Fibrous Cortical Defect Research Articles

Are Fibrous Cortical Defects (FCDs) and Non-Ossifying Fibromas (NOFs) Only Radiological Findings? The Relationship between Radiological/Clinical Findings and Physical Activity in Children and Adolescents: A Cross-Sectional Study.

Background: Fibrous cortical defect (FCD) and non-ossifying fibroma (NOF) are incidentally recognised and benign developmental lesions. The objective of this study was to ascertain the clinical manifestations and symptoms of FCDs/NOFs in children and adolescent patients, to characterise the lesions radiologically using X-ray and MRI techniques, and to determine the relationship between physical activity and the condition. Methods: The study included patients under the age of 18 with radiological lesions on their extremities. The lesions were classified as FCD or NOF in accordance with the distinctive imaging features. For each lesion, the bone involved, the site involved, the size of the lesion, and the type of lesion (according to the Ritschl classification) were recorded. In the anamnesis, the patient's presenting complaint, the character of the pain, if any, and the level of activity were investigated. Pain was quantified using the visual analogue scale (VAS) and the 21-Numbered Circle VAS (21-NCVAS). The 21-Numbered Circle Activity Scale (21-NCAS) and the International Physical Activity Questionnaire (IPAQ) were employed for the assessment of physical activity. Results: The study included 34 lesions in 28 children (14 girls/14 boys). There was no difference in age between girls and boys (p = 0.45). According to Ritschl's classification, 18 (52.9%) lesions were stage A, 9 (26.5%) were stage B, and 7 (20.6%) were stage C. The lesion size increased with increasing Ritschl stage (p < 0.02). The main presenting complaint was pain (n = 13, 49.9%). In 21.4% of the children (n = 6), lesions were detected incidentally on radiographs. According to IPAQ, 39.3% of the children were physically inactive. There was a significant negative correlation between 21-NCAS and Ritschl stage (r = -0.51, p < 0.05). Activity decreased as the Ritschl stage increased. There was a significant negative correlation between 21-NCAS and VAS (r = -0.69, p < 0.05). Conclusions: Spontaneous pain was observed in 49.9% of patients diagnosed with FCD/NOF. No correlation was identified between lesion size and the presence or severity of pain. As the severity of pain and Ritschl stage increased, there was a corresponding decrease in physical activity.

Importance of adequate and timely diagnosis in non-neoplasic bone lesions: case report

Non-ossifying fibroma is defined as a bone lesion of non-neoplasic origin, characterized by the presence of fibrous tissue in eddies, it differs from the fibrous cortical defect due to its size, being the result of the periosteal cortical bone development defect that leads to failure of ossification. We present a case of a 12-year-old female adolescent who comes to this center presenting knee pain, claudication while walking and reduced range of motion of the left knee and that in the CT scan shows a hyper-enhanced lesion, hypointense on T1, hyperintense on T2, in addition to cortical lesion at the level of both distal femurs. Planning is carried out for taking a percutaneous biopsy whose report reports a non-ossifying fibroma of the bilateral distal femur, and it is decided to perform surgery on the right distal femur, with good results, in the case the clinical and radiographic characteristics of the patient and the resolution of this are described.

The Role of Surveillance in Predicting Fracture in Pediatric Patients With Incidentally Discovered Nonossifying Fibromas and Fibrous Cortical Defects: Is It Worth It?

Nonossifying fibroma (NOF) and fibrous cortical defect (FCDs), the most common benign pediatric bone lesions, are usually incidental x-ray findings. Surveillance of characteristic lesions has been recommended to monitor for enlargement and assess fracture risk. However, no accepted fracture risk prediction guidelines exist, so indications for prophylactic surgery are unclear. The study's purposes were to (1) characterize the timing of NOF/FCD-associated fractures, (2) quantify the resources devoted to surveillance, and (3) evaluate the potential for surveillance to prevent pathologic fracture. A single institution retrospective review was conducted to identify pediatric patients (below 18y old) with clinical-radiographic documentation of an NOF or FCD diagnosis from 2012 to 2020. Patients who presented with fracture were tallied but excluded from the surveillance analysis. Patients without at least one follow-up visit were also excluded. Lesional radiographic features were characterized on initial imaging. The number of visits and imaging studies devoted to surveillance were tabulated. The number of fractures and prophylactic surgeries were recorded to quantify the potential of surveillance to prevent pathologic fractures. The study population presenting without fracture consisted of 301 patients with 364 lesions with a mean follow-up of 20 months. By contrast, over the same period, 38 patients presented with NOF/FCD associated pathologic fractures. Surveillance included 1037 additional imaging tests over 1311 follow-up visits, or on average, 3.4 imaging studies and 4.4 visits per patient. During surveillance, only 2 (0.55%) lesions fractured. Another 10/364 (2.8%) patients underwent curettage and grafting, suggesting that-at best-the potential for preventing pathologic fracture by surveillance, assuming all 10 patients who underwent surgery would have subsequently fractured along with the 2 documented fractures, is 3.3% of lesions (12/364). The small number of fractures and surgeries during the follow-up period probably does not justify additional resources for surveillance beyond the initial visit, except in symptomatic patients with large lesions. However, subsequent visits may play a role in educating patients and their families regarding the natural history of these lesions. Prognostic Level II-retrospective study.

