{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T09:05:38Z","timestamp":1779959138792,"version":"3.53.1"},"reference-count":34,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Aneurysmal bone cyst (ABC) is a benign but locally aggressive osteolytic lesion that typically arises in the metaphysis of long bones in children and adolescents. Extension across an open proximal humeral physis into the epiphysis is uncommon and creates a diagnostic challenge because unicameral bone cyst and telangiectatic osteosarcoma may show overlapping radiological features. Case Presentation: A 12-year-old girl presented with pain and restricted motion of the left shoulder after a bicycle-related fall. Radiographs demonstrated a large expansile lytic lesion of the proximal humerus with cortical thinning and pathologic fracture. CT showed cortical ballooning, septation-like internal architecture, and extension across the open proximal humeral physis into the epiphysis. MRI demonstrated a multiloculated cystic lesion with thin internal septa and thin peripheral\/septal enhancement, without nodular solid enhancement or a bulky extraosseous soft-tissue component. Curettage, bone cement filling, and elastic intramedullary nailing were performed. Histopathology, immunohistochemistry, and USP6 FISH analysis supported the final integrated diagnosis of ABC, although USP6 rearrangement was not detected. At 40 months, the patient was pain-free, had essentially normal shoulder motion, had returned to normal school and daily activities, and required no further surgery; radiographs showed stable remodeling without aggressive re-expansion. Conclusions: A focused literature review supports that frank transphyseal ABC is rare, particularly in the proximal humerus. The diagnostic contribution of this case lies in the integration of radiography, CT, MRI, histopathology, ancillary testing, and long-term clinical and radiographic follow-up. In a skeletally immature patient with a proximal humeral cystic lesion, transphyseal extension should prompt careful multimodality assessment. Imaging can substantially narrow the differential diagnosis, but integrated radiologic\u2013pathologic confirmation remains essential when malignant mimics are possible.<\/jats:p>","DOI":"10.3390\/diagnostics16111657","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T08:00:36Z","timestamp":1779955236000},"page":"1657","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transphyseal Proximal Humeral Aneurysmal Bone Cyst with Pathologic Fracture in a Child: A Case Report"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7818-5946","authenticated-orcid":false,"given":"Taichun","family":"Li","sequence":"first","affiliation":[{"name":"Department of Pediatric Orthopedics, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingmiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziming","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1007\/s00247-022-05396-6","article-title":"Update on Aneurysmal Bone Cyst: Pathophysiology, Histology, Imaging and Treatment","volume":"52","author":"Restrepo","year":"2022","journal-title":"Pediatr. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"81","DOI":"10.4132\/jptm.2023.02.23","article-title":"Aneurysmal Bone Cyst: A Review","volume":"57","author":"Nasri","year":"2023","journal-title":"J. Pathol. Transl. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100384","DOI":"10.1016\/j.jbo.2021.100384","article-title":"Current Strategies for the Treatment of Solitary and Aneurysmal Bone Cysts: A Review of the Literature","volume":"30","author":"Deventer","year":"2021","journal-title":"J. Bone Oncol."},{"key":"ref_4","first-page":"e53587","article-title":"Diagnosis and Current Treatment of Aneurysmal Bone Cysts","volume":"16","author":"Bakarman","year":"2024","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e30000","DOI":"10.1002\/pbc.30000","article-title":"Imaging of Pediatric Bone Tumors: A COG Diagnostic Imaging Committee\/SPR Oncology Committee White Paper","volume":"70","author":"Cederberg","year":"2023","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1148\/rg.2017160143","article-title":"Pediatric Benign Bone Tumors: What Does the Radiologist Need to Know?: Pediatric Imaging","volume":"37","author":"Shah","year":"2017","journal-title":"Radiographics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1007\/s00256-020-03432-w","article-title":"The Differentiation between Aneurysmal Bone Cyst and Telangiectatic Osteosarcoma: A Clinical, Radiographic and MRI Study","volume":"49","author":"Zishan","year":"2020","journal-title":"Skelet. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.amsu.2018.06.005","article-title":"Unicameral Bone Cysts: Current Concepts","volume":"34","author":"Noordin","year":"2018","journal-title":"Ann. Med. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s43465-022-00607-6","article-title":"Unicameral Bone Cysts: Review of Etiopathogenesis and Current Concepts in Diagnosis and Management","volume":"56","author":"Rajasekaran","year":"2022","journal-title":"Indian J. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s002560050191","article-title":"Epiphyseal Extension of a Unicameral Bone Cyst","volume":"26","author":"Haims","year":"1997","journal-title":"Skelet. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.21037\/tp-22-290","article-title":"Risk Factors for Pathological Fractures of Simple Bone Cysts of the Humerus in Children: A Retrospective Cohort Study","volume":"11","author":"Wang","year":"2022","journal-title":"Transl. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jbo.2017.11.003","article-title":"Telangiectatic Osteosarcoma: Outcome Analyses and a Diagnostic Model for Differentiation from Aneurysmal Bone Cyst","volume":"11","author":"Yin","year":"2017","journal-title":"J. Bone Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1148\/rg.210171","article-title":"Pediatric Osteosarcoma: Correlation of Imaging Findings with Histopathologic Features, Treatment, and Outcome","volume":"42","author":"Nguyen","year":"2022","journal-title":"Radiographics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1542\/pir.2015-0128","article-title":"Understanding Unicameral and Aneurysmal Bone Cysts","volume":"40","author":"Rosenblatt","year":"2019","journal-title":"Pediatr. