ANEURYSMAL BONE CYST

An aneurysmal bone cyst consists of a blood-filled benign lesion in the bone that tends to expand or grow. While doctors refer to it as a cyst, it appears as a true benign surrounded by a thin wall of bone. Aneurysmal bone cysts (ABCs) can occur in any bone, but doctors commonly find them around the knee, pelvis, or spine.

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Aneurysmal Bone Cyst

An aneurysmal bone cyst (ABC) consists of a blood-filled benign and expansive lesion that appears as a fluid-filled cavity within a bone. Doctors find these cysts in the long bones of the body, such as the femur and tibia, but can also occur in the spine and other bones. Treatment options include surgical excision or curettage (removal of the cyst with a spoon-shaped surgical instrument) and bone grafting. In some cases, doctors will just observe the cyst.

Who gets an Aneurysmal Bone Cyst?

Doctors find aneurysmal bone cysts (ABCs) as relatively rare, accounting for less than 5% of benign bone tumors. They occur more frequently in children and young adults, with the majority of cases being diagnosed before the age of 30. Boys are more frequently affected than girls. It’s not known exactly what causes ABCs. Some researchers believe that they develop from a blood vessel that ruptures within the bone, leading to a cyst formation. Genetic factors may also play a role in the development of ABCs.

While the precise origin remains a mystery, several hypotheses exist. Some suggest these cysts arise due to disturbances in the blood vessels of the affected bone. In about half of all cases, a pre-existing tumor, such as fibrous dysplasia, non-ossifying fibroma, a solitary bone cyst, or osteosarcoma, may exist alongside the cyst, indicating a potential connection.

There are also reports of abnormalities in the chromosomes of tumor cells, though the significance of these findings is not yet fully understood. Despite ongoing research, there is no definitive explanation for why these cysts occur. It’s crucial to remember that there’s nothing you could have done to prevent the development of an ABC.

Some researchers believe that they develop from a blood vessel that ruptures within the bone, leading to a cyst formation. Genetic factors may also play a role in the development of ABCs. It is important to note that ABCs are benign tumors and are not cancerous. They do not spread to other parts of the body. However, they can cause damage to the surrounding bone if left untreated.

QUESTIONS AND ANSWERS

What is an Aneurysmal Bone Cyst?

An Aneurysmal Bone Cyst (ABC) identifies as a benign and locally aggressive bone tumor that typically occurs in children and young adults. Although a non-cancerous lesion, it can develop in various bones, and it commonly affects the long bones, spine, and pelvis. ABCs normally contain blood-filled spaces within the bone, causing the expansion and weakening of the affected area.

What identifies the symptoms of an Aneurysmal Bone Cyst?

The symptoms of an Aneurysmal Bone Cyst may vary depending on the location and size of the lesion. Common signs include localized pain, swelling, and tenderness over the affected bone. The cyst’s expansion can weaken the bone, leading to an increased risk of fractures. In some cases, pressure on nearby structures or nerves can cause neurological symptoms like numbness or weakness.

How do doctors treat an Aneurysmal Bone Cyst

The treatment approach for an Aneurysmal Bone Cyst depends on various factors, such as the size, location, and aggressiveness of the lesion, as well as the patient’s age and overall health. Small and asymptomatic ABCs may not require treatment and doctors can monitor it with regular imaging. However, for larger or symptomatic cysts, treatment options include surgical intervention, embolization (a procedure to block the blood supply to the cyst), or a combination of both. Surgery aims to remove the cyst and stabilize the affected bone, often with bone grafts or other reconstructive techniques. Regular follow-up becomes essential to monitor the condition’s progress and ensure appropriate management.

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Where are Most Aneurysmal Bone Cysts Found?

Aneurysmal bone cysts (ABCs) are commonly found in the long bones of the body, such as the femur and tibia. They can also occur in the vertebral column, pelvis, skull, and other bones. In long bones, the ABCs are found in the metaphysis, which is the growing part of the bone, near the epiphyseal plate (the area where the bone grows in length). In the vertebral column, the ABCs are found in the back part of the the vertebral body.

