Aneurysmal bone cyst: Concept, controversy, clinical presentation, and imaging

The origin of the term 'aneurysmal bone cyst' stems from two cases reported by Jaffe and Lichtenstein [3] in their article on unicameral bone cysts in 1942. In that report, they noted two 'peculiar blood-containing cysts of large size,' which they described as aneurysmal cysts. In a subsequent paper, Jaffe chose the name 'aneurysmal bone cyst' as the descriptive term for this lesion, with the word 'aneurysmal' to emphasize the 'blown-out,' distended contour of the affected bone, and the words 'bone cyst' to underscore that when the lesion is entered through a thin shell of bone, it appears largely as a blood-filled cavity [4] (Fig. 1). As originally described by Jaffe and Lichtenstein in 1942, and in following articles by each [3-6], aneurysmal bone cyst was sufficiently characteristic to identify it as a distinctive radiologic-pathologic entity. However, its nature has remained unclear. In both the original and an ensuing paper on the subject, Jaffe postulated that aneurysmal bone cyst may be a secondary phenomenon due to a hemorrhagic 'blow-out' in a preexisting lesion, which may be destroyed in the process [3, 4]. Lichtenstein also suggested a vascular origin but postulated that the lesion was the result of a 'local circulatory disturbance,' noting that although 'the precise basis for this vascular disturbance is not readily discernible... it could conceivably be thrombosis of a sizable vein, or perhaps an anomalous arteriovenous communication' [5, 6].