2. Simple bone cysts are common, benign, fluid-filled, cystic lesions that cause minimal expansion of the bone and occur mostly in the metaphysis of long bones. Vertebral pneumatocysts: uncommon lesions with pathognomonic imaging characteristics. St. Louis: Mosby; Patterns of Intrathecal Ossification in Arachnoiditis Ossificans: A Retrospective Case Series, Spinal Cord Sarcoidosis Occurring at Sites of Spondylotic Stenosis, Mimicking Spondylotic Myelopathy: A Case Series and Review of the Literature, The Dominant Anterior Thoracic Artery of the Spinal Cord, Thanks to our 2022 Distinguished Reviewers, Copyright American Society of Neuroradiology. (d) Retrolisthesis of less than a third of the length of the vertebral body is a feature of unilateral facet dislocation Correspondence address. Roberts CC, Andrews CL et-al. This may be followed up to detect any increase in the size, but there is no specific treatment. These cysts are most commonly found within the vertebral bodies, iliac bones or sacrum. Appearances on MRI are less definitive than on CT. Gas appears as low signal/signal void on both T1 and T2, and so appears similar to sclerotic bone. CT Considered the best method of diagnosis. It might show concerning features such as cortical breach or soft tissue extension 7,8. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Most patients are between 20 and 40 years old. In this study, we describe the computed tomography (CT) features of pulmonary laceration in a study population, which included 364 client-owned dogs that underwent CT examination for thoracic trauma, and compared the characteristics and outcomes of dogs with and without CT evidence of pulmonary laceration. Rapp T, Ward J, Alaia M. Aneurysmal Bone Cyst. (2006) Proceedings (Baylor University. Physical examination was unremarkable except for tenderness over the lower thoracic spine. In conclusion, this study presents two cases of SBCs and reviews the literature. The definitive diagnosis of aneurysmal bone cysts is based on a combination of typical radiological and pathological features. Cervical MR images showed a unilocular homogeneous cyst having regular contours and measuring 10 8 mm in the spinous process of C4 vertebra (Fig 3). Aneurysmal bone cysts have been first described by the American bone pathologist Louis Lichtenstein in 1950 14. Any other prior symptoms are mild pain, local tenderness, and swelling (5). 3). 2023 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X. Aneurysmal bone cysts are poorly vascular 10. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Hacking C, Weerakkody Y, et al. Scaglietti O, Marchetti PG, Bartolozzi P. Oxford University Press is a department of the University of Oxford. . Caro P, Mandell G, Stanton R. Aneurysmal Bone Cyst of the Spine in Children. AJR Am J Roentgenol. Musculoskeletal Imaging. Simple or solitary bone cysts (SBC) also known as unicameral bone cysts are benign lesions commonly seen in the peripheral skeleton [1]. A case report, Unicameral bone cyst of a lumbar vertebra. Diehn FE, Maus TP, Morris JM et-al. 5. It breaks down the cartilage. 2005;23(27):6756-62. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Benign osteoporotic and malignant vertebral compression fractures have extremely different management and prognostic implications. CT and MR Imaging of the Whole Body. A: Histological features of aneurysmal bone cysts usually show blood-filled spaces without endothelial lining between fibrous stromata. MR images show a multiloculated mass of heterogeneous signal intensity that usually has blood products within (7). The unicameral bone cyst (UBC), or simple or solitary bone cyst (SBC), is a common, benign, fluid-containing lesion, usually occurring in the metaphysis of long bones.The cause of the lesion is unknown. 74 (2): 157-68. Typically vertebral haemangiomas occur in the thoracic spine, specifically within the vertebral body. Simple Bone Cyst in Spinous Process of the C4 Vertebra. A: Surgical resection or curettage of the tumor and bone graft with or without adjuvant treatment, including cryotherapy, sclerotherapy, radionuclide ablation, radiotherapy, selective arterial embolization, and minimally-invasive intervention radiology treatment. 