Understanding the Types of Aneurysmal Bone Cysts

Aneurysmal bone cysts (ABCs) are generally classified into two main types: active and aggressive. These classifications help in understanding their behavior and potential impact on the bone and surrounding areas.

Active Aneurysmal Bone Cysts

Active ABCs are primarily contained within the bone itself. While they may lead to deformity, they do not usually spread beyond their original boundaries.

Aggressive Aneurysmal Bone Cysts

On the other hand, aggressive ABCs extend beyond the bone and infiltrate the nearby soft tissues. This type typically demands medical intervention, as they seldom resolve without treatment.

Common Symptoms

Pain and Swelling: Both types often present with noticeable discomfort and swelling in the affected area.
Risk of Fractures: Though uncommon, both types can lead to fractures in the bone.

It’s crucial to identify the type of ABC for proper management and treatment, as these cysts rarely disappear on their own.

Long-term Outlook for Children with Aneurysmal Bone Cysts

The recurrence rate for aneurysmal bone cysts in children is approximately 20%. To manage this potential risk, children undergo regular monitoring, typically every three months for the first two years following treatment.

If a cyst reappears, doctors generally apply the same treatment methods. However, in some cases, they may choose a more intensive approach to reduce the likelihood of another recurrence. This comprehensive care plan aims to ensure children maintain optimal bone health and functionality.

While the possibility of recurrence continues as a concern, consistent follow-up and prompt treatment adjustments contribute positively to the long-term outlook. Most children respond well to these strategies, enabling them to lead active and healthy lives.

Symptoms of an Aneurysmal Bone Cyst

The symptoms of an aneurysmal bone cyst (ABC) can vary depending on the size and location of the cyst. Common symptoms include:

Pain: The cyst may cause pain or discomfort in the affected bone, especially when located near a joint.
Swelling: The cyst may cause a visible bump or swelling in the affected area.
Fracture: ABCs can weaken the bone leading to fractures.
Limb length discrepancy: The cyst can cause a limb length discrepancy when located in the long bones of the body.
Neurological symptoms: When the cyst occurs in the spine, it may cause neurological symptoms like numbness, tingling, or weakness in the arms or legs.

It’s important to note that some people may have an ABC without any symptoms at all. These cysts are often discovered by chance during an x-ray or scan for an unrelated issue.

Diagnosing Aneurysmal Bone Cysts

Understanding aneurysmal bone cysts starts with a comprehensive diagnostic process. Here’s how physicians typically approach diagnosing these cysts:
Thorough Physical Examination

Physicians begin with a detailed physical examination, focusing on the specific area where the cyst may exist. This helps to assess outward signs and any discomfort experienced by the patient.

Imaging Techniques

X-Rays: Initial imaging often involves X-rays, which help visualize the size and shape of the cyst and check for any potential risk of fractures.
MRI (Magnetic Resonance Imaging): To get a more detailed view, doctors will order an MRI scan. This modality provides intricate images of the bone’s internal structures, aiding in understanding the cyst’s characteristics and confirming its type.
CT (Computerized Tomography) Scans: In certain cases, a CT scan is utilized to offer a sharper look at the bone anomaly, helping to refine the diagnosis.

Biopsy for Definitive Diagnosis

A biopsy, where a tissue sample is collected via a needle, is critical for conclusively identifying the cyst type. This step ensures the accuracy of the diagnosis by providing microscopic details.

Once all diagnostic data is collected, medical teams will analyze and synthesize the findings. They will then discuss the insights with the patient and family, presenting the nature of the cyst and suggesting the most effective treatment options tailored to the patient’s needs.

