Case contributed by Jeremy Jones


Knee injury while playing football. Restriction of movement and anterior tibial tenderness.

Patient Data

Age: 15 years
Gender: Male

Tibial lesion of the proximal anterior cortex. Predominantly narrow transition zone. Mixed lucent (cranial) and more sclerotic (caudal). No periosteal reaction. Appearances are indeterminate with some aggressive and some non-aggressive features. Further imaging required. Will likely require biopsy.


The lesion demonstrated on the plain film is T1 hypointense, T2/STIR hyperintense and enhances following contrast. There is accompanying diffusion restriction. No periosteal reaction or soft tissue mass. The lesion is mixed sclerotic-lytic with features of an aggressive lesion, but no periosteal reaction. In this location, the most likely diagnosis is adamantinoma.

Case Discussion

The lesion is part solid, part lytic with diffusion restriction. There is no cystic component. In this location, an aggressive cortical tumor is most likely to be an adamantinoma, and this was proven at biopsy.

Adamantinoma, though much rarer than fibrous dysplasia, should always be included in the differential diagnosis for a mixed lytic-sclerotic lesion in the tibial shaft 1.

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