Bone Cysts & Tumor-like Bone Pathologies Flashcards
What are 2 alternative names for a simple bone cyst?
- Unicameral bone cyst
- Solitary bone cyst
What causes a simple bone cyst?
disturbance of bone growth following trauma
What age group is primarily affected by simple bone cysts?
<20 years
What is the preferential location of simple bone cysts?
proximal metaphysis
- humerus
- femur
- tibia
Describe the pathogenesis of a simple bone cyst
- trauma –> hematoma forms & resolves
- formation of fibrous lining
- fibrous tissue pulls serous fluid into lesion
- fluid pressure leads to bone resorption
- some reactive bone formation (solid)
- produces lytic lesion with thin, well-defined margin and sclerotic border
A simple bone cyst occurs over the course of ____
months
What pattern of destruction is seen in a simple bone cyst?
geographic lytic
A simple bone cyst has a ____ zone of transition
short/narrow
How does the cortical bone appear in a simple bone cyst?
thinning of cortex due to resorption of bone, may lead to pathologic fractures
Why is a simple bone cyst referred to as a “migrating tumor”?
Lesion tends to develop in metaphysis, and can go into diaphysis with age
(NOT a neoplasia)
Is a simple bone cyst a true cyst? Why or why not?
- not a true cyst because there is no distinct cell lining/membrane (which would completely separate it from surrounding tissues)
- has a fibrous lining that allows serous fluid in
What type of cells are found in a simple bone cyst?
- osteoclastic giant cells
- macrophages
- chronic inflammatory cells
- osteoclasts in advancing area of cyst
What type of periosteal reaction may be present in a simple bone cyst?
solid (non-aggressive)
How would a patient present clinically with a simple bone cyst?
- asymptomatic
- incidental finding, usually due to patho. Fx
What are the radiographic characteristics of a simple bone cyst?
- unilocular radiolucent lesion with sclerotic border
- “fallen fragment” sign
- usually centrally located
What is the treatment for a simple bone cyst?
- intralesional corticosteroids
- curettage (scoop out) and bone grafting (pack with bone chips)
- tends to recur
How is a simple bone cyst prevented from recurring?
inject with phenol to kill fibrous lining
What is an aneurysmal bone cyst?
multiloculated lytic lesion with septa composed of fibrous tissue and reactive bone
What age group is primarily affected by aneurysmal bone cysts?
<20 years
What is the preferential location of aneurysmal bone cysts?
80% occur in metaphyseal region of long bones & in the spine
What parts of the spine do aneurysmal bone cysts prefer?
posterior elements:
- articular processes
- pedicles
- lamina
- SPs
What is a primary aneurysmal bone cyst?
(genetic) USP6 overexpression, which leads to ^proteases and transcription factors that upregulate cystic resorption of bone
What is a secondary aneurysmal bone cyst?
develop with other primary tumors
eg. giant cell tumor, osteosarcoma
What does multiloculated mean?
multiple chambers
Aneurysmal bone cysts are filled with ____
blood
Simple bone cysts are filled with ____
serous fluid
What does the appearance of an aneurysmal bone cyst resemble?
“soap bubble” appearance or sponge filled with blood and blood clots
Aneurysmal bone cysts grow (rapidly/slowly)
rapidly
Simple bone cysts grow (rapidly/slowly)
slowly
Are aneurysmal bone cysts typically central or eccentric?
can be either
Are simple bone cysts typically central or eccentric?
central
What are the radiographic characteristics of aneurismal bone cysts?
- expansile
- intact periosteum & cortex, with thinning of cortex (balloon-like)
- multilocular radiolucent lesion
What pattern of destruction occurs in an aneurysmal bone cyst?
geographic lytic
An aneurysmal bone cyst has a ____ zone of transition
short/narrow
What does expansile mean?
enlarged bone
How will a patient with an aneurysmal bone cyst present clinically?
- pain
- swelling
- cyst may blow out and cause local hemorrhage
- patho. Fx (rare)
- possible neurological deficits