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The differentiation between aneurysmal bone cyst and telangiectatic osteosarcoma: a clinical, radiographic and MRI study

Skeletal Radiology volume 49, pages 1375–1386 (2020)Cite this article

Abstract

Objectives

Aneurysmal bone cyst (ABC) and telangiectatic osteosarcoma (TOS) share several clinical and imaging features, including young presentation, long bone involvement, lytic appearance on radiography and fluid-fluid levels on MRI. Therefore, they may be difficult to differentiate. The aim of this study is to identify clinical, radiological and MRI features which aid differentiation of the two lesions.

Materials and methods

Retrospective review of all histologically confirmed ABC and TOS over an 11-year period. Data recorded include age at presentation, sex, skeletal location and various radiographic and MRI features.

Results

This retrospective study included 183 patients, 92 males and 91 females. Mean age at presentation of 18.4 years (range 1–70 years); 152 cases of ABC and 31 TOS. No significant difference between age and sex. TOS was significantly less likely to involve the axial skeleton; no difference related to location within the bone. Radiographic findings significantly favouring ABC included a less aggressive pattern of bone destruction, a purely lytic appearance, an expanded but intact cortex, no periosteal response and no soft tissue mass. MRI features significantly favouring ABC included smaller tumour size (maximum mean dimension 46 mm compared to 95 mm for TOS), absence of soft tissue mass, > 2/3 of the lesion filled with fluid levels and thin septal enhancement following contrast.

Conclusions

Several radiographic and MRI features aid in the differentiation between ABC and TOS. Lesions with a geographic Type 1A or IB pattern of bone destruction which are completely filled with FFLs on MRI can confidently be diagnosed as ABC.

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References

  1. Kransdorf MJ, Sweet DE. Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging. AJR Am J Roentgenol. 1995;164:573–80.

    Article  CAS  Google Scholar 

  2. Rapp TB, Ward JP, Alaia MJ. Aneurysmal bone cyst. J Am Acad Orthop Surg. 2012;20:233–41.

    Article  Google Scholar 

  3. Mascard E, Gomez-Brouchet A, Lambot K. Bone cysts: unicameral and aneurysmal bone cyst. Orthop Traumatol Surg Res OTSR. 2015;101:S119–27.

    Article  CAS  Google Scholar 

  4. Yarmish G, Klein MJ, Landa J, Lefkowitz RA, Hwang S. Imaging characteristics of primary osteosarcoma: nonconventional subtypes. Radiogr Rev Publ Radiol Soc N Am Inc. 2010;30:1653–72.

    Google Scholar 

  5. Sangle NA, Layfield LJ. Telangiectatic osteosarcoma. Arch Pathol Lab Med. 2012;136:572–6.

    Article  Google Scholar 

  6. Yin J-Q, Fu Y-W, Xie X-B, Cheng X-Y, Yang X-Y, Liu W-H, et al. Telangiectatic osteosarcoma: outcome analyses and a diagnostic model for differentiation from aneurysmal bone cyst. J Bone Oncol. 2018;11:10–6.

    Article  Google Scholar 

  7. Gao Z-H, Yin J-Q, Liu D-W, Meng Q-F, Li J-P. Preoperative easily misdiagnosed telangiectatic osteosarcoma: clinical-radiologic-pathologic correlations. Cancer Imaging Off Publ Int Cancer Imaging Soc. 2013;13:520–6.

    Google Scholar 

  8. Rajeswaran G, Malik Q, Saifuddin A. The role of needle biopsy for focal bone lesions with complete fluid-fluid levels on magnetic resonance imaging. Skelet Radiol. 2013;42:765–9.

    Article  CAS  Google Scholar 

  9. Mahnken AH, Nolte-Ernsting CCA, Wildberger JE, Heussen N, Adam G, Wirtz DC, et al. Aneurysmal bone cyst: value of MR imaging and conventional radiography. Eur Radiol. 2003;13:1118–24.

    Article  CAS  Google Scholar 

  10. Vanel D, Tcheng S, Contesso G, Zafrani B, Kalifa C, Dubousset J, et al. The radiological appearances of telangiectatic osteosarcoma. A study of 14 cases. Skelet Radiol. 1987;16:196–200.

    Article  CAS  Google Scholar 

  11. Murphey MD, wan Jaovisidha S, Temple HT, Gannon FH, Jelinek JS, Malawer MM. Telangiectatic osteosarcoma: radiologic-pathologic comparison. Radiology. 2003;229:545–53.

