Scribd Logo
Upload

Welcome to Scribd!

  • 45 views

    Download

    Uploaded by

    noname19191
    children bone tumors imaging

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Download

    Uploaded by

    noname19191
    45 views3 pages
    children bone tumors imaging

    Original Title

    Download (1)

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    children bone tumors imaging

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    45 views3 pages

    Download

    Uploaded by

    noname19191
    children bone tumors imaging

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Annals of Diagnostic Pathology 17 (2013) 207209

    Contents lists available at SciVerse ScienceDirect

    Annals of Diagnostic Pathology

    Nonossifying broma developed in metaphysis and epiphysisa case report


    Jung Ho Noh, MD, PhD a, Kyung Nam Ryu, MD, PhD b, Ji Yoon Bae, MD c,
    Young Hak Roh, MD d,, In Seok Choi, MD e
    a

    Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do 200-722, South Korea
    Department of Radiology, Kyung Hee University Medical Center, Seoul, South Korea
    Department of Pathology, National Police Hospital, Seoul, South Korea
    d
    Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, 1198 Kuwol-dong, Namdong-gu, Incheon 405760, South Korea
    e
    Department of Orthopaedic Surgery, National Police Hospital, Seoul, South Korea
    b
    c

    a r t i c l e
    Keywords:
    Nonossifying broma
    Metaphysis
    Epiphysis

    i n f o

    a b s t r a c t
    Nonossifying broma is developed in childhood and adolescence and is usually asymptomatic. It is typically
    arises in the metaphysis of long bone and migrates toward the diaphysis with growth. We present a very rare
    case of nonossifying broma involving metaphysis and epiphysis of the distal femur in a 20-year-old man.
    Nonossifying broma is a benign broblastic lesion, which is also termed benign cortical defect and
    broxanthoma. A nonossifying broma rarely causes problems and does not interfere with healing or growth.
    The lesions are usually asymptomatic. With growth and remodeling of the bone, the lesion typically
    disappears and is replaced with normal bone. However, the lesion may weaken the involved bone, causing
    fracture. The lesion typically arises in the metaphysis of long bones and may migrate toward the diaphysis
    with growth. There have never been reports of nonossifying broma involving epiphysis that we know of. We
    report a very rare case of nonossifying broma involving metaphysis and epiphysis in a young adult. Written,
    informed consent was obtained from the patient to publish this case report, including the images.
    2013 Elsevier Inc. All rights reserved.

    1. Case report
    A 20-year-old man visited the authors' hospital because of pain on
    the left knee for 4 months. Physical examination revealed that mild
    tenderness on the medial side of the knee with no swelling, no
    effusion, and no limitation of motion. He did not have any history of
    trauma or medical illnesses.
    Plain radiographs of the left knee showed well-dened osteolytic
    bone destruction at the metaphysis and epiphysis of the distal femur
    with thin sclerotic rim. There was no signicant contour change of
    cortex (Fig. 1A). On computed tomography (CT), the lesion showed
    involvement of distal metaphysis and epiphysis at the medial femoral
    condyle. The lesion showed well-dened osteolytic bone destruction
    with thin sclerotic rim with minimal expansion of cortex. Most of the
    lesion showed osteolytic bone destruction; however, linear and
    amorphous bone formations were seen along the periphery of the
    lesion. In the proximal portion of the lesion, a focal cortical
    discontinuity was seen (Fig. 1B). Gadolinium-enhanced magnetic
    resonance imaging was taken. Short TI inversion recovery images
    showed well-dened low-signal lesion at the metaphysis and
    epiphysis of the distal femur. The ossied areas within lesion on CT

    Corresponding author. Tel.: +82 32 460 8916; fax: +82 32 468 5437.
    E-mail addresses: [email protected] (J.H. Noh), [email protected] (Y.H. Roh).
    1092-9134/$ see front matter 2013 Elsevier Inc. All rights reserved.
    http://dx.doi.org/10.1016/j.anndiagpath.2012.07.003

    showed dark signal intensities (Fig. 1C). T1 spectral presaturation by


    inversion recovery-enhanced images showed diffused high-signal
    intensity with contrast enhancement; however, ossied areas within
    lesion on CT showed no signicant signal changes. Based on the
    radiographic ndings, chondromyxoid roma, nonossifying broma,
    enchondroma, chondroblastoma, and brous dysplasia were considered as differential diagnoses.
    Curettage and bone graft were performed. Microscopic ndings of
    the tumor showed cellular stroma of spindle-shaped broblasts in a
    whorled storiform pattern, among which irregularly scattered multinucleated osteoclast-type giant cells were seen (Fig. 2). Collections of
    foam cells, with small dark nuclei, and hemosiderin-laden macrophages were frequently present. Scattered inammatory cells, mainly
    lymphocytes, were present. Mitotic gures were inconspicuous, and
    no nuclear atypia was noted. These features were consistent with the
    diagnosis of nonossifying broma.
    2. Discussion
    Nonossifying broma is a benign lesion occurring most commonly
    in the distal femur and proximal and distal tibia [1]. The incidence of
    nonossifying broma is 30% to 40% of children 2 to 15 years old, and
    male:female ratio is 2:1 [2]. It is typically arises in the metaphysis of
    long bone and migrates toward the diaphysis with growth [3]. The
    lesions are usually asymptomatic and are discovered incidentally on

