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Presented by Edward McCarthy, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 5: A 15 year-old boy had a painful lump over his lower leg.
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1. Question
Week 243: Case 5
A 15 year-old boy had a painful lump over his lower leg. A radiograph demonstrated a well-defined lytic lesion with sclerotic rim in the anterior cortex of the mid-shaft of his tibia.images/oct 24 2005 case 5 1.jpg
images/oct 24 2005 case 5 2.jpg
images/oct 24 2005 case 5 3.jpgCorrect
Answer: Osteofibrous dysplasia
Histology: none provided
Discussion: The lesion is osteofibrous dysplasia because of the pattern of the fibro-osseous tissue which occurs in the mid shaft of the tibia and anterior cortex. This radiograph is a characteristic pattern for osteofibrous dysplasia. This lesion occurs almost exclusively in the tibia. Histologically, there is cellular fibrous tissue with many seams of woven bone in a haphazard pattern. The woven bone spicules are lined by osteoblasts. This osteoblastic lining distinguishes this lesion from fibrous dysplasia.
The lesion is not fibrous dysplasia because of the osteoblastic rimming of the trabeculae. Moreover, the typical radiographic pattern of fibrous dysplasia is not present in this case. Fibrous dysplasia is typically a long lesion in a long bone with a ground glass appearance.
The lesion is not a non-ossifying fibroma because of the pattern of woven bone in cellular fibrous tissue. Non-ossifying fibroma is a well-defined lytic lesion which occurs in the metaphyseal portion of bone rather than the anterior midshaft cortex.
Incorrect
Answer: Osteofibrous dysplasia
Histology: none provided
Discussion: The lesion is osteofibrous dysplasia because of the pattern of the fibro-osseous tissue which occurs in the mid shaft of the tibia and anterior cortex. This radiograph is a characteristic pattern for osteofibrous dysplasia. This lesion occurs almost exclusively in the tibia. Histologically, there is cellular fibrous tissue with many seams of woven bone in a haphazard pattern. The woven bone spicules are lined by osteoblasts. This osteoblastic lining distinguishes this lesion from fibrous dysplasia.
The lesion is not fibrous dysplasia because of the osteoblastic rimming of the trabeculae. Moreover, the typical radiographic pattern of fibrous dysplasia is not present in this case. Fibrous dysplasia is typically a long lesion in a long bone with a ground glass appearance.
The lesion is not a non-ossifying fibroma because of the pattern of woven bone in cellular fibrous tissue. Non-ossifying fibroma is a well-defined lytic lesion which occurs in the metaphyseal portion of bone rather than the anterior midshaft cortex.
