Management of Intraosseous Lipoma and Simple Bone Cyst
Asymptomatic Lesions: Observation Only
For both asymptomatic intraosseous lipomas and simple (unicameral) bone cysts that are definitively benign on radiographs, no further imaging or intervention is required—observation alone is appropriate. 1, 2
Initial Approach for Asymptomatic Lesions
No additional imaging is needed when radiographs clearly demonstrate benign characteristics 1, 2
Document the finding in the medical record to prevent unnecessary future workup 2
Verify complete absence of symptoms: no pain, no functional limitation, no history of trauma to the area 2, 3
Special Consideration for Aneurysmal Bone Cysts
While not the primary focus, if dealing with an asymptomatic aneurysmal bone cyst (ABC), the American College of Radiology recommends surveillance imaging with baseline radiographs and follow-up at 3-6 month intervals initially, extending to annual imaging if stable after 1-2 years 4
Symptomatic Lesions: Surgical Intervention
When either lesion becomes symptomatic with pain, surgical curettage with bone grafting is the treatment of choice. 3, 5
Indications for Surgical Treatment
Extensive or persistent pain that interferes with function 3, 6
Risk of pathological fracture based on:
Surgical Technique Options
Open curettage with bone grafting (autologous or allogenic) is the standard approach 3, 5, 6
Minimally invasive endoscopic ossoscopy with curettage and allogenic bone chip grafting is an effective alternative for calcaneal lesions, offering reduced surgical risks and faster recovery 7, 5
- This technique showed good to excellent functional outcomes (AOFAS scores 74-100) with all lesions healing radiographically 5
When Symptoms Develop: Imaging Before Surgery
If a previously asymptomatic lesion becomes symptomatic, obtain MRI without and with IV contrast to identify complications such as 1, 2:
- Stress fracture
- Secondary aneurysmal bone cyst formation
- Malignant transformation (rare)
Alternatively, CT without IV contrast may be useful for identifying complications, determining fracture risk, or surgical planning 1, 2
Key Clinical Pitfalls to Avoid
Do not pursue aggressive workup for radiographically benign lesions in asymptomatic patients—this represents overtreatment and unnecessary cost 1, 2
Do not assume all calcaneal lucent lesions are lipomas—histology frequently reveals simple bone cysts even when radiologists diagnose intraosseous lipoma 6
Counsel patients to report new pain immediately, as this may indicate lesion expansion or impending fracture requiring intervention 4
Asymptomatic calcaneal cysts rarely cause pathological fractures and should be managed non-operatively 6