THE KNEE JOINT IS THE ACHILLES' HEEL OF A CHILD'S BODY

The study objective was to draw practicing physicians’ attention to the risk of knee joint disorders in children during intensive growth to ensure timely detection and treatment. Materials and Methods. We analyzed the results of studies on the diseases of the knee joint carried out by modern scientists over the past ten years. We also took into account the clinical observations of children receiving inpatient treatment at the regional children's hospital. The examination methods were radiography, computer tomography, magnetic resonance imaging, and ultrasound. Results and Discussion. During growth, a child's knee joint is subjected to enormous loads and is sensitive to external and internal factors. The knee joint plays a dominant role in the limb’s longitudinal growth; the growth zones grow so intensively that they can be compared to the work of a "bone nuclear reactor." The bones of the skeleton grow unevenly and intermittently. The peak height velocity is observed at 10–14 years in girls and at 13–18 years in boys; then, height velocity slows down, and after 19 years, height growth almost stops. During the period of intensive growth, bones are very sensitive to internal and external factors of shape formation (growth hormones, physiological loads, radiation, vibration, injuries, hypothermia, metabolic disorders, etc. Therefore, this part is most sensitive to various endogenous and exogenous factors, which is manifested by various dysplastic changes and diseases. Conclusions. During the intensive growth of the child, the knee joint is most vulnerable to various endogenous and exogenous negative factors, which is manifested by various diseases. Osteogenic sarcoma, fibrous cortical defect, and juvenile osteocartilaginous exostoses most often affect the weakest place of the knee joint – the metaphyses of the femur and tibia (Achilles’ heel).

Non-ossifying fibromas and fibrous cortical defects around the knee - an epidemiologic survey in a Japanese pediatric population

BackgroundThe aim of the present study was to evaluate the prevalence of non-ossifying fibroma (NOF) and fibrous cortical defect (FCD) in a Japanese pediatric population and the association between the lesion size and pain.MethodsThis retrospective study, conducted across 10 Japanese institutions, included patients aged 5–15 years who had undergone standard antero-posterior and lateral view radiography of the knee. Using these radiographs, we diagnosed the lesion as a NOF or FCD. Patient demographics, including age, sex, the size and location of the NOF, and chief complaint were recorded. The lesion size was determined using radiographs. Student’s t-test was used to compare the associations between the lesion size and spontaneous pain.ResultsA total of 6222 subjects (3567 boys and 2455 girls) were included in this study. The number of NOF and FCD cases was 143 and 437, respectively, and the prevalence of NOF and FCD was 2.3% and 7.0%, respectively. The average size of NOF and FCD was 22.1 mm (range: 4–102 mm) and 13.2 mm (range: 5–21 mm), respectively. Three patients (2.1%) had pathological fractures due to NOF. Of the 140 NOFs and 437 FCDs, we obtained complaints from the medical records of 126 and 393 patients, respectively. The number of patients with spontaneous pain or other problems with NOF was 68 (54%) and 58 (46%), respectively, that of patients with FCD was 195 (50%) and 198 (50%) patients, respectively. The lesion size was not associated with spontaneous pain in either lesion (p = 0.67 and p = 0.27, respectively).ConclusionThe prevalence of NOF and FCD around the knee was lower than that reported in previous studies. The prevalence of NOF increased and that of FCD decreased with advancing age. In both lesions, the lesion size may not be associated with pain.

Prevalence of benign bone lesions of the lower extremity in the pediatric spinal disorders: a whole-body imaging study.

