Aneurysmal bone cyst versus hemangioma of the mandible. Report of a long-term follow-up of a self-limiting case

A Radicular Cyst and an Aneurysmal Bone Cyst Converging in the Maxilla: A Concurrent Encounter

We present a unique case of a patient in early adolescence presenting with swelling in the upper left back region of the jaw, attributed to a failed root canal treatment of the upper left first molar. Clinical and radiographic assessments led to a preliminary diagnosis of a radicular cyst. Surgical enucleation revealed unexpected findings, with a steady ooze of blood encountered from one side of the lesion and the retrieval of an epithelial lining from the other side. Histologic examination confirmed the presence of both a radicular cyst and a secondary aneurysmal bone cyst (ABC). To the best of our knowledge, this is the first reported case of an ABC of the maxilla coexisting with a radicular cyst. This case underscores the importance of thorough evaluation and histological examination in cases of suspected cystic lesions, as well as the potential for unexpected findings and coexisting pathologies.

First report of an aneurysmal bone cyst presenting as subungual mass

Painful subungual tumor masses in the toes usually emerge as glomus tumors or subungual exostoses. We present a patient with an aneurysmal bone cyst located subungually in whom the diagnosis was delayed due to inadequate diagnostic procedures, which led to marked destruction of the distal phalanx of the great toe of the right foot. After biopsy, the distal phalanx could not be preserved due to critical soft tissue involvement and the size of the process. Thus, we describe this rare entity to encourage clinicians to establish the diagnosis by biopsy of a tissue swelling of unclear origin and duration that does not resolve after a short time. Imaging examinations are useful in demonstrating periosteal involvement and extension of the lesion and can be helpful in the diagnostic algorithm. An interdisciplinary approach is a top priority to ensure optimal treatment.

Assessment of 120 maxillofacial aneurysmal bone cysts: a nationwide quest to understand this enigma

PURPOSE

Compared with other maxillofacial lesions, oral and maxillofacial (OM) aneurysmal bone cysts (ABCs) are rare, and most studies have been case reports. Because the features or radiographic findings of 1 case could not be representative of the whole, conclusions cannot be drawn and data analyses will not be feasible. Our aim was to assess and describe the clinical and histopathologic characteristics of a large sample of subjects with ABCs. To our knowledge, the present case series of OM ABCs is the largest ever reported.

MATERIALS AND METHODS

To address our research purpose, we designed and implemented a retrospective case series. A multicenter retrospective cohort study of patient charts dated from 1967 to 2013 (46 years) at 10 major universities in 8 cities was undertaken to assess OM ABCs nationwide. Subjects were included if they had documented chart data and definitive histopathologic slides confirming the diagnosis and treatment of ABC. They were excluded if their histopathologic slides did not confirm the diagnosis of an ABC. Data were collected, and special forms were completed. Variables such as age, gender, site (ie, maxilla, mandible, anterior, posterior), histologic type (ie, solid, mixed, vascular), signs, symptoms, radiographic features (ie, radiolucency, unicystic or multilocular), and outcomes (ie, treatment modal, recurrence, complications) of the lesion were evaluated and documented by OM surgeons and confirmed by OM pathologists for assurance. Data analyses were performed using Statistical Package for Social Sciences, version 20, software (SPSS, Chicago, IL) (P < .05).

RESULTS

We assessed the medical records and histopathologic slides of 120 patients diagnosed and treated for OM ABCs nationwide. Of these patients, 69 were male (57.5%) and 51 were female (42.5%), with no predilection found. The key findings were as follows. The mean age of occurrence was 20.7 ± 2.5 years (range 4 to 78), and occurrence was significantly greater in the first 2 decades of life (P < .001). The incidence was 2.6 cases/year. ABCs were significantly more common in the mandible (P < .05) and posterior areas (P < .05). The most common histopathologic type was the mixed type (P < .05). Firm swelling was the most common clinical presentation (P < .05); all cases were radiolucent and commonly unilateral (P < .05). Most were treated by excision and curettage. Recurrence was reported in 11 patients (9.2%) during the follow-up period (1 to 45 years).

CONCLUSIONS

The present retrospective cohort found ABCs with a variable presentation, disease course, and histopathologic type, with no gender predilection. ABCs were significantly more common in childhood and adolescence and in the mandible and posterior areas of the jaws. Of the cases reviewed, 90% were treated by excision and curettage. ABCs had a relatively low recurrence rate (<10%), precluding the need to perform aggressive surgery primarily.

Solitary osseous capillary-type vascular malformation of the distal humerus in a child

Vascular malformations are abnormal proliferations of the endothelial lining of the blood vessels that are most commonly found in skin and can penetrate the local soft tissue and muscle. Only 1% of all vascular malformations are found in the bone. Skeletal vascular malformations of the long bones, including the humerus, are extremely rare entities that are particularly uncommon in children. Only 4 reports involving the humerus have been described in children previously. We present the case of an intraosseous capillary vascular malformation of the right distal humerus in a 3-year-old boy. Definitive treatment was successful with a single operation using curettage and intramedullary decompression with grafting of an osteoconductive calcium sulfate pellet filler and autogenous bone graft. This is, to our knowledge, the youngest reported case of a solitary intraosseous capillary vascular malformation involving the distal humerus.

