Aneurysmal Bone Cyst : Treatment

Comments:
Treatment of Aneurysmal Bone Cyst (ABC): ABC is treated by aggressive curettage or en bloc resection. Amputation is not an option given that ABC is a benign tumor. En bloc resection is also not preferred in most patients because of the resulting disability and the need for reconstructive surgery. En bloc resection can be done if the tumor involves an expendable bone like fibula, scapula or a rib.

Curettage is still the standard of care in most cases. The resultant defect is packed with allograft bone chips or polymethylmethacrylate cement. However, curettage is followed by local recurrences in 20-50% of cases. Recurrences usually appear within 6 months of treatment and can undergo rapid growth, creating a concern for malignancy. Recurrences can be managed conservatively. Some cases regress even after incomplete removal.

Radiation therapy has been used for skull or spine lesions where resection may be difficult. Other nonsurgical approaches have been used, including intralesional steroid or calcitonin injections, selective arterial embolization, percutaneous sclerotherapy, and RANKL inhibitor denosumab.

This image from a solid area of an ABC shows fibroblastic proliferation with numerous osteoclast-type giant cells, hemosiderin-laden macrophages and other inflammatory cells. A focus of immature woven bone is seen at the lower left.