    Article  Google Scholar 

  12. Miller TT. Bone tumors and tumorlike conditions: analysis with conventional radiography. Radiology. 2008;246:662–74.

    Article  Google Scholar 

  13. Costelloe CM, Madewell JE. Radiography in the initial diagnosis of primary bone tumors. AJR Am J Roentgenol. 2013;200:3–7.

    Article  Google Scholar 

  14. Sasaki H, Nagano S, Shimada H, Yokouchi M, Setoguchi T, Ishidou Y, et al. Diagnosing and discriminating between primary and secondary aneurysmal bone cysts. Oncol Lett. 2017;13:2290–6.

    Article  Google Scholar 

  15. Leithner A, Windhager R, Lang S, Haas OA, Kainberger F, Kotz R. Aneurysmal bone cyst. A population based epidemiologic study and literature review. Clin Orthop Relat Res. 1999:363:176–9

  16. Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer. 1992;69:2921–31.

    Article  CAS  Google Scholar 

  17. Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC. Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23:6756–62.

    Article  Google Scholar 

  18. Dabska M, Buraczewski J. Aneurysmal bone cyst. Pathology, clinical course and radiologic appearances. Cancer. 1969;23:371–89.

    Article  CAS  Google Scholar 

  19. Capanna R, Bettelli G, Biagini R, Ruggieri P, Bertoni F, Campanacci M. Aneurysmal cysts of long bones. Ital J Orthop Traumatol. 1985;11:409–17.

    CAS  PubMed  Google Scholar 

  20. Tsai JC, Dalinka MK, Fallon MD, Zlatkin MB, Kressel HY. Fluid-fluid level: a nonspecific finding in tumors of bone and soft tissue. Radiology. 1990;175:779–82.

    Article  CAS  Google Scholar 

  21. Van Dyck P, Vanhoenacker FM, Vogel J, Venstermans C, Kroon HM, Gielen J, et al. Prevalence, extension and characteristics of fluid-fluid levels in bone and soft tissue tumors. Eur Radiol. 2006;16:2644–51.

    Article  Google Scholar 

  22. Alyas F, Saifuddin A. Fluid-fluid levels in bone neoplasms: variation of T1-weighted signal intensity of the superior to inferior layers--diagnostic significance on magnetic resonance imaging. Eur Radiol. 2008;18:2642–51.

    Article  Google Scholar 

  23. Huvos AG, Rosen G, Bretsky SS, Butler A. Telangiectatic osteogenic sarcoma: a clinicopathologic study of 124 patients. Cancer. 1982;49:1679–89.

    Article  CAS  Google Scholar 

  24. Angelini A, Mavrogenis AF, Trovarelli G, Ferrari S, Picci P, Ruggieri P. Telangiectatic osteosarcoma: a review of 87 cases. J Cancer Res Clin Oncol. 2016;142:2197–207.

    Article  Google Scholar 

  25. O’Donnell P, Saifuddin A. The prevalence and diagnostic significance of fluid-fluid levels in focal lesions of bone. Skelet Radiol. 2004;33:330–6.

    Article  Google Scholar 

  26. Hegde V, Burke ZDC, Park HY, Zoller SD, Johansen D, Kelley BV, et al. Is core needle biopsy reliable in differentiating between aggressive benign and malignant radiolucent bone tumors? Clin Orthop. 2018;476:568–77.

    Article  Google Scholar 

  27. Bahk W-J, Mirra JM. Differential diagnostic value of “blue reticulated chondroid-like material” in aneurysmal bone cysts: a classic histopathologic analysis of 215 cases. Am J Clin Pathol. 2015;143:823–9.

    Article  Google Scholar 

  28. Kubo T, Furuta T, Johan MP, Sakuda T, Ochi M, Adachi N. A meta-analysis supports core needle biopsy by radiologists for better histological diagnosis in soft tissue and bone sarcomas. Medicine (Baltimore). 2018;97:e11567.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Queen Elizabeth University Hospital and Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK

    Umme Sara Zishan

  2. Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Ian Pressney, Michael Khoo & Asif Saifuddin

Authors
  1. Umme Sara Zishan
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  2. Ian Pressney
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  3. Michael Khoo
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  4. Asif Saifuddin
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Correspondence to Michael Khoo.

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Zishan, U.S., Pressney, I., Khoo, M. et al. The differentiation between aneurysmal bone cyst and telangiectatic osteosarcoma: a clinical, radiographic and MRI study. Skeletal Radiol 49, 1375–1386 (2020). https://doi.org/10.1007/s00256-020-03432-w

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  • DOI: https://doi.org/10.1007/s00256-020-03432-w

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