Aneurysmal Bone Cysts

In a comprehensive review of the records of more than 2,000 primary bone lesions encountered at operation at the Mayo Clinic in the period 1905–52, 26 aneurysmal bone cysts were found. The lesion first was recognized by Jaffe and Lichtenstein (1), this being one of the many contributions they have made in the field of bone pathology. Our investigation reaffirms their belief that aneurysmal bone cyst is a distinct clinical and pathologic entity. The specific term “aneurysmal bone cyst” does not appear in the literature until 1942, when Jaffe and Lichtenstein stated for the first time that it was probably a distinct entity and described the findings in 2 cases. In many papers prior to this (2–7), especially those concerning giant-cell tumors and their “variants,” more or less complete descriptions of the lesion are encountered under a variety of names. Ewing (8), in 1940, employed the term “aneurysmal giant-cell tumor” for the condition, which he considered to be a benign variant of a giant-cell tumor taking the gross form of a bone aneurysm. Although the term “aneurysmal bone cyst” was coined in 1942, the literature of the succeeding eight years contains no single comprehensive article on this subject. A number of writers continued to make mention of typical cases, but under a great variety of names (9–13). In 1944, Mayer and Kestler (14) reported 2 cases of “aneurysmal bone cysts of the spine,” the diagnosis in these cases being confirmed by Jaffe. By 1950, Lichtenstein (15) and Jaffe (16) each had collected enough cases to write comprehensive articles on the subject. In all important respects these authors are in complete agreement, their only differences being in theories concerning the origin of the lesion and in the reason for choosing its particular name. The clinical, roentgenologic, and pathologic features, as described by them, will be given in detail in the discussion of our cases. Clinical Considerations The age distribution of our 26 patients was as follows: ages five to nine, 5 cases; ten to fourteen, 6 cases; fifteen to nineteen, 7 cases; twenty to twenty-four, 4 cases; twenty-five to twenty-nine, 2 cases; thirty-five to thirty-nine, 2 cases. The average age was 17.2 years, with a range from five to thirty-seven. Eighteen patients were less than twenty years old. This age distribution is similar to that of the previously reported cases. Females predominated in our series in a ratio of 16 to 10. Jaffe, in “approximately 20 cases,” noted a similar sex distribution. In Lichtenstein's series reported in 1950 (15), there were 7 males and 1 female, but in a recent personal communication he stated that in a later study he found no sex predilection. The apparent predominance of females in our study cannot at this time be said to be statistically significant.