Radiographic and histopathologic characteristics of simple bone cysts: a retrospective study of 46 cases

This study aimed to evaluate the clinical, radiographic, and histopathological characteristics of simple bone cysts and to investigate the relationships among these parameters.

A total of 46 cases diagnosed with SBC were included in this retrospective study, analyzing clinical, radiological, histopathological, and treatment data, as well as recurrence. Radiographic evaluations were performed using panoramic imaging and/or cone-beam computed tomography. Associations among clinical, radiological, and histopathological variables were analyzed using chi-square and Fisher's exact tests.

The results showed a slight female predilection and a predominant occurrence in the second decade of life. All lesions were located in the mandible, most commonly in the posterior region. Radiographically, lesions were typically unilocular radiolucencies, often with scalloped borders (63.1%) and pseudosepta (56.5%). Histopathologically, fragmented normal bone and fibrous septa were the most frequent findings. Curettage was the most common treatment, and no recurrences were observed. Correlation analyses demonstrated significant associations between multilocular appearance and vascular connective tissue (66.7% vs. 5.9%, p = 0.008), and between lesion size and age, with larger lesions predominantly seen in patients under 20 years, while all patients over 20 years had small lesions (p = 0.002). Although other associations did not reach statistical significance, inflammatory changes were more frequent in symptomatic cases (28.6% vs. 9.4%), and both hemosiderin deposition (25% vs. 10.9%) and vascular connective tissue (21.4% vs. 6.3%) tended to be more common in trauma-associated cases.

SBCs most often present as well-defined, unilocular radiolucencies in the posterior mandible; however, internal variations such as pseudosepta and radiopaque areas may complicate their appearance and highlight the need for careful differential diagnosis from more aggressive lesions. Correlation analyses indicated that multilocular radiographic appearance was linked to vascular connective tissue and lesion size was age-dependent, suggesting that clinical, radiological, and histopathological features are interrelated and should be evaluated together.