14-Year-Old Female With Leg Pain and Swelling

Jonathan Gordon, M.D., Ph.D.

December 09, 2004

Discussion

This lesion displays a classic appearance and location for an ABC. They most commonly occur in children and young adults with no sex predilection. They usually present with pain and swelling occurring over weeks to years. Pathologic fracture occurs in up to 20%. Although any bone may be affected, they most frequently are found in the metaphysis of long bones, most commonly the tibia. 12-30% occur in the spine. ABC's may result from trauma or an underlying tumor such as osteosarcoma or giant cell tumor. The lesion is composed of blood-filled anastomosing cavernous spaces with septae composed of fibroblasts, osteoid and giant cells. On MRI, these spaces with fluid/fluid levels are visualized with varying signal in the dependent portions on T1 and T2-weighted images representing layering blood products of various ages. They are best seen with MRI rather than CT. The septal components may enhance. These findings were once thought to be specific for ABC but have also been found in telangiectatic osteosarcoma, chondroblastoma, giant cell tumors, fibrous dysplasia, and malignant fibrous histiocytoma. Such entities must be taken under suspicion if solid components are encountered. Prior to treatment, a pre-existing lesion should be excluded. If there is no coexisting lesion, curettage and bone grafting are usually performed with consideration for preoperative embolization. More aggressive measures are undertaken in the presence of aggressive lesions such as an osteosarcoma. For a benign ABC, the recurrence rate is 10-20%. The differential for this lesion includes unicameral bone cyst, chondromyxoid fibroma, giant cell tumor, telangiectatic osteosarcoma and metastasis.

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