LETTER TO THE EDITOR Year : 2022  |  Volume : 30  |  Issue : 2  |  Page : 56-57

Solid aneurysmal bone cyst of the orbit

Majid Ismayilzade1, Fazli Cengiz Bayram2, Mehmet Dadaci1, Bilsev Ince1
1 Department of Plastic Reconstructive and Aesthetic Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
2 Private Practicioner in Denizli, Denizli, Turkey

Date of Submission11-Aug-2021Date of Acceptance30-Oct-2021Date of Web Publication23-Mar-2022

Correspondence Address:
Dr. Majid Ismayilzade
Department of Plastic Reconstructive and Aesthetic Surgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya
Turkey

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjps.tjps_45_21

How to cite this article:
Ismayilzade M, Bayram FC, Dadaci M, Ince B. Solid aneurysmal bone cyst of the orbit. Turk J Plast Surg 2022;30:56-7

Dear Sir,

Aneurysmal bone cysts (ABCs) are rarely encountered nonneoplastic expansile lesions of bones with a thin wall consisting of blood-filled cystic cavities.[1] The most common localizations of ABCs are long bones and vertebra, while 2%–6% of them have cranial involvement, and even fewer show sphenoid or orbital involvement.[2]

In the review study in 2012, it was stated that 25 cases with orbital ABC were reported since then.[3] Painless swelling is a typical clinical sign of ABC; however, according to the literature, 100% of the cases with orbital ABC presented exophthalmos preoperatively.[3] In this study, we aimed to present a case of solid orbital ABC in a 56-year-old patient without any visual impairment and exophthalmos.

A 56-year-old man with a 5-year history of painless swelling of the right lateral orbital rim was admitted to our clinic [Figure 1]. Upon physical examination, a 2 cm nonmobile swelling with intact skin was palpated on the right lateral orbital rim. There was no eye restriction or proptosis. Surprisingly, the patient did not present any exophthalmos of the affected eye, decreased vision, and diplopia either. CT of the orbit revealed a ground-glass density of the expansile lytic lesion with a thinned-out cortex and bony enlargement into the orbit [Figure 2].

Figure 1: Mild swelling was observed in preoperative assessment of the patient

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Figure 2: Computed tomography scan analysis demonstrated a bony enlargement of expansile lytic lesion into the lateral orbital wall and zygomatic arch

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The solid cystic lesion was completely removed through subciliary incision extended 12 mm lateral to the lateral canthus positioned in a natural transverse crease [Figure 3]. Histopathological analysis showed that the lesion was confined within a fibrous capsule, which consisted of numerous blood-filled sinusoidal spaces devoid of endothelial linings. The fibrous capsule and septations contained a number of multinucleate giant cells as well as hemosiderin-laden macrophages and cellular fibrous tissue containing some bony trabeculae.

Figure 3: Intraoperative images of aneurysmal bone cyst. (a and b) Cystic cavities separated by multiple septations are clearly seen. (c) Although destruction of the lateral orbital wall by a cyst was observed intraoperatively, reconstruction was not required as the sufficient buttress remained after the total removal of aneurysmal bone cyst

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The first case of orbital ABC was reported by Fite et al. and they demonstrated the treatment of a 8-year-old girl with severe exophthalmos.[4] In 2012, Yu et al. specified that a total of 25 cases had ABC-associated exophthalmos in his review study.[3] Orbital roof was involved in 19 of the patients, while 4 patients had ABC in the medial orbital wall, and 2 of 25 patients presented lateral orbital involvement, respectively. Besides its rare lateral orbital rim localization, our study is the first solid orbital ABC case presenting no any visual impairment and exophthalmos sign.

A typical age at presentation is 10–30 years and up to 85% of cases, it occurs at the age of 20 or less.[3] After a 56-year-old patient presented in our study, the eldest patient with orbital ABC was 49-year-old female reported in 2015.[5]

In contrast to literature examples with orbital ABCs, the occurrence of this lesion is surprisingly possible without any clinical sign of visual impairment and exophthalmos. Several treatment methods can be applied in known localizations of ABCs, however, the complete excision seems to be the safest method presently due to the limited number of cases.

Declaration of patient consent

Written informed consent was obtained from the patient and is on file for publication of this case report. This study adhered to the tenets of the Declaration of Helsinki.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Biesecker JL, Marcove RC, Huvos AG, Miké V. Aneurysmal bone cysts. A clinicopathologic study of 66 cases. Cancer 1970;26:615-25.  
    2.Bozbuğa M, Turan Süslü H. Aneurysmal bone cyst of the sphenoid bone extending into the ethmoid sinus, nasal cavity and orbita in a child. Turk Neurosurg 2009;19:172-6.  
    3.Yu JW, Kim KU, Kim SJ, Choi S. Aneurysmal bone cyst of the orbit: A case report with literature review. J Korean Neurosurg Soc 2012;51:113-6.  
    4.Fite DJ, Schwartz JF, Calhoun FP. Aneurysmal bone cyst of the orbit (a clinicopathological case report). Trans Am Acad Ophthalmol Otolaryngol 1968;72:614-8.  
    5.Wang JC, Zhang M, Zhao XX. Aneurysmal bone cyst of the orbit. Chin Med J (Engl) 2015;128:562-3.  
    
  [Figure 1], [Figure 2], [Figure 3]