A 13-year-old female presented with a 6 month history of pain and swelling in her right thigh. On examination, a solitary 6x8 cm swelling was observed on the medial aspect of the right thigh. Imaging revealed an expansile osteolytic lesion in the femur diaphysis. Differential diagnoses included unicameral bone cyst, aneurysmal bone cyst, and telangiectatic osteosarcoma. Histopathology of a biopsy was consistent with aneurysmal bone cyst, which are benign, expansile lesions composed of blood filled spaces most commonly seen in children and adolescents. Surgical curettage and bone grafting is the traditional treatment, with a recurrence rate of around 20%.

1. PRESENTER : Dr. SAUMYA AGARWAL
Junior resident Dept of Orthopaedics
J.N.Medical College and Dr. Prabhakar
Kore Hospital and MRC, Belgaum

2. NAME : XYZ
AGE : 13 Yrs
SEX : FEMALE
I.P NO. : 659161
ADDRESS : RESIDENT OF BELGAUM
OCCUPATION : STUDENT

3.  Patient complaints of pain in right thigh since
2 months
 Swelling in right thigh since 2 months

4.  Patient was apparently alright 2 months back
when she started complaining of pain in right
thigh due to injury with a bench.
 Pain was insidious in onset, gradually progressive,
aggravated on working and relieved on rest
and later it was present at rest and during night.

5.  Swelling was insidious in onset and was initially
peanut size and now progressed to present size
(06×08cm)
 Swelling is associated with pain which is dull
aching in nature and intermittent.

6. No history of :
1) Fever
2) Significant Loss of body weight
3) Steroid intake
4) Seizures
5) Other joint pain

7.  No history of similar complaints in the past.
 Not a Known case of Diabetes Mellitus, Hypertension
and Ischemic heart disease.
 Not a known case of Tuberculosis, hyperthyroidism
and other chronic illness.
FAMILY HISTORY
 Nothing significant

8.  Diet : Mixed
 Appetite : Not decreased
 Sleep : Disturbed
 Bowel & Bladder : Normal and regular

9.  Patient is conscious, cooperative and well oriented to time ,
place and person .
 Moderately built
 Afebrile
 Pulse – 76 /min
 Blood pressure - 116/80 mmHg
 Respiratory rate – 20 / min
 No pallor / cyanosis / edema / icterus / clubbing /
lymphadenopathy

10.  CVS : S1 S2 heard, No murmurs
 RS : Air entry equal on both sides
 PA : Soft, Non tender, no organomegaly, Bowel
. sounds heard
 CNS : No focal neurological deficit

11.  Gait – Antalgic gait
 Attitude – Patient is in supine position with
both patella facing upward and outward and
foot facing outwards.

12. INSPECTION – Left thigh – normal
 Right thigh –
 A solitary swelling over medial aspect approximately
6*8 cm with smooth surface and ill defined margins
 There are dilated veins over swelling
 Skin over the swelling appears normal

13.  No any sinus / scar / discharge / inflammatory
changes
 No evidence of shortening of both lower limbs

14. PALPATION –
 All the inspectory findings were confirmed
 local rise of temperature present
 Tenderness – present over the right thigh
 a solitary swelling over medial aspect of thigh
measuring 06*08 cm with ill defined edge
 hard in consistency, not mobile

15.  Range of movement of right hip restricted
terminally
 Range of movement of right knee restricted terminally
 No muscle wasting
 Toe movements – present
 Distal pulses – felt on both sides
 No neurological deficit

16.  Hb – 11.4 gm%
 TLC – 8920/ cumm
 RBC - 4,50000 / cumm
 ESR – 14
 Platelet count – 2,53000/ cumm
 PCV - 36.3
 Blood Group – B +

17.  S. Creatinine – 0.9
 Blood Urea – 19
 S. Sodium – 138 meq/l
 S. Potassium – 4.8 meq/l
 S. Calcium - 9.8
 S. Alkaline phosphatase – 600

20.  An expansile osteolytic lesion seen in
diaphysis of femur with thin sclerotic rim.

21. 1) Unicameral bone cyst
2) Aneurysmal bone cyst
3) Telengiectatic osteosarcoma

23. Aneurysmal bone cysts (ABC)
are benign expansile tumour-like
bone lesions of uncertain
aetiology, composed of numerous
blood filled channels, and mostly diagnosed
in children and adolescents

24. Aneurysmal bone cysts are primarily seen in
children and adolescents, with 80% occurring in
the patients less than 20 years of age with female
preponderence

25. ABCs consist of blood-filled spaces of variable size
that are separated by connective tissue containing
trabeculae of bone or osteoid tissue and osteoclast
giant cells.
They are not lined by endothelium.
FNAC is usually non-diagnostic and is dominated by
fresh blood

26. Peculiar lesion of the bone characterized
by the presence of multilocular cystic
tissue filled with blood.
Benign, locally destructive, prone for
recurrence.
No underlying condition can be
identified radio graphically/
microscopically.

27.  Spongy, multilocular cystic
lesion filled with blood (
size varies from 1 mm-
several cms.).
 Small amount of spongy red
brown soft tissue or thin
membranous septa.
 Borders- Irregular,
lobulated, sharply
demarcated.

28. • Vascular spaces.
• osteoclast like giant cells.
• Intervening stroma is
cellular, no malignant
osteoid.
• Solid areas-spindle cell
proli
• Mitosis.
• Chondroid areas-benign.
• Degen. calcifying
fibromyxoid tissue.

29.  Aneurysmal bone cysts that are superimposed on a
pre existing condition.
 M/C - < 20 years.
 In contrast to primary, M/C seen in weight bearing
bones.

30.  Similar to primary aneurysmal bone cyst along with
residual foci with microscopic features of an
underlying condition.

31.  Patients may present with pain, which may be
of insidious onset or abrupt due to pathological
fracture, with a palpable lump or with restricted
movement.

32. They are typically eccentrically located in
the metaphysis of long bones, adjacent to an
unfused growth plate.
Although they have been described in most
bones, the most common locations are
long bones: 50-60%, typically of the metaphysis
 lower limb: 40%
tibia and fibula: 24%, especially proximal
tibia
femur: 13%, especially proximally
 upper limb: 20%

33. spine and sacrum: 20-30%
 especially posterior elements, with
extension into vertebral body in 40%
of cases
craniofacial: jaw, basi-sphenoid, and
paranasal sinuses

34.  Radiographs demonstrate sharply defined,
expansile osteolytic lesions, with thin
sclerotic margins.
 CT will demonstrate these findings to a
greater degree, and is also better at
assessing cortical breach and extension into
soft tissues.

35.  Doughnut sign: increased uptake
peripherally with a photopenic centre.

36.  Traditionally these lesions have been treated
operatively (curettage and bone grafting) with a
recurrence rate of ~20% (range 11-31%)
 Percutaneous treatment with fibrosing agents has
also been performed, either in isolation as a
precursor to surgical excision