There is a paucity of knowledge about benign bone lesions. The advances in imaging methods can screen bone lesions incidentally, and missing information can be provided. The aim of the study is to collect information about the prevalence and natural history of benign bone lesions with the use of whole-body biplanar slot-scanning imaging (EOS). EOS images acquired between 2015 and 2020 were retrospectively analyzed. Anatomical locations of lesions, number of lesions with polyostotic involvement and radiographic features of each were recorded. Fibrous lesions were further categorized according to the transition stages. The natural course was noted as remained in the same stage, progressed and disappeared during follow-up. A total of 1944 EOS images of 1378 (936 women and 442 men) patients were analyzed. The mean age was 12.3 (5-18) years. Bone lesions of the lower extremities were found in 278 scans (14.3%) of 196 (139 women and 57 men) patients (14.2%). Monostotic lesions were observed in 172 patients, and 24 had polyostotic lesions. The prevalence of lesions was 10.5%, 1.8%, 1.7%, 1.7% and 1.4‰ for fibrous cortical defect (FCD), nonossifying fibroma (NOF), osteochondroma, bone island and simple bone cyst, respectively. Among 145 FCDs, 55.2% of the lesions were stage A, 27.6% were stage B, 9.6% were stage C and 7.5% were stage D. EOS images acquired predominantly for spinal pathologies revealed a prevalence of 14% of benign bone tumors in the lower extremities. With the developments in imaging methods, the probability of encountering incidental lesion increases, and information about bone pathologies can be gathered.

FIBROUS CORTICAL DEFECT OF THE MANDIBLE: A CASE REPORT AND IMUNOHISTOCHEMICAL ANALYSIS

Fibrous cortical defect (FCD) is a benign non-neoplastic lesion, commonly found in long bones of adolescents. FCD in the jaws is rare. Only 9 cases have been previously reported, all affecting the mandible, preferentially of young females. A 15-year-old female patient was referred with complaint of swelling in the right side of the mandible. Imaginologic examination presented heterogeneous density with spiculate contour and irregularity in the basal mandibular cortex, suggesting FCD or benign fibro-osseous lesion. After surgical removal, microscopy showed a benign spindle cell proliferation with focal storiform pattern. Immunohistochemical analysis showed positivity for HLA-DR, CD68, CD163, FXIIIA, and alpha-SMA; Ki-67 labeling index

A Field Study of Histologic and Bacteriologic Characterization of Femoral Head Separation and Femoral Head Necrosis

Histologic and bacteriologic features for groups of average 31-day-old broilers displaying three gross categories of femoral head alterations were documented. Categories included simple femoral head separation (FHS), femoral head transitional changes (FHT), and femoral head necrosis (FHN). Groups with grossly normal (NORM) femoral heads and cull birds with FHN and having gross signs of sepsis (Cull-FHN) were also included in the study. There was a 10% occurrence of positive bacterial cultures for all birds tested. Most positive cultures (33%) were found in the Cull-FHN group, while only a 12% occurrence was seen in the FHS group, and no positives were present in the FHT or FHN groups. A 14% total occurrence of femoral bacterial chondronecrosis with osteomyelitis or simple osteomyelitis (BCO-O) was observed. A progressive increase in the prevalence of BCO-O was apparent between groups going from NORM (0%), FHS (4%), FHT (14%), FHN (13%), and reaching a maximum of 67% in the Cull-FHN group. Minimal to mild femoral head cartilage necrosis was present in 40% of NORM broilers and 100% of the FHS, FHT, and FHN groups, but at moderate severity in 20% of the Cull-FHN group. Thus, the majority of FHN cases were associated with aseptic cartilage necrosis rather than BCO-O. These findings suggest that aseptic cartilage necrosis may be as important as septic necrosis as a cause of gross femoral head disease. A 26% overall occurrence was seen for hip synovitis-arthritis, but group differences were not statistically significant. Synovitis was not seen in the NORM group and was present in some (12%) of the FHS group but was observed at a high rate in both the FHN (43%) and the Cull-FHN (50%) groups. Morphometric measurements demonstrated that the area size of femoral fibrous cortical defects or "cutback zones" were generally larger for all gross categories relative to NORM, with a significant difference between NORM and FHS groups. This study underscores the multifactorial etiology of FHN and the importance of conducting both histologic and bacteriologic evaluations in which gross evidence of FHN or BCO-O occurs.