Extensive giant cell tumour of the mandible: a case report with review

Giant Cell Tumour (GCT) is a rare benign, osteolytic, pseudocystic solitary localized lesion. The lesion is common in skeletal structure but not as common in craniofacial skeleton. They are composed of sinusoidal and vascular spaces filled with blood and surrounded by fibrous tissue septa. There is a controversy as to whether it is a distinct radiological and pathological entity or a pathological change superimposed on a preexisting lesion. We present a case of a 19 year old female patient who reported with swelling and pain in the right mandible associated with pain and gradual increase in size since 4 years. On the radiographic study expansive, multilocular lesion extending to right coronoid process was observed. Incisional biopsy showed the lesion to be a dental cyst, however, enucleation with curettage of the cyst confirmed it to be GCT. GCT are non neoplastic but locally aggressive tumors with occasional rapid growth that may be differentiated from other multilocular lesions like ameloblastoma, giant cell granuloma and sarcomas. There have been reports which have appeared regarding its pathogenesis, response to treatment. However many questions remain regarding its treatment and prognosis.

Aneurysmal bone cyst, a lesion of the mandibular condyle

Benign and malignant tumors of the temporomandibular joint are rare. An aneurysmal bone cyst (ABC) of the condyle is even more unusual and usually presents as a slowly enlarging firm swelling which occasionally may be associated with pain and tenderness. Surgical curettage or excision is the treatment of choice, in an attempt to reduce the potential problem of recurrence; we undertook surgical resection of the affected bone. Immediate mandibular reconstruction using autologous bone was deferred though it is generally recommended in such type of cases.

Giant aneurysmal bone cyst of the mandible

The aneurysmal bone cyst is a type of pseudocysts of the jaw. It is a nonneoplastic lesion of the bone, characterized by replacement with fibro-osseous tissue containing blood-filled sinusoidal or cavernous spaces. The lesion remains a relatively uncommon finding in the facial bones, and the cause and pathogenesis are yet to be elucidated. Aneurysmal bone cyst was first described as a distinct clinical and pathologic entity by Jaffe and Lichtenstein in 1942. Aneurysmal bone cyst comprises 1.5% of all nonodontogenic cysts of the jaws and 1.9% of all aneurysmal bone cysts of skeleton. A rare case of giant aneurysmal bone cyst of mandible in a 10-year-old child is presented, which was managed by surgical curettage with a long-term follow-up.

Review Article: Aneurysmal Bone Cysts of the Jaws

Aneurysmal bone cyst (ABC) is a osteolytic bone lesion that rarely involves the jaws. To date, a total of 92 cases of JABCs have been described in detail in English literature. They prevalently occur in the first 2 decades (72.8%) with slight female predilection. It affects the mandible more often (68.5%) with a predominant location in the mandibular ramus (31.3%) and its posterior regions (20.4%). A painless (54.7%) or painful (43.2%) bone swelling is the most frequent clinical sign. Radiologically 93.8% of the lesions present as a radiolucency; in 69.4% multilocular in appearance. 15.2% of JABCs were secondary in nature, including 8 cases associated with fibrous dysplasia. The recurrence rate (13.3%) did not differ significantly when comparing the surgical technique (curettage, 15.2%; resection, 11.8%). JABCs are known for their different clinical and radiographic features, therefore often posing a diagnostic dilemma. Some JABC's may be secondary in nature. Careful curettage is considered to be suitable as treatment for JABCs.

Variable presentations of aneurysmal bone cysts of the jaws: 51 cases treated during a 30-year period

PURPOSE

Our study aimed to assess the clinicohistopathological features of maxillofacial aneurysmal bone cysts (ABCs) to distinguish parameters significant to diagnosis and treatment, adding to the body of literature on the subject.

MATERIALS AND METHODS

Fifty-one patients with maxillofacial ABCs treated during a 30-year period were evaluated. The demographics, histopathological findings, site, age, gender distribution, and types of maxillofacial ABCs were evaluated. The data, therapeutic results, and recurrences were then analyzed.

RESULTS

Fifty-one patients diagnosed and treated for ABCs were studied in our series. These included 29 (56.9%) males and 22 (43.1%) females ranging in age from 7 to 58 years, with a mean age of 19.53 +/- 10.79. More than 3/4 of the lesions involved the mandible. ABCs were significantly more common in the mandible and in the first 2 decades of life (P < .05). The site distribution of the location of ABCs within the arch was about equal. Rapidly growing swelling was a significant clinical feature in the majority of the cases (92.2%). ABCs had variable radiographic presentation, but all were radiolucent. All cases were treated by excision and curettage with 84.4% success in the first operation. Eight patients (15.6%) had recurrences after treatment during the follow-up period (2-30 years).

