Top 3 Differentials in Radiology, A Case Review. Simple bone cysts are common, benign, fluid-filled, cystic lesions that cause minimal expansion of the bone and usually occur in the metaphysis of long bones. 1950;3(2):279289. the sacroiliac joint. In general, vertebral pneumatocysts are less common than intraosseous pneumatocysts in the pelvis, especially adjacent to the sacroiliac joint. Aneurysmal bone cysts have been first described by the American bone pathologist Louis Lichtenstein in 1950 14. The differential diagnosis for bone tumors is dependent on the age of the patient, with a very different set of differentials for the pediatric patient. Fig. It is important to remember that the presence of fluid-fluid levels, although characteristic of aneurysmal bone cysts, is by no means pathognomonic, and is seen in other lesions as well, both benign and malignant (e.g. They shared a spinal cord and had the presence of an open spinal defect type meningocele . A large clear fluid-filled cavity was curetted and the cavity was filled with an autologous bone graft from iliac crest. Check for errors and try again. Logout. Hudson T. Fluid Levels in Aneurysmal Bone Cysts: A CT Feature. The current study aimed to investigate the imaging manifestations of vertebral aneurysmal bone cyst (ABC), and examine the clinical value of interventional embolization. 2 VHs are more frequently found in women, especially in the fourth-to-sixth decades of life. MR images show a multiloculated mass of heterogeneous signal intensity that usually has blood products within (7). You can use Radiopaedia cases in a variety of ways to help you learn and teach. They compose 28% of all skeletal hemangiomas, and the thoracic spine is the most frequent location. Primary bone tumors of the spine are much less common than secondary metastatic disease: plasmacytoma/multiple myeloma: most common primary bone cancer, chordoma: more common in sacrum (50%) and clivus (35%) than cervicothoracic vertebral column (15%), Langerhans cell histiocytosis(eosinophilic granuloma). Harry B. Skinner. In support of this theory is the fact that they are primarily encountered in young men, and are often hemorrhagic at surgery 1. Simple bone cysts are found in the metaphysis of long tubular bones in 9095% of cases, and 565% of such cysts involve the proximal humerus; 2530%, the femur; and the rest, the proximal tibia, fibula, radius, ulna, ileum, patella, rib (8), and calcaneus (9). Q: What are the clinical manifestations of spine aneurysmal bone cysts? The teardrop fragment comes from the anteroinferior aspect of the vertebral body. If the spine is affected, they may present with symptoms related to nerve root compression 1,3. subarticular zone stenosiswith nerve root compression. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Hacking C, Weerakkody Y, et al. A 24-year-old male presented with acute low back pain with no prior traumatic events. Brant WE, Helms C. Fundamentals of Diagnostic Radiology. Bone mineral density in cystic fibrosis: benefit of exercise capacity. Focal areas of high T1 and T2 signal 4 are also seen, presumably representing areas of blood of variable age (see aging blood on MRI). These cysts are most commonly found within the vertebral bodies, iliac bones or sacrum. Haithcock JA, Layton KF, Opatowsky MJ. Spinal hemangiomas are the most common primary tumor of the spine. It should be stated that if any sign of malignant lesion was encountered, the surgery would have stopped and only biopsy would have been performed. The reported age ranges from 4 to 50 years, which is usually presented in the second decade [27]. The unicameral bone cyst (UBC), or simple or solitary bone cyst (SBC), is a common, benign, fluid-containing lesion, usually occurring in the metaphysis of long bones.The cause of the lesion is unknown. Treatment is not always required and discal cysts have been reported to spontaneously regress 1. VH are the most common spine tumors with an estimated incidence of 1.9-27% in the general population. Difficult to detect, but sometimes gas lucencies are seen within the vertebral bodies. 15 (3): 333. Surgery shows promising outcomes in large SBCs in the vertebral body with a high risk of fracture. Rapp T, Ward J, Alaia M. Aneurysmal Bone Cyst. Primary bone tumors of the spine are much less common than secondary metastatic disease: plasmacytoma/multiple myeloma: most common primary bone cancer Giant cell tumors have been described at the ends of long bones, characteristically around the knee. Lippincott Williams & Wilkins. Spinal SBC, especially in the vertebral body, is not a common lesion and there is limited data regarding managing these lesions [626]. Gas measures about -580 to -1000 HU in density 3. A: The differential diagnosis of aneurysmal bone cysts is giant cell tumor, chondroblastoma, chondromyxoid fibroma, osteoblastoma, eosinophilic granuloma, and telangiectatic osteosarcoma. 2. , who described a fetus in fetu with spinal . The biology behind the human intervertebral disc and its endplates. Society of Skeletal Radiology- White Paper. The interosseous arteries branch off segmental arteries (one per vertebra) which arise directly from the aorta. (2012) ISBN:1608319113. 2022;6(2):179-83. The neural arch is composed of bilateral pedicles, pars interarticularis, and laminae; from the neural arch arise the spinous process, bilateral transverse processes, and bilateral superior and inferior articulating processes. . MRI Imaging at 0.5 Tesla. The patient had no recurrence seven years after surgery. The following molecular criterion is desirable: USP6 gene (at 17p13.2 locus) rearrangement; occurs in 63% of cases. 