Aggressive Management of Surface Aneurysmal Bone Cyst: A Case Report

Abstract

Aneurysmal bone cyst originating from the surface of the bone is an unusual subtype. Surface ABCs have a predilection for diaphysis of long tubular bones. Radiologically it may mimic telangiectatic osteosarcoma which can be differentiated on the basis of histology. We present here a case of 17 year old male with proximal humerus surface ABC with extensive cortical breach. Clinico-radiographic presentation of the patient was more aggressive than conventional ABC. Plain radiograph demonstrated a permeative type of destructive pattern and the cross-sectional imaging demonstrated extensive cortical breach and intramedullary spread. MR Imaging suggested that intramedullary spread was more extensive in dimension as compared to the subperiosteal component. Biopsy was suggestive of ABC. Preoperatively selective arterial embolisation was done. Management was done by wide en-bloc resection and treatment of resected segment with liquid nitrogen by free freezing method followed by reimplantation and internal xation with a proximal humerus plate along-with bular strut graft. Patient on follow up after 5 months post operatively was able to perform his activities of daily living. Most cases reported in literature were managed by curettage and bone grafting. Literature for aggressive management of surface ABC's is sparse with no literature available regarding the use of liquid nitrogen in its management