Metaphyseal Fibrous Defect Research Articles

Retrospective Evaluation of Primary Bone Tumors and Their Incidence in the “Ignacio García Téllez” Specialty Hospital CMN IMSS

In 1948, Steiner conducted an analysis of cancer registries in the United States of America, estimating that primary bone tumors constituted approximately 1% of all fetal malignancies. For its part, in Great Britain, a similar incidence of primary bone tumors is observed, fluctuating between 0.8% and 0.9%. A later statistic from the United States at v of 1.87:1000 000 deaths among children under 14 years of age, increasing to 11.97:1000 000 deaths in people aged 11 to 19 years. Since all bone components are derived from the mesoderm, they have the potential to be composed of any of the four basic types of cells: fibroblasts, chondroblasts, osteoblasts and the reticulo-myelogenous series, to achieve a correct diagnosis it is necessary to have the complementary radiological and pathological support to part of biochemical and hematological investigations. The present investigation focused on a retrospective, observational, quantitative, risk-free study, based on the review of records and tracking of histological reports of patients who were treated at the “Ignacio García Téllez” CMN IMSS Specialty Hospital in a period of 5 years, including all those cases with primary tumors of bone or cartilage origin, both benign and malignant of bone marrow and vascular, in addition to pseudotumor lesions such as fibrous dysplasia, metaphyseal fibrous defect, solitary bone cyst. A total of 182 histological records and reports were recorded in a period of 5 years where a total of 93 women and 89 men were recorded, with ages ranging from 3 months of extrauterine life to 87 years. With a mean of 56.53 years and a standard deviation of 18.48 years. 129 benign tumors were reported in 63 men and 66 women; Meanwhile, a total of 53 malignancies were counted in 26 men and 27 women. The current study facilitates the evaluation of the most common neoplasms in our environment, with the aim of raising awareness about the importance of having adequate resources to develop a timely diagnosis and treatment plan for the benefit of patients.

Epidemiology of benign tumors and pseudo tumoral lesions of the femur based on an analysis of patients receiving orthopedic care

Benign tumors and pseudo tumoral lesions of the bones belong to the largest group ofan abnormal growth of tissue in bone, which is characterized by many specific clinical, radiological and histological features. The study of data on the spread of pathology, localization, frequency of recurrence depending on gender and age characteristics helps to determine the category of people who need a more detailed examination. Aim: Determination of the incidence of an abnormal growth of tissue in bone, the most typical localization, as well as the likelihood of recurrence and malignancy in patients with benign abnormal growth of tissue in the femoral bone. Materials and methods: Materials obtained during the analysis of casesur, as well as radiographs of 465 patients operated in the Department of Traumatology and Orthopedics of the Astrakhan State Medical University from 2 years old to 70 years, from 1977 to 2018, using nonparametric analysis methods. Differences were considered significant at r 0.05. Results: Studying various tumors depending on age, it was found that the median age of patients with aneurysmal bone cyst (13.5) was significantly lower than the median age of patients with giant cell tumor (osteoclastoma) (25), respectively. When comparing persons suffering from a metaphyseal fibrous defect (non-ossifying fibroma) and a chondroma (enchondroma), a difference was noted in the average age values, which amounted to 13.5 years and 45 years, respectively. A significant difference was also found between those with a solitary bone cyst and chondroma (enchondroma), where average was 45 years. When analyzing the significance of differences in the incidence of tumors of certain localizations depending on the patients gender, it was found that the differences are not significantly significant in any of the compared groups. A certain dependence of the tumor localization on gender is not determined, which indicates that the localization of the tumor is not related to the sex of the patient. The frequency of recurrence of an abnormal growth of tissue in femoral bone is also not related to gender. Conclusions: The primary incidence of femorals tumor is predominantly characteristic of patients aged 15 years. In the groups of patients with aneurysmal bone cyst, osteochondroma (bone and cartilage exostosis) and solitary bone cyst, the median age of a person is the smallest. In the comparison of patients with giant cell tumor (osteoclastoma), metaphyseal-fibrous defect (non-ossifying fibroma), osteoid osteoma, chondroma (enchondroma), female patients predominated, and in patients with osteochondroma (osteocartilaginous exostosis) and osteoma, male patients predominated. The incidence of recurrence in the compared groups with a diagnosis of aneurysmal bone cyst, giant cell tumor (osteoclastoma), fibrous dysplasia and chondroma (enchondroma) was significantly higher than in other groups.

