Malignant transformation of aneurysmal bone cyst, with an analysis of the literature

Abstract

An 11‐year‐old girl had a lytic, benign‐appearing, expansive lesion of the distal tibia radiologically interpreted as an aneurysmal bone cyst (ABC). Tissue from two extensive curettage procedures was also histologically diagnosed as ABC. Approximately 50 months after the onset of symptoms, and 28 months after her last curettage, a highly pleomorphic osteosarcoma developed. The patient had not received prior radiation therapy. The cases in the literature of possible malignant transformation of ABC are reviewed. The authors separate their case from telangiectatic osteosarcoma, and from “ aneurysmal bone cyst‐like osteosarcoma”.

Aneurysmal bone cyst of the mobile spine: the therapeutic role of embolization

“…Options for treating ABCs have included simple curettage with or without bone grafting, complete excision, embolization, radiation therapy, or a combination of these methods [3,4]. Progression to malignancy has been described in the literature after treated with radiation therapy [6][7][8]. Although there are good results regarding the type of treatment, local recurrence has been described within all protocols of therapy and cannot be predicted.…”

Computed tomography-guided cementoplasty combined with radiation therapy for an aneurysmal bone cyst in a dog: a case report

“…However, we found no reports of malignant transformation due to the use of PMMA. Some authors suggested that ABCs may occur per se as a secondary component of a prior lesion, either benign or malignant, that cannot be identified after the ABC has destroyed its architecture (Kyriakos and Hardy 1991). This additional fact could partly explain the malignant transformation of ABCs (Feigenberg et al 2001).…”

“…Complications associated with ABCs in dogs include pathological bone fractures, recurrence, and malignant transformation (Barnhart 2002;Sarierler et al 2004). The same complications have been reported in humans, as well as surrounding bone-tissue invasion and metastasis (Kyriakos and Hardy 1991;Feigenberg et al 2001;Mendenhall et al 2006).…”

“…Radiotherapy has been used conservatively for ABC treatment in humans due to the possible risk of radiation-induced secondary malignancies (Kyriakos and Hardy 1991;Feigenberg et al 2001;Yavuz et al 2004). However, most patients who developed radiation-induced bone malignancies were treated with orthovoltage or other low-energy photons.…”

“…Furthermore, Increased radiopacity of the proximal part of the lesion can be observed the treatment in this case was justified because more side effects were reported following amputation of the limb (Seegenschmiedt 2008). Malignant transformation and metastasis of ABC have also been reported after curettage alone, without radiotherapy (Kyriakos and Hardy 1991;Feigenberg et al 2001;Barnhart 2002;Sarierler et al 2004;Mei et al 2009;Van De Luijtgaarden et al 2009). Other studies over the past decades have described the occurrence of malignant tumours in association with surgical implants, increasing the concern about the carcinogenicity of foreign bodies in orthopaedics (Mei et al 2009).…”