Giant Aneurysmal Bone Cyst of the Anterior Cranial Fossa and Paranasal Sinuses Presenting in Pregnancy: Case Report and Literature Review

Aneurysmal Bone Cyst of the Orbit With USP6 Gene Rearrangement

PURPOSE

Aneurysmal bone cyst (ABC) of the orbit is a very rare tumor, occurring mostly in the pediatric population, and can result in sight threatening complications and disfigurement. This review discusses previously reported cases with a focus on evolving treatment options and molecular genetics.

METHODS

We report the youngest case of an orbital ABC with a confirmed gene fusion: a 17-month-old girl, with confirmed FGFR-UPS6 (Fibroblast Growth Factor Receptor 1-ubiquitin specific peptidase 6/tre-2). A literature search for relevant publications on the topic was performed via Medline and PubMed, with the appropriate data extracted.

RESULTS

Thirty-two cases of orbital aneurysmal bone cyst were identified in the literature. Presentations are varied and can include pain, proptosis, decreased vision, and extraocular motility disturbance. Typical imaging and histopathology findings are discussed, in particular the usefulness of identifying USP6 gene arrangements. Treatment modalities are reviewed including surgery, embolization, and receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors. Recurrences can occur, usually within 2 years.

CONCLUSIONS

Orbital ABC is a neoplasm that presents unique diagnostic and treatment challenges. Gene rearrangements can confirm primary ABC and rule out other underlying pathology. Disfigurement and sight threatening complications can occur due to both the disease process and with treatment. Outcomes may be improved with the use of systemic therapy.

Benign bony tumors of the paranasal sinuses, orbit, and skull base

Benign bony tumors of the skull base and paranasal sinuses are uncommon entities, with an overall higher incidence in males. Benign bony tumors may lead to local expansion with resultant mass effect of potentially critical structures. Some benign bony tumors may undergo malignant transformation. This article reviews the presentation and management of benign bone tumors of the skull base and paranasal sinuses with special consideration to involvement of the adjacent orbit, intracranial and critical neurovascular structures. This review covers tumor incidence, location, gross and histologic appearance as well as radiographic findings, treatment, and recurrence rates. Tumors discussed in this article include osteochondromas, osteomas, osteoid osteomas, aneurysmal bone cysts, fibrous dysplasia, giant cell tumors, cemento-ossifying fibroma, ameloblastic fibro-odontoma, ecchordosis physaliphora, chondromyxoid fibroma, primary chronic osteomyelitis, primary chronic osteomyelitis, osteochondromyxoma, and dense bone islands.

Primary Aneurysmal Bone Cyst of Nasal Cavity and Sinuses in a Child: Case Report and Literature Review

INTRODUCTION

Aneurysmal bone cysts (ABCs) are a rare benign bone lesion, which are divided into primary and secondary categories, and occur mainly in the vertebra and the long tubular bones. Primary ABCs in the nasal cavity and the sinuses are rare.

CASE PRESENTATION

We reported on a one-year-old boy who suffered from progressive nasal obstruction and intermittent nosebleeds over a period of approximately 1 month. The patient had no history of trauma or surgery. Physical examination showed a red tumor in his right nasal cavity. A magnetic resonance imaging scan showed a multicystic lesion arising from the ethmoid sinus. The lesion was resected under a nasal endoscope without any complications. Histological evaluation confirmed that the lesion was an aneurysmal bone cyst. Because an osteoma was found during the surgery on the cyst, the lesion was considered secondary clinically. However, fluorescence in situ hybridization testing showed a rearrangement of the USP6 (ubiquitin-specific protease 6) oncogene on chromosome 17. No recurrence was observed after 1 year.

CONCLUSION

An ABC of the nasal cavity and sinuses in such a young child is very rare and needs to be further analyzed according to postoperative pathology and combined with a genetic examination to make a diagnosis. Endoscopic sinus surgery is an effective method of treatment for this kind of disease.

