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Iwate Medical University School of Medicine Morioka 020-8505,
Japan
Koshigaya Hospital Dokkyo University School of Medicine Koshigaya
343-8555, Japan
We read with interest the article titled "Solid Variant of Aneurysmal Bone Cyst in Long Tubular Bones: Giant Cell Reparative Granuloma" in AJR [1]. "Solid cyst" is a confusing term. In this article dealing with "solid variant of aneurysmal bone cyst," the authors included two cases containing cysts with fluid levels, and one of them was shown in figure 11.
In the original description of solid variant of aneurysmal bone cyst, Sanerkin et al. [2] excluded lesions with cystic components, although macroscopically they allowed "scattered blood-filled sinusoids." On the other hand, ordinary aneurysmal bone cysts (not the solid variant) have been described as containing significant solid components [3, 4]. Cystic component was one of the features in giant cell reparative granuloma in the original description [5], and the difference between cystic giant cell reparative granuloma and aneurysmal bone cyst is fuzzy if giant cell reparative granuloma is histologically the same as the solid component of an aneurysmal bone cyst.
Perhaps the authors can tell whether the particular cyst-containing tumors in their article should be characterized as cystic solid variant of aneurysmal bone cyst, regular aneurysmal bone cyst, or something else.
References
Mayo Clinic Rochester, MN 55905
Drs. Ehara and Yamaguchi wonder whether placing the word "cystic" before the term "solid variant of aneurysmal bone cyst" would serve to distinguish this entity from conventional aneurysmal bone cyst. We think not. It will, in our view, only confound the issue without serving any practical value. To speak of "cystic" solid variant of aneurysmal bone cyst is to imply that an entity of solid variant of aneurysmal bone cyst without cyst formation exists, which of course is not the case. The eventual diagnosis of solid aneurysmal bone cyst is based on microscopic evidence and is made when a preponderance of solid to cystic elements is found. The admixture of cystic and solid elements is a variable in each given lesion that can further artificially be influenced by what the surgeon curettes and how much of the intact lesion the pathologist receives.
In the introduction to our article [1], we summarized the evolution of the now-synonymous terms of "solid variant of aneurysmal bone cyst" and "giant cell reparative granuloma," as well as we have understood them, from the literature of the past four decades. We also briefly discussed the question of why these terms are less than precise. Most musculoskeletal pathologists are familiar with these histologic terms, which were coined by pathologists.
A further name modification as suggested by Ehara and Yamaguchi does not serve to address the critical question of preventing the mistaken histologic diagnosis of a sarcoma, which is known to occur when dealing with this benign lesion. We illustrated one manifestation of this lesion with an MRI showing solid and cystic elements in an expansive osteolytic lesion to suggest that radiologists might consider the solid variant of aneurysmal bone cyst in their differential diagnosis based on imaging findings. The solid variant of aneurysmal bone cyst in long tubular bones is rare, and it remains to be seen how frequently the mix of solid and cystic elements will be encountered on MRI, given the varied imaging features of this lesion.
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