Aneurysmal Bone Cyst

aneurysmal bone cysts.
aneurysmal bone cyst is benign expansile vascular lesion,
it is blood-filled, fibrous cysts that expand the bone.
Even though they are not cancerous,
typically appearing within the first 20 years of life.
primary aneurysmal bone cyst.
or be a secondary reaction to another bony growth elsewhere in the body
(specifically chondroblastoma and giant cell tumors).
This is called a secondary aneurysmal bone cyst.
Symptoms:
Patients can experience pain and swelling in a bone or joint.
Often, pain starts without any injury or trauma.
Pain or swelling may gradually develop and can get worse over time.
Patients might have stiffness or decreased range of motion in the arm, leg, hand, or foot.
Sometimes, a broken bone is the first sign .
If the cyst is in the spine, patients may experience back or neck pain,
nerve pain spreading into the hands or feet.
cysts that cross the growth plate may cause growth arrest .
diagnosis:
the doctor will ask about child's general health and medical history and ask about symptoms.
he will perform a physical exam and assessing the lump and the area around it.
the doctor will likely order X-rays to look at the underlying bone.
On radiographs, aneurysmal bone cysts appear as aggressive, expansile, lytic metaphyseal lesions
with an "eggshell" sclerotic rim.
The cortex is usually intact, although it may be thin.
Pathologic fracture or periosteal reaction may be present.
The lesions are sharply circumscribed.
They may have a "soap bubble" appearance.
After reviewing the X-rays, the doctor may order magnetic resonance imaging (MRI) scan.
the classic appearance of an aneurysmal bone cyst on MRI shows fluid-filled cavities with a fluid level
may be identified with multiple septations.
the aneurysmal bone cyst is considered as "don't touch" lesion.
As the name suggests,
"don't touch" lesions do not require the use of biopsy or other invasive procedures to diagnose.
Treatment:
nonoperative management is indicated for aneurysmal bone cyst with acute fracture until fracture has healed.
Once healed,
cyst is treated as a cyst without fracture
unless the fracture has led to spontaneous healing of the cyst.
Surgery is the mainstay of treatment for symptomatic aneurysmal bone cyst without acute fracture,
surgical options include:
curettage, and bone grafting .
The surgeon uses tools to scrape the tumor out of the bone.
The goal is to remove as much of the tumor as possible without damaging the healthy bone or the growth plate.
Preoperative embolization of the aneurysmal bone cyst may be performed to reduce the risk of excessive bleeding during surgery.
To clean out the tumor cavity and destroy any remaining tumor cells and to help reduce the chance of the tumor returning,
the surgeon may use an argon beam coagulation to burn the tumor bed ,
or hydrogen peroxide, phenol or cryotherapy with liquid nitrogen.
After the tumor is removed, the surgeon will fill the empty hole in the bone with a bone graft.
Sometimes, the surgeon needs to support the bone with plates and screws or other hardware.
Wide Resection.
Surgery with a wide resection, or en bloc resection, involves removing a large segment of bone where the cyst is located.
Surgery with a wide resection is usually reserved for aneurysmal bone cyst that have caused severe bone destruction
or have recurred multiple times.
Surgery with a wide resection usually requires the bone to be reconstructed
or rebuilt with a large piece of donor bone
or joint replacement.
Sclerotherapy or Radiotherapy:
Sclerotherapy and radiotherapy are saved for large, difficult-to-access tumors
that would be challenging to remove safely during surgery.
The Sclerotherapy involves directly injecting a solution into the tumor or blood vessels near the tumor.
The solution coagulates blood and promotes the creation of scar tissue that eventually heals and hardens into bone.
Medical treatment with denosumab can reduce tumor size and tumor-related pain in areas that are difficult to treat surgically,
(such as cysts in the spine or pelvis) .
Recovery and Surveillance:
Recovery time after surgery can vary based on the size and location of the cyst.
It can take several months for the bone to heal.
(usually 3 to 6 months).
Unfortunately, the bone tumor can come back.
aneurysmal bone cysts recur approximately 25% of the time.
(This means the tumor grows back in 1 out of 4 patients).
It is, therefore, important for you or your child to follow up with the surgeon as scheduled
to check for appropriate healing and recovery.
After the bone heals, surgeons frequently start surveillance.
The surgeon might monitor the aneurysmal bone cyst with X-rays every 3 to 6 months
to make sure the tumor does not grow back.
surveillance may continue for 2 years or until the patient reaches skeletal maturity
when the bone is finished growing.
In most cases, an aneurysmal bone cyst tumor will not recur more than two years after surgery.

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