Aneurysmal Bone Cyst – Review
Original Article | Volume 6 | Issue 1 | JBST Jan-April 2020 | Page 17-20| DOI: 10.13107/jbst.2020.v06i01.009
Author: Nitin Shetty[1], Prateek Hegde[2], Hemant Singh[3], Ashish Gulia[4]
[1]Department of Radio-Diagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
[2]Department of Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India.
Address of Correspondence
Dr. Ashish Gulia
Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai – 400 012, India.
E- mail: aashishgulia@gmail.com
Abstract
Background: Aneurysmal bone cyst (ABC) is a rare, benign, expansile lesion that produces blood-filled cavities inside the bone. The term, ‘Aneurysmal bone cyst’ was first time used by Jaffe and Lichtenstein in 1942 [1]. The name is a misnomer, as they are neither aneurysmal nor are, they truly cystic, as these lesions do not have an endothelial lined cyst wall. ABC is a disease of childhood or young adulthood with a median age of 13 years, with an incidence of 0.14 per 105 individuals with slight female preponderance [2].
Pathophysiology: ABC usually present as a solitary lesion either as a primary neoplasm (translocation driven) or a secondary lesion arising adjacent to previous bony lesions like giant cell tumours (GCT), osteoblastomas, chondroblastomas [3]. Few authors have proposed post traumatic hypothesis whereas others feel it could due to an hemodynamic disturbance especially venous impedance.
Primary ABCs: Primary ABC is one where it occurs in a bone without any previously known lesion. But now there has been identification of TRE17 also known as USP6 (ubiquitin-specific protease 6) gene on chromosome 17p13.Pathogenesis of some primary ABC involves transcriptional up-regulation of USP6 when there is the chromosomal translocation t(16;17)(q22;p13) which fuses the promoter region of the osteoblast cadherin 11 gene (CDH11) on chromosome 16q22 to the entire coding sequence of the ubiquitin protease USP6 gene on chromosome 17p13 [4].
Secondary ABCs: Approximately one third of the ABCs appear secondary to other pre-existing bone tumours, most commonly from GCT, which accounts for 19-39% of these cases [5]. Other common precursor lesions are chondroblastomas, chondromyxoid fibroma, fibrous dysplasia, osteoblastomas, haemangioendothelioma, angioma, fibroxanthoma (nonossifying fibroma), solitary bone cyst, fibrous histiocytoma, eosinophilic granuloma, radiation osteitis, osteosarcoma, trauma (including fracture), fibrosarcoma and even metastatic carcinoma [3, 5].
ABCs have been likened to a “blood-filled sponge”, composed of blood-filled, anastomosing, cavernomatous spaces, separated by a cyst like wall composed of fibroblasts, myofibroblasts, osteoclast like giant cells, osteoid and woven bone.
In approximately one third of cases, a characteristic reticulated lacy chondroid like material, described as a calcified matrix with a chondroid aura, is seen [6]. These are called as “solid aneurysmal bone cyst”. The term “solid aneurysmal bone cyst,” was coined by Sanerkin et al. in 1983 [7].
References
1. Jaffe HL, Lichtenstein L. Solitary Unicameral Bone Cyst: with emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg. 1942;44(6):1004–1025.
2. Leithner A, Windhager R, Lang S, Haas O, Kainberger F, Kotz R. Aneurysmal bone cyst. A population based epidemiologic study and literature review. Clin Orthop 1999; 363:176–179.
3. Bonakdarpour A, Levy WM, Aegerter E. Primary and secondary aneurysmal bone cyst: A radiological study of 75 cases. Radiology. 1978;126(1):75–83.
4. Oliveira AM, Hsi BL, Weremowicz S, Rosenberg AE, Dal Cin P, Joseph N, et al. USP6 (Tre2) fusion oncogenes in aneurysmal bone cyst. Cancer Res. 2004;64:1920–1923.
5. Kransdorf M J and Sweet D E.Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging. American Journal of Roentgenology. 1995;164:573-580.
6. Mirra JM. Bonetumors: clinical, radiological and pathologic correlations. Philadelphia: Lea & Fefiger; 1989:1233–1334.
7. Sanerkin NG, Mott MG, Roylance J. An unusual intraosseous lesion with fibroblastic, osteoblastic, aneurysmal and fibromyxoid elements: “solid” variant of aneurysmal bone cyst. Cancer. 1983;51:2278 –2286.
8. Capanna R, Bettelli G, Biagini R, Ruggieri P, Bertoni F, Campanacci M. Aneurysmal cysts of long bones. Ital J Orthop Traumatol. 1985;11:409–417.
9. Dabska M, Buraczewski J. Aneurysmal bone cyst: Pathology, clinical course and radiologic appearances. Cancer. 1969;23(2):371-389.
10. Mahnken AH, Nolte-Ernsting CC, Wildberger JE, Heussen N, Adam G, Wirtz DC, et al. Aneurysmal bone cyst: Value of MR imaging and conventional radiography. Eur Radiol. 2003;13(5):1118-1124.
11. Rapp TB, Ward JP, Alaia MJ. Aneurysmal bone cyst. J Am Acad Orthop Surg. 2012;20(4):233–241.
12. Kumar V, Abbas AK, Aster JC. Robbins and Cotran pathologic basis of disease. Philadelphia: Elsevier Saunders; 2015.
13. Murphey MD, wan Jaovisidha S, Temple HT, Gannon FH, Jelinek JS, Malawer MM. Telangiectatic osteosarcoma: radiologic-pathologic comparison. Radiology.2003;229(2):545–553.
