Is an intralesional approach a sufficient treatment for solid variant aneurysmal bone cysts in long bones? A case series

Background/Aim: The solid variant of aneurysmal bone cysts (SVABC) is a rare subtype, representing 3.4–7.5% of all aneurysmal bone cysts, which themselves account for 1.4% of benign skeletal tumors. This study evaluates the outcomes of four patients with SVABC in long bones (three femurs, one humerus), a condition rarely reported in the literature. Methods: We conducted a retrospective case series analysis of patients who were definitively diagnosed with SVABC through histopathological examination following surgical intervention at our clinic. Inclusion criteria consisted of patients with radiologically identified bone lesions suspected to be SVABC and confirmed by postoperative pathology. Diagnostic workup included detailed imaging with MRI and CT to evaluate lesion morphology, vascularity, and cortical integrity. Surgical treatment involved intralesional curettage, structural allograft bone grafting, and internal osteofixation. Postoperative follow-up included regular clinical examinations and radiographic assessments at 1, 3, 6, and 12 months to monitor healing, detect recurrence, and evaluate functional recovery. Results: Four patients met the inclusion criteria and underwent surgical management as described. All patients achieved radiological union and demonstrated significant functional improvement, with return to full weight-bearing and daily activity within six months. No postoperative complications, such as infection or hardware failure, were observed. Imaging at one-year follow-up showed no evidence of local recurrence or graft resorption. Functional assessments indicated full range of motion and absence of pain in all cases. Conclusion: SVABC is a rare benign bone tumor that often mimics other aggressive lesions both radiologically and histologically. Despite its nonaggressive appearance, it requires accurate diagnosis and appropriate surgical management to prevent recurrence. Our findings suggest that thorough preoperative imaging, histopathological confirmation, and a combination of curettage with grafting and fixation can result in excellent clinical and radiological outcomes. SVABC should be considered in the differential diagnosis of solid-appearing bone lesions, particularly those with osteoblastic activity and giant cell–rich histology.