Nonossifying Fibroma with Pathologic Fracture - MSK Radiology
• Cortically based, geographic, lucent lesion with a sclerotic peripheral margin measured > 3cm.
• MRI demonstrates the cortically based lesion with T1- and T2-heterogenous signal with regions of hypointense signal representing fibrous/hemosiderin portions. The arrows delineate a nondisplaced linear fracture emanating from the lesion into the femoral metadiaphysis with surrounding marrow edema.
• Nonossifying Fibroma and Fibrous Cortical Defects are histologically similar and sometimes differentiated based on size (NOF > 3cm). Both coined "Fibroxanthoma".
• Do Not Touch lesions with no follow-up or biopsy necessary in almost all cases. Diagnose with X-RAY; usually resolve by age 20-25.
• This case shows potential of pathologic fracture in athletes.
• Multiple NOF's in NF-1 or Jaffe-Campanacci syndrome.
Differential diagnosis for similar lesion:
• Simple bone cyst: Central, "cyst-like" lesion on MRI without hypointense fibrous tissue.
• Aneurysmal bone cyst: Eccentric expansile lesion, MRI shows fluid-fluid levels.
Dr. Donald von Borstel @DrvonBorstel
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