150 likes | 543 Vues
ABC's. Classified as a benign boney lesionMore specifically,
E N D
1. Aneurysmal Bone Cysts(ABCs) Dr. Ted Scriven
Sept 8, 2008
2. ABCs Classified as a benign boney lesion
More specifically, benign-aggressive
Benign-aggressive = marked bone destruction, soft tissue extension or pathologic fractures
3. Etiology Specific translocation @ 17p13
Can arise de novo, or be associated with another primary:
GCT, chondroblastoma, UBC, osteoblastoma, fibrous dysplasia, nonossifying fibroma, chondromyxoid fibroma, osteosarcoma
4. Etiology Result from local circulatory abnormality:
Increased venous pressure
Local hemorrhage
Osteolysis
More bleeding
Source of bleeding = capilliaries in cyst membrane
Hemorrhage progresses to destructive lesion
5. Clinical Picture Age: often < 20
Gender: F > M (slight)
Location:
metaphysis or metadiaphysis of long bones (prox humerus, distal femur, prox tibia)
Occasionally iluim or lumbar vertebrae (15 20%)
6. Clinical Picture Mild pain or swelling
May have neuro deficits with spinal lesions
Duration = weeks ? years
Symptoms may worsen with pregnancy (more blood volume)
7. Investigations Start with thorough Hx & PE
Xray:
Radiolucent destructive cyst, expands surrounding cortex ? Soap-Bubbles
Often eccentric, can be central or subperiosteal
8. Investigations Bone Scan:
Diffuse or peripheral tracer uptake
Central area of decreased uptake
Angiography:
Accumulation of contrast throughout +/- hypervascularity of periphery
Absence of viable afferent or efferent vessels
9. Investigations CT
Helps deliniate lesion in areas of complex boney anatomy
MRI
Multiloculated cavities, fluid levels, +/- associated soft tissue mass
Helps to differentiate between ABC & UBC
10. DDx UBC
Chondromyxoid Fibroma
Chondroblastoma
GCT
Osteoblastoma
Talengiectatic Osteosarcoma
11. Pathology Gross:
Cavitary w/ blood filled spaces
Surrounded by thin layer of bone & raised periosteum
12. Pathology Micro:
Hemorrhagic tissue with spaces separated by cellular stroma
No endothelial lining or smooth muscle only lining is compressed fibroblasts
ALWAYS be sure to examine entire speciman and surrounding area (association with other primaries!!)
13. Treatment Curettage & Bone Grafting
Caution: lesion prone to heavy bleeding!
Tourniquet
Pre-op embolization
+/- local adjuvent tx for cavity sterilization:
Phenol, liquid nitrogen, argon
Ressection:
If area is expendable (fibula, metatarsal, etc)
Radiation:
Not routinely used d/t potential for malignant transformation
14. Prognosis If primary:
Usually a favourable prognosis
Recurrence:
Rate after curettage = 14 34%
Usually within 6/12, rare after 2 yrs
More common in age < 15 yo, centrally located lesions, and when contents not all removed
If associated with another primary:
Classification, treatment and prognosis based on the other (primary) lesion