1. The exact pathogenesis of the lesion is unknown [2]. Bone cysts have previously been considered a minor diagnostic criterion [2], but they are no . Although not completely understood, some authors believe a vertebral pneumatocyst is an extension of intradiscal gas (vacuum phenomenon) 1. General imaging differential considerations include 8,10: giant cell tumor of bone:usually older, extending to the articular surface, non-ossifying fibroma: eccentric, cortical base, aneurysmal bone cyst (ABC): usually eccentric, differential diagnosis of expansile lytic lesions without cortical destruction of bone. In a recent article, Zener, Alpert, and Klainer (1) reviewed two previously reported cases of sarcoidosis involving the vertebrae in which the diagnosis was established antemortem by biopsy and added a third of their own. Check for errors and try again. Features on CT are similar to plain radiographs but CT has the advantage of characterizing extent, detecting radiograph-occult fractures, and assessing internal density (usually between 10-15 HU) 8. 2 VHs are more frequently found in women, especially in the fourth-to-sixth decades of life. The histopathology showed a pattern compatible with an aneurysmal bone cyst. Imaging technology precisely guides minimally invasive procedures with needles, catheters and other devices. Cyst removed from a vertebral body Fig. (2008) ISBN: 9783131354211 -, 16. (1975) Journal of anatomy. C, Mesothelium-like flat endothelial cells line the wall of the simple bone cyst (hematoxylin eosin stain 400). mri Axial T2 Sagittal T2 Sagittal STIR Sagittal T1 Sagittal T1 fat sat Axial T1 C+ Sagittal T1 C+ MRI Axial T2 . 7. X-ray and CT scans showed a lytic lesion with a sclerotic border in the right half of the body of the L5 vertebra (Figs 6 and 7). The larger posterior part of the vertebral body is displaced backward into the spinal canal. Lovell and Winter's Pediatric Orthopaedics. The most frequent sites are proximal humerus and proximal femur [1, 3]. Vertebral body mass: differential diagnosis, Differential diagnosis of a vertabral body mass, 1. Vertebral body mass. These rearrangements also occur in the aneurysmal bone cysts of the hand and feet but not in lesions of the jawbones 1. Unable to process the form. Gas measures about -580 to -1000 HU in density 3. Dawson EG, Mirra JM, Yuhl ET, Lasser K. Brodsky AE, Khalil M, VanDeventer L. Matsumoto K, Fujii S, Mochizuki T, Hukuda S. Park CK, Cho KK, Lee SW, Jeon JS, Kang JK, Choi CR. You can use Radiopaedia cases in a variety of ways to help you learn and teach. 9). The pain can. Depending on the type of surgery. The term aneurysmal is derived from its radiographic appearance. The following molecular criterion is desirable: USP6 gene (at 17p13.2 locus) rearrangement; occurs in 63% of cases. The diagnosis of spinal tumors is based on patient age, topographic features of the tumor, and lesion pattern as seen at CT and MR imaging. (2012) ISBN: 9789350258835 -. Q: What is the treatment for aneurysmal bone cysts? Nayman A, Guler I, Erdogan H, Koplay M. Funayama T, Gasbarrini A, Ghermandi R, Girolami M, Boriani S. Boude AB, Vsquez LG, Alvarado-Gomez F, Bedoya MC, Rodrguez-Mnera A, MoralesSaenz LC. Spinal Cord and Spinal Column Tumors. The vertebra is divided anatomically into the vertebral body anteriorly and the neural arch posteriorly. , who described a fetus in fetu with spinal . Vertebral tumor signs and symptoms may include: Pain at the site of the tumor due to tumor growth. (Table 1). The surgical intervention, when required, consists of primary closure of the dural defect through a posterior approach, accompanied by laminectomy and/or costotransversectomy.1 Although rare, arachnoid cysts can be a complication of Radiographic evaluation of vertebral body lesions has three goals: (1) to identify lesions, (2) characterize lesions and generate a differential diagnosis, and (3) assess for associated complications (in particular cord compression) and treatment response. Radiographics. Mankin H, Hornicek F, Ortiz-Cruz E, Villafuerte J, Gebhardt M. Aneurysmal Bone Cyst: A Review of 150 Patients. In younger patients with vertebral body lesions most likely diagnosis is histiocytosis, whereas the lesions involving posterior elements of the spine may have ABC, Osteoblastoma, and Tuberculosis as