Benign fibrohistyocytoma of maxilla: a case report

Background: Benign fibrous histiocytoma (BFH) is a soft tissue neoplasm. Till date, a single case has been described with histological features of bony BFH in maxilla. Although the lesion shares similar histologic features with fibrous cortical defect, and nonossifying fibroma, they differ in their behaviour and clinical and radiographic presentations. We describe another case with Benign Fibrous Histiocytoma in maxilla.

Indeterminate bone lesion: the diagnosis

The diagnostic approach is statistical[1,2]. Age is important: before 5 years old, malignant tumour is almost always metastatic neuroblastoma; between 5 and 15 years old, it is often osteosarcoma or Ewing’s sarcoma; after 40 years old, it tends to be metastasis or myeloma. Clinical symptoms vary little and are most often pain and swelling. Although fever suggests infection, it may also be found in Ewing’s sarcoma. The first step in the evaluation of a tumour is to determine its aggressiveness by conventional radiology. Important parameters include the tumour size, type of matrix, and periosteal reaction. Certain tumours are more common in particular bones. Adamantinoma, usually found in the adult, selectively involves the tibia and fibula. The most common epiphyseal tumour in childhood is the chondroblastoma. In addition, the aggressiveness of some tumours may relate to their location in the axial or appendicular skeleton: in the hand, cartilaginous tumours are almost always benign, whereas in the pelvis, they are often malignant. If necessary, multiple lesions may be estimated with bone scanning. Multiple lesions are seen in chondromas, osteochondromas, histiocytosis X and metastases. The first necessary step is to definitively diagnose benign lesions based on clinical and radiologic signs, and for which biopsy is not necessary. These lesions are fibrous cortical defect, non-ossifying fibroma, periosteal desmoid, fibrous dysplasia, osteochondroma or exostoses, chondroma, simple bone cyst, vertebral angiomas and myositis ossificans. Diagnosis may be difficult. In these cases, the next step is CT. Problems can result from bone locations which are difficult to evaluate on conventional X-ray (short, flat bones especially the pelvis, sacrum, sternum, and vertebrae). Sometimes, the study of the tumour matrix can provide features necessary for the diagnosis. It can be fluid density, small calcifications allowing diagnosis of cartilaginous tumour, osteoid matrix, or fat[3]. CT is the examination of choice in the diagnosis of the nidus of osteoid osteoma in dense bone[4]. Small lytic lesions of the cortex, localized involvement of the soft tissues and thin peripheral periosteal reaction can be seen; lesions with slow evolution which displace and expand the cortex peripherally can be distinguished from more aggressive lesions which cross the cortex. CT can show the tumour on both sides of the cortex before it is destroyed. This is the case for Ewing sarcomas and osteosarcomas[5]. CT allows measurement of the thickness of a non-calcified cuff of a cartilaginous tumour: the cuff is thin in benign lesions and thick (more than 3 cm) in chondrosarcomas[6,7]. In other cases, evidence favours a malignant lesion. Examination for metastases, and MRI examination before biopsy, must be performed.

F-18 FDG PET-Positive Cortical Fibrous Defect in a Patient with Peripheral T Cell Lymphoma (PTCL).

Fibrous cortical defects (FCD) are relatively common skeletal lesions that are often discovered incidentally on radiographs of children and young adults. They are most often located in the metaphysis or diametaphyseal junction of the distal femur or proximal tibia[1–5]. Fibrous cortical defects generally undergo spontaneous regression over time and are rarely seen radiographically after the second decade of life [2, 3]. FCD histological appearance is that of whorled proliferations of spindle cells intermixed with multinucleate giant cells, and foam cells. (Fig 1). In some cases the central abnormality may be also surrounded by leucocyte infiltration[13]. Conventional radiographic, CT, and MRI characteristics of fibrous cortical defects have been well described[1–4]. Several studies have also described the appearance of fibrous cortical defects on Tc-99m methylene diphosphonate (Tc-99m MDP) bone scintigraphy [5,6]. On CT a fibrous cortical defect is defined as a radiolucent, cortically based round to ovoid absence of bone measuring less than 2.0 cm in greatest diameter, with sharp sclerotic margins and no associated soft-tissue or bone marrow abnormality. MRI image usually shows cortically based soft tissue replacing bone without involvement of extraosseous soft tissues. On MR, the cortical defect often has a bright centre and a dark peripheral margin on T2- weighted images and shows central enhancement and a dark peripheral margin on contrast-enhanced T1- weighted images[7]. Bone scan shows markedly increased radionuclide accumulation in both early perfusion and delayed bone imaging in typical cortical defects. . However, absence of markedly increased tracer accumulation does not mean this diagnosis should be excluded. The use of F-18 fluorodeoxyglucose positron emission tomography (FDGPET) is established for the staging of malignant disease[8]. However, it is well known that FDG is not a tumor-specific agent and intense FDG uptake can occur in many non-malignant conditions such as infection, active inflammation, healing trauma and benign tumors[9]. As a consequence, increased FDG uptake in a benign lesion can be misinterpreted as a site of metastatic disease in patients with known malignancy. Very few reports have described the appearance of fibrous cortical defects on PET/CT [7].