Aneurysmal Bone Cysts of the Paranasal Sinuses: The Mayo Clinic Experience and Review of the Literature

OBJECTIVE/HYPOTHESIS

Aneurysmal bone cysts (ABCs) are benign, lytic bone lesions, which rarely present in the paranasal sinuses. There is no published consensus on the appropriate diagnostic or treatment approach. Our objective was to elucidate the clinical behavior, treatment, and outcomes for patients with ABCs of the paranasal sinuses (psABCs).

STUDY DESIGN

Retrospective case series and system review of the literature.

METHODS

A retrospective chart review was performed to identify patients evaluated at the authors' institution with psABC and consolidated with literature reports of psABC.

RESULTS

Eighty-nine patients met inclusion criteria. The most common presenting symptom was painless facial swelling (n = 35, 39%). The ethmoid sinuses were the most common site involved (n = 55, 62%). Surgical approach was reported in 74 cases including 20 endoscopic and 54 with an open or combined approach. Fifty-nine patients (71%) underwent gross total resection. Follow up data was reported for 67 patients. Fifteen patients (22%) were found to have recurrence or progression at follow up; 10/15 (66%) patients within the first 12 months, 14/15 (93%) within the first 24 months, and 1/15 (7%) greater than 24 months after treatment. Patients were more likely to have recurrence/progression if they presented with nasal discharge (P = .05), proptosis (P = .01), or orbital involvement (P = .03).

CONCLUSIONS

psABCs typically present with painless swelling or nasal obstruction. Orbital involvement is a negative prognostic indicator with these patients more likely to have recurrence after treatment. Recurrence or progression of disease is most likely to occur within 2 years after treatment. Therefore, patients should be monitored closely during this time.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E2525-E2533, 2021.

Aneurysmal bone cyst of the head & neck: A review of reported cases in the literature

The aneurysmal bone cyst (ABC) is a benign, blood-filled bony lesion that notoriously affects the vertebral column and long bones of the body. Rarely, ABCs can manifest in the head and neck (HNABC). The purpose of this paper is to provide a comprehensive review of existing literature on HNABC. This review includes: case reports and case series on ABCs manifesting in the head and neck region published in the English language. All cases identified via PubMed were analyzed individually. Articles were included according to specified eligibility criteria. The total number of cases analyzed were 72 (39 case reports; 33 case series). The average age at the time of HNABC diagnosis was 19.1 years (range: 0.42-62 years). The ratio of prevalence by gender affected exhibited an even 1:1 male-to-female split. CT in combination with MRI proved to be the most prevalent imaging modality utilized (37.2%). HNABC was most commonly detected in the mandible (37.1%), followed by the sinus (14.3%) and cranium (11.4%). The most frequently employed single treatment modality was surgical excision (94.1%). 94.4% of patients were alive with no evidence of disease at follow-up, while 5.6% of patients exhibited disease at follow-up. The average follow-up period was 3.59 years (range: 0.17-17.0 years). Aneurysmal bone cyst of the head and neck region is a rare condition that should be considered in the differential diagnosis of bony, vascular lesions presenting in the aforementioned locations. Since aneurysmal bone cyst of the head and neck region can present as a rapidly growing, expansive and destructive lesion, it is crucial that clinicians are aware of this entity so that patients are accurately diagnosed and treated.

Secondary Aneurysmal Bone Cyst in a Craniofacial Fibrous Dysplasia: Case Report

Aneurysmal bone cyst (ABC) is a rare non-neoplastic bone lesion that involves mostly the long bones and vertebrae and may occur very rarely in the craniofacial bones. ABCs may occur as secondary bony pathologies in association with various benign and malignant bone tumors and with fibrous dysplasia (FD). FD is a common non-neoplastic bony pathology mostly affecting craniofacial bones. Secondary ABC occurring in craniofacial FD is extremely rare, with only approximately 20 cases reported in the literature to date. Here, we report on a case of secondary ABC in a 25-year-old woman who has had a craniofacial deformity for over 10 years and who presented to us with a rapidly growing painful pulsatile mass in the right frontal region that began over 2 months prior to admission. On thorough examination of computed tomography and magnetic resonance imaging brain scans taken at two-month interval, an aggressive, rapidly enlarging ABC, arising from the right frontal FD, was diagnosed. The patient underwent preoperative embolization followed by gross total resection of the ABC and cranioplasty. The 6-month follow up showed no recurrence of the ABC, nor was any progression of the FD noticed.

