Telangiectasic osteosarcoma versus aneurysmal cyst

ucjournals June 3, 2023

45 2 minutes read

Presented in Breast pathology & Breast Cancer Conference Online
Speaker Name: Marwa Krifa
Category: Poster Presentation
Keywords: Telangiectasic osteosarcoma, aneurysmal cyst, , long bone, CT scan, surgical biopsy

Introduction: Aneurysmal bone cyst (ABC) and telangiectatic osteosarcoma (TOS) share several clinical and imaging features, including young presentation, long bone involvement, lytic appearance on radiography and fluid-fluid levels on MRI. Therefore, they may be difficult to differentiate.

Case presentation: It was about a 6 year old patient with surgical history of a fracture of the right femur operated in 2020.After 6 months, the patient presented a functional impotence and significant edema of the right lower limb. The CT scan showed a diaphysis clear lesion of the upper end of the right femur surrounded by a peripheral sclerotic border without obvious signs of invasion of the surrounding soft tissues. A surgical biopsy was done, concluded to an aneurysmal cyst. But the evolution was fast requiring management in a specialized center of orthopedics where the diagnosis of telangiectatic osteosarcoma (TOS) was proposed. And a second surgical biopsy was done. It showed large blood spaces ( Figure 1) surrounded by fibro connective tissues containing giant cells and without any atypical cells (Figure 2). After a clinical, radiological and pathological confrontation, the diagnosis of aneurysmal bone cyst (ABC) was retained.

Discussion: As a rare subtype of osteosarcoma, TOS may be easily misdiagnosed as ABC. These 2 entities share the same clinical and radiological profile (1). As for the pathological examination, often we can distinguish the TOC from the ABC by the demonstration of cellular atypia, the presence of numerous mitoses and the presence of necrosis (2,3). Nevertheless in some studies, the comparison between the clinical, radiological and pathological aspects remains important as in our case (1)

Conclusion: The current case has identified clinical, radiographic and pathological features which aid in the differentiation between ABC and TOS.

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