differentials. Lippincott Williams & Wilkins. On rare occasions, this is the result of a pathologic fracture. AJR Am J Roentgenol. Felix S. Chew. Michael A. Blake, Mannudeep K. Kalra. To our knowledge, only four were in cervical vertebrae (36), and the rest were in lumbar vertebrae (2, 4). Search Main Page; Pub Med; Search Feeback He remained free of symptoms in the back and had a high level of sports activity. The cartilaginous layer is related to the nucleus pulposus and annulus fibrosus and has an important role in intervertebral disc nutrition 1. (2006) European Spine Journal. The tumor has a heterogeneous appearance on both T1 and T2-weighted MR, with focal areas of high T1 signal, presumably representing blood. Tel: +989125028172; Fax: +982188927852; E-mail: Understanding unicameral and aneurysmal bone cysts, Simple bone cyst. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. A few examples include: a corduroy vertebral body (hemangioma; Figure 3), a fallen fragment sign (simple bone cyst; Figure 4), intralesional gas in a juxta-articular lesion (subchondral cyst, such as a degenerative cyst or intraosseous ganglion cyst; Figure 5), an enlarged bone with coarsened trabeculae and a thickened cortex (Paget's disease . The most frequent presentation is due to pathological fracture1,2,6. In some instances, surgery with curettage and bone grafting is required. Alanazi O, Alshebromi A, Albaz A, Bassi M. Thoracic Spine Aneurysmal Bone Cyst Causing Paraplegia in a Child: A Case Report. Neuroradiology Companion. Both lesions were found to be SBC and confirmed by pathology. Giant cell tumors have been described at the ends of long bones, characteristically around the knee. On CT aneurysmal bone cysts are characterized as lucent bone lesions with a mean density higher than fat 7. AJR Am J Roentgenol. We present a simple bone cyst involving the C4 vertebra of a 26-year-old female patient. MR signal characteristics for an uncomplicated lesion include 8,10: Fluid-fluid levelscan be seen in the setting of fibrous septations, which can enhance 8. The end plates (zones of provisional calcification) maintain normal mineralization, and so appear strikingly dense compared to adjacent osteoporotic bone. 1. The tumors may affect your spinal cord or the nerve roots, blood vessels, or bones of your spine. In the case of our patient, the lesion did not cause any such fracture in the bone. Differential Diagnosis in Orthopaedic Oncology. Lippincott Williams & Wilkins. CT proved to be more useful in the initial assessment and measurement of progress of this disease than conventional radiography and myelography. 2. 9. Internal signal heterogeneity, periosteal reaction and soft tissue edema can be seen in the setting of fracture 8. According to the radiologic findings, the lesion was identified as a simple bone cyst, and the diagnosis was verified by surgical and histopathologic examinations. 2020;68(4):843. Multiple-choice questionnaire: Musculoskeletal radiology (c) Hangman's fracture involves the pars interarticu- (e) Giant cell tumours of the sacrum may grow across laris of C2. 15 (3): 333. Both cases were managed with surgery, the cavity was filled with bone graft and posterior spinal fusion and instrumentation with pedicle screws, and rods were carried out. Our goal was to present two cases of SBC who were referred to our department of spine surgery and review the literature. An aneurysmal bone cyst is an expansile osteolytic lesion with a thin wall, containing blood-filled cystic cavities. hemangioma, synovial cyst (10,11), abscess and epidural hematoma. A single vertebral surgical approach for spinal extradural meningeal cysts spanning multiple vertebral segments by auxiliary neuroendoscope. CT and MRI add little to the diagnosis, however, can be helpful in eliminating other entities that can potentially mimic a simple bone cyst (see differential diagnosis below) 8. 3. A 26-year-old male presented with pain over the lower lumbar area. Brant WE, Helms C. Fundamentals of Diagnostic Radiology. 