Osteofibrous Dysplasia

History: A 13-year-old boy presents with increasing right calf mass. 

Sagittal proton density image of the area of concern:

Axial fat suppressed images through the area of concern:

Diagnosis: Osteofibrous dysplasia

Findings: Cortically based lucency of the middle tibia. No medullary involvement and without periosteal reaction. Status post bone graft packing on final images. 

Comments: Osteofibrous dysplasia is a rare bone tumor of the tubular bones, most commonly in the anterior cortex of the tibia, which is often referred to as an ossifying fibroma of the tubular bones. Thought to exist within a spectrum of benign to malignant with adamantinoma. Treatment is controversial but follow up radiographs and careful observation is paramount to assess for possible degeneration to adamantinoma.

Resources:

Resnick, Kransdorf, Bone and Joint Imaging 3rd Edition. 2005.
“Osteofibrous dysplasia of the tibia. Is there a need for a radical surgical approach?” Lee RS, Weitzel S, Eastwood DM, Monsell F, Pringle J, Cannon SR, Briggs TW.
“Adamantinoma of tibia: a study of 12 cases” Desai SS, Jambhekar N, Agarwal M, Puri A, Merchant N.
EMedicine.com: Osteofibrous Dysplasia

Case courtesy Hospital for Special Surgery. Click here for more Case Studies from HSS.