    208

    J.H. Noh et al. / Annals of Diagnostic Pathology 17 (2013) 207209

    Fig. 2. Photomicrographs of the lesion. (A) Spindle-shaped broblasts in a whorled


    storiform pattern, and collections of foam cells are seen (hematoxylin and eosin, original
    magnication 40). (B) Scattered osteoclast-like multinucleated giant cells in whorled
    broblastic background (hematoxylin and eosin, original magnication 100).

    radiographs. On plain radiographs, the lesion is eccentric and multi- or


    uniloculated. It is well demarcated with sclerotic rim [4]. The
    diagnosis of nonossifying broma can be made with plain radiographs
    with an accuracy of 100% [5,6].
    Surgery is generally not required because of a high rate of
    spontaneous regression and a lack of symptoms [7-10]. Operative
    treatment is considered if the lesion is larger than 33 mm and involves
    more than 50% of the bone's diameter or if the lesion is not typical to
    be diagnosed [2,11]. If an operation is recommended, curettage and
    bone graft are the procedures of choice.
    The prognosis is excellent. The lesion generally resolves spontaneously, usually at skeletal maturity. Recurrence is rare.
    The lesion in this case developed in usual site at uncommon
    age, which made the diagnosis difcult. The authors suggest
    that the biopsy is necessary for accurate diagnosis of such a case,
    Fig. 1. (A) Anteroposterior and lateral views of the left knee show well-dened bone
    destruction at the metaphysis and epiphysis of the distal femur. Lesion shows thin
    sclerotic rim. (B) Computed tomographic images of the distal femur show well-dened
    bone destruction with thin sclerotic rim, and the lesion shows mild expansion of cortex.
    Septa-like and amorphous ossications are seen within the lesion. Coronal image of
    distal femur shows focal discontinuity of cortex at the superior portion of lesion. (C) T1
    spectral presaturation by inversion recovery coronal magnetic resonance image shows
    well-dened low-signal lesion at the metaphysis and epiphysis of the distal femur. The
    ossied areas within lesion on CT show dark signal intensities.

    J.H. Noh et al. / Annals of Diagnostic Pathology 17 (2013) 207209

    although most cases of the nonossifying broma can be diagnosed


    by plain radiographs.
    References
    [1] Dormans JP, Pill SG. Fractures through bone cysts: unicameral bone cysts,
    aneurysmal bone cysts, brous cortical defects, and nonossifying bromas. Instr
    Course Lect 2002;51:457-67.
    [2] Betsy M, Kupersmith LM, Springeld DS. Metaphyseal brous defects. J Am Acad
    Orthop Surg 2004;12:89-95.
    [3] Easley ME, Kneisl JS. Pathologic fractures through nonossifying bromas: is
    prophylactic treatment warranted? J Pediatr Orthop 1997;17:808-13.
    [4] Resnick D, Greenway G. Distal femoral cortical defects, irregularities, and
    excavations. Radiology 1982;143:345-54.

    209

    [5] Schwartz AM, Ramos RM. Neurobromatosis and multiple nonossifying bromas.
    AJR Am J Roentgenol 1980;135:617-9.
    [6] Klein MH, Rosenberg ZS, Lehman WB. Nonossifying broma of bone: a case report.
    Bull Hosp Jt Dis Orthop Inst 1990;50:64-9.
    [7] Cunningham JB, Ackerman LV. Metaphyseal brous defects. J Bone Joint Surg Am
    1956;38-A:797-808.
    [8] Drennan DB, Maylahn DJ, Fahey JJ. Fractures through large non-ossifying bromas.
    Clin Orthop Relat Res 1974:82-8.
    [9] Hatcher CH. The pathogenesis of localized brous lesions in the metaphyses of
    long bones. Ann Surg 1945;122:1016-30.
    [10] Ritschl P, Karnel F, Hajek P. Fibrous metaphyseal defectsdetermination of their
    origin and natural history using a radiomorphological study. Skeletal Radiol
    1988;17:815.
    [11] Arata MA, Peterson HA, Dahlin DC. Pathological fractures through non-ossifying
    bromas. Review of the Mayo Clinic experience. J Bone Joint Surg Am 1981;63:
    980-8.

    You might also like