• Jun Takada, Manabu Hoshi, Naoto Oebisu, Makoto Ieguchi, Anna Kakehashi, Hideki Wanibuchi, and Hiroaki Nakamura.
• Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
• Foot Ankle Int. 2014 Apr 1; 35 (4): 374-82.

BackgroundThe potential unrevealed clinicopathological differences between simple bone cysts situated in the calcaneus (calcaneal bone cysts) and those situated in long bones (long bone cysts) were investigated in the present study.MethodsA total of 41 cysts from 41 patients who underwent operative treatment were evaluated: 16 cysts in the calcaneus, 17 in the humerus, 7 in the femur, and 1 in the tibia. The clinical course, radiological findings, and histological features were retrospectively reviewed.ResultsThe mean patient age was 11.5 years (range, 3 to 25 years), and the mean follow-up was 33.0 months (range, 12 to 77 months). The mean patient age was significantly higher in patients with calcaneal bone cysts (13.5 years; long bone cysts, 10.2 years, P < .05). No treatment failure was seen for patients with calcaneal bone cysts, while 7 long bone cysts required reoperation. In H&E-stained specimens of the cyst wall, cholesterol clefts were identified in 10 of the 16 calcaneal bone cysts (62.5%), whereas none were identified in long bone cysts (0%; P < .0001).ConclusionOur study elucidates the different clinicopathological features existing between calcaneal bone cysts and long bone cysts. Cholesterol clefting is most likely due to hemorrhaging and the subsequent breakdown of blood in the cyst. The significance of these differences between long bone and calcaneal cysts is still open to conjecture.Level Of EvidenceLevel III, retrospective comparative series.

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