Brain Tumor Res Treat.  2018 Oct;6(2):86-91. 10.14791/btrt.2018.6.e15.

Secondary Aneurysmal Bone Cyst in a Craniofacial Fibrous Dysplasia: Case Report

• Lee HS
• Koh YC
• Roh HG
• Park HK
• Kim SY

• KMID: 2423980
• DOI: http://doi.org/10.14791/btrt.2018.6.e15

Abstract

Aneurysmal bone cyst (ABC) is a rare non-neoplastic bone lesion that involves mostly the long bones and vertebrae and may occur very rarely in the craniofacial bones. ABCs may occur as secondary bony pathologies in association with various benign and malignant bone tumors and with fibrous dysplasia (FD). FD is a common non-neoplastic bony pathology mostly affecting craniofacial bones. Secondary ABC occurring in craniofacial FD is extremely rare, with only approximately 20 cases reported in the literature to date. Here, we report on a case of secondary ABC in a 25-year-old woman who has had a craniofacial deformity for over 10 years and who presented to us with a rapidly growing painful pulsatile mass in the right frontal region that began over 2 months prior to admission. On thorough examination of computed tomography and magnetic resonance imaging brain scans taken at two-month interval, an aggressive, rapidly enlarging ABC, arising from the right frontal FD, was diagnosed. The patient underwent preoperative embolization followed by gross total resection of the ABC and cranioplasty. The 6-month follow up showed no recurrence of the ABC, nor was any progression of the FD noticed.

Keyword

Aneurysmal bone cysts; Fibrous dysplasia of bone; Frontal bone; Craniotomy

MeSH Terms

Adult
Aneurysm*
Bone Cysts*
Bone Cysts, Aneurysmal
Brain
Congenital Abnormalities
Craniotomy
Female
Fibrous Dysplasia of Bone
Follow-Up Studies
Frontal Bone
Humans
Magnetic Resonance Imaging
Pathology
Recurrence
Spine

Figure

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  Fig. 1 Preoperative CT scan of the patient; axial (A), coronal (B), and sagittal (C) image. Image shows diffuse fibrous dysplasia in the frontal bone with an osteolytic lesion.

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  Fig. 2 MRI, gadolinium-enhanced T1-weighted image. Extensive fibrous dysplasia involving frontal, sphenoid, and ethmoid bones, midline parietal bones, both temporal bones, midline and left occipital bone, clivus, and right zygomatic bone (A: axial image, B: coronal image, C: sagittal image). Fluid-fluid level with a large aneurysmal bone cyst (6.2×5.5×5.0 cm) was seen in the right frontal bone (D: axial image, E: coronal image, F: sagittal image).

• 

  Fig. 3 Trans-femoral cerebral angiography image of the patient. The pre-embolization image showed prominent vascular stain in the right frontal area, at the margin of the aneurysmal bone cyst (A: anterior-posterior view, B: right lateral view). An endovascular embolization was performed in a branch of the right middle meningeal artery and the right superficial temporal artery. After embolization, vascular staining was markedly decreased, but residual staining was seen in the posterior and inferior margins (C: anterior-posterior view, D: right lateral view).

• 

  Fig. 4 Histological examination of the resected lesion. A: The aneurysmal bone cyst wall (hematoxylin and eosin staining, original magnification ×100). B: A multinucleated osteoclastic giant cell (hematoxylin and eosin staining, original magnification ×200). C: Woven bone with proliferating fibrous tissue (hematoxylin and eosin staining, original magnification ×200).

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  Fig. 5 Postoperative axial CT scan of the setting bone shows the partial removal of the fibrous dysplasia around the aneurysmal bone cysts (A and B).

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  Fig. 6 Cosmetic improvement of the patient's forehead (A: preoperative image, B: postoperative image).

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