Clinical and Pathologic Characteristics and Surgical Management of Benign Fibrous Histiocytoma of the Mandible: A Case Report

Benign fibrous histiocytomas (BFHs) of the bone are unusual mesenchymal neoplasms arising from fibroblasts and histocytes. These fibroblasts and histocytes are arranged in a storiform pattern; thus, BFHs are often confused with histologically similarly fibrohistiocytic lesions such as nonossifying fibromas (NOFs), fibrous cortical defects, and metaphyseal fibrous defects. BFHs of the soft tissues are well-recognized entities; however, BFHs occurring in the bone are rare. Thus, few unique pathologic features that might aid in the diagnosis and treatment have been described. BFHs of bone appear most often in the long bones, with histologic characteristics identical to BFHs in the soft tissue. However, lesions arising in the jaws are so rare only a few cases have been reported. Our case report describes the clinicopathologic characteristics and surgical management of a BFH in the mandible. BFH of the flat bones have distinct clinical, radiologic, and pathologic characteristics and require unique surgical management.

Phacomatosis spilorosea with oligodontia, scoliosis and fibrous cortical defects

Journal of the European Academy of Dermatology and VenereologyVolume 26, Issue 2 p. 260-262 LETTER TO THE EDITOR Phacomatosis spilorosea with oligodontia, scoliosis and fibrous cortical defects M. Valdivielso-Ramos, Corresponding Author M. Valdivielso-Ramos M. Valdivielso-Ramos. E-mail: mvaldira@yahoo.esSearch for more papers by this authorC. Mauleón, C. Mauleón Department of Dermatology, Hospital Infanta Leonor, Servicio de Dermatologia, C/Gran Vía del Este, 80, 28031, Madrid, Spain.Search for more papers by this authorJ.M. Hernanz, J.M. Hernanz Department of Dermatology, Hospital Infanta Leonor, Servicio de Dermatologia, C/Gran Vía del Este, 80, 28031, Madrid, Spain.Search for more papers by this author M. Valdivielso-Ramos, Corresponding Author M. Valdivielso-Ramos M. Valdivielso-Ramos. E-mail: mvaldira@yahoo.esSearch for more papers by this authorC. Mauleón, C. Mauleón Department of Dermatology, Hospital Infanta Leonor, Servicio de Dermatologia, C/Gran Vía del Este, 80, 28031, Madrid, Spain.Search for more papers by this authorJ.M. Hernanz, J.M. Hernanz Department of Dermatology, Hospital Infanta Leonor, Servicio de Dermatologia, C/Gran Vía del Este, 80, 28031, Madrid, Spain.Search for more papers by this author First published: 24 March 2011 https://doi.org/10.1111/j.1468-3083.2011.04051.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume26, Issue2February 2012Pages 260-262 RelatedInformation

Reply to Letter to the Editor: Fibroxanthoma: A Complication of a Biodegradable Screw

