Conversion of the primary aneurysmal bone cyst into osteogenic sarcoma following treatment with percutaneous sclerotherapy using polidocanol injection


  • Kamal Kishor Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
  • Ashish Ragase Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
  • Love Kapoor Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
  • Venkateshan S. Kumar Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
  • Asit R. Mirdha Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
  • Shah A. Khan Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India



Aneurysmal bone cyst, Polidocanol, Osteogenic sarcoma, Ankle arthrodesis, Sclerotherapy


The intralesional injection of sclerosing agents has been identified as a safe method for treating primary aneurysmal bone cysts (ABC). However, to the best of our knowledge, there have been no reported instances in the literature of a primary ABC transforming into osteogenic sarcoma following complete healing facilitated by an intralesional sclerosing agent, such as polidocanol. We present the case of a 20-year-old female diagnosed with a histologically proven primary ABC located at the distal end of the tibia. She underwent a series of 5 intralesional injections of 3% polidocanol (hydroxypolyaethoxydodecan) and achieved complete clinical and radiological healing. However, after 10 years, her symptoms resurfaced, and subsequent histological examinations revealed osteogenic sarcoma. Surgical excision was performed, followed by bone grafting and ankle arthrodesis. This case suggests that intralesional alcohol injections might not prevent the inherent potential for malignant transformation of primary ABCs. To ascertain whether such injections increase the risk of sarcomatous conversion, further long-term follow-up studies are imperative.


Kerimoğlu S, Citlak A, Kerimoğlu G, Turgutalp H. Primary aneurysmal bone cyst of the distal tibial epiphysis: a case report. J Pediatr Orthop B. 2014;23(3):266-9.

Park HY, Yang SK, Sheppard WL, Hegde V, Zoller SD, Nelson SD, et al. Current management of aneurysmal bone cysts. Curr Rev Musculoskelet Med. 2016;9(4):435-44.

Kansagra AP, Wan JJ, Devulapalli KK, Horvai AE, O'Donnell RJ, Link TM. Malignant Transformation of an Aneurysmal Bone Cyst to Fibroblastic Osteosarcoma. Am J Orthop (Belle Mead NJ). 2016;45(6):E367-72.

Song X, Qiao Y, Zhang H, Sha L, Lou J, Yu X, et al. Malignant transformation of an aneurysmal bone cyst of the femoral neck: A case report. Exp Ther Med. 2023 9;26(2):362.

Noordin S, Ahmad T, Umer M, Allana S, Hilal K, Uddin N, et al. Aneurysmal bone cyst of the pelvis and extremities: Contemporary management. Int J Surg Oncol. 2019;4:1.

Restrepo R, Zahrah D, Pelaez L, Temple HT, Murakami JW. Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment. Pediatr Radiol. 2022;52(9):1601-14.

Zishan US, Pressney I, Khoo M, Saifuddin A. The differentiation between aneurysmal bone cyst and telangiectatic osteosarcoma: a clinical, radiographic and MRI study. Skeletal Radiol. 2020;49(9):1375-86.

Grahneis F, Klein A, Baur-Melnyk A, Knösel T, Birkenmaier C, Jansson V, et al. Aneurysmal bone cyst: A review of 65 patients. J Bone Oncol. 2019;18:100255.

Chang CY, Kattapuram SV, Huang AJ, Simeone FJ, Torriani M, Bredella MA. Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid. Skeletal Radiol. 2017;46(1):35-40.

Rastogi S, Varshney MK, Trikha V, Khan SA, Choudhury B, Safaya R. Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol. J Bone Joint Surg Br. 2006;88-B(9):1212-6.

Varshney MK, Rastogi S, Khan SA, Trikha V. Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts? Clin Orthop Relat Res. 2010;468(6):1649-59.

Sasaki H, Nagano S, Shimada H, Yokouchi M, Setoguchi T, Ishidou Y, et al. Diagnosing and discriminating between primary and secondary aneurysmal bone cysts. Oncol Lett. 2017;13(4):2290-6.

Gao ZH, Yin JQ, Liu DW, Meng QF, Li JP. Preoperative easily misdiagnosed telangiectatic osteosarcoma: clinical-radiologic-pathologic correlations. Cancer Imaging. 2013;13(4):520-6.

Marcove RC, Sheth DS, Takemoto S, Healey JH. The treatment of aneurysmal bone cyst. Clin Orthop Relat Res. 1995;(311):157-63.

Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK. Aneurysmal bone cyst. A clinicopathologic study of 238 cases. Cancer. 1992;69(12):2921-31.

Zhang J, Jing Z, Schliephake DE, Otto J, Malouf GM, Gu YQ. Efficacy and safety of Aethoxysklerol® (polidocanol) 0.5%, 1% and 3% in comparison with placebo solution for the treatment of varicose veins of the lower extremities in Chinese patients (ESA-China Study). Phlebology. 2012;27(4):184-90.






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