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 15% in spine >60% in long bones (Femur and tibia being most common) 51% occured in the lower extremities, 22.5% in upper extremities usually in metaphysis metatarsal and calcaneus are the most common locations in the foot 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 17 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.267) A 14-year-old girl complains of persistent ankle pain and intermittent swelling that is worse after playing lacrosse. Figure A is a radiograph and Figures B and C are low-power microscopy images of the lesion. What is the diagnosis and best next treatment step? Tested Concept QID: 4902 FIGURES: A B C Type & Select Correct Answer 1 Curettage and bone graft for giant cell tumor 14% (697/5011) 2 Aspiration and steroid injection for unicameral bone cyst 9% (448/5011) 3 Curettage and bone graft for aneurysmal bone cyst 71% (3533/5011) 4 Wide resection for telangiectic osteosarcoma 1% (59/5011) 5 Chemotherapy and wide resection for telangiectic osteosarcoma 5% (246/5011) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (SBQ12FA.41) A 21-year-old male presents with gradual foot pain over the past several months. There is no history of trauma. Figures A and B are his plain radiographs and subsequent biopsy specimen. Which of the following is the most likely diagnosis? Tested Concept QID: 3848 FIGURES: A B Type & Select Correct Answer 1 Unicameral bone cyst 3% (47/1411) 2 Enchondroma 13% (187/1411) 3 Chronic osteomyelitis 0% (7/1411) 4 Aneurysmal bone cyst 77% (1081/1411) 5 Giant cell tumor 6% (84/1411) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (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. Tested Concept QID: 4471 FIGURES: A B C D E Type & Select Correct Answer 1 Curettage and bone grafting 72% (3285/4540) 2 Phenol injection 3% (128/4540) 3 Observation 6% (259/4540) 4 Percutaneous high-frequency ablation 2% (75/4540) 5 Wide resection and perioperative chemotherapy 17% (766/4540) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept 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 (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? Tested Concept QID: 3049 FIGURES: A B C Type & Select Correct Answer 1 Ewings sarcoma 1% (26/2825) 2 Osteosarcoma 3% (97/2825) 3 Simple bone cyst 0% (13/2825) 4 Aneurysmal bone cyst 92% (2609/2825) 5 Unicameral bone cyst 3% (73/2825) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (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)? Tested Concept QID: 3063 FIGURES: A B C D E F Type & Select Correct Answer 1 Image B 77% (1750/2259) 2 Image C 9% (194/2259) 3 Image D 6% (136/2259) 4 Image E 5% (109/2259) 5 Image F 2% (52/2259) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept 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 (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? Tested Concept QID: 668 FIGURES: A B Type & Select Correct Answer 1 Open biopsy for adequate diagnostic tissue 8% (163/1950) 2 Open reduction internal fixation of the distal ulna 4% (82/1950) 3 Immediate curettage and adjuvant chemo/radiotherapy 13% (261/1950) 4 Nonoperative fracture management 67% (1307/1950) 5 Preoperative chemotherapy and resection of tumor 6% (125/1950) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (OBQ06.79) Intralesional curettage and bone grafting is an accepted component of the treatment plan for all of the following conditions EXCEPT? Tested Concept QID: 190 Type & Select Correct Answer 1 Giant cell tumor 10% (170/1724) 2 Aneurysmal bone cyst 4% (62/1724) 3 Chondroblastoma 18% (314/1724) 4 Chondromyxoid fibroma 18% (310/1724) 5 Osteofibrous dysplasia 50% (860/1724) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (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? Tested Concept QID: 2192 FIGURES: A B C D Type & Select Correct Answer 1 Unicameral bone cyst 7% (49/728) 2 Aneurysmal bone cyst 89% (649/728) 3 Chondrosarcoma 1% (8/728) 4 Giant cell tumor 2% (11/728) 5 Non ossifying fibroma 1% (5/728) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept
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Proximal Femoral Bone Cyst with Pathologic Fx in a 9M (C2810) Saad Gaballah Pathology - Aneurysmal Bone Cyst E 4/29/2017 288 2 6 Expansile lytic lesion of distal ulna (C2447) Surendra Shetty Pathology - Aneurysmal Bone Cyst E 11/28/2015 1015 1 9 OLD OPTD CASE OF CALCANEAL CYST (C2246) Rohit Vikas Pathology - Aneurysmal Bone Cyst E 5/28/2015 89 0 11 See More See Less