Aneurysmal bone cysts of the appendicular skeleton: Variable presentations and treatment outcomes of four cases

Abstract

Background: Aneurysmal bone cysts (ABCs) are benign but locally aggressive osteolytic lesions that predominantly affect children and young adults. They commonly involve the metaphyses of long bones and may present with pain, swelling, or pathological fractures. Radiological features may overlap with other lytic bone tumors, making accurate diagnosis and individualized management essential. Methods: We report a case series of four patients with aneurysmal bone cysts of the appendicular skeleton, encompassing varied age groups and anatomical locations. Clinical presentation, imaging characteristics, treatment modalities, histopathological findings, and functional outcomes were evaluated. Management strategies included percutaneous polidocanol sclerotherapy, surgical curettage with bone grafting and fixation, and conservative treatment for stable pathological fractures. Results: The cases demonstrated diverse presentations ranging from incidental lytic lesions to pathological fractures. Percutaneous polidocanol sclerotherapy resulted in progressive ossification and complete functional recovery in select cases. Surgical curettage with bone grafting and prophylactic fixation provided good structural stability and excellent functional outcomes in lesions at high risk for fracture. Conservative management was effective in a pediatric patient with a stable pathological fracture. One case initially diagnosed radiologically as ABC was later identified as a giant cell tumor on histopathology, highlighting the diagnostic challenges and importance of tissue confirmation. Conclusion: Aneurysmal bone cysts show variable clinical and radiological presentations and require tailored treatment based on patient age, lesion location, structural risk, and diagnostic certainty. Polidocanol sclerotherapy is a safe and effective minimally invasive option for suitable lesions, while surgical intervention remains essential for structurally compromised bones. Histopathological confirmation is crucial to avoid misdiagnosis and ensure appropriate management, ultimately leading to favorable functional and radiological outcomes.