Non-ossifying fibroma (NOF)

Case contributed by Assoc Prof Frank Gaillard

Presentation

Sprained ankle playing sport.

Patient Data

Age: 14 years
Gender: Male

Ankle x-ray demonstrates a well circumscribed lucency in the distal diaphysis/metaphysis of the tibia. The margins are slightly sclerotic. No periosteal reaction is present. It does not abut the growth plate. 

Case Discussion

Fibroxanthomas can be divided into:

  1. Non-ossifying fibroma (>2 cm)
  2. Fibrous cortical defect (<2 cm)

Both are pathologically identical.

Non-ossifying fibromas have the following features (all shown here):

  1. present in adolescents and young adults
  2. commonest location is the femur and tibia
  3. dia-metaphyseal in location
  4. eccentric with mild expansion
  5. well defined lucent lesion with a sclerotic margin
  6. cortical thinning, but not breach.

Lesions are asymptomatic and are usually an incidental finding. Lesions often spontaneously regress.

Case courtesy of Dr Ian Bickle

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