The Treatment for an Aneurysmal Bone Cyst

The treatment for an aneurysmal bone cyst (ABC) depends on the size and location of the cyst. It also includes the patient’s age and overall health. Treatment options include:

Surgical Excision: This appears as the most common treatment for ABCs. The surgeon removes the cyst along with a surrounding margin of healthy bone. This procedure occurs in conjunction with a bone graft. The bone graft helps to fill the hole left by the removal of the cyst and promotes healing.
Curettage: This procedure involves the removal of the cyst with a spoon-shaped surgical instrument (curette). This is often done in combination with bone grafting that fills the void created by the removal of the cyst
Observation: If the cyst appears small and does not cause any symptoms, your doctor may recommend observation without treatment.
Radiotherapy: In some cases, Radiotherapy can shrink the cyst and reduce the risk of recurrence.
Cryotherapy: Cryotherapy refers to a procedure that uses extreme cold to destroy abnormal cells. Cryotherapy can treat these cysts using liquid nitrogen.

It’s important to note that the treatment of aneurysmal bone cysts depends on each individual. However, the best option will depend on a variety of factors, including the patient’s age, the size and location of the cyst, and the patient’s overall health. Our orthopedic surgeon will provide you with the best advice based on your case.

How Long Does it Take to Recuperate from the Removal of an Aneurysmal Bone Cyst?

Recovery time after the removal of an aneurysmal bone cyst (ABC) can vary depending on several factors. These factors include the size and location of the cyst, the patient’s overall health, and the type of surgery performed. If the cyst is located in a long bone such as the femur or tibia, the patient may need to use crutches or a brace to protect the affected limb during the healing process. Physical therapy will regain strength and range of motion in the affected limb. Recovery time can vary from several weeks to several months.

If the cyst is located in the spine, the recovery time will depend on the extent of the surgery. In this case, the patient may need to wear a brace to support the spine during the healing process. Recovery time can take several weeks to several months. It’s important to note that recovery time can vary from person to person. Nevertheless, patients should follow their surgeon’s advice and guidelines for post-surgery care and follow-up.

Why should a Person with an Aneurysmal Bone Cyst Come to the Medical City Children’s Orthopedics and Spine Specialists?

Medical City Children’s Orthopedics and Spine Specialists is a specialized center that offers comprehensive care for children and adolescents with aneurysmal bone cysts (ABCs) and other bone tumors. There are several reasons why patients with ABCs should consider coming to this center:

Expertise: The team at Medical City Children’s Orthopedics and Spine Specialists includes specialists with extensive experience in treating ABCs and other bone tumors in children and adolescents. They are familiar with the latest treatment options and have access to the latest technology.
Multidisciplinary approach: The team of specialists at Medical City Childdren’s Orthopedics and Spine Specialists works together to provide a comprehensive treatment plan that addresses all aspects of the patient’s condition. They work closely with other specialists such as radiologists, physical therapists, and rehabilitation specialists to ensure that the patient receives the best possible care.Our approach is deeply rooted in collaboration, ensuring that each case benefits from the insights of various experts. This multidisciplinary strategy means that every patient’s condition is evaluated by a diverse team before crafting a tailored treatment plan.Comprehensive and Personalized Care
Holistic Treatment Plans: We provide both medical and surgical care options, ensuring that each aspect of the condition is meticulously addressed.
Expert Involvement: Specialists from different fields contribute their expertise, fostering a well-rounded understanding of the patient’s needs.
Customized Solutions: Each treatment plan is personalized, taking into account the unique circumstances and health goals of the patient.

By integrating these elements, our program not only focuses on the immediate needs but also on long-term outcomes, offering a thorough and compassionate approach to care.

Experience with children and adolescents: Medical City Children’s Orthopedics and Spine Specialists are experienced in treating children and adolescents, as a cyst can affect the growth plates.
Experience in the latest surgical techniques: The center is familiar with the latest surgical techniques for treating ABCs such as minimally invasive surgical procedures, which can lead to faster recovery times and less pain for the patient.
Follow-up care: The center provides follow-up care to ensure that the patient is recovering well and to monitor for any recurrence of the cyst.

Conclusion

Overall, Medical City Children’s Orthopedics and Spine Specialists is a specialized center, with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, Texas, that offers comprehensive care for children and young adults with aneurysmal bone cysts and other bone tumors. We provide the expertise, multidisciplinary approach, and experience that can make a difference in a child’s medical condition or illness outcome. We welcome new patients and invite you to call our office and make an appointment for your child.

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Footnote:

Medscape: Aneurysmal Bone Cyst

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