Non-ossifying fibroma (metaphyseal fibrous defect)

Non-ossifying fibroma (NOF) or metaphyseal fibrous defect (MFD) is benign fibroblast proliferation with the presence of osteoclast-like multinucleated giant cells. The most cases of NOF/MFD occur in the metaphysis of the long tubular bones of the lower extremities, more commonly in the metaphysis of the femur and in the proximal metaphysis of the tibia. This lesion has a characteristic X-ray pattern and requires no surgical intervention, except for cases of a pathologic fracture or a risk for the latter. The paper analyzes 35 NOF/MFD cases in children and adolescents. It has been found that one and all patients have undergone surgery, suggesting the low awareness of this abnormality among radiodiagnosticians, pathologists, and surgeons.

Proliferative, reparative, and reactive benign bone lesions that may be confused diagnostically with true osseous neoplasms

Diagnostic problems attending intraosseous and parosteal pseudoneoplastic lesions can be radiographic, or histological, or both. Proliferations in this category may contain cellular fibro-osseous or chondro-osseous tissues that are difficult to separate microscopically from those seen in various true neoplasms of the bones. This review considers the clinicopathologic features of fibrous dysplasia, benign fibro-osseous lesions of the jawbones, osteofibrous dysplasia, metaphyseal fibrous defect, giant-cell reparative granuloma, "brown tumor" of hyperparathyroidism, synovial chondrometaplasia, aneurysmal bone cyst, tumefactive chronic osteomyelitis, proliferative Paget disease, and polyvinylpyrrolidone storage disease of bone.

Spindle cell sarcoma of bone arising from a non-ossifying fibroma: A case report.

The majority of malignant bone lesions, and spindle cell sarcoma of bone is no exception, arise spontaneously. Less frequently, they may be secondary to other conditions like radiation therapy, bone pathologies like Paget's disease, bone infarct, aseptic necrosis and many benign tumors or tumor like bone conditions like metaphyseal fibrous defect (MFD), giant cell tumor (GCT), osteochondroma, chondroma and others.1 This work describes a very rare case of sarcoma of bone arisen in the same area of a benign lesion, diagnosed occasionally ten years ago, which has not undergone previously medical, radiotherapic or surgical treatment.

Benign fibrous histiocytoma of bone: A case report

Introduction: Benign fibrous histiocytoma of bone is a rare tumor. Only few cases have been reported in literature. Case Report: A 45­year­ old female presented with pain in the ankle. Radiological findings revealed osteolytic lesion of talus and histological features were similar to non­ossifying fibroma and metaphyseal fibrous defect. Because of pain, unusal location and unusual age group the lesion was diagnosed as benign fibrous histiocytoma of Talus. Conclusion: Benign fibrous histiocytoma should be considered as one of the histopathological diagnosis although benign fibrous histiocytoma of bone is a rare entity.

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.

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.

Non-ossifying fibroma (metaphyseal fibrous defect) of the mandible

A 15-year-old young man was referred for evaluation of a non-tender swelling of the left mandibular angle region. A non-ossifying fibroma was diagnosed. The lesion was enucleated under general anesthesia. The postoperative course was uneventful. There have been no signs of recurrence, and there was complete bone regeneration in the region 24months after operation. This report also reviews other fifteen cases of non-ossifying fibroma in the mandible reported in the literature.

BENIGN FIBROUS HISTOCYTOMA OF THE DISTAL RADIUS: A REPORT OF A CASE AND A REVIEW OF THE LITERATURE

Benign fibrous histocytoma of bones is a very rare tumour and only a few cases have been reported. We report a case of 40-year-old patient with no significant previous medical history who presented with a painful lesion in his right wrist joint. Incision biopsy was done and there was a histological picture similar to a metaphyseal fibrous defect (non-ossifying fibroma). This was managed with excision of the lesion and filling the defect with cancellous and cortical bone grafts from the left iliac bone. To our knowledge, this is the second case report of a benign fibrous histocytoma involving the distal radius in adult. In this case report, we review similar cases in the literature and discuss the differential diagnoses of this lesion.

