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Axial CT with bone window settings: expansile lesion replacing right ethmoid air cells surrounded by thin rim of bone deficient in places and extension of the lesion into right orbit (open arrows).
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Aneurysmal bone cyst is an expansile bone lesion, non-neoplastic in nature, occurring most commonly in long bones. It is uncommon in facial bones and exceptionally rare in ethmoid bone. Ten cases of aneurysmal bone cysts of ethmoid bone have been reported so far.
A young adolescent presented with decreased vision and pain in the right eye. MRI reve...
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Aneurysmal bone cyst is a non-neoplastic lesion consisting of blood filled sinusoidal spaces that expand from the affected bone. The most common locations of aneurysmal bone cysts are the metaphysis of long bones, followed by flat bones. Only 2% of all are found in the head and neck area, with mandible and maxilla being the most frequent sites invo...
Citations
... 7 Reports state that 87% appear as radiolucent and only 2% are radiopaque with the rest having mixed opacity. 7,8 Other findings also include groundglass density, osseous expansion, narrowing of the foramina and contrast enhancement. 8 Fluid levels are present on CT in 35% of cases, with increased attenuation of the dependent level. ...
... 7,8 Other findings also include groundglass density, osseous expansion, narrowing of the foramina and contrast enhancement. 8 Fluid levels are present on CT in 35% of cases, with increased attenuation of the dependent level. 9 The fluid level is suggestive of a mixture of proteinaceous and blood products. ...
... 7 The mass also presents with associated bony remodelling, as well as areas of non-aggressive bony resorption. 8 MRI shows fluid levels better than CT. 9 However, fluid levels may also be seen in simple bone cysts, soft tissue cavernous hemangiomas and cystic hygromas. 10 Other MRI findings include multiple internal septations and lobulations with varying blood degradation intensities. ...
Objective
Aneurysmal bone cysts (ABCs) rarely involve the cranium. We report a case arising in the ethmoid sinus with orbital and intracranial invasion. Imaging suggested an associated fibro-osseous lesion. The lesion was completely resected. Histology confirmed the imaging diagnosis of ABC on top of an ossifying fibroma. A multidisciplinary approach is essential for optimal surgical outcomes.
Methods
We report a case of an 8-year-old boy with a 5 week history of painless, increasing prominence of the left eye. Clinical examination revealed non-pulsatile left proptosis. Visual acuity and ocular movements were normal. CT and MRI scans of the maxillofacial regions showed a large space-occupying lesion involving the left ethmoid air cells with left orbital and left inferior frontal intracranial extension. Multiple fluid levels with blood products were seen. Areas of the bony component of the lesion showed ground-glass density on CT. Imaging was consistent with an ABC with an underlying fibro-osseous lesion; probably fibrous dysplasia which was confirmed after surgical removal of the lesion. A multidisciplinary team of maxillofacial, neurosusugery and ENT surgeons performed the surgery.
Results
ABC arising from an osseous fibroma of the skull is rare. Total resection can be achieved with a multidisciplinary surgical approach. Post-operative histology confirmed by the imaging findings.
... Aneurysmal bone cyst (ABC) is an expansible, blood-filled bone lesion, which is rarely seen in otolaryngology field [1][2][3][4][5][6][7]. Jaffe and Lichtenstein were the first who described ABC in 1942 [1][2][3]. ...
... Aneurysmal bone cyst (ABC) is an expansible, blood-filled bone lesion, which is rarely seen in otolaryngology field [1][2][3][4][5][6][7]. Jaffe and Lichtenstein were the first who described ABC in 1942 [1][2][3]. It was described as blood filled cyst surrounded by fibrous tissue. ...
... It was described as blood filled cyst surrounded by fibrous tissue. The pathophysiology of ABC is not well understood; however, the long bones, vertebral column, and pelvis are a common site for ABC [1][2][3]. ABC affects females more than males with a ratio of 2:1 [1]. It is mainly found in young age group ranging from 11 months to 20 years old [1,6]. ...
Introduction: Aneurysmal bone cyst (ABC) is an expansible bone lesion that occurs usually in long bones. Rarely, it involves the head and neck regions. Case report: A 31-year-old woman who presented with epistaxis and right side nasal cavity mass. Radiologically, there was an expansible lytic anterior ethmoid lesion, which extended to right maxillary, frontal sinuses, and nasal cavity causing nasal septum deviation to the left side. Several biopsies were taken during functional endoscopic sinus surgery (FESS) and showed fibrous proliferation with new bone formation, giant cells, and hemorrhagic cysts, which are the characteristics of the aneurysmal bone cyst. Then, the patient underwent surgical excision of the mass. Conclusion: ABC is a rare disease in the head and neck and can be confused with other diagnoses on imaging. Therefore, the histopathological diagnosis is required. Regular follow up after the surgical excision using imaging is necessary considering previously reported recurrence rate.