120 (Pt 1): 49-68. Surg Neurol Int. This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking. The specimen was sent for pathologic examination. The pathogenesis of simple bone cysts is still unknown. Vertebral body origin intraosseous hemangioma metastases Paget disease multiple myeloma osteonecrosis vertebral body osteomyelitis lymphoma plasmacytoma g. Differential diagnosis of vertebral lesions is very wide. A complementary MRI performed as part of in-hospital management showed an incidental finding of a cystic lesion in the vertebral body of C2 (Figure 1). The patient was asymptomatic and the beginning of bony healing was evident. Considered the best method of diagnosis. Vertebral body endplatesare anatomically-discrete structures that form the interface between the vertebral bodies and the adjacent intervertebral discs. It may be asymptomatic, and hence the incidence is unknown. Spinal hemangiomas are the most common primary tumor of the spine. The synovial cyst is a lesion that can be treated by z-joint intra-articular injections as an alternative to surgery. Clinical presentation is indistinguishable from disc herniation with sciatica and back pain the most common presenting symptoms 2. 1981;136(6):1231-2. The reported peak is between 3 and 14 years of age, with the mean age at diagnosis being approximately 9 years. especially posterior elements of the spine with extension into the vertebral body in 40% of cases 5. obturator foramen in . Lippincott Williams & Wilkins. Until now, to our knowledge, only 10 cases of a simple bone cyst involving the vertebrae have been reported, with four of them in the cervical vertebrae. Usually, diagnosis of SBC disease is based on pathologic confirmation due to its rarity and non-specific clinical presentation. The only symptom reported by the patient was cervical pain irradiated to shoulders. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Abdrabou A, El-Feky M, Straka E, et al. Vertebral metastasesare significantly more common than primary bone tumors, especially in an older patient or one with known primary disease elsewhere. Blumberg M. CT of Iliac Unicameral Bone Cysts. However in patients older than 40 years, while dealing with posterior element lesions, metastasis must always be kept in mind. Q: What is the differential diagnosis of aneurysmal bone cysts? MRI can demonstrate the characteristic fluid-fluid levels exquisitely, as well as identify the presence of a solid component and concerning features suggesting an aneurysmal bone cyst-like appearance of another tumor entity. 6. They are most common at cervical levels. We discuss the radiologic differential diagnosis of simple vertebral bone cysts, and the surgical and histopathologic verifications of the diagnosis are presented. The diagnosis of spinal SBC may be difficult and delayed until operative treatment when it is confirmed by histological assessment. MRI Imaging at 0.5 Tesla. The terms 'giant cell reparative granuloma of small bone'2,3 or 'giant cell lesion of small bone' have been discouraged 1. Aneurysmal bone cysts display cytogenetic rearrangements of the USP6 gene. They are constituted peripherally by an epiphyseal bone ring and centrally by a cartilaginous layer. The cysts are of a variable signal, with a surrounding rim of low T1 and T2 signals. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Unicameral bone cysts are well defined geographic lucent lesionswith a narrow zone of transition,mostly seen in skeletally immature patients, which are centrally located and show a thin sclerotic margin in the majority of cases with no periosteal reactionor soft tissue component. Percutaneous treatment with fibrosing agents has also been performed, either in isolation or as a precursor to surgical excision 3,11,12. Neurol India. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Imaging differential considerations include 1: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Rai A & Collins J. Percutaneous Treatment of Pediatric Aneurysmal Bone Cyst at C1: A Minimally Invasive Alternative: A Case Report. CT Axial non-contrast CT scan of the thoracic spine reveals an osteolytic bony lesion involving T3 left posterior element and vertebral body, with a soft tissue mass resulting in cord compression. Spinal Cyst Treatment Conservative treatment may include rest, anti-inflammatory medications, painkillers, steroid injections and drainage. show answer. Although they are benign, aneurysmal bone cysts can display different clinical natural courses: quiescent, active or aggressive. Typical signal intensity is as follows 1: If performed, contrast injected into the disc space passes into the cyst 1,2. Moreover, our patient was 26 years old, well above the usual age for lesions in the long bones (7). 