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Pathologic fracture - non-ossifying fibroma

Case contributed by Domenico Nicoletti
Diagnosis certain

Presentation

Sprained ankle during football match.

Patient Data

Age: 10 years
Gender: Male

In the distal tibia there's an eccentric lucent lesion with thinned cortex, multilocular appearance, sclerotic margin and pathologic fracture.

The lesion has a narrow zone of transition and a sclerotic rim. There is no aggressive-appearing periosteal reaction. The lesion is predominantly low signal intensity on T1-weighted images but demonstrates a central area of high signal intensity that represents a residual island of normal fatty marrow entrapped in the lesion. Fracture doesn't involve the growth plate.

Case Discussion

Nonossifying fibroma is a benign intracortical, multilocular and well-circumscribed lesion that affects young patients. It originates from the proliferation of fibrous tissue and histocytes. The most common locations are the distal femoral and distal tibial metaphyses. The lesion may move into the diaphysis with bone growth. At skeletal maturity, most NOF begin to heal on their own. Nonossifying fibroma is usually asymptomatic. When non-ossifying fibromas are less than 2 cm they are referred to as fibrous cortical defects. NOFs can also pose an increased risk of pathological fractures.

 

Radiographer: TSRM Fabio Imola

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