Occipital aneurysmal bone cyst secondary to eosinophilic granuloma

Unusual presentation of aneurysmal bone cyst (ABC) in children: pediatric intracranial osteosarcoma with secondary ABC

A 13-year-old female patient presented with painless vision loss and proptosis for 18 months. Imaging findings were highly suggestive of a supraorbital aneurysmal bone cyst (ABC) for which she underwent complete surgical excision. Postoperatively, she developed left hemiparesis. Computed tomography angiography (CTA) revealed right complete internal carotid arterial (ICA) thrombosis. This was managed conservatively, and she improved in hemiparesis over the next 3 weeks. Histopathology report revealed osteosarcoma with secondary ABC, for which she was referred for radiotherapy. At 1.5 months follow-up, the patient's left lower limb power improved to 4 + /5. She was walking without support, and her left upper limb power was 4/5.

Langerhans cell histiocytosis with aneurysmal bone cyst-like changes: a case-based literature review

BACKGROUND

Langerhans cell histiocytosis (LCH) is a neoplastic transformation of myeloid precursors that commonly presents as an osteolytic lesion of the long or flat bones in children. Aneurysmal bone cysts (ABC) are benign neoplasms that frequently affect the metaphysis of long bones and the spine, often revealing a rapidly expansile lesion with fluid-fluid levels. LCH with secondary ABC-like changes is a rare condition that has only been reported five times, with two presentations in the cranium. The aim of this paper is to review the etiology, clinical and radiographic presentations, and treatment of this condition, as well as to present a novel case on the topic.

CASE DESCRIPTION

We describe a 5-year-old boy with a rapidly growing head mass and eye pain resulting in a diagnosis of LCH with secondary ABC-like changes. Radiography demonstrated an expansile, lytic lesion of the left parietal bone with fluid-fluid levels. A confirmatory diagnosis was made through histopathology, demonstrating an inflammatory, histiocytic infiltrate staining positive for CD1a, CD68, CD207 (Langerin), and S-100. The lesion was surgically excised, and the patient recovered without any complications.

CONCLUSION

We present a novel case of LCH with secondary ABC-like changes managed with surgical excision. While a radiographic workup with multiple imaging modalities is helpful for diagnosis, a thorough immunohistochemical analysis is essential as imaging characteristics are variable and nonspecific. Furthermore, surgical excision should be considered first-line treatment for lesions involving the skull in surgically accessible areas as it is curative, alleviates symptoms, and allows for histopathological diagnosis.

Clinical and magnetic resonance imaging feature differences between solitary and multiple type Langerhans cell histiocytosis involving the craniofacial bone

PURPOSE

To investigate the clinical and contrast-enhanced magnetic resonance imaging (MRI) features of craniofacial bone Langerhans cell histiocytosis (LCH) and discuss the differences between a solitary lesion group (SLG) and multiple lesions group (MLG).

METHOD

This study included 22 consecutive patients with pathologically proven LCH who underwent contrast-enhanced MRI. The clinical data and MRI features were retrospectively assessed.

RESULTS

The mean patient age was 5 years, and 15 patients were male. The frontal bone was the most frequently affected bone. Ten and 12 patients were classified into the SLG and the MLG, respectively. The following MRI features were observed in >50% cases: T1WI hyperintensity in 15 (68%) cases, T2WI hyperintensity in 16 (73%) cases, bulging sign in 18 (82%) cases, concentric or eccentric soft tissue mass formation in 13 (59%) cases, soft tissue edema in 16 (73%) cases, any grade of bone marrow edema in 16 (73%) cases, surrounding bone enhancement in 17 (77%) cases, and surrounding soft tissue enhancement in 16 (73%) cases. Patient age was significantly higher in the SLG than that in the MLG (P = 0.0014). Perilesional bone marrow edema and enhancement were significantly more prominent in the SLG than in the MLG (P = 0.032, P = 0.040).

CONCLUSIONS

Contrast-enhanced MRI showed additional significant findings of mainly the surrounding details. Older age, extensive bone marrow edema, and enhancement may indicate solitary-type LCH rather than multiple-type LCH. These differences may help distinguish between solitary- and multiple-type LCH, which have different treatment strategies.

LCH of the Scapula in a 2-Year-Old Masquerading as an ABC: A Case Report and Literature Review

We describe a unique case of Langerhans Cell Histiocytosis (LCH) arising in the scapula of a 2-year old male child masquerading as an aneurysmal bone cyst (ABC) at clinical presentation and on imaging. Scapular involvement is only occasionally noted in LCH cases. Solitary bone involvement in our patient’s age group is uncommon in LCH without multi-organ involvement. Careful pathologic examination and immunohistochemistry was crucial in establishing this diagnosis due to the presence of a solitary lesion with fluid-fluid levels.