9.2 Large open cyst with multiple daughter vesicles inside The clear, yellow hydatid fluid contains sodium chloride, proteins, lipids, polysaccharides, and ions, having a neutral pH. Difficult to detect, but sometimes gas lucencies are seen within the vertebral bodies. (2012) ISBN:1608319113. SBC accounts for the 'S' in the popular mnemonic for lucent bone lesions FEGNOMASHIC. Giant cystic Schmorl's nodes are unusual entities; their radiologic appearance differs dramatically from the classic description and is diagnostically challenging. essential: simple cyst lacking a true lining with typical imaging features, desirable: fibrin-like deposits +/- mineralization forming cementum-like structures. UBCs can be rarely seen in adults in unusual locations such as in the talus, calcaneus, or the iliac wing. 3. 3. giant cell tumors (GCT), chondroblastoma, simple bone cystsand telangiectatic osteosarcomas). Dogs . Reference article, Radiopaedia.org (Accessed on 18 Jan 2023) https://doi.org/10.53347/rID-14992, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":14992,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/vertebral-body-mass/questions/1314?lang=us"}. Discal cysts (also known as a disk cyst or disc cyst) are uncommon lesions of the spine, representing an extrathecal cyst which communicates with the adjacent intervertebral disc through an annular fissure. A case report and review of literature, A solitary bone cyst in the spinous process of the cervical spine: a case report, Simple bone cyst in cervical vertebral spinous process and laminae: report of a case, Simple bone cyst of lamina of lumbar spine: a case report, Unicameral bone cyst of a cervical vertebral body and lateral mass with associated pathological fracture in a child. Vertebral pneumatocyst. Enter multiple addresses on separate lines or separate them with commas. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Check for errors and try again. The introduction of bone cement into the vertebral body produces a sclerotic appearance on radiographs and CT, distinguishing this from the lucent appearance of . 11. Komiya S, Minamitani K, Sasaguri Y, Hashimoto S, Morimatsu M, Inoue A. Mascard E, Gomez-Brouchet A, Lambot K. Rodallec MH, Feydy A, Larousserie F, Anract P, Campagna R, Babinet A, et al. A growing body of research supports the above study [Lee S.W. If large and threatening to fracture, or causing deformity then an intralesional steroid injection can be performed 3-5. The most common differential diagnoses for SBC are aneurysmal bone cyst, brown tumor (hyperparathyroidism), infection and less commonly giant cell tumor. The patient reports progressive thoracic pain, loss of strength at the T4 sensory level, gradual deterioration of neurological status with lower limb paralysis, and loss of sphincter control. They rarely extend into the nearby ribs or adjacent vertebrae. This study presents two cases of spinal SBC managed surgically with no recurrence in long-term follow-up. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Knipe H, Deng F, et al. The Author(s) 2021. Although they have been described in most bones, the most common locations are 3-5: typically eccentrically located in the metaphysis, especially femur, proximal tibia and fibula, and humerus, especially posterior elements of the spine with extension into the vertebral body in 40% of cases 5, short bones of hands and feet: more often with a central location, craniofacial: jaw, basisphenoid, and paranasal sinuses, epiphysis, epiphyseal equivalent,or apophysis: rare but important. Solid variant ABC of long tubular bones: A diagnostic conundrum for the radiologist. Cross-sectional imaging may be required when lesions are in unusual . Those cysts predominantly occur in male patients with a ratio of 2.5:1. Hence, we used all these three imaging techniques to make a complete diagnosis. Q: What are the histopathologic characteristics of aneurysmal bone cysts? Gas measures about -580 to -1000 HU in density 3. 