Extended Curettage for Benign Bone Lesions

Benign bone lesions present a unique challenge to the practicing orthopaedist. They are a not uncommon problem that often present in the pediatric or young adult population. The most common diagnoses include giant cell tumor of bone, aneurysmal bone cysts, unicameral (simple) bone cysts, metaphyseal fibrous defects, and fibrous dysplasia. Appropriate surgical intervention must balance acceptable recurrence rates and surgical morbidity in line with their benign diagnosis. Historically, early surgical invention had unacceptably high recurrence rates. A more aggressive surgical approach to these lesions significantly decreased recurrence rates but surgical morbidity rose to levels considered unacceptable for benign lesions. Extended curettage offers a satisfactory compromise with decreased recurrence rates and significantly less surgical morbidity. Extended curettage is a technique of intralesional excision where the margins of the excision are extended by a surgical, chemical, or thermal adjuvant. Adjuvant options include phenol, liquid nitrogen, high-speed burr, cementation with polymethylmethacrylate, and argon-beam coagulation. The technique described here uses a combination of high-speed burr, argon-beam coagulation, and cementation to treat benign bone lesions resulting in an acceptable recurrence rate and acceptable rate of surgical morbidity.

Periosteal chondromyxoid fibroma: A case study using imprint cytology

Bone surface is an exceptional location for chondromyxoid fibroma. Only 14 cases of juxtacortical chondromyxoid fibroma have been reported to date and, to our knowledge, none of these cases are documented with imprint cytology. We report a case of periosteal chondromyxoid fibroma located in the distal tibial metaphysis of a 4-yr-old boy. The clinical diagnosis was metaphyseal fibrous defect. Cytologic examination revealed a mixoid matrix, with stellate and spindle-shaped cells seen singly, focus of chondroid material, and epithelioid cells. Multinucleate giant cells were not seen. The diagnosis of periosteal chondromyxoid fibroma can be made by fine-needle aspiration or imprint cytology with clinico-radiologic correlation.

Clinical and Roentgenologic Semiotics of Long Bone Pathologic Fractures

During 1965-2002 one thousand two hundred thirty patients with bone tumors and tumor-like diseases were treated at Astrakhan Medical Academy, Clinic of Traumatology and Orthopaedics. Out of them 163 (13.3%) patients had pathologic fractures. One hundred eight fractures were localized within long bones: humerus (61), femur (37), tibia (29), fibula (6), radius (5). Long bones fractures were commonly resulted from destructive lesions: solitary bone cyst - 48 cases, fibrous dysplasia - 26, giant cell tumor - 24, aneurismal bone cyst - 18, metaphyseal fibrous defect -11. Clinical and roentgenologic semiotics was studied and complex of roentgenologic signs of long bone pathologic fractures was systematized. Peculiarities of fractures (injury mechanism, typical localization of pathologic process, pattern of destruction focus) in various nosologic forms of primary disease were detected. The data obtained simplify diagnosis and allow trustworthy making prehistologic diagnosis as well as to choose optimum treatment tactics.

Metaphyseal fibrous defects.

Nonossifying fibromas and fibrous cortical defects are the most common benign lesions of the skeletal system. They are frequently detected incidentally on radiographs taken for an unrelated reason. The diagnosis is routinely made solely on the basis of the history, physical examination, and radiographic appearance. The incidence of multifocal nonossifying fibroma is typically underestimated in patients initially found to have a solitary lesion; the use of a limited skeletal survey rather than bone scan may help detect multifocal lesions in this population. Small, asymptomatic lesions may be followed over time using serial radiographs. Incisional biopsy, curettage, and bone grafting are indicated for large lesions that raise concern for impending pathologic fracture, for lesions that have become painful, and for lesions whose characteristics prevent a definitive radiographic diagnosis. Pathologic fractures involving these lesions should be treated with cast immobilization until the fracture has healed, followed by biopsy, curettage, and bone grafting.

