Aneurysmal Bone Cysts: Diagnosis and Treatment Approaches

Aneurysmal bone cysts (ABCs) are benign but often locally aggressive osseous lesions that predominantly affect children and young adults. Once regarded as reactive, they are now recognised as true neoplasms in most cases, frequently driven by rearrangements of the USP6 oncogene. Clinically, ABCs present with pain, swelling or pathological fracture and may affect any skeletal site, with a metaphyseal predilection in long bones and occasional involvement of the spine or pelvis. Radiographically, they characteristically appear as expansile, lytic lesions with multiloculated chambers and fluid–fluid levels; cross‐sectional imaging by magnetic resonance offers superior delineation of cyst extent and soft‐tissue relationships. Histological confirmation is recommended when imaging overlaps with entities such as unicameral cysts or telangiectatic osteosarcoma. Traditional management has centred on intralesional curettage with or without adjuncts—phenol, cryotherapy, laser coagulation—and reconstruction using bone grafts or substitutes. Minimally invasive alternatives, including image‐guided sclerotherapy and selective arterial embolisation, have gained traction. In anatomically challenging sites, off‐label use of denosumab has shown promise in reducing osteoclastic activity and facilitating surgical containment. Long‐term surveillance remains essential to detect and manage recurrence.

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Aneurysmal Bone Cysts: Diagnosis and Treatment Approaches publication trend

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Technical terms

Aneurysmal bone cyst (ABC): A benign bone tumour characterised by blood‐filled cavities separated by septa of connective tissue and osteoid, often driven by USP6 gene rearrangements.

Curettage: A surgical technique involving the scraping of a lesion’s internal surface to remove pathological tissue while preserving surrounding bone.

Sclerotherapy: A minimally invasive procedure in which a sclerosing agent (e.g. polidocanol) is injected to induce fibrosis and obliteration of cystic spaces.

Denosumab: A monoclonal antibody against RANK ligand that inhibits osteoclast formation and activity, used off‐label to promote recalcification in ABCs.

Fluid–fluid levels: Imaging sign on MRI or CT indicating layering of fluids of different densities within cystic chambers, typical of aneurysmal bone cysts.

References

1. Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment. Pediatric Radiology (2022).
2. Primary Aneurysmal Bone Cyst and Its Recent Treatment Options: A Comparative Review of 74 Cases. Cancers (2021).
3. Denosumab Therapy in the Management of Aneurysmal Bone Cysts: A Comprehensive Literature Review. Cureus (2019).