Aneurysmal Bone Cyst: an uncommon and aggressive presentation

  • Arnab Chaudhuri Medical College, Kolkata. West Bengal University of Health Sciences.
  • Ayandip Nandi Medical College, Kolkata. West Bengal University of Health Sciences.
  • Sarbani Chattopadhyay North Bengal Medical College, Siliguri. West Bengal University of Health Sciences.
  • Ranajit Bhatta Medical College, Kolkata. West Bengal University of Health Sciences.
Keywords: Aneurysmal bone cyst, Solid variant, Bone neoplasms, Giant cell reparative granuloma.

Abstract

The solid variant of  is a rare subtype of aneurysmal bone cyst with a preponderance of solid compared to cystic elements. We present a case of solid ABC affecting the proximal tibia-an unusual site, and presenting with rapid progression mimicking malignant neoplasm.12 year old girl presented with pain and swelling just below left knee for 9 months.  X-Ray and CT scan demonstrated a lytic expansile lesion over metaphyseal region of tibia and diagnosed radiologically as aneurysmal bone cyst. Histology of curettage established it as solid variant of ABC. After 5 months, patient presented with a fungating mass over skin below knee with foul smelling discharge. Histology of incisional biopsy from outside suggested osteosarcoma, though no osteoid was found. Above knee amputation was done and histology of the whole specimen conclusively proved it to be a case of solid variant of ABC. Solid ABC has been of great interest because it may be mistaken for malignant tumor, mainly giant cell tumor, osteosarcoma or synovial sarcoma, because of cellularity and variable mitotic activity.

Author Biographies

Arnab Chaudhuri, Medical College, Kolkata. West Bengal University of Health Sciences.
Post Graduate Trainee, Department of Pathology.
Ayandip Nandi, Medical College, Kolkata. West Bengal University of Health Sciences.
Demonstrator, Department of Pathology.
Sarbani Chattopadhyay, North Bengal Medical College, Siliguri. West Bengal University of Health Sciences.
Professor, Department of Pathology.
Ranajit Bhatta, Medical College, Kolkata. West Bengal University of Health Sciences.
Professor, Department of Orthopedics.

References

1. Bertoni F, Bacchini P, Capanna R, Ruggieri P, Biagini R, Ferruzzi A, et al. Solid variant of aneurysmal bone cyst. Cancer 1993;71:729–34.

2. Unni KK, Inwards CY. Tumors of the osteoarticular system. In: Fletcher CDM, editor. Diagnostic Histopathology of Tumors, 3rd edn. Vol. 2. New York: Churchill Livingstone; 2007;p.1634–36.

3. Ilaslan H, Sundaram M, Unni KK. Solid variant of aneurysmal bone cysts in long tubular bones: giant cell reparative granuloma. Am J Roentgenol 2003;180:1681-7.

4. Sanerkin NG, Mott MG, Roylance J. An unusual intraosseous lesion with fibroblastic, osteoclastic, osteoblastic, aneurysmal and fibromyxoid elements. "Solid" variant of aneurysmal bone cyst. Cancer 1983;51:2278-86.

5. Chakarun CJ, Forrester DM,Gottsegen CJ,Patel DB, White EA,Matcuk GR. Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment. RadioGraphics 2013;33:197–211.

6. Klein MJ, Siegal GP. Osteosarcoma: Anatomic and Histologic Variants. Am J Clin Pathol 2006;125:555-81.

7. Fisher C. Synovial Sarcoma. Ann Diagn Pathol 1998;2(6):401-21.

8. Eyden BP, Manson C, Banerjee SS, Roberts ISD, Harris M. Sclerosing epithelioid fibrosarcoma: a study of five cases emphasizing diagnostic criteria. Histopathology 1998;33:354–60.

9. Sciot R, Dorfman H, Brys P, Dal CP, De Wever I, Fletcher CD, et al. Cytogenetic-morphologic correlations in aneurysmal bone cyst, giant cell tumor of bone and combined lesions: a report from the CHAMP study group. Mod Pathol 2000;13:1206-10.

10. Schreuder HWB, Veth RPH, Pruszczynski M, Lemmens JAM, Koops HS, Molenaar WM. Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting. J Bone Joint Surg [Br] 1997;79-B:20-5
Published
2015-11-01
Section
Case Report