Metaphyseal fibrous defects in juveniles from medieval Norwich

AbstractTwo juvenile skeletons excavated from medieval Norwich each have a well‐defined cystic cavitation. One involves the distal femur and the other the proximal tibia. The dry bone and radiographic appearance, as well as the location and age of the individuals, support a diagnosis of metaphyseal cortical defects. Although well‐known in clinical practice, especially in children, this appears to be the first published evidence for the condition in British archaeological material. No other anomalies were detected on the two skeletons. However, the occurrence of two cases in the same cemetery raises the possibility of a genetic influence in the condition. Copyright © 2002 John Wiley & Sons, Ltd.

Metaphyseal fibrous defect (nonossifying fibroma) in the mandible: A case report

A 7-year-old boy presented in whom a metaphyseal fibrous defect was diagnosed. The lesion was enucleated under local anesthesia. The postoperative course was uneventful; and there have been no signs of recurrence as of 14 months after operation. Although rare, metaphyseal fibrous defect should be included in the differential diagnosis of tumors arising in the jaws.

Pitfalls and typical false interpretations in bone tumors. From the viewpoint of long-term consultation

Problems in diagnosis of bone tumors in routine laboratories concern very rare tumors, differentiation between chondroma and low grade chondrosarcoma, the recognition of lesions containing multinucleated giant cells, lesions with secondary cysts simulating iuvenile or aneurysmal bone cyst and sometimes the discrimination of callus from osteosarcoma. Real misdiagnoses are done in ossifying pseudotumors interpreted as osteosarcoma, metaphyseal fibrous defect confound with giant cell tumor and chondroblastoma misdiagnosed as giant cell tumor or osteosarcoma. All these mistakes are avoidable if the clinical and radiological features, especially age and exact site in bone studied on the x-rays, are taken into consideration.

Oncogenic osteomalacia: a clinicopathologic study of 17 bone lesions.

Oncogenic osteomalacia is an unusual and rare clinicopathologic syndrome characterized by mesenchymal tumors that apparently produce osteomalacia and biochemical abnormalities consisting of hypophosphatemia, normocalcemia, and increased levels of alkaline phosphatase. We collected from the Mayo Clinic files and from our consultation files the records for 17 cases of osteomalacia associated with bone lesions. There were five cases of fibrous dysplasia, three of hemangiopericytoma, and two of phosphaturic mesenchymal tumor. There was one case each of osteosarcoma, chondroblastoma, chondromyxoid fibroma, malignant fibrous histiocytoma, giant cell tumor, metaphyseal fibrous defect, and hemangioma. In this study we can figure out that the most common characteristic histologic features of our cases were hemangiopericytomatous vascular proliferation, fine lace-like stromal calcification, and stromal giant cells. In most of the cases, the clinical and biochemical symptoms and signs resolved soon after complete resection of the lesion. When the lesion recurred or metastasized, the symptoms and signs also recurred.

Fibrous metaphyseal defect

The tendon and ligaments inserted into the perichondrium of the epiphyseal plate were examined in 152 autopsy specimens of tubular long bones. In the region of two areas where tendons were inserted (Ranvier's nodes), the normal medullary tissue is replaced by fibroblastic tissue. A retrospective radiological examination of 155 fibrous metaphyseal defects shows that they are situated at characteristic sites on the circumference of the metaphysis of long tubular bones. This can be related to the insertion of a tendon or ligament near the epiphyseal growth plate which corresponds to areas found in the morphological study and is the site of origin of fibrous metaphyseal defects.

Der fibröse metaphysäre Defekt - eine stadien- und altersabhängige Differentialdiagnostik

Based on 57 fibrous metaphyseal defects the conventional radiologic signs are described as diagnostically reliable including asymptomatic patients as well as patients with a history of pain and lesions with positive scintigraphy. The radiologic morphology of the fibrous endosteal and medullary defects differs with the age of the patient. Beyond the age of 18 years there is a sclerosis of the lesion and a less marked arrosion of the corticalis. The differential diagnosis depends on the cortical, endosteal of medullary site of the fibrous defect as well as on the age of patient and includes the cortical metastasis, the juxta-articular osteoid-osteoma, the periosteal chondroma, the cortical irregularity, the solitary bone cyst, the fibrous dysplasia, the chronic osteomyelitis and the osteosclerotic osteosarcoma.