Secondary Aneurysmal Bone Cyst in a Craniofacial Fibrous Dysplasia: Case Report

Craniofacial fibrous dysplasia with cystic degeneration - A diagnostic challenge

Benign fibro-osseous lesions with cystic degenerations have been scarcely reported in craniofacial bones and its unusual characteristics pose a diagnostic challenge. Here, we report a case of craniofacial fibrous dysplasia presenting a large cystic degeneration. A 55-year-old woman had a history of pain, slight asymmetry on the zygomatic region and ocular pressure. Computed tomography revealed on the right side, multiple craniofacial bones showing a ground glass aspect, associated with an extensive hypodense, unilocular, well circumscribed lesion in the maxilla, and smaller lesions in the sphenoid bone. After a surgical procedure performed in another service, there was a complete improvement in symptoms, and after 1 year, the patient remains stable, with no changes. In the literature review, thirty-three reported cases of the same association in the craniofacial region were found. The main symptoms were sudden increase in the lesion and pain, and the indication of intervention in cystic lesions was only indicated in symptomatic cases or functional deficit. The knowledge of the possibility of the association of benign fibro-osseous lesions and cystic degenerations in craniofacial bones is essential to perform a correct diagnosis and treatment for these patients, consequently avoiding unnecessary procedures. Key words:Craniofacial fibrous dysplasia, Fibrous dysplasia, Benign fibro-osseous lesions, Cystic degeneration.

Craniofacial fibrous dysplasia and aneurismal bone cyst in a patient with McCune-Albright syndrome. A case report and review of the literature

McCune-Albright syndrome (MAS) is a rare heterogeneous genetic disorder that is characterized by a triad of polyostotic fibrous dysplasia (FD), café au lait spots (CAL), and multiple hyperfunctional endocrinopathies. In general, it is diagnosed clinically. From the triads, 2 of the findings are enough to make the diagnosis. Craniofacial fibrous dysplasia is a term that is used to describe the fibrous dysplasia, which was localized at the craniofacial skeleton and is common in MAS patients. Aneurysmal bone cyst (ABC) is a rare non-neoplastic bone lesion that involves mostly the long bones and vertebrae and may occur very rarely in the craniofacial bones. ABCs may occur as secondary bony pathologies in association with various benign and malignant bone tumors and with fibrous dysplasia. Secondary ABC occurring in craniofacial FD is extremely rare. We present the case of a 21-year-old patient treated at our center for a right orbital aneurysmal bone cyst associated with MAS and provide a review of the relevant literature.

Fibrous Dysplasia With Aneurysmal Bone Cyst Presenting as Sinonasal Mass

Craniofacial involvement in fibrous dysplasia is a rare occurrence and complications of it are even rarer. Involvement of the sinonasal region can pose a challenge in both diagnosis and management. We hereby present a case of craniofacial fibrous dysplasia complicated with secondary aneurysmal bone cyst formation in a 15-year-old male patient.

Aneurysmal bone cyst on top of fibro-osseous lesion of the ethmoid sinus with orbital and intracranial extension in a child

Objective

Aneurysmal bone cysts (ABCs) rarely involve the cranium. We report a case arising in the ethmoid sinus with orbital and intracranial invasion. Imaging suggested an associated fibro-osseous lesion. The lesion was completely resected. Histology confirmed the imaging diagnosis of ABC on top of an ossifying fibroma. A multidisciplinary approach is essential for optimal surgical outcomes.

Methods

We report a case of an 8-year-old boy with a 5 week history of painless, increasing prominence of the left eye. Clinical examination revealed non-pulsatile left proptosis. Visual acuity and ocular movements were normal. CT and MRI scans of the maxillofacial regions showed a large space-occupying lesion involving the left ethmoid air cells with left orbital and left inferior frontal intracranial extension. Multiple fluid levels with blood products were seen. Areas of the bony component of the lesion showed ground-glass density on CT. Imaging was consistent with an ABC with an underlying fibro-osseous lesion; probably fibrous dysplasia which was confirmed after surgical removal of the lesion. A multidisciplinary team of maxillofacial, neurosusugery and ENT surgeons performed the surgery.

Results

ABC arising from an osseous fibroma of the skull is rare. Total resection can be achieved with a multidisciplinary surgical approach. Post-operative histology confirmed by the imaging findings.

Aneurysmal Bone Cysts of the Craniofacial Origin: A Systematic Review

Objective

Aneurysmal bone cysts (ABCs) are blood-filled, locally destructive, benign bone tumors. Our objective was to conduct a systematic review outlining patient demographics, clinical characteristics, management, and outcomes of those with ABCs of the craniofacial bones.

Data Sources

Using PubMed, Cochrane, and Embase databases, 116 studies were included.

Review Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was conducted. Data including patient demographics, clinical characteristics, treatment strategies, and patient outcomes were collected.

Results

A total of 127 patients from 116 studies were identified. Age ranged from 8 months to 90 years, with a mean age of 19.0 years. The most commonly affected craniofacial locations were the mandible (n = 31, 24.4%), temporal bone (n = 21, 16.5%), and occipital bone (n = 14, 11.0%). The most common presenting symptoms included a nontender mass (n = 51, 40.2%), a tender mass (n = 31, 24.4%), and generalized headache (n = 30, 23.6%). Imaging modalities included computed tomography (CT) and magnetic resonance imaging (MRI) (n = 77, 60.6%), CT alone (n = 31, 24.4%), and MRI alone (n = 8, 6.2%). All patients underwent surgical resection, with 1 patient requiring adjuvant radiation in addition to surgery. In total, 121 patients were disease-free and symptom-free without evidence of recurrence (17.4-month mean follow-up, 5.4 months average time to first recurrence).

Conclusion

The current literature’s characterization of ABCs in craniofacial bones is limited to case reports and case series. Given the rarity of these tumors, head and neck surgeons may rely on systematic reviews such as the present analysis to guide management.

Monostotic craniofacial fibrous dysplasia: report of two cases with interesting histology

Fibrous dysplasia (FD) is a relatively rare osseous disease of unknown etiology, wherein the normal bone is replaced by collagen-rich tissue, comprising of fibroblasts and variably abundant immature woven bone. Clinically, it may involve a single bone or multiple bones. It commonly arises in the jaw bone, skull, rib, and proximal femur. Those arising in the skull and the jaw are together termed “craniofacial fibrous dysplasia.” The differential diagnosis at this location includes meningioma and metastatic carcinoma. In this report, we highlight two diagnostically challenging cases presenting with orbital swelling and headache as the main complaints. Our first case was misinterpreted as meningioma on intraoperative squash smear, and paraffin sections revealed characteristic features of FD. The second case highlights the morphological feature of non-specific cystic degeneration occurring in FD. Radiographs in such cases show cystic swelling, which is indicative of a secondary aneurysmal bone cyst.