Aneurysmal Bone Cyst of Lateral Cuneiform: Challenge in Diagnosis and Management.

INTRODUCTION: Aneurysmal bone cyst (ABC) is a benign, locally aggressive lesion seen in the long bones and vertebrae. The tumor is rarely seen in the tarsal bones. Chronic pain and pathological fracture are often the presenting features. Radiographs and Magnetic Resonance Imaging are usually diagnostic and guide the management.

CASE REPORT: We present a case of a 27-year-old male with chronic midfoot pain diagnosed as avascular necrosis of the lateral cuneiform, managed with biopsy needle decompression and platelet-rich plasma injection. The patient presented with persistent pain, and the workup revealed an ABC with a pathological fracture. Core biopsy report suggested ABC of lateral cuneiform, which was later managed by excisional curettage and pan lateral cuneiform arthrodesis using a tricortical Iliac crest graft with a favorable outcome.

CONCLUSION: ABC in a long bone is a straightforward diagnosis due to its classical radiographic features. The diagnosis is challenging when presented in unusual locations. An incisional biopsy to is the easiest way to confirm the histopathological diagnosis and aid in surgical planning.