14. Wallace MT, Henshaw RM. Results of cement versus bone graft reconstruction after intralesional curettage of bone tumors in the skeletally immature patient. J Pediatr Orthop. 2014;34(1):92–100.
15. Reddy KIA, Sinnaeve F, Gaston CL, Grimer RJ, Carter SR.Aneurysmal bone cysts: do simple treatments work? Clin OrthopRelat Res. 2014;472(6):1901–1910.
16. Steffner RJ, Liao C, Stacy G, Atanda A, Attar S, Avedian R, et al. Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? J Bone Joint Surg Am. 2011;93(21):1221–1229.
17. Park HY, Yang SK, Sheppard WL, Hegde V, Zoller SD, Nelson SD, et al. Current management of aneurysmal bone cysts. Curr Rev Musculoskelet Med. 2016;9(4):435-444.
18. Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK. Aneurysmal bonecyst. A clinicopathologic study of 238 cases. Cancer. 1992;69:2921–2931.
19. Flont P, Kolacinska-Flont M, Niedzielski K. A comparison of cyst wall curettage and en bloc excision in the treatment of aneurysmal bone cysts. World J Surg Oncol.2013;11:109.
20. Elsayad K, Kriz J, Seegenschmiedt H, Imhoff D, Heyd R, Eich HT, et al.Radiotherapy for aneurysmal bone cysts: a rare indication. Strahlenther Onkol.2017;193(4):332-340.
21. Batisse F, Schmitt A, Vendeuvre T, Herbreteau D, Bonnard C. Aneurysmal bone cyst: A 19-case series managed by percutaneous sclerotherapy. Orthop Traumatol Surg Res.2016;102(2):213-216.
22. Varshney MK, Rastogi S, KhanSA, Trikha V. Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts? Clin Orthop Relat Res. 2010;468(6):1649-1659.
23. Falappa P, Fassari FM, Fanelli A, Genovese E, Ascani E, Crostelli M, et al. Aneurysmal bone cysts: treatment with direct percutaneous Ethibloc injection: long-term results. Cardiovasc Intervent Radiol.2002;25(4):282–290.
24. Rastogi S, Varshney MK, Trikha V, Khan SA, Choudhury B, Safaya R. Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol. A review of 72 cases with long-term follow-up.J Bone Joint Surg Br. 2006;88(9):1212–1216.
25. Puri A, Hegde P, Gulia A, Mishil P. (in press). Primary aneurysmal bone cysts – Is percutaneous sclerosant therapy effective? The Bone & Joint Journal.
26. Gupta P, Gamanagatti S. Preoperative transarterial Embolisation in bone tumors. World J Radiol.2012;4(5):186-192.
27. Lange T, Stehling C, Fröhlich B, Klingenhöfer M, Kunkel P, Schneppenheim R, et al. Denosumab: a potential new and innovative treatment option for aneurysmal bone cysts. Eur Spine J.2013;22(6):1417–1422.
28. Brastianos P, Gokaslan Z, McCarthy EF. Aneurysmal bone cysts of the sacrum: a report of ten cases and review of the literature. Iowa Orthop J.2009;29:74–78.
29. Papagelopoulos PJ, Choudhury SN, Frassica FJ, Bond JR, Unni KK, Sim FH. Treatment of aneurysmal bone cysts of the pelvis and sacrum. J Bone Joint Surg Am.2001;83(11):1674–1681.
30. Terzi S, Gasbarrini A, Fuiano M, Barbanti Brodano G, Ghermandi R, Bandiera S, et al. Efficacy and safety of selective arterial embolization in the treatment of aneurysmal bone cyst of the mobile spine: A retrospective observational study. Spine (Phila Pa 1976).2017;42(15):1130-1138.
31. Rossi G, Rimondi E, Batalena T, Gerardi A, Alberghini M, Staals EL,et al. Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate. Skeletal Radiol.2010;39(2):161–167.
32. Amendola L, Simonetti L, Simoes CE, Bandiera S, De Iure F, Boriani S. Aneurysmal bone cyst of the mobile spine: the therapeutic role of embolization. Eur Spine J. 2013; 22(3):533-541.
33. Donati D, Frisoni T, Dozza B, DeGroot H, Albisinni U, Giannini S. Advance in the treatment of aneurysmal bone cyst of the sacrum. Skeletal Radiol.2011;40(11):1461-1466.
34. Elsayad K, Kriz J, Seegenschmiedt H, Imhoff D, Heyd R, Eich HT, et al.Radiotherapy for aneurysmal bone cysts: a rare indication. Strahlenther Onkol.2017;193(4):332-340.
35. Duivenvoorden WC, Hirte HW, Singh G. Use of tetracycline as an inhibitor of matrix metalloproteinase activity secreted by human bone-metastasizing cancer cells. Invasion Metastasis. 1997;17(6):312–322.
36. Neville-Webbe HL, Holen I, Coleman RE. The anti-tumour activity of bisphosphonates. Cancer Treat Rev.2002;28(6):305–319.
37. Yamagishi T, Kawashima H, Ogose A, Ariizumi T, Sasaki T, Hatano H, et al. Receptor-Activator of Nuclear KappaB Ligand Expression as a New Therapeutic Target in Primary Bone Tumors. PLoS One.2016;11(5):e0154680.
| How to Cite this article: Shetty N, Hegde P, Singh H, Gulia A. Aneurysmal Bone Cyst – Review. Journal of Bone and Soft Tissue Tumors January-April 2020;6(1): 17-20. |
