整形外科腫瘍学ジャーナル

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Symptoms and Treatment of Aneurysmal Bone Cyst

Dr. Ajeet Yadav

Aneurysmal bone cysts are benign tumors with potential for aggressive behaviour and capacity to metastasize. Although rarely lethal, benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations. Its histogenesis remains unclear. It is characterized by a proliferation of mononuclear stromal cells and the presence of many multi- nucleated giant cells with homogenous distribution.

Aneurysmal bone cysts of bone is generally a benign tumor composed of mononuclear stromal cells and characteristic multinucleated giant cells that exhibit osteoclastic activity. It usually develops in long bones but can occur in unusual locations. The typical appearance is a lytic lesion with a well-defined but nonsclerotic margin that is eccentric in location, extends near the articular surface, and occurs in patients with closed physes. However, GCT may have aggressive features, including cortical expansion or destruction with a soft-tissue component. Fluid-fluid levels, consistent with secondary formation of aneurysmal bone cysts, are seen in 14% of cases. GCT can mimic or be mimicked by other benign or malignant lesions at both radiologic evaluation and histologic analysis.

There are advocates of varying surgical techniques ranging from intra-lesional curettage to wide resection. As most aneurysmal bone cysts are benign and are located near a joint in young adults, several authors favor an intralesional approach that preserves anatomy of bone in lieu of resection. Although GCT is classified as a benign lesion, few patients develop progressive lung metastases with poor outcomes. Treatment is mainly surgical. Options of chemotherapy and radiotherapy are reserved for selected cases.