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AJR 2005; 184:349
© American Roentgen Ray Society

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Uncommon Aneurysmal Bone Cyst: Radiographic and MRI Findings

Frank W. Roemer, Philipp Remplik and Klaus Bohndorf

Department of Radiology Klinikum Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany

We read with interest the radiologic–pathologic conference by Barrett et al. on cortical aneurysmal bone cyst of the tibia [1]. The presentation gives an excellent overview of this entity and its radiologic findings. Barrett et al. mention correctly that most aneurysmal bone cysts arise from the diaphyses of the long bones. We would like to comment on a less common site of occurrence and present a case of an aneurysmal bone cyst of the pubis with subtle radiographic findings. To our knowledge, pubic aneurysmal bone cysts have been described only rarely in the literature [2–4].

The 18-year-old patient presented with a 6-month history of a right inguinal mass that had been increasing in size. Conventional radiographs revealed a discrete irregularity and reduced radiopacity in the right pubic cortex (Fig. 1A). MRI showed a hyperintense lobulated mass with fluid–fluid levels (Fig. 1B). A close relationship to the os pubis and a small erosion of the anterior cranial cortex was observed (Fig. 1C). Enhancement of the septal walls was seen after IV contrast administration on T1-weighted fat-suppressed images (not shown). At surgical resection, the tumor was found to have originated from the anteromedial cortical pubic bone. Histologic analysis of the lesion showed multiple blood-filled cavernous channels without endothelial lining. The cyst walls presented with a thin edge of fibrous trabecular structures including osteoblasts and chondroid matrix. No atypia or increased mitotic activity was visible. A diagnosis of aneurysmal bone cyst was confirmed.



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  		Fig. 1A. —Aneurysmal bone cyst in pelvis of 18-year-old male. Radiograph of pelvis shows subtle contour irregularity and diminished radiopacity (arrow) of cranial cortex of right pubis.

 


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  		Fig. 1B. —Aneurysmal bone cyst in pelvis of 18-year-old male. Axial T2-weighted non-fat-suppressed turbo spin-echo image reveals cystic hyperintense mass (arrow) in right inguinal region with fluid–fluid levels.

 


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  		Fig. 1C. —Aneurysmal bone cyst in pelvis of 18-year-old male. Sagittal T2-weighted non-fat-suppressed turbo spin-echo image shows hyperintense lesion originating from os pubis. Arrow indicates erosion of anterior cortex.

 

In conclusion, we would like to emphasize the importance of including aneurysmal bone cyst in the differential diagnosis of peripheral soft-tissue masses in adolescents and young adults, especially if cystic features and fluid–fluid levels are present.

References

  1. Barrett TJ, Beall DP, Ly JQ, Davis SW. Cortical aneurysmal bone cyst of the tibia. AJR2004; 182:740[Free Full Text]
  2. Garnjobst W, Hopkins R. Aneurysmal bone cyst of pubis: report of a case presenting as an abdominal mass. J Bone Joint Surg Am 1967;49:971 -975[Free Full Text]
  3. Macpherson RI, Halvorsen R. Tumors of the pubis: an analysis by probabilities. J Can Assoc Radiol1981; 32:168 -170[Medline]
  4. Sundaram M, McDonald DJ, Steigman CK, Bocchini T. Metachronous multiple aneurysmal bone cysts. Skeletal Radiol1997; 26:564 -567[Medline]

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This Article
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