Aneurysmal bone cyst

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]


Aneurysmal bone cyst (ABC) accounts for 1% to 2% of all primary bone tumors. The incidence of aneurysmal bone cyst is approximately 0.14 per 100,000 individuals worldwide. Adolescents and children are most affected by aneurysmal bone cyst. The age distribution of aneurysmal bone cyst is between 1.5-25 years. The mean age of the patients with aneurysmal bone cyst is 16 years. Women are more commonly affected than men, with a 1:0.84 ratio. In 1942, Jaffe and Lichtenstein first described aneurysmal bone cyst. Aneurysmal bone cyst can be classified based on mechanism of origin into primary and secondary. The true causes of aneurysmal bone cyst are not known. ABCs usually present in the long bones such as the humerus, femur, tibia and fibula. About 25% of ABC's are seen in posterior element of spine. ABC's typically occur in the metaphysis of the long bones. The hallmark of ABC is Pain, swelling and pathological fracture. The mainstay of treatment for ABC is surgery in form of curettage and bone grafting.

Historical Perspective

  • In 1942, Jaffe and Lichtenstein first described aneurysmal bone cyst.[1][2]
  • In 1940, Ewing propoosed that aneurysmal bone cyst was caused by increased venous pressure.
  • In 1956, Cruz and Coley also supported Ewing's hypothesis.
  • In 1956, Barnes hypothesized that aneurysmal bone cyst was due to an abnormal response to injury.
  • In 1956, Otterdoom after a thorough pathological study, concluded that aneurysmal bone cyst was an angioma of bone.


  • Aneurysmal bone cyst(ABC) can be classified based on imaging findings and on mechanism of origin.

Mechanism of Origin

Based on mechanism of origin, aneurysmal bone cyst can be classified into:[3][4]

Primary Aneurysmal Bone Cyst(ABC)

  • When ABC arises de novo, it is called primary ABC.
  • About 70% of ABC's are primary in origin.

Secondary Aneurysmal Bone Cyst(ABC)

Enneking (MSTS) Staging System

Stages Description
1 Latent: Well demarcated borders
2 Active: Indistinct borders
3 Aggressive: Indistinct borders


  • The exact pathogenesis of aneurysmal bone cyst is not fully understood.[6][7]
  • Various theories have been proposed concerning the pathogenesis of aneurysmal bone cyst:
    • Local alteration in hemodynamics resulting in markedly increased venous pressure and development of a dilated vascular bed within the involved bone.[8][9]
    • Primary ABCs demonstrate a t(16;17)(q22;p13) fusion of the TRE17/CDH11-USP6 oncogene leading to increased cellular cadherin-11 activity which arrests osteoblastic maturation in a more primitive state.[10][11][12]
  • ABCs usually present in the long bones such as the humerus, femur, tibia; and fibula.
  • About 25% of ABC's are seen in posterior element of spine.
  • ABC's typically occur in the metaphysis of the long bones.


Differentiating Aneurysmal Bone Cyst from Other Diseases

Aneurysmal bone cyst must be differentiated from following bone disorders:

Disease Bubbly lytic lesion on x-ray Lakes of Blood on histology Diagnosis Treatment is curretage and bone grafting
Aneurysmal bone cyst + + Radiology and biopsy +
Unicameral bone cyst + - Radiology and biopsy -
Non ossifying fibroma + - Radiology and biopsy -
Giant cell tumor - - Radiology and Biopsy +
Chondroblastoma - - Biopsy +
Chondromyxoid Fibroma - - Radiology and biopsy +
Osteoblastoma - - Radiology and biopsy +
Telangiectatic osteosarcoma - + Radiology and biopsy -

Epidemiology and Demographics

Risk Factors

There are no established risk factors for aneurysmal bone cyst.


There is insufficient evidence to recommend routine screening for aneurysmal bone cyst.

Natural History, Complications, and Prognosis


Diagnostic Study of Choice

History and Symptoms

Physical Examination

X-ray showing aneurysmal bone cyst of left proximal femur.Source: Case courtesy of Dr Lawrence Chia Wei Oh,, rID: 28998
  • Common physical examination findings of aneurysmal bone cyst include:
    • Deformity
    • Decreased range of motion, weakness, or stiffness
    • Torticollis
    • Occasionally, bruit over the affected area
    • Warmth over the affected area

Laboratory Findings

There are no diagnostic laboratory findings associated with aneurysmal bone cyst.


There are no ECG findings associated with aneurysmal bone cyst.


CT scan showing aneurysmal bone cyst of posterior element of spine.Source: Case courtesy of RMH Neuropathology,, rID: 29294
  • Radiologically aneurysmal bone cyst can be stratified into 4 phases:[23]
    • Initial phase 1 – Small, lytic lesion without evidence of lifting off of the periosteum.
    • Phase 2 - Rapidly enlarging demonstrating a characteristic blowout appearance.
    • Phase 3 - Growth slows or stops after some sort of intervention.
    • Phase 4 - Healing with progressive ossification and calcification of the cavity.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with aneurysmal bone cyst.

CT scan

  • CT scan confirms the x-ray findings.[24]
  • In addition, CT demonstrates internal septation such as calcified rim, giving an eggshell appearance, which may be completely or partially intact.
  • Fluid-fluid levels can also be seen.


MRI showing aneurysmal bone cyst of left proximal femur.Source: Case courtesy of Dr Lawrence Chia Wei Oh,, rID: 28998

Other Imaging Findings

Bone Scan

  • Increased uptake is observed around the lesion of aneurysmal bone cyst.
  • Findings often demonstrate a halo effect of increased radionuclide uptake surrounding an area of little uptake.

Other Diagnostic Studies


  • Angiography demonstrates a hypervascular area around the aneurysmal bone cyst.
  • An intense diffuse area of persistent contrast accumulation may be visualized without main afferent or efferent vessels observed.
  • It can be helpful to plan selective arterial embolization as the primary treatment or as a preoperative method to help control intraoperative blood loss.


Medical Therapy

There is no treatment for aneurysmal bone cyst, the mainstay of therapy is surgery.


Aggressive curettage with adjuvant and bone grafting


  • Symptomatic aneurysmal bone cyst without acute fracture



  • Local recurrence in up to 25% and more common in children with open ephyses.

Primary Prevention

There are no established measures for the primary prevention of aneurysmal bone cyst.

Secondary Prevention

There are no established measures for the secondary prevention of aneurysmal bone cyst.


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