... It is also possible to highlight the endocavitary fluid levels (characteristic but not a pathognomonic sign of this lesion), the presence of endocardial hemorrhages occurring in later periods (evidenced by the different signal intensity in the T1-and T2-weighed phases) and the presence of a peripheral orbit of a fibrous nature, separating the cyst from the adjacent tissues and evidenced as a low intensity signal in T1-and T2-weighed images, indicating the benignity of the neoformation and thus allowing differential diagnosis to be made with other malignant diseases such as osteogenic teleangectasis sarcoma. Preoperative arteriography highlights the vascularization of the lesion and thus makes pre-surgical embolization possible (3,8,24) . ...
Aneurysmal Bone Cyst (ABC) are extremely rare in the head and neck region and even rare in sinuses. It's a benign multicystic mass that is locally-destructive and rapidly expandable. The etiopathogenesis, even today, is not entirely clear. However, hemorragic fluid content and septated appearance are the characteristic feature of ABC. The clinical presentation produces symptoms due to the compression of adjacent structures or as a result of a pathological fracture and depends on localization. Most common location in this area are the mandible and maxillary bones. The complete surgical excision is the treatment of choice. There are limited reports in literature on these tumors at the sinonasal level. We present a complete review of the literature as well as an unusual localization of ABC in this district.
... 24 Há relatos ainda do uso de interferon alfa-2a nas lesões tidas como irressecáveis. 29 Conclusão O relato de caso traz à luz o conhecimento da ocorrência de cistos ósseos aneurismáticos em topografias incomuns, como a base do crânio, fazendo-se necessário o diagnóstico diferencial de lesões típicas do eixo hipotálamo-hipofisário, como o adenoma hipofisário e o craniofaringioma. Apesar de o tratamento de escolha ser a ressecção completa, esta se torna inviável para a localização apresentada. ...
Introduction Aneurysmal bone cysts (ABCs) are pseudotumoral bone lesions of unknown etiology that are also hypervascularized, benign, and locally destructive. They are rare in the base of the skull. The present case report describes a case of aneurysmal bone cyst in the sella turcica.
Case Report The present study was developed at the department of neurosurgery of the Hospital Universitário Professor Alberto Antunes of the Universidade Federal de Alagoas (HUPAA-AL, in the Portuguese acronym), Maceió, state of Alagoas, Brazil, and is accompanied by a review of the literature from the PubMed database. A 17-year-old female patient with bitemporal hemianopia and intense left hemicranial headache associated with symptoms from the cranial nerves contained in the cavernous sinus. Neuroimaging evidenced a large lesion in the suprasellar region with calcification foci, sellar erosion, and extension to the cavernous sinus. The patient was submitted to a partial lesion resection and the histopathological analysis showed an aneurysmal bone cyst.
Conclusion A rare case of intracranial aneurysmal bone cyst, with the important differential diagnosis from pituitary adenoma.
... These bonycystic lesions are frequently filled with blood and destroy the architecture of the affected bone and surrounding tissue. 1,2 Although histopathological and radiologic characteristics of ABCs are well defined, pathogenesis is not clearly investigated yet: most probably local blood circulation disturbance can cause ABCs. 3 Usually metaphysis of long bones and the vertebral column are affect by ABCs. Only about 2% of ABCs occur in the head and neck region, mainly affecting the mandible. ...
... Only about 2% of ABCs occur in the head and neck region, mainly affecting the mandible. 1,3,4 Other benign bony lesions such as non-ossifying fibroma, giant cell granuloma, fibrous dysplasia and fibromyxoma can be associated with these pseudocysts. 4 Although radical surgery is the gold-standard therapy for ABCs, this cannot be achieved in all cases due to the occurrence of extensive tumors at difficult anatomical structures. 2 Moreover in benign lesions surgical mutilation particularly in young patients should be avoided. ...
... ABCs are benign cystic lesions that destroy and expand the affected bone. 1,2,4 Radiologic appearance similar to vascular aneurysms lead to the name 'ABC'. 2 Primary and secondary lesions can be differentiated: primary ABCs have no history of trauma or other associated tumors, while one third of the lesions occur secondary to other tumors such as giant cell tumor or chondroblastoma. 2,5 Due to the uneventful medical history of our young patient the lesion can be defined as 'primary' ABC. ...
