From the Research
An aneurysmal bone cyst is a benign, but locally aggressive, lesion that predominantly affects children and young adults, characterized by a lytic and expansile appearance with fluid-fluid levels on imaging, and is now recognized as a true neoplasm in approximately 70% of cases. The diagnosis of aneurysmal bone cysts typically involves radiographs and magnetic resonance imaging (MRI) to demonstrate characteristic fluid-fluid levels, extent, and margins 1. The treatment options for aneurysmal bone cysts range from curettage with or without adjuncts, such as phenol, liquid nitrogen, argon laser, and bone grafting or bone substitutes, to more recently employed alternatives, including image-guided sclerotherapy with various sclerosing agents and monoclonal antibodies (e.g., Denosumab) 1. Some key points to consider in the management of aneurysmal bone cysts include:
- The importance of biopsy to confirm the diagnosis and rule out other conditions, such as unicameral bone cyst and telangiectatic osteosarcoma 1
- The use of MRI-guided percutaneous cryoablation as a treatment option for residual or recurring lesions 2
- The potential for aneurysmal bone cysts to be locally aggressive, causing bone destruction, pain, swelling, and sometimes pathological fractures
- The exact cause of aneurysmal bone cysts remains unclear, but many cases arise secondary to other bone lesions or following trauma, suggesting a vascular response to pre-existing conditions rather than a primary bone tumor 1. The mainstay of treatment is surgery, with most patients being cured with one or more operations, and a small subset of patients with incompletely resectable, aggressive, and/or recurrent aneurysmal bone cysts may be cured with low-dose radiotherapy 3.