| Images of Musculoskeletal Oncology |
| Aneurysmal Bone Cyst - Primary |
| A 35 year old female presents with a slightly tender swelling in the posterolateral aspect of one thigh for two months. |
| Radiographs demonstrate an intracortical osteolytic lesion in the lateral cortex of the femur, with expansion of this part of the femur. Periosteal new bone or Codman's triangle is seen at the proximal and distal aspect. The rest of the femur appears normal. |
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| A biopsy yielded tissues made up of vascular fibrous tissue with multinucleated giant cells and new bone, quite typical of an aneurysmal bone cyst. |
 | OR photograph demonstrates the attempt to aspirate blood from the lesion without success. The lesion grossly did not bleed significantly, although cystic vascular tissue is evident. At times radiographs reveal a fluid filled level representing collections of blood in the lesion; this was not found in this case. |
 | Surgical removal of the intracortical lesion by intralesional curettage and debridement was performed. The expanded cortex was removed. Reconstruction was not necessary since the debridement had not significantly weakened the femur. |
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| Many years of follow up demonstrate complete subsidence of symptoms, there is no evidence of recurrence. |
| Learning Issues: 1. Aneurysmal dilation of only the peripheral portion of a cortex is not an uncommon radiological presentation of an aneurysmal bone cyst. 2. Incomplete curettage is often adequate treatment. |
| Images of Musculoskeletal Oncology |
| University at Buffalo Department of Orthopaedics |