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2905671","DOI":"10.1155\/2019\/2905671","article-title":"Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features","volume":"2019","author":"Mohaidat","year":"2019","journal-title":"Adv. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/BF00349089","article-title":"Juxtaepiphyseal Aneurysmal Bone Cyst","volume":"13","author":"Capanna","year":"1985","journal-title":"Skelet. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s00776-011-0070-2","article-title":"Primary Aneurysmal Bone Cyst of the Proximal Tibia Crossing the Open Physis","volume":"16","author":"Arora","year":"2011","journal-title":"J. Orthop. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"20208","DOI":"10.7547\/20-208","article-title":"Primary Aneurysmal Bone Cyst of the Distal Tibia Crossing the Open Physis","volume":"111","author":"Arora","year":"2021","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1007\/s00247-025-06329-9","article-title":"Aneurysmal Bone Cysts Abutting the Growth Plate: Evaluation of the Impact of Alcohol Sclerotherapy","volume":"55","author":"Pastor","year":"2025","journal-title":"Pediatr. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1148\/rg.2017170029","article-title":"Imaging of Pediatric Growth Plate Disturbances","volume":"37","author":"Nguyen","year":"2017","journal-title":"Radiographics"},{"key":"ref_21","first-page":"e23761","article-title":"A 5-Year-Old Female with an Aneurysmal Bone Cyst of the Proximal Humerus","volume":"14","author":"Sivakumar","year":"2022","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e263437","DOI":"10.1136\/bcr-2024-263437","article-title":"Complete Remodelling Post-Intralesional Resection of an Aggressive Proximal Humerus Aneurysmal Bone Cyst Mimicking Telangiectatic Osteosarcoma","volume":"18","author":"Singh","year":"2025","journal-title":"BMJ Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Di Costa, D., Gabrielli, E., Cerrone, M., Di Gialleonardo, E., Maccauro, G., and Vitiello, R. (2024). Pathological Fractures in Aneurysmal Bone Cysts: A Systematic Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13092485"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"20201341","DOI":"10.1259\/bjr.20201341","article-title":"Pathological Fracture in Paediatric Bone Tumours and Tumour-Like Lesions: A Predictor of Benign Lesions? Br","volume":"94","author":"Chaib","year":"2021","journal-title":"J. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100255","DOI":"10.1016\/j.jbo.2019.100255","article-title":"Aneurysmal Bone Cyst: A Review of 65 Patients","volume":"18","author":"Grahneis","year":"2019","journal-title":"J. Bone Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1302\/2633-1462.22.BJO-2020-0168","article-title":"Efficacy of Treatment Interventions for Primary Aneurysmal Bone Cysts: A Systematic Review","volume":"2","author":"Bavan","year":"2021","journal-title":"Bone Jt. Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s00068-022-02077-9","article-title":"Management of Juvenile and Aneurysmal Bone Cysts: A Systematic Literature Review with Meta-Analysis","volume":"49","author":"Strohm","year":"2023","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/MOP.0000000000001205","article-title":"The Treatment of Aneurysmal Bone Cysts","volume":"35","year":"2023","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103272","DOI":"10.1016\/j.otsr.2022.103272","article-title":"Minimally Invasive Treatment of Aneurysmal Bone Cysts: Systematic Literature Review","volume":"108","author":"Cottalorda","year":"2022","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Samargandi, R., Alkameshki, M., Barnawi, M., Alzahrani, K., Iskander, O., Nicolas, Q., Hetaimish, B., Berhouet, J., and Le Nail, L.-R. (2023). Efficacy of Percutaneous Treatment of Primary Aneurysmal Bone Cysts (ABCs): A Systematic Review and Meta-Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12237213"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1007\/s00247-022-05326-6","article-title":"Percutaneous Image-Guided Treatment of Aneurysmal Bone Cysts: Is There a Superior Treatment Option?","volume":"52","author":"Arleo","year":"2022","journal-title":"Pediatr. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.jor.2022.05.010","article-title":"Clinicoradiological Outcome of Percutaneous Intralesional Polidocanol in Aneurysmal Bone Cysts: A Prospective Study of 43 Patients in a Single Tertiary Care Centre","volume":"32","author":"Rai","year":"2022","journal-title":"J. Orthop."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Deventer, N., Schulze, M., Gosheger, G., de Vaal, M., and Deventer, N. (2021). Primary Aneurysmal Bone Cyst and Its Recent Treatment Options: A Comparative Review of 74 Cases. Cancers, 13.","DOI":"10.3390\/cancers13102362"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e79","DOI":"10.1097\/BPO.0000000000002536","article-title":"Use of Surgical Adjuvants Does Not Decrease Recurrence of Aneurysmal Bone Cysts in Surgical Intervention with Pediatric Patients","volume":"44","author":"Gettleman","year":"2024","journal-title":"J. Pediatr. Orthop."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1657\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T08:17:51Z","timestamp":1779956271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1657"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":34,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16111657"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16111657","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}