Aneurysmal bone cyst of the frontal bone - A radiologic-pathologic correlation

We present a case of 27-year-old female who presented for a progressive frontal swelling with ipsilateral headache. Subsequent CT scan revealed an extradural and expansile multiloculated mass with thin and strongly enhanced septations and MRI evaluation showed internal hyperintensity on T2 with no restriction of diffusion and confirmed the multiple cystic spaces with enhancing septations and rare hemorrhagic fluid-fluid levels. Surgery was performed and diagnosis of aneurysmal bone cyst was made on frozen section. Identification of USP6 fusion gene by in situ hybridization technique permitted to confirm the diagnosis of primary ABC. Although aneurysmal bone cyst (ABC) of the skull is a very rare entity and accounts for 2-6% of all ABCs, we should think about it in front of osteolytic and cystic skull changes even with very few fluid-fluid levels. Following description of our case and differential diagnoses, we conduct a literature review of skull ABCs imaging characteristics and discuss the interest of USP6 rearrangement identification.

Imaging review of the anterior skull base

The anterior skull base (ASB) is intimately associated with the unique soft tissue subtypes of the nasal cavity, paranasal sinuses, orbits, and intracranial compartment. Pathology involving the ASB is rare but the causes are manifold and can be broadly subdivided into those intrinsic to the skull base and processes extending from below or above. Sinonasal pathology is the most commonly encountered and poses significant management challenges that rely heavily on accurate interpretation of the radiological findings. We illustrate the normal anatomy of the ASB and present a cross-sectional imaging review of the pathological entities that may be encountered, focusing on the specific features that will impact on clinical and surgical management.

An Aneurysmal Bone Cyst in the Skull Base

An aneurysmal bone cyst (ABC) is believed to be attributable to intraosseous circulatory disturbance. An ABC is a vascular tumor of the bone caused by bony expansion after partial vascular occlusion and congestion. Most ABCs are found in adolescents (approximately 75% of ABCs are observed in patients under 20 years of age). The most common ABC sites are the long bones of the limbs, the vertebrae, and the cranial bone. Aneurysmal bone cysts in the skull base or ethmoid sinus have been but rarely reported worldwide. The authors report on a patient with a very large ABC in the skull base and the ethmoid sinus; this was successfully managed by a neurosurgeon.

Paediatric aneurysmal bone cyst: not as easy as ABC

Aneurysmal bone cysts (ABCs) are expansile cystic lesions that can affect any bone of the body. Whilst these lesions are histologically benign, the lesions are locally aggressive and can affect the integrity of the affected bone as well as surrounding structures. ABCs arising in the head and neck region, particularly the paranasal sinuses are rare and they are limited to case reports in the literature. Due to the proximity of critical anatomical structures and the visual apparatus, the potential complications can be devastating. The present article discusses both the clinical and radiological findings of an ABC arising from the ethmoid sinuses in a 6-year-old child and the potentially challenging diagnosis with its complex ensuing surgical management. The identification of an ABC arising in the paranasal sinuses is both a diagnostic and surgical challenge and ideally requires complex management in a joint paediatric ENT and craniofacial unit.

Frontal skull osteoblastoma with aneurysmal bone cyst-like changes associated with trauma during pregnancy: a case report

We report the case of a large osteoblastoma arising in the frontal bone of a 20-year-old female. The lesion was first noted after a fall, and grew steadily in size following further head injury during pregnancy. Initial plain radiography demonstrated an area of radiolucency, with subsequent cross-sectional imaging revealing the extent of the lesion. Following successful surgical resection, histological features were suggestive of an aggressive osteoblastoma with aneurysmal bone cyst-like changes. We consider the influence of pregnancy and trauma on osteoblastoma behavior.