Reply: I thank Dr. Bauer and appreciate his interest in our case report, “Fibroxanthoma: A Complication of a Biodegradable Screw”, published in a recent issue of the journal [7]. Most of his concerns were raised by the referees during the editorial process. I disagree with his statement that the term, fibroxanthoma, is misleading. Various synonyms have been used in the literature for fibroxanthoma such as fibrous histiocytoma [3], xanthofibroma [1, 2], nonossifying fibroma, fibrous cortical defect [8], and benign fibrous histiocytoma [6]. Use of these various terms stem from authors’ disagreements regarding the histiogenesis. Although considered by some as nonneoplastic, others believe it is a neoplastic process, and yet others think of it as a reactive process [1–3]. Second, Dr. Bauer states that we described a soft tissue swelling at the site of the tibial tunnel but that is not what we described. Rather, we observed and described a slowly progressive, painful, bony swelling (1 × 1.5 cm) at the site of the tibial tunnel. Our initial clinical impression was an ectopic bone formation, delayed allergic reaction to a screw, or disengagement and backing out of a screw. Surgery was performed with the intent to curettage the new bone and/or debride the backed-out screw. At surgery, the macroscopic appearance was that of obliteration of the tibial entry portal, and irregular thickening of the cortex around it gave the impression of a periosteal reaction to the screw. Excision and thorough curettage of the abnormal bone and debridement of the tibial tunnel with a rongeur were done. I agree with Dr. Bauer that correct diagnosis requires a correlation between clinical and histologic findings. A biopsy report of a progressively painful bony mass localized at the entry site and obliterating the tibial tunnel initially was surprising. However, the histopathologic finding of large areas of foam cells interspersed with fibrovascular septations, which were negative for S-100 and positive for anti-human macrophage marker HAM-56, was consistent with the diagnosis of a fibroxanthoma [4, 5]. Finally, I thank Dr. Bauer for providing details regarding the mechanism of degradable orthopaedic devices.

Bone Lesions: Benign and Malignant

1. Rani Gereige, MD, MPH* 2. Mudra Kumar, MD, MRCP† 1. *Editorial Board. 2. †Associate Professor of Pediatrics, University of South Florida, Tampa, Fla. After completing this article, readers should be able to: 1. Describe the usual presenting symptoms of osteosarcoma. 2. Identify the clinical and laboratory features of osteoid osteoma. 3. Discuss the treatment of fibrous cortical defect. 4. Understand the potential actions of Ewing sarcoma and osteosarcoma. 5. Explain the appropriate procedure for biopsy of a malignant bone tumor. Bone lesions can be benign or malignant. Patients may present to the primary care practitioner with common complaints such as pain or fracture or lesions may be found incidentally on radiographs obtained for other reasons. Pediatricians should maintain a high degree of suspicion and be familiar with the clinical presentation and initial evaluation of a child who has bone pain. This article reviews the common types of bone lesions and their clinical characteristics, differentiating features, diagnostic evaluation, and treatment. Primary bone tumors are the sixth most common neoplasm occurring in children and constitute approximately 6% of all childhood malignancies. Sixty percent of all primary bone tumors occur in patients younger than 45 years of age, with a peak incidence in 15- to 19-year-old individuals. These lesions are the third most common tumors in adolescents and young adults (exceeded only by leukemia and lymphoma). Osteosarcoma and Ewing sarcoma are the most common malignant bone tumors in this age group. Although the overall incidence of osteosarcoma is higher than Ewing sarcoma in adolescents younger than 20 years, Ewing sarcoma is more common in children younger than 10 years of age. Benign bone lesions, fortunately, are more common compared with the (relatively) rare malignant neoplasms of bone. Focal bone lesions can be classified into three primary categories: benign, malignant (primary or …

Fibrous cortical defect (nonossifying fibroma) of the mandibular ramus: report of 2 cases

Fibrous cortical defect, also known as metaphyseal fibrous defect and nonossifying fibroma, among other terms, is a benign, non-neoplastic proliferative process that is relatively common in the long bones of skeletally immature adolescents. Although the lesion is thought to be a developmental abnormality or defect, the exact etiopathogenesis is largely unknown. The lesion has a limited growth potential and good treatment outcome. This process is very rare in the gnathic bones, and only a few sporadic case reports are documented. This article presents the clinicopathologic features of 2 additional cases and reviews the relevant literature in attempt to identify key features and facilitate rendering definitive diagnosis for this rare entity.