CONCLUSION

Maxillofacial ABCs are uncommon lesions with variable clinical and histological presentations that often respond to treatment by surgical curettage. Recurrence may be attributed to incomplete removal of the lesion.

Cystic lesions of the mandible and maxilla

Cystic lesions appearing in the maxilla and mandible have been shown with their typical radiographic features. In addition, this article has presented radiographic techniques used to diagnose these lesions. Cysts of the jaws are classified into two categories: odontogenic and nonodontogenic. Key features to differentiate among these cysts have been discussed. Finally, the article discussed the differentiation of jaw cysts from benign tumors that appear in the jaws.

MR features of aneurysmal bone cyst of the mandible and characteristics distinguishing it from other lesions

Aneurysmal bone cyst (ABC) is a relatively rare, non-neoplastic expansile lesion of bone. Bleeding may occur during an operation or biopsy for ABC, as this cyst is an aneurys with numerous pools of blood. Therefore, it is necessary to diagnose ABC before treatment or biopsy. In the present report, we describe the characteristic computed tomography (CT) and magnetic resonance imaging (MRI) features of ABC in the mandible. Based on the literature and on our own experiences, we compare with the features of ABC with the corresponding features of other lesions showing similar conventional radiographic appearances. In the present case, bone-targeting CT showed the characteristic feature, which reflected the histopathological appearance of a partially cystic meshwork divided by coarse septa. MRI showed almost homogeneous intermediate signal intensity, including a partial slight low-signal-intensity area on the T1-weighted image, and homogeneous high signal intensity, which showed a 'bubbly' appearance, on T2-weighted image. On the enhanced T1-weighted image, the intermediate signal intensity areas apart from the areas that showed slight low-signal intensity on the non-enhanced T1-weighted image, were well enhanced. This creates a 'honeycomb' appearance. The 'meshwork' appearance on bone-targeting CT, the 'bubbly' appearance on the T2WI and the 'honeycomb' appearance on Gd-T1WI may be the characteristic features of ABC.

Aneurysmal bone cysts of the jaws: clinicopathological features, radiographic evaluation and treatment analysis of 17 cases

This article re-evaluates the various clinicopathological presentations and array of radiographic features displayed by aneurysmal bone cysts (ABCs) of the jaws. In this retrospective clinical study, 17 cases of ABCs of the jaws surgically treated during an 11-year period from 1986-1997 are evaluated. The age and sex distribution, diagnostic characteristics, mode of treatment and long-term surgical results are presented and compared with the international literature. Investigation included serial clinical examinations, appropriate radiographic evaluation, CT scans and angiograms when indicated. All the patients had mandibular lesions and were managed by complete surgical curettage of the lesions. Ten were in males (58.8%) and seven (41.2%) in females. The mean age of occurrence was 21.05 years, ranging from 7 to 58 years. Clinical presentation in these patients ranged from an asymptomatic incidental radiographic finding to an expanding, rapidly progressive and destructive lesion resulting in a pathological fracture. Radiographic findings varied from unicystic radiolucencies or moth-eaten radiolucencies to extensive multilocular lesions causing bilateral expansion and destruction of the mandibular cortices. Twelve of the patients (70.5%) could recall a history of trauma. Needle aspiration with a 16 or 18 guage needle was positive, producing syringes full of blood in all but two of the cases (88.2%). Six cases (35.2%) were extremely vascular and had increased rapidly in size, and three required angiographic studies for preoperative diagnosis and differentiation from other vascular entities. Nine of the cases (52.9%) were found in the mandibular angle-ramus area. Four cases (23.5%) required extraoral surgical access for curettage while the remainder were treated intraorally. During the follow-up period, which ranged from 2-11 years, no recurrences have occurred. Restoration of facial symmetry and bone formation has been favourable in all patients, despite the fact that grafts were not used. This 11-year study shows that ABCs present with varied clinicopathological and radiographic features and thus may pose a diagnostic dilemma. As we have not noted any recurrences following surgical curettage of mandibular lesions, we feel that initial surgical resection or bone grafting is not necessary, provided that adequate access and complete curettage can be obtained.

Aneurysmal bone cysts of the maxilla: a clinicopathologic review

PURPOSE

This study evaluated the significant differences in clinicopathologic features of aneurysmal bone cyst in the maxilla and mandible.

MATERIALS AND METHODS

A search of the literature showed 30 recorded maxillary cases, and these together with one previously unrecorded case formed the basis of the study.

RESULTS

There were no differences in the age and sex incidence. Only two patients complained of pain, and no patient complained of tenderness. No patient gave a history of trauma. Swelling was present in virtually every patient. In seven cases, there was tooth mobility or migration of teeth. Two patients complained of paresthesia. Four patients presented with proptosis, two of whom complained of diplopia. The radiographic appearance of the aneurysmal bone cyst is suggestive but not diagnostic.

CONCLUSION

Although these differences do not enable the clinician to make a definitive diagnosis before biopsy, they have important implications for management.