The Cure of Aneurysmal Bone Cyst

Abstract

Although the pathogenesis of aneurysmal bone cyst remains obscure and the condition did not achieve the distinction of a succinct description classifying it as a separate entity until the work of Jaffe and Lichtenstein was published in 1942, it has now been accepted as a distinct bone lesion with rather classical radiographic and pathologic characteristics. Much, however, remains to be said about the appropriate treatment of these lesions since, although benign, they often present serious complications. There are many isolated case reports as well as several more extensive reviews of larger series of cases, but the majority of these papers treat aneurysmal bone cyst as an unusual and interesting entity worthy of discussion and description. Treatment may be relegated to the last paragraph, and in most cases surgery is advocated. Several authors, notably Lichtenstein, suggest radiation therapy for lesions which are surgically inaccessible, and isolated cases so treated were reported as cured. We have not, however, found any advocates of radiation therapy as the primary treatment of choice, and the present paper has been written in an attempt to establish this principle. A representative sampling of the recent literature reveals the following: 2 of Taylor's 3 patients were cured three and nine years after radiation therapy (9). Phelan (8) described 5 cases, none of which received radiation therapy. Lichtenstein (7) cited a number of patients treated with irradiation with excellent results. Eight cases were described in detail, and in all the growth of the lesion was arrested, with good healing demonstrated at follow-up. Dahlin et al. (4) reported 26 cases and mentioned that in some of them radiation therapy had been administered, but no specific follow-up data are presented. Donaldson (5) described 6 cases, in 2 of which the patients were treated successfully with irradiation and were well three and six years following treatment. Of Barnes's (1) 5 reported cases, none had radiation therapy. In standard textbooks on bone tumors, Jaffe (6) does not comment upon the efficacy of radiation therapy, but Coley (2) recommends radiation therapy if the tumor is surgically inaccessible. The present paper comprises the total experience with aneurysmal bone cyst at Memorial Hospital in the period from 1923 through 1965. There are 33 cases, summarized in Tables I and II, some of which have been reported previously (3). This is the largest single series of cases thus far reported in detail; Lichtenstein included 50 cases in his paper, but many were sent to him for consultation only, and he did not have the opportunity to follow those patients throughout the entire course of the disease. All of our cases have been carefully reviewed and documented, and all conform to the clinical, radiologic, and pathologic criteria that have been established for making the diagnosis of aneurysmal bone cyst.