6. Detection of associated intradiscal gas and communication between the vertebral and intradiscal gas can be demonstrated. The differential diagnosis depends on the modality. 3 These . A soft tissue mass is often present. Differential diagnosis of vertebral lesions is very wide. Although there is an overlap in appearances, characteristic imaging features can aid in the distinction between these 2 types of compression fractures. Our case reports the fifth simple bone cyst developing in cervical vertebrae. There have been 21 cases of SBCs in English literature, and only 8 cases have been reported in the vertebral body. The patient underwent surgical resection of the tumor. Jeffrey Stuart Ross. VH are the most common spine tumors with an estimated incidence of 1.9-27% in the general population. Rarely, they are truly multiloculated, which can occur after repeated fractures 3,10. (2020) ISBN: 9789283245025 -. The teardrop fragment comes from the anteroinferior aspect of the vertebral body. According to the radiologic findings, the lesion was identified as a simple bone cyst, and the diagnosis was verified by surgical and histopathologic examinations. WHO Classification of Tumours, 5th Edition. An otherwise healthy 26-year-old female patient presented with a 1-year history of neck pain radiating to both upper extremities. 4.Tomaszewski KA, Saganiak K, Gadysz T, Walocha JA. 5. Aneurysmal bone cysts are typically characterized by their lobulated and multiseptated appearance with fluid-fluid levels and blood degradation products on MR images. The laboratory tests including complete blood count, renal function tests, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, serum calcium, serum phosphorus and parathyroid hormone were all within normal limits. Posterior spinal fusion was performed with instrumentation with pedicle screws from T10 to L2 and a mixture of autologous bone graft and allograft was used to achieve better fusion (Fig. Spinal aneurysmal bone cysts nearly always arise in the posterior vertebral arch but frequently extend into the ipsilateral pedicle and vertebral body, epidural space, or adjacent neural foramen (see Figs. They are recognized incidentally on radiographic examinations. WHO Classification of Tumours Editorial. Current Diagnosis & Treatment in Orthopedics. Steven P. Meyers. The stroma corresponds to septations with fibroblasts, spindle cells, osteoids, and numerous benign giant cells. Pain resolved; paresthesia improved and no recurrence. The current study aimed to investigate the imaging manifestations of vertebral aneurysmal bone cyst (ABC), and examine the clinical value of interventional embolization. Enlarging vertebral body pneumatocysts in the cervical spine. No enhancement was observed on T1-weighted images following contrast medium administration (Fig 5). The sensitivity to specify a vertebral lesion on an X-ray is difficult as well. Soft Tissue and Bone Tumours. Surgical exploration, curettage, filled w/ hydroxyapatite, Surgical exploration, curettage, removal of SP, The patient was satisfied and no recurrence, She was without complain and no recurrence, A favorable result was achieved and no recurrence, The patients low back pain decreased and no recurrence. There is vivid enhancement of the mass. 1 Two types of endplate changes were originally described, with a third type subsequently added in a later publication: 2, 3 We recommend SBC as a differential diagnosis in young patients with an unremarkable laboratory tests and suggestive imaging. Soft Tissue and Bone Tumours. Vertebral body origin intraosseous hemangioma metastases Paget disease multiple myeloma osteonecrosis vertebral body osteomyelitis In support of this theory is the fact that they are primarily encountered in young men, and are often hemorrhagic at surgery 1. (2019) BioMed Research International. Some of them are found in diaphysis. Radiology Review Manual. Rarely, vertebral hemangiomas can exhibit extraosseous expansion with resulting compression of the spinal cord. They are typically intramedullary and active cysts are found in the metaphysis of long bones, abutting the growth plate 1. O'Brien WT. In general, vertebral pneumatocysts are less common than intraosseous pneumatocysts in the pelvis, especially adjacent to the sacroiliac joint.