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Monostotic fibrous dysplasia in the proximal tibial epiphysis: a case report.

Gwark JY, Jeong JH, Hwang SC, Nam DC, Lee JH, Na JB, Kim DH - J Med Case Rep (2014)

Bottom Line: A 14-year-old Asian girl was referred to our hospital after slipping down with pain on the left knee.A magnetic resonance image showed the lesion at low signal intensity on a T1-weighted image and at high signal intensity on a T2-weighted image.The biopsy results led us to conclude that the lesion was a fibrous dysplasia.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Research Institute of Clinical Medicine, Gyeongsang National University School of Medicine and Hospital, 15 Jinju-daero 816 beon-gil, Jinju 660-750, South Korea. dhkim8311@gnu.ac.kr.

ABSTRACT

Introduction: Fibrous dysplasia is one of many well-known disorders in which there is a defect in the remodeling process of immature bone to mature into lamellar bone, and it often exists in metaphyseal and diaphyseal parts of the long bone. In this report, we describe a rare case where fibrous dysplasia was found only in the proximal part of the epiphysis of the tibia without other bony lesions.

Case presentation: A 14-year-old Asian girl was referred to our hospital after slipping down with pain on the left knee. A radiograph showed an abnormal finding of a central radiolucent lesion with a marginal sclerotic border near the proximal tibial spine. A magnetic resonance image showed the lesion at low signal intensity on a T1-weighted image and at high signal intensity on a T2-weighted image. The biopsy results led us to conclude that the lesion was a fibrous dysplasia.

Conclusion: If an abnormal lesion on the epiphysis, especially in long bones, is detected on a radiograph, several differential diagnoses can be made. Although fibrous dysplasia is usually not encountered as an epiphyseal lesion, it is important to incorporate all the clinical, radiographic and pathologic features to diagnose monostotic fibrous dysplasia when the lesion is located at the epiphyseal location.

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Histopathologic findings and post-operative radiographs. (A) Bone tissue is replaced by loose fibrous tissue with irregular spicules of immature bone (hematoxylin and eosin stain; original magnification, ×100). (B) The immature bone is formed from fibrous stroma without osteoblasts rimming (original magnification, ×400). (C) Simple radiographs obtained 2 years after surgery show bone formation with well-sustained screw fixation.
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Fig3: Histopathologic findings and post-operative radiographs. (A) Bone tissue is replaced by loose fibrous tissue with irregular spicules of immature bone (hematoxylin and eosin stain; original magnification, ×100). (B) The immature bone is formed from fibrous stroma without osteoblasts rimming (original magnification, ×400). (C) Simple radiographs obtained 2 years after surgery show bone formation with well-sustained screw fixation.

Mentions: On the basis of the clinical and radiological findings, a benign bone tumor of a slow-growing nature, chondroblastoma, was suspected at first. Excisional biopsy, curettage and filling with demineralized bone matrix followed by 2.5mm screw fixation were performed. Histologic analysis of hematoxylin and eosin–stained specimens showed irregularly shaped spicules of immature bone without osteoblastic rimming and fibrous stroma without any mitotic activity. Radiographs taken 2 years after surgery demonstrated bone formation at the lesion, and the patient was able to squat and run freely without any pain (Figure 3).Figure 1


Monostotic fibrous dysplasia in the proximal tibial epiphysis: a case report.

Gwark JY, Jeong JH, Hwang SC, Nam DC, Lee JH, Na JB, Kim DH - J Med Case Rep (2014)

Histopathologic findings and post-operative radiographs. (A) Bone tissue is replaced by loose fibrous tissue with irregular spicules of immature bone (hematoxylin and eosin stain; original magnification, ×100). (B) The immature bone is formed from fibrous stroma without osteoblasts rimming (original magnification, ×400). (C) Simple radiographs obtained 2 years after surgery show bone formation with well-sustained screw fixation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307750&req=5

Fig3: Histopathologic findings and post-operative radiographs. (A) Bone tissue is replaced by loose fibrous tissue with irregular spicules of immature bone (hematoxylin and eosin stain; original magnification, ×100). (B) The immature bone is formed from fibrous stroma without osteoblasts rimming (original magnification, ×400). (C) Simple radiographs obtained 2 years after surgery show bone formation with well-sustained screw fixation.
Mentions: On the basis of the clinical and radiological findings, a benign bone tumor of a slow-growing nature, chondroblastoma, was suspected at first. Excisional biopsy, curettage and filling with demineralized bone matrix followed by 2.5mm screw fixation were performed. Histologic analysis of hematoxylin and eosin–stained specimens showed irregularly shaped spicules of immature bone without osteoblastic rimming and fibrous stroma without any mitotic activity. Radiographs taken 2 years after surgery demonstrated bone formation at the lesion, and the patient was able to squat and run freely without any pain (Figure 3).Figure 1

Bottom Line: A 14-year-old Asian girl was referred to our hospital after slipping down with pain on the left knee.A magnetic resonance image showed the lesion at low signal intensity on a T1-weighted image and at high signal intensity on a T2-weighted image.The biopsy results led us to conclude that the lesion was a fibrous dysplasia.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Research Institute of Clinical Medicine, Gyeongsang National University School of Medicine and Hospital, 15 Jinju-daero 816 beon-gil, Jinju 660-750, South Korea. dhkim8311@gnu.ac.kr.

ABSTRACT

Introduction: Fibrous dysplasia is one of many well-known disorders in which there is a defect in the remodeling process of immature bone to mature into lamellar bone, and it often exists in metaphyseal and diaphyseal parts of the long bone. In this report, we describe a rare case where fibrous dysplasia was found only in the proximal part of the epiphysis of the tibia without other bony lesions.

Case presentation: A 14-year-old Asian girl was referred to our hospital after slipping down with pain on the left knee. A radiograph showed an abnormal finding of a central radiolucent lesion with a marginal sclerotic border near the proximal tibial spine. A magnetic resonance image showed the lesion at low signal intensity on a T1-weighted image and at high signal intensity on a T2-weighted image. The biopsy results led us to conclude that the lesion was a fibrous dysplasia.

Conclusion: If an abnormal lesion on the epiphysis, especially in long bones, is detected on a radiograph, several differential diagnoses can be made. Although fibrous dysplasia is usually not encountered as an epiphyseal lesion, it is important to incorporate all the clinical, radiographic and pathologic features to diagnose monostotic fibrous dysplasia when the lesion is located at the epiphyseal location.

Show MeSH
Related in: MedlinePlus