3. We discuss the radiologic differential diagnosis of simple vertebral bone cysts, and the surgical and histopathologic verifications of the diagnosis are presented. Figure 1: distribution of unicameral bone cysts, Case 7: with classic "fallen fragment" sign, Case 14: with pathological humeral shaft fracture, bizarre parosteal osteochondromatous proliferation (Nora lesion), conventional intramedullary chondrosarcoma, dysplasia epiphysealis hemimelica (Trevor disease), solitary bone plasmacytoma with minimal bone marrow involvement, mixed lytic and sclerotic bone metastases, Lodwick classification of lytic bone lesions, Modified Lodwick-Madewell classification of lytic bone lesions. vertebral hemangioma. During the active phase, the cyst remains adjacent to the growth plate. 2015 ;15(10):e11, A simple bone cyst in cervical vertebrae of an adolescent patient, Resection and reconstruction of a simple bone cyst of the fourth lumbar spine: a case report and review of the literature, A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the spine oncology study group, Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group, The effects of methylprednisolone acetate in the treatment of bone cysts. There are multiple internal septations with enhancement and fluid-fluid levels. The patient had no recurrence in 10-year follow up. Thus patients should be referred to an orthopedic oncologist 7. Vertebral tumor signs and symptoms may include: Pain at the site of the tumor due to tumor growth. A case report and review of literature, A solitary bone cyst in the spinous process of the cervical spine: a case report, Simple bone cyst in cervical vertebral spinous process and laminae: report of a case, Simple bone cyst of lamina of lumbar spine: a case report, Unicameral bone cyst of a cervical vertebral body and lateral mass with associated pathological fracture in a child. This rare pathognomic radiologic finding is known as fallen fragment sign (12). An aneurysmal bone cyst is an expansile osteolytic lesion with a thin wall, containing blood-filled cystic cavities. Prominent ridges of bone can appear as pseudotrabeculation on x-ray but in fact, UBC is usually unilocular. Its imaging diagnosis is usually difficult, . Unicameral bone cysts were initially described by the German pathologist Rudolf Virchow in 1891 8,9. A: Clinical presentation of spine aneurysmal bone cysts varies depending on the tumor location and involvement of the spinal cord and nerve roots. Saeid Safaei, Mirbahador Athari, Parisa Azimi, Ahmadreza Mirbolook, Taravat Yazdanian, Farhad Hamzehzadeh, Simple bone cyst of spinal vertebrae: two case reports and literature review, Journal of Surgical Case Reports, Volume 2021, Issue 11, November 2021, rjab507, https://doi.org/10.1093/jscr/rjab507. Aneurysmal bone cysts do not express H3.3pGly34Trp, a feature that can be used to differentiate them from giant cell tumors of bone with aneurysmal bone cyst-like changes 1. The surgical intervention, when required, consists of primary closure of the dural defect through a posterior approach, accompanied by laminectomy and/or costotransversectomy.1 Although rare, arachnoid cysts can be a complication of Simple bone cyst (SBC) is not a common lesion in the spine and especially in the vertebral body. They are constituted peripherally by an epiphyseal bone ring and centrally by a cartilaginous layer. No enhancement was observed on T1-weighted images following contrast medium administration (Fig 5). We do not capture any email address. In the spine, the most typical site of localization is the sacrum; other vertebral segments are rarely involved (7). This is referred to as the doughnut signwhich results in increased uptake peripherally and a photopenic center. 7. Aneurysmal bone cysts are multiloculated, expansile, highly vascular, osteolytic lesions that are filled with free-flowing blood products with fluid levels. The reported peak is between 3 and 14 years of age, with the mean age at diagnosis being approximately 9 years. Soft Tissue and Bone Tumours. They may occur in all parts of the skeleton and particularly involve the metaphysis of long bones (5, 7) but occasionally involve spine, especially cervical and thoracic regions. Magnetic resonance imaging (MRI) revealed a well-defined lesion with low signal intensity on T1 and high signal intensity on T2 weighted images (Fig. Lippincott Williams & Wilkins. Embolization is another option 3. This study presents two cases of spinal SBC managed surgically with no recurrence in long-term follow-up. (2000) ISBN: 9780781725286 -, 4. The introduction of bone cement into the vertebral body produces a sclerotic appearance on radiographs and CT, distinguishing this from the lucent appearance of . Coskun B, Akpek S, Dogulu F, Uluoglu O, Eken G. Simple Bone Cyst in Spinous Process of the C4 Vertebra. According to many authors, the lesions in the long bones are due to the developmental defect of the epiphyseal plate (4). Most of the simple bone cysts are asymptomatic, unless they come with pathologic fracture. A: Aneurysmal bone cysts are benign osteolytic lesions comprised of blood-filled channels separated by multiple connective septations containing osteoid tissue and osteoclast giant cells. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Nayman A, Guler I, Erdogan H, Koplay M. Funayama T, Gasbarrini A, Ghermandi R, Girolami M, Boriani S. Boude AB, Vsquez LG, Alvarado-Gomez F, Bedoya MC, Rodrguez-Mnera A, MoralesSaenz LC. (2006) ISBN: 9780781753586 -, 5. Speak With Our Team. Curtis A. Dickman, Michael Fehlings, Ziya L. Gokaslan. Soft Tissue and Bone Tumours. Adam Greenspan, Gernot Jundt, Wolfgang Remagen. show answer. 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