Fatigue-type stress fractures of the lower limb associated with fibrous cortical defects/non-ossifying fibromas in the skeletally immature

To investigate the association of a fatigue-type stress fracture and a fibrous cortical defect/non-ossifying fibroma (FCD/NOF) of the lower limb long bones in skeletally immature patients. The patient database of a specialist orthopaedic oncology centre was searched to determine the number of skeletally immature patients (<or=16 years of age) over an 18 year period with a lower limb long bone lesion ultimately shown to be a fatigue-type stress fracture. The diagnosis was established by a combination of typical imaging findings of a fatigue-type stress fracture, the absence of aggressive features suggestive of a sarcoma (e.g., interrupted periosteal reaction, cortical breach, and a soft-tissue mass) together with evidence of consolidation or healing on follow-up radiographs and resolution of symptoms over the subsequent weeks. The database was also used to determine the number of skeletally immature cases (<or=16 years of age) referred in the same period in which the principal lesion was shown to be a fibrous cortical defect (FCD) or non-ossifying fibroma (NOF) of the lower limb long bones. The clinical and imaging features of those cases common to both groups (i.e., with both a fatigue-type stress fracture and a FCD or NOF) were reviewed. Six percent of patients (five cases) referred to an orthopaedic oncology unit, who were subsequently shown to have a stress fracture of the lower limb long bones, were found to have a related FCD/NOF. All had been referred with a suggested diagnosis of a bone sarcoma and/or osteomyelitis. The possibility of a stress fracture had been raised in only one case. Four cases involved the proximal tibia and one the distal femur. Radiographs revealed that both lesions arose in the posteromedial cortex in all but one of the cases. The radiographs and magnetic resonance imaging (MRI) features were considered typical of the overlapping pathological features of the lesions. A sarcoma could be effectively excluded in the absence of true cortical destruction and soft-tissue extension. Both fatigue-type stress fractures and FCD/NOFs occur at similar sites in the long bones. It is postulated that the existence of the latter may cause localized weakening of the bone thereby predisposing to the development of a stress fracture. The co-existence of these two conditions in the skeletally immature should be recognized as the dual pathological processes may contribute to radiological misdiagnosis.

Benign Bone Tumors of the Upper Extremities in Children

Bone tumors are rare in children. Most bone tumors tend to involve the areas of fastest growth. Lower extremity tumors are more common than upper extremity ones, however upper extremity bone tumors do occur and can have a negative impact in the child's activities. Luckily, most bone tumors seen in children are benign and can be effectively treated by means of observation or local control by surgery. In this article we review and discuss the diagnosis and management of the most common pediatric benign bone tumors seen in the upper extremities including unicameral bone cyst, aneurysmal bone cyst, fibrous cortical defect, non-ossifying fibroma, osteochondroma, osteoid osteoma and enchondroma.

Adolescent health in medieval Serbia: signs of infectious diseases and risk of trauma

Although pattern of health in adults has been frequently assessed in past human populations, health status of adolescents as a distinct life stage has usually been overlooked. Inconsistency in number and meaning of recognised age categories in anthropological literature, as well as chronological age ranges used to define them, further complicate the interpretation of adolescent health. In this study, we analysed signs of pathological conditions on skeletal remains of 81 adolescents from a medieval site of Stara Torina (northern Serbia). Diagnostic palaeopathological procedures comprised gross examination, digital radiography, and histological analysis. Skeletal signs of anaemia such as cribra orbitalia and other porotic phenomena as well as signs of non-specific bone infection were observed frequently, while evidence of bone trauma was recorded in a very low percentage of individuals. In addition, we recorded two conditions relatively rarely observed in palaeopathological contexts: a case of skull and vertebral asymmetry indicative of congenital muscular torticollis, and a case of a fibrous cortical defect on distal femur. Comparison with available information from other medieval adolescent samples from Serbia demonstrated that while mortality was relatively constant throughout the sample, Stara Torina showed a much higher occurrence of bone disease. Characteristics of observed skeletal conditions, supported by available historical reports, suggest that the health of medieval adolescents in the examined population was most significantly affected by infectious processes.

Non-ossifying fibroma, fibrous cortical defect and Jaffe–Campanacci syndrome: a biologic and clinical review

Non-ossifying fibroma of bone (NOF) is a common entity, more frequently found in male children and consisting of a solitary eccentric, lytic expanded lesion in the metaphysis of a long bone. The disorder is benign and most often asymptomatic but may result in a fracture requiring therapy. Of some importance is to distinguish NOF from another very similar but smaller lesion, fibrous cortical defect, which is almost always asymptomatic and eccentrically located. Even more striking is a very rarely encountered lesion known as Jaffe-Campanacci syndrome, which also occurs in children who present with typical non-ossifying fibromatous tumors but in multiple sites. In addition, these patients have some systemic and dermal findings resembling those seen in patients with Type 1 neurofibromatosis.