Benign bony tumors of the skull base and paranasal sinuses are uncommon entities, with an overall higher incidence in males. Benign bony tumors may lead to local expansion with resultant mass effect of potentially critical structures. Some benign bony tumors may undergo malignant transformation. This article reviews the presentation and management of benign bone tumors of the skull base and paranasal sinuses with special consideration to involvement of the adjacent orbit, intracranial and critical neurovascular structures. This review covers tumor incidence, location, gross and histologic appearance as well as radiographic findings, treatment, and recurrence rates. Tumors discussed in this article include osteochondromas, osteomas, osteoid osteomas, aneurysmal bone cysts, fibrous dysplasia, giant cell tumors, cemento-ossifying fibroma, ameloblastic fibro-odontoma, ecchordosis physaliphora, chondromyxoid fibroma, primary chronic osteomyelitis, primary chronic osteomyelitis, osteochondromyxoma, and dense bone islands.
Background
Aneurysmal bone cyst (ABC) is a benign, expansile bony lesion, primarily found in long bones. It is uncommon in facial bones and exceptionally rare in the sphenoethmoid sinus.
Case presentation: A 28-year-old male presented with complaints of bilateral nasal block and recurrent epistaxis. Rhinoscopy examination showed a lobulated lesion in the bilateral posterior nasal cavity and nasopharynx. A nasopharyngeal angiofibroma was suspected on radiological assessment. Pre-operative incisional biopsy revealed the tumor as hemangioma. With a probable diagnosis of hemangioma, the lesion was explored under general anesthesia. An endoscopic endonasal excision of a tumor mass attached to the sphenoid skull base was undertaken. Histopathological examination of the resected tissue confirmed the diagnosis of an aneurysmal bone cyst.
Conclusion
ABC should be considered a rare differential for a hemorrhagic sinonasal mass in a young adult. Histopathological examination of the excised tissue is mandatory for a confirmatory diagnosis. Radiologic assessment and pre-operative incisional biopsy are essential from the diagnostic point of view; however, they can often cause a diagnostic dilemma with other vascular tumors such as nasopharyngeal angiofibroma or hemangioma.
Objective/hypothesis:
Aneurysmal bone cysts (ABCs) are benign, lytic bone lesions, which rarely present in the paranasal sinuses. There is no published consensus on the appropriate diagnostic or treatment approach. Our objective was to elucidate the clinical behavior, treatment, and outcomes for patients with ABCs of the paranasal sinuses (psABCs).
Study design:
Retrospective case series and system review of the literature.
Methods:
A retrospective chart review was performed to identify patients evaluated at the authors' institution with psABC and consolidated with literature reports of psABC.
Results:
Eighty-nine patients met inclusion criteria. The most common presenting symptom was painless facial swelling (n = 35, 39%). The ethmoid sinuses were the most common site involved (n = 55, 62%). Surgical approach was reported in 74 cases including 20 endoscopic and 54 with an open or combined approach. Fifty-nine patients (71%) underwent gross total resection. Follow up data was reported for 67 patients. Fifteen patients (22%) were found to have recurrence or progression at follow up; 10/15 (66%) patients within the first 12 months, 14/15 (93%) within the first 24 months, and 1/15 (7%) greater than 24 months after treatment. Patients were more likely to have recurrence/progression if they presented with nasal discharge (P = .05), proptosis (P = .01), or orbital involvement (P = .03).
Conclusions:
psABCs typically present with painless swelling or nasal obstruction. Orbital involvement is a negative prognostic indicator with these patients more likely to have recurrence after treatment. Recurrence or progression of disease is most likely to occur within 2 years after treatment. Therefore, patients should be monitored closely during this time.
Level of evidence:
4 Laryngoscope, 2021.
Aneurysmal bone cyst cinched the #10 position for MCF abnormalities as benign, osteolytic, expansile, occasionally locally destructive lesions which more frequently involve long bones.
Giant cell tumor took the #12 position for ACF abnormalities as a “common” lytic, locally aggressive expansile tumor characterized by regular recurrence and sporadic metastasis. Although generally benign, 5–10% are malignant. Our Classic Clue describes a young adult female presenting with headache and cranial nerve deficits who is found to have an aggressive appearing, destructive, lytic skull base lesion exhibiting avid enhancement with fluid-fluid levels. Pertinent CT and MRI features are described including T1, T2, and T1 Gd. Multiple representative MRI images are provided for perusal. Treatment and prognosis are discussed. Incidence: Only in medicine would we call “common” a bone tumor which involves one person in a million. While 2% of giant cell tumors involve the head and neck, only 1% involve the skull. GCTs typically tend to be histologically benign but locally aggressive. However, 5–10% undergo malignant transformation. They may metastasize when both the primary and secondary lesions are “histologically benign”. Somewhat suggestive of the “Strange Case of Dr. Jekyll and Mr. Hyde,” GCTs present pathologists with “histologically benign” patterns while simultaneously parading malevolent manifestations before radiologists. GCTs regularly appear radiographically indistinguishable from malignant tumors. And, they may metastasize while the pathologist is still signing them off as being benign!