Secondary aneurysmal bone cyst in Langerhans cell histiocytosis: Case report, literature review

Langerhans cell histiocytosis (LCH) is a rare disease of the myeloid precursor cells, it predominantly occurs in the skull and long bones as unifocal bone lesions. Aneurysmal bone cysts (ABC) are benign, expansive and lytic bone. Reports of secondary ABC occurring in LCH are rare, having only been reported twice in the skull. Here, we report the first case of LCH masquerading as ABC in a 14-month-old female child who presented with a rapidly growing mass in her left femur. The lesion had typical radiological features of ABC, and only histological examination revealed the presence of cells suggestive of LCH.

CT and MRI of pediatric skull lesions with fluid-fluid levels

Fluid-fluid levels can occur whenever different fluid densities are contained within a cystic or compartmentalized lesion, usually related to the evolution of hematoma or necrosis. Review of the literature demonstrated that throughout the skeletal system, the most common etiology for fluid-fluid levels is aneurysmal bone cyst, but there are no dedicated studies of the pediatric calvaria, to our knowledge. In this report, we present clinicopathologic characteristics and CT and MR imaging of 11 patients with pediatric skull mass lesions demonstrating fluid-fluid levels. MR imaging demonstrated more fluid-fluid levels compared with CT in all cases. The etiologies of skull lesions with fluid-fluid levels were Langerhans cell histiocytosis in 4 (36.6%), aneurysmal bone cysts in 3 (27.2%), cephalohematoma in 3 (27.2%), and metastatic neuroblastoma in 1 (9%). Radiologists should be aware of the other etiologies of calvarial lesions with fluid-fluid levels in the pediatric skull.

Giant pediatric aneurysmal bone cysts of the occipital bone: case report and review of the literature

Cranial aneurysmal bone cysts are uncommon. Cranial aneurysmal bone cysts of the occipital bone are exceedingly rare. A 2-year-old toddler with this rare cyst presented with a large space-occupying lesion of the posterior fossa, with cerebellar tonsillar herniation. The patient experienced complete recovery after total excision of the lesion. We review the literature regarding this rare presentation, and discuss the origin, pathogenesis, pathologic features, imaging characteristics, and treatment of cranial aneurysmal bone cysts.

Characteristics of cranial aneurysmal bone cyst on computed tomography and magnetic resonance imaging

Aneurysmal bone cysts are benign bone tumors that most commonly occur in people younger than 30 years. The cysts are most often found in the metaphyses of long bones and rarely affect the skull. We present a 54-year-old woman with a rapidly enlarging mass in the left occipital region that caused tenderness for 2 weeks. Computed tomography (CT) revealed an expansile, osteolytic lesion with characteristic soap-bubble appearance and fluid-fluid levels. Magnetic resonance images showed a dark rim surrounding the lesion, as well as multilocular spaces with fluid-fluid levels. The tumor was soft, fragile, and pulsatile during surgery. The patient was treated with en bloc resection of the tumor with cranioplasty. Follow-up CT 5 months later showed no evidence of recurrence.

Aneurysmal bone cysts of the cranium in children

Aneurysmal bone cysts (ABCs) of the cranium in children are rare, with only 3 to 6% of cases occurring in this anatomical location. Consequently, not much is known about ABCs and the most effective modality of treatment. The authors present the cases of three patients with ABCs and discuss the origin, pathogenesis, clinical presentation, pathological features, and imaging characteristics of these lesions. Furthermore the authors review the literature to find out the current treatment options for these lesions.

Aneurysmal bone cyst of the orbit

We report the case of an aneurysmal bone cyst of the left orbital roof in a 12-year-old boy who presented proptosis of the left eye and painless swelling of the left orbital rim. A 3-cm-large tumor developed in less than 3 months, with first visible signs about 2 months after a minor head injury. Radiologically, the lesion was osteolytic and multicystic. The cyst, filled with hematic fluid, was surgically removed via left frontal craniotomy and a simple curettage with high-speed bur. The patient recovered well and has been in good health throughout 14 months of follow-up.

[Aneurysmal bone cyst of the frontal bone]

BACKGROUND

Aneurysmal bone cyst (ABC) is a benign, expansive, osteolytic lesion that mainly occurs in young people, and involves the skull bones only exceptionally. The origin of ABC is controversial: secondary reactive bone lesion, or primary disease that represents an independent nosological entity. Blunt head trauma was suggested as a possible etiological factor.

CASE REPORT

A case of a 19-year-old man with primary ABC of the right frontal bone was reported. The lesion was totally excised through frontal craniotomy, and the skull bone defect primarily reconstructed with an acrilate cranioplasty. Five years after the surgery, the patient was without signs of local recurrence.

CONCLUSION

Clinical and neuroradiological presentation of the skull ABC was not specific. Pathohistology confirmed the diagnosis. Total excision was the treatment of choice.