J Korean Orthop Assoc.  2012 Aug;47(4):305-310. 10.4055/jkoa.2012.47.4.305.

The Solid Variant of the Aneurysmal Bone Cyst in the Lumbar Spine Mimicking a Malignant Bone Tumor

• Kwak YH
• Lyu HD
• Park HR
• Kim SW

• KMID: 2185379
• DOI: http://doi.org/10.4055/jkoa.2012.47.4.305

Abstract

The Solid variant of the aneurysmal bone cyst is clinically important, because its solid composition is comparable to that observed in osteosarcoma or osteoblastoma, presenting difficulty for the correct diagnosis. The fluid-fluid level, which is a common sign of the conventional aneurismal bone cyst, is not apparent in radiographs of the solid type. These cysts were localized, equally within the whole spine as compared to most conventional aneurysmal bone cysts in which are localized to the posterior neural arch of the cervical spine. In this particular patient case, a young male aged 11.5 years presented with lower back pain and radiating pain which was misdiagnosed as a malignant bone tumor. Surgical intervention was considered and the incisional biopsy and laminectomy were conducted due to the low possibility of malignancy. We present this case and literature reviews with radiological and pathological findings as an example of the differential diagnosis of malignant tumors.

Keyword

spine; aneurysmal bone cyst; laminectomy

MeSH Terms

Aged
Aneurysm
Biopsy
Bone Cysts
Bone Cysts, Aneurysmal
Diagnosis, Differential
Humans
Laminectomy
Low Back Pain
Male
Osteoblastoma
Osteosarcoma
Spine

Figure

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  Figure 1 Ultrasonography of the pa tient. Partially scanned right posterior paravertebral mass at the lower lumbar area extending into the spinal canal.

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  Figure 2 Magnetic resonance imaging of the patient showed mass lesion with heterogenouos enhancement involving posterior column of L4 and adjacent posterior paravertebral muscle and posterior epidural soft tissue.

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  Figure 3 Computed tomography showed destructive bony lesion in lamina of right 4th lumbar.

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  Figure 4 For selective embolization, right L4 lumbar artery angiography showed round hypervascular tumor staining at the L4, 5 verterbral body level.

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  Figure 5 Postoperative plain radiograph after right L4 laminectomy.

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  Figure 6 (A) Blood-filled cavities are lined by osteoclast-like multinucleated giant cells. The intervening stroma is fibroblastic but contains no neoplastic osteoid. (B) Osteoclast-like giant cells are irregularly distributed within the fibroblastic stroma (H&E, ×100).

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