Struthers P J, Shear M
Int J Oral Surg. 1984 Apr;13(2):92-100. doi: 10.1016/s0300-9785(84)80078-2.
The pathogenesis of the aneurysmal bone cyst is the subject of much controversy. This study was undertaken to test the hypothesis that the aneurysmal bone cyst is a secondary phenomenon which occurs in a primary lesion of bone. Histological material from 303 bone lesions was studied for evidence of development of aneurysmal bone cyst. Microcysts and blood-filled spaces, similar to those seen in aneurysmal bone cysts, were observed in 15 of 54 central giant cell granulomas studied (28%). The frequency was lower (10%) in 49 cases of fibrous dysplasia and very low in ossifying and cementifying fibromas. 1 of 7 cases of Paget's disease of bone showed large blood spaces. It is postulated that the initiating process of the aneurysmal bone cyst is the microcyst, which forms as a result of intercellular oedema in a primary lesion with loose, unsupported stroma. Rupture of vessels into the microcysts introduces blood under haemodynamic pressure. With little resistance provided by the stroma, the blood spaces resorb the surrounding bone and lift the periosteum, which produces a thin shell of new bone. Similar histological features were observed in 6 of 42 fibrosarcomas examined (14%) and in 8 of a series of 75 osteosarcomas (11%). While many of these lesions did not present with clinical similarity to the aneurysmal bone cyst, it is postulated that this type of case may account for the so-called malignant aneurysmal bone cyst occasionally reported.
动脉瘤样骨囊肿的发病机制是一个备受争议的话题。本研究旨在验证动脉瘤样骨囊肿是一种继发于骨原发性病变的现象这一假说。对303例骨病变的组织学材料进行研究，以寻找动脉瘤样骨囊肿发展的证据。在54例研究的中央巨细胞肉芽肿中，有15例（28%）观察到了与动脉瘤样骨囊肿中所见相似的微囊肿和充满血液的间隙。在49例骨纤维异常增殖症中，这一频率较低（10%），而在骨化性纤维瘤和牙骨质化纤维瘤中则非常低。7例骨Paget病中有1例出现大的血腔。据推测，动脉瘤样骨囊肿的起始过程是微囊肿，它是在具有疏松、无支撑间质的原发性病变中细胞间水肿的结果。血管破裂进入微囊肿，在血流动力学压力下引入血液。由于间质提供的阻力很小，血腔吸收周围的骨并掀起骨膜，从而产生一层新骨薄壳。在42例检查的纤维肉瘤中有6例（14%）以及在75例骨肉瘤系列中有8例（11%）观察到了类似的组织学特征。虽然这些病变中的许多在临床上与动脉瘤样骨囊肿并不相似，但据推测，这类病例可能解释了偶尔报道的所谓恶性动脉瘤样骨囊肿。
