Introduction A benign and non-neoplastic reactive bone lesion filled with multiple blood-filled cavities can be locally destructive to normal bone and may extend to soft tissue Epidemiology demographics 75% of patients are < 20 yrs. location 25% in spine 20% in long bones (distal femur, proximal tibia) usually in metaphysis posterior elements of pelvis may be found in similar location as telangiectatic osteosarcomas Pathophysiology primary and secondary forms primary ABC: now known to be neoplasms driven by upregulation of the ubiquitin-specific protease USP6 (Tre2) gene on 17p13 when combined by translocation with a promoter pairing most commonly described translocation t(16;17)(q22;p13) leading to juxtaposition of promoter region CDH11 on 16q22 secondary ABC: not considered a neoplasm because no known translocation has been identified Associated conditions associated with other tumors 30% of time giant cell tumor chondroblastoma fibrous dysplasia chondromyxoid fibroma NOF Prognosis good Presentation Symptoms pain and swelling may present with pathologic fracture Physical exam neurologic deficits possible with spine lesions Imaging Radiographs expansile, eccentric and lytic lesion with bony septae ("bubbly appearance") usually in metaphyseal classic cases have thin rim of periosteal new bone surrounding lesion no matrix mineralization MRI or CT scan will show multiple fluid lines lesion can expand into soft tissue Studies Histology Characteristic findings cavernous space blood-filled spaces without endothelial lining cavity lining numerous benign giant cells spindle cells thin strands of woven (new) bone present Differential Radiographic differential includes UBC telangiectatic osteosarcoma Histologic differential includes telangiectatic osteosarcoma giant cell tumor Treatment Nonoperative nonoperative fracture management indications ABC with acute fracture indicated until fracture has healed. Once healed, treat as an ABC without fracture unless the fracture has led to spontaneous healing of the ABC Operative aggressive curettage (+/- adjuvant) and bone grafting indications symptomatic ABC without acute fracture technique possible adjuvants phenol argon beam liquid nitrogen outcomes local recurrence in up to 25% and more common in children with open physes Differential & Groups "Bubbly" lytic lesion on xray "Lakes of Blood" on histology Treatment is curretage and bone grafting (1) Aneurysmal Bone cyst • • • UBC • NOF • Giant Cell Tumor • Chondroblastoma • Chondromyoid fibroma • Osteoblastoma • Telangiectatic osteosarcoma • ASSUMPTIONS: (1) assuming no impending fracture IBank Location Xray Xray CT B. Scan MRI MRI Histo(1) Case A tibia Case B calcaneus Case C pelvis Case D femur Case E femur (1) - histology does not always correspond to clinical case
QUESTIONS 1 of 16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.111) A 12-year-old boy presents with pain in the left hip for 6 weeks duration. Physical exam shows he is afebrile. He has a WBC of 12.2, and an ESR of 16. A radiograph is shown in Figure A. A T2-weighted MRI is shown in Figure B. A T1-weighted MRI with and without contrast is shown in Figure C and D respectively. What is the most appropriate next step in treatment. Review Topic QID: 4471 FIGURES: A B C D E 1 Curettage and bone grafting 72% (2807/3888) 2 Phenol injection 3% (110/3888) 3 Observation 6% (233/3888) 4 Percutaneous high-frequency ablation 2% (59/3888) 5 Wide resection and perioperative chemotherapy 17% (655/3888) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (OBQ09.236) You are seeing a 16-year-old female with shoulder pain. She is otherwise healthy and denies trauma. Based on the radiograph, MRI, and histology shown in Figures A-C, what is your diagnosis? Review Topic QID: 3049 FIGURES: A B C 1 Ewings sarcoma 1% (20/2216) 2 Osteosarcoma 3% (75/2216) 3 Simple bone cyst 0% (8/2216) 4 Aneurysmal bone cyst 92% (2047/2216) 5 Unicameral bone cyst 3% (59/2216) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (OBQ09.250) A 10-year-old male presents with knee pain after a collision with another soccer player. Knee radiographs are taken and show a cystic-appearing lesion in the metaphyseal region of the proximal tibia without evidence of fracture. An MRI is performed and is shown in Figure A. If a biopsy is performed, the histology would most likely resemble which Figure (B-F)? Review Topic QID: 3063 FIGURES: A B C D E F 1 Image B 79% (1384/1757) 2 Image C 8% (148/1757) 3 Image D 6% (97/1757) 4 Image E 4% (79/1757) 5 Image F 2% (36/1757) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (OBQ07.7) A 12-year-old female is involved in a low speed motor vehicle accident and presents with a pathologic fracture in the ulna. A radiograph is shown in Figure A. A needle biopsy is performed and histology is shown in Figure B. What is the best next step in treatment? Review Topic QID: 668 FIGURES: A B 1 Open biopsy for adequate diagnostic tissue 8% (129/1532) 2 Open reduction internal fixation of the distal ulna 4% (63/1532) 3 Immediate curettage and adjuvant chemo/radiotherapy 11% (174/1532) 4 Nonoperative fracture management 69% (1062/1532) 5 Preoperative chemotherapy and resection of tumor 6% (94/1532) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (SBQ04PE.7) A 6-year-old male presents with pain and swelling in his proximal tibia after twisting his knee. AP and lateral radiographs are shown in Figures A and B. Figure C shows a sagittal section from an MRI, and Figure D shows the high-power histology specimen from biopsy. What is the most likely diagnosis? Review Topic QID: 2192 FIGURES: A B C D 1 Unicameral bone cyst 7% (22/314) 2 Aneurysmal bone cyst 89% (279/314) 3 Chondrosarcoma 1% (3/314) 4 Giant cell tumor 1% (3/314) 5 Non ossifying fibroma 1% (3/314) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (OBQ06.79) Intralesional curettage and bone grafting is an accepted component of the treatment plan for all of the following conditions EXCEPT? Review Topic QID: 190 1 Giant cell tumor 10% (128/1333) 2 Aneurysmal bone cyst 3% (45/1333) 3 Chondroblastoma 18% (240/1333) 4 Chondromyxoid fibroma 19% (256/1333) 5 Osteofibrous dysplasia 49% (658/1333) ML 4 Select Answer to see Preferred Response PREFERRED RESPONSE 5 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
Proximal humurus Cystic lesion Pathology - Treatment Consult 9year old boy 1.Presented to A&E following a fall and direct impact on sho...
Proximal femoral bone cyst in a 9M (C2810) Pathology - Aneurysmal Bone Cyst HPI - The condition started six months ago after a minor twisting injury and XRays confirmed a pathologic fracture through a bone cyst in the proximal femur. The fracture was treated conservatively and completely united but the cyst persisted. What other investigations are needed? 4/29/2017 207 2 5 Expansile lytic lesion of distal ulna (C2447) Pathology - Aneurysmal Bone Cyst HPI - parents noticed a swelling of the righ wrist around a month,no h/o fall What is the most likely diagnosis base on the radiographs alone 11/28/2015 892 1 9 OLD OPTD CASE OF CALCANEAL CYST (C2246) Pathology - Aneurysmal Bone Cyst HPI - Optd in other center 04 yrs back for some calcaneal lesion - Curettage + Autologous iliac crest Bone grafting was done. (Documents, previuo radiographs and HPE report not available) .. wounds healed. Sustained trauma to same side 01 yr back.. developed swelling laterally in hind foot. Had some discharge for a months which resolved on medications.(? antibiotics) and dressings. Presently has swelling over the hind foot behind and below lateral malleolus (Picture for reference). Mild pain on weight bearing. No discharge. Treatment options presently 5/28/2015 82 0 11 See More See Less