Gigantic lumbar aneurysmal bone cyst with abdominal extension in a pediatric patient - case report and its multidisciplinary management

Sep 30, 2026

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A case report describes a 12-year-old female with painless flank swelling and abdominal fullness, in whom imaging revealed a gigantic expansile lytic lesion at L4 with extension toward left-sided visceral organs and mild scoliotic deformity. Biopsy confirmed an aneurysmal bone cyst (ABC). After embolization and sclerotherapy failed to control the tumor, the patient underwent anterior intralesional excision combined with posterior instrumented fusion, resulting in improved symptoms, deformity, and alignment. Multidisciplinary surgical management achieved favorable clinical and radiological outcomes with no recurrence at last follow-up.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Introduction

Case presentation

Case Description

Management approaches

Conclusions

Keywords and publication information

Gigantic lumbar aneurysmal bone cyst with abdominal extension in a pediatric patient: case report and its multidisciplinary management Anouar Bourghli1,2, Faisal Konbaz1,2, Firas Alsebayel3, Monerah Annaim1, Ziad Alyousif1, Jehan Howsawi1, Zakaria Habib4, Khalid AlMusrea1 1Department of Spine Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 3Department of Orthopedic Surgery, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 4Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia Contributions: (I) Conception and design: A Bourghli, F Konbaz; (II) Administrative support: None; (III) Provision of study materials or patients: ABourghli, M Annaim, F Konbaz; (IV) Collection and assembly of data: F Alsebayel, J Howsawi; (V) Data analysis and interpretation: F Alsebayel; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Firas Alsebayel, MBBS. Department of Orthopedic Surgery, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, P.O. Box 3660, Riyadh 11481, [Saudi Arabia. Email: Firas@Alsebayel.com](Saudi Arabia. Email: Firas@Alsebayel.com). Background: Aneurysmal bone cyst (ABC) is a rare, benign, and highly vascular osteolytic lesion characterized by expansile cystic spaces filled with blood and surrounded by thinned cortical bone. ABC is most commonly found in the vertebral column, most specifically in the posterior element of the lumbar spine. Management of spinal ABCs poses a challenge to the treating physician given its proximity to the neural structures. Surgical intervention, radiation therapy, cryotherapy, and embolization are effective treatment methods. However, no treatment protocol has been established in the literature, particularly when the tumor is uncommonly large. Case Description: We present the case of a 12-year-old female with a flank mass and abdominal fullness, imaging showed a gigantic expansile lytic lesion with left sided extension to the visceral organs at the level of L4 with mild scoliotic deformity. A biopsy confirmed an ABC. Patient underwent embolization and sclerotherapy which failed to achieve tumor control. Patient was taken for anterior tumor intralesional excision with posterior instrumented fusion. Postoperatively patient symptoms, deformity and her overall alignment improved. Conclusions: The current case described the largest ABC spine tumor of the current pediatric literature. Multidisciplinary surgical management enabled satisfactory clinical and radiological outcomes with no recurrence at the last follow-up. Keywords: Spine tumor; aneurysmal bone cyst (ABC); back pain; case report Submitted May 31, 2025. Accepted for publication Aug 15, 2025. Published online Dec 12, 2025. doi: 10.21037/jss-25-84 View this article at: [https://dx.doi.org/10.21037/jss-25-84](https://dx.doi.org/10.21037/jss-25-84) Introduction Aneurysmal bone cyst (ABC) is a rare, benign, and highly vascular osteolytic bone lesion. It is characterized by expansile cystic spaces filled with blood and surrounded by thinned cortical bone (1) . ABCs were first described in 1942 by Dr. Jaffe and Lichenstein as a “peculiar blood containing cyst of large size”. ABCs comprise 1.4% of all primary bone tumors. The vertebral column is involved in 3–30% of cases and most commonly found in the posterior elements of the lumbar spine. ABC occurs in the first two decades of life with slight female predominance (2) . The evaluation of ABC typically includes radiological © AME Publishing Company. J Spine Surg 2025;11(4):1175-1183 | [https://dx.doi.org/10.21037/jss-25-84](https://dx.doi.org/10.21037/jss-25-84) 1176 Bourghli et al. Gigantic lumbar ABC studies like computed tomography (CT) and magnetic resonance imaging (MRI), which characteristically exhibit well defined, th

FAQs

What symptoms and imaging findings were reported in the pediatric case?

The patient had painless flank swelling and abdominal fullness. Imaging showed a gigantic expansile lytic lesion at L4 with left-sided extension toward visceral organs and mild scoliotic deformity.

How was the diagnosis of aneurysmal bone cyst confirmed?

A biopsy confirmed aneurysmal bone cyst (ABC) after imaging and clinical presentation.

What treatments were attempted and what was the final surgical approach?

Embolization and sclerotherapy were performed but failed to achieve tumor control. The patient then underwent anterior intralesional tumor excision with posterior instrumented fusion.

Sep 30, 2026

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