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Presented by Edward McCarthy, M.D. and prepared by Sharon Swierczynski, M.D., Ph.D.
Case 1: A 14 year-old boy twisted his ankle and heard a snap.
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1. Question
Week 145: Case 1
A 14 year-old boy twisted his ankle and heard a snap. A radiograph demonstrated a well-defined lytic lesion in the distal tibial metaphysis with a pathologic fracture. A biopsy was taken./images/072803case1fig1.jpg
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/images/072803case1fig3.jpgCorrect
Answer: Non-ossifying fibroma
Histology: A nonossifying fibroma is a developmental lesion that results in a benign spindle cell proliferation in a storiform pattern. These spindle cells are admixed with varying amounts of multinucleated giant cells. The lesion may be cellular, but there is no atypia. The radiographic appearance of an inactive lesion in a metaphysis is almost diagnostic.
Discussion: The lesion is not a giant cell tumor. Despite the presence of many multinucleated giant cells, the location of the lesion (being confined to the metaphysis) is not the pattern of a giant cell tumor. By contrast, giant cell tumors always involve the epiphyseal end of long bones. Although giant cell tumors may contain spindle cell areas of the stroma, the location of this lesion in the metaphysis indicates nonossifying fibroma.
The lesion is not fibrous dysplasia. The typical “Chinese letter” pattern of new woven bone deposition is not present in this case.
The lesion is not a fibrosarcoma. There is no atypia or abnormal mitotic figures.
Incorrect
Answer: Non-ossifying fibroma
Histology: A nonossifying fibroma is a developmental lesion that results in a benign spindle cell proliferation in a storiform pattern. These spindle cells are admixed with varying amounts of multinucleated giant cells. The lesion may be cellular, but there is no atypia. The radiographic appearance of an inactive lesion in a metaphysis is almost diagnostic.
Discussion: The lesion is not a giant cell tumor. Despite the presence of many multinucleated giant cells, the location of the lesion (being confined to the metaphysis) is not the pattern of a giant cell tumor. By contrast, giant cell tumors always involve the epiphyseal end of long bones. Although giant cell tumors may contain spindle cell areas of the stroma, the location of this lesion in the metaphysis indicates nonossifying fibroma.
The lesion is not fibrous dysplasia. The typical “Chinese letter” pattern of new woven bone deposition is not present in this case.
The lesion is not a fibrosarcoma. There is no atypia or abnormal mitotic figures.
