Fibrous Cortical Defect Workup
- Author: Bernardo Vargas, MD; Chief Editor: Harris Gellman, MD more...
Usually, the diagnosis can be established based on plain radiographs, as in the images below, and biopsy is not necessary.[14, 15, 16]
The classic picture is that of an elliptical radiolucent lesion eccentrically located within the metaphyseal cortex of long bones, especially the femur. The margins are sharply demarcated, and the appearance is often septated.
CT scan should not be performed unless a strong doubt about diagnosis is present, except to confirm a pathologic fracture, as in the image below. This lesion is located eccentrically, and CT scans should depict a central lucency. CT scans may confirm a minimally displaced fracture.[14, 15, 16]
CT scan could help in preoperative planning for FCDs in unusual locations, such as the femoral neck.
This study is not indicated for diagnosis. Nevertheless, in some cases, a methylene diphosphonate (MDP) technetium bone scan can help to appreciate biologic activity of the lesion.[14, 15, 16]
Minimal increased uptake can be seen in, as in the image below. In associated fractures, this study is not useful.
See the list below:
Biopsy is rarely needed because radiographs typically are diagnostic. 
Histologic analysis of FCD reveals a predominantly bland fibroblastic component with a few histiocytes, myofibroblast cells, and giant cells, as in the image below. The lesion is marked by proliferations of spindle cells arranged in a storiform pattern. Hemosiderin deposits also are found. Around the lesion, some leukocyte infiltration may be present.
Fractures through an FCD may change the histologic pattern. In these cases, blood deposits due to the fracture and formation of new bone are seen. Care must be taken not to confuse early callus with osteogenic sarcoma.
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