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Presented by Dr. John Gross and prepared by Dr. Yembur Ahmad
This case talks about a 29-year-old female with a rib lesion.
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1. Question
This is a 29-year-old female with a rib lesion.
Diagnosis:
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The neoplasm contains bland spindle cell stroma which directly gives rise to woven bone. Notably, there is a lack of osteoblastic riming. The woven bone fragments are in variable shapes, resembling letters. These are the typical features of fibrous dysplasia. The diffuse expansion of bone is seen on imaging is quite characteristic of this entity.
Differential Diagnosis: Osteochondroma would present as a polypoid growth of bone away from the growth plate, and would demonstrate endochondral ossification histologically. Osteosarcoma, even if low grade, would demonstrate greater cytologic atypia and would show MDM2 amplification if of the low grade central type which is the main differential diagnosis here. Osteoid osteoma would have a distinct radiographic appearance, more vascularized stroma, and would have well-developed riming of new bone.Incorrect
The neoplasm contains bland spindle cell stroma which directly gives rise to woven bone. Notably, there is a lack of osteoblastic riming. The woven bone fragments are in variable shapes, resembling letters. These are the typical features of fibrous dysplasia. The diffuse expansion of bone is seen on imaging is quite characteristic of this entity.
Differential Diagnosis: Osteochondroma would present as a polypoid growth of bone away from the growth plate, and would demonstrate endochondral ossification histologically. Osteosarcoma, even if low grade, would demonstrate greater cytologic atypia and would show MDM2 amplification if of the low grade central type which is the main differential diagnosis here. Osteoid osteoma would have a distinct radiographic appearance, more vascularized stroma, and would have well-developed riming of new bone.
