Symptomatic juxtaphyseal aneurysmal bone cyst of proximal humerus in a 4 year old: Case report

Abstract

Considered by many surgeons and radiologists as a “don’t touch lesion” meaning lesions that need no further attention as described by CA Helms in 2013, Aneurysmal Bone Cyst (ABC) is a misnomer. This is so because it’s neither an aneurysm nor a cyst. ABCs are benign expansile bone tumours representing about 1% of all bone tumours and affecting mostly those younger than 20 years of age. Typically found in the metaphysis of long bones, pelvis and posterior vertebral elements. They may have physeal extensions leading to growth abnormalities. The current mainstay of treatment following diagnosis is curettage with or without bone graft and use of adjuvant therapy according to the surgeon’s preference. In spite of the number of techniques reported in literature, there remains a recurrence rate of 5% to over 40%. This is a case report of a 4 year old boy who presented with 6 months history of recurrent right shoulder pain, associated with swelling and reduced range of motion. Following blood work ups, physical exam and radiological assessment, a preoperative impression of proximal humerus Juxta-physeal ABC was made. Open curettage, biopsy and bone substitute was performed through the deltopectoral approach. Histopathology results confirmed ABC. Seven months of follow up has  demonstrated clinical and radiological remission.

Key words: Aneurysmal Bone Cyst, Curettage