise 1% of primary bone tumours. As both osteoblastomas and aneurysmal bone cysts are not common, osteoblastomas with secondary aneurysmal bone cysts of calvaria are extremely rare. Only three cases describing a secondary aneurysmal bone cyst in the setting of a calvarial osteoblastoma can be found in the literature. We report the case of the surgical resection of the fronto-parietal osteoblastoma accompanying a secondary aneurysmal bone cyst., Case Description: The case is a 24-year-old male with a 2-year history of a painless lump in the hair-bearing region of the left fronto-parietal area without neurologic symptoms. Computed tomography showed an intradiploic tumour with maintained inner and outer cortex of the left front-parietal bones. 3.0-T magnetic resonance imaging showed a well-circumscribed, intradiploic, multilocular cystic tumour. A gadolinium-enhanced sequence showed strong peripheral and septal enhancement. These findings were consistent with an osteoblastoma associated with secondary aneurysmal bone cyst. An en bloc tumour resection with a 10-mm horizontal margin was completed without complications. The calvarial defect was covered by calvarial bone graft harvested from the contralateral fronto-parietal bone. The postoperative course was uneventful. Pathological diagnosis was consistent with the osteoblastoma with secondary aneurysmal bone cyst. After a follow-up period of 2 years, there was no evidence of recurrence., Conclusion: The combination of osteoblastoma and aneurysmal bone cyst of the calvaria is a rare clinical entity. Careful preoperative examination and complete resection of the tumour are essential., (Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Although primary malignancies of bone are rare, thousands of benign bone tumors are diagnosed annually. It is important to be able to distinguish benign lesions from malignant lesions and differentiate those lesions that can be watched versus lesions that require further treatment and referral to an orthopaedic oncologist. Learning to distinguish these entities and their appropriate treatment or triage will positively affect the patient and the surgeon's practice.

Aneurysmal bone cyst, commonly reported in the second and third decades of life, is characterized by a rapid growth pattern with resultant bony expansion and facial asymmetry. Interestingly, these lesions can occur in association with other primary bone pathologies, where they are referred to as "hybrid lesions" or "ABC-Plus." Their rarity, especially in the head and neck region, may pose a diagnostic challenge to clinicians. Following is a discussion of one such enigmatic lesion that includes description of a unique case of ABC-Plus that affected the right mandible of a young male.

Aneurysmal bone cyst is a benign tumor-like bony lesion with a propensity to develop in the pediatric population. It generally involves one vertebral level when localized to the spine. The degree of resection correlates highly with fewer recurrences. En bloc spondylectomy is the procedure of choice for this reason, but its high complication rate has led to the development of alternative surgical methods. This paper presents a three-level aneurysmal bone cyst that was excised totally in two stages, and the safety and efficacy of this method especially in the pediatric population are emphasized. This paper also states that anterior and posterior instrumented fusions are necessary in spite of the growing spine.

Aneurysmal bone cysts (ABCs) are vascular lesions with well-defined radiological signs. A fairly common MRI finding in both ABC and other primary bone tumors with high vascularity is the presence of cysts with fluid-fluid levels. Metastatic lesions with fluid-fluid leveling have not previously been defined in the literature. We report three cases of fluid-fluid leveling of the axial skeleton in metastatic lesions. Two patients had single-level and one multi-level neoplastic disease with distinctive cysts showing fluid-fluid levels on MRI evaluation. Diagnosis of gastric carcinoma in two patients and breast carcinoma in the third was achieved with trocar biopsies. At the time of this report all patients had completed initial oncologic treatments and were disease free.

Chondromyxoid fibroma (CMF) is a rare, benign cartilaginous tumor, comprising less than 1% of primary bone tumors, and usually occurs in the metaphysis of a long tubular bone around the knee. We report a rare case of CMF of the rib. The patient was a 25-year-old man who visited the hospital for left upper back pain. Roentgenography revealed an 8-cm mass in the left upper lung field; computed tomography revealed a large multicystic tumor with aneurysmal bone cyst (ABC)-like features in the posterior mediastinum. ABCs are also a rare benign tumor representing 2.5% of primary bone tumors, and most of ABCs are located in the metaphysis of long bones and vertebrae. To the best of my knowledge, there is no report of CMF with secondary ABC of the rib. We performed total resection of the tumor. Complete tumor resection may be the best treatment option for a cure.

A 38-year-old man presented with pain in the left shoulder following a fall. A rotator cuff tear was suspected but roentgenograms revealed a lytic, expanded, multiseptate lesion of the scapula adjacent to glenoid. This was compatible with a giant cell tumor, aneurysmal bone cyst or simple bone cyst. The MRI showed rim enhancement and clinched the diagnosis of simple bone cyst. An infraspinous approach to scapula was undertaken and open biopsy confirmed the diagnosis of simple bone cyst. Definitive treatment in the form of curettage and calcium phosphate cementation was carried out. The postoperative period was uneventful. Early mobilization was started. Patient remained well on follow-up and has returned to work in a physically demanding capacity.

An aneurysmal bone cyst (ABC) in the right mandibular condyle and ramus of a 37-year-old woman was surgically resected and immediately reconstructed with a costochondral graft. She was followed up for 5 years. A review of the 10 cases of condylar-ABC available in the literature revealed mean age of 16.8 (± 7.6) years, with equal distribution between men and women. In all cases symptoms included swelling and asymmetry, while temporomandibular disorder/dysfunction symptoms were reported in 50%. Parasthesia was not reported, except for self-limited postoperative neuropathy. Curettage or resection was employed equally and recurrence rates were 60% after curettage, 20% after resection; which are higher than reported in non-condylar-ABC's. All recurrences occurred within 12 months. Thus close post-operative follow up, for at least 12 months, is warranted., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)