Fibrous Cortical Defect Workup

  • Author: Bernardo Vargas, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Jul 13, 2011
 

Imaging Studies

Plain radiographs

Usually, the diagnosis can be established based on plain radiographs, as in the images below, and biopsy is not necessary.[12, 13, 14]

Plain radiograph of fibrous cortical defect of thePlain radiograph of fibrous cortical defect of the proximal tibia. Lateral radiograph demonstrating a solitary fibrouLateral radiograph demonstrating a solitary fibrous cortical defect in the proximal tibia.

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

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.[12, 13, 14]

CT scan of the fibrous cortical defect shown in thCT scan of the fibrous cortical defect shown in the plain radiographs in Images 2-3; note the cortical location and the sclerotic rim around the central lucency.

CT scan could help in preoperative planning for FCDs in unusual locations, such as the femoral neck.

Bone scan

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.[12, 13, 14]

Minimal increased uptake can be seen in, as in the image below. In associated fractures, this study is not useful.

Methylene diphosphonate technetium bone scan of thMethylene diphosphonate technetium bone scan of the fibrous cortical defect in Images 2-4; uptake is minimally increased at the site of the lesion.
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Diagnostic Procedures

  • Biopsy is rarely needed because radiographs typically are diagnostic.
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Histologic Findings

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.

Histologic section of a fibrous cortical defect deHistologic section of a fibrous cortical defect demonstrating a bland fibrous stroma in the absence of nuclear atypia or mitoses; a few giant cells are scattered within the stroma.

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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Contributor Information and Disclosures
Author

Bernardo Vargas, MD  Consulting Staff, Department of Pediatric Orthopedic Surgery, Pediatric Hospital of Geneva, Switzerland

Disclosure: Nothing to disclose.

Specialty Editor Board

Howard A Chansky, MD  Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center

Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Sean P Scully, MD, PhD  Professor, Department of Orthopedics, University of Miami

Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Sontag L, Pyle S. The appearance and nature of cyst-like areas in the distal metaphyses of children. Am. J. Roentgenol. 1941;46:185-188.

  2. Jaffe H., Liechtenstein L. Non-osteogenic fibroma of the bone. Am J Pathol. 1942;18:205-221.

  3. Mallet JF, Rigault P, Padovani JP, Touzet P, Nezelof C. Non-ossifying fibroma in children: a surgical condition ?. Chir Pediatr. 1980;21:179-89. [Medline].

  4. Arata M, Peterson H, Dahlin D. Pathological fractures through Non-Ossifying Fibromas. Review of the Mayo Clinic experience. J Bone J Surg. 1981;63A:980 - 988.

  5. Sakamoto A, Tanaka K, Yoshida T, Iwamoto Y. Nonossifying fibroma accompanied by pathological fracture in a 12-year-old runner. J Orthop Sports Phys Ther. Jul 2008;38(7):434-8. [Medline].

  6. Campanacci M, Laus M, Boriani S. Multiple non-ossifying fibromata with extraskeletal anomalies: a new syndrome?. J Bone J Surg. 1983;65B:627-632. [Medline].

  7. Hoeffel C, Panuel M,, Plenat F, Mainard L, Hoeffel JC. Pathological fracture in non-ossifying fibroma with histological features simulating aneurysmal bone cyst. Eur Radiol. 1999;9(4):669-71. [Medline].

  8. Peuchmaur M, Forest M, Tomeno B, Abelanet R. Multifocal nonosteogenic fibroma: report of a case with ultrastructural findings. Hum Pathol. Jul 1985;16(7):751-3. [Medline].

  9. Skrede O. Non-osteogenic fibroma of bone. Acta Orthop Scand1970;41(4):362-80. [Medline].

  10. Faure C, Laurent JM, Schmit P, Sirinelli D. Multiple and large non-ossifying fibromas in children with neurofibromatosis. Ann Radiol (Paris). 1986;29(3-4):369-73. [Medline].

  11. Hetts SW, Hilchey SD, Wilson R, Franc B. Case 110: Nonossifying fibroma. Radiology. Apr 2007;243(1):288-92. [Medline].

  12. Huzjan R, Vukelic-Markovic M, Brkljacic B, Ivanac G. The value of ultrasound in diagnosis and follow-up of fibrous cortical defect. Ultraschall Med. Oct 2005;26(5):420-3. [Medline].

  13. Loberant N, Samovsky M, Papura S. Gray-scale and Doppler characteristics of fibrous cortical defects in a child. J Clin Ultrasound. Sep 2003;31(7):369-74. [Medline].

  14. von Falck C, Rosenthal H, Gratz KF, Galanski M. Nonossifying fibroma can mimic residual lymphoma in FDG PET: additional value of combined PET/CT. Clin Nucl Med. Aug 2007;32(8):640-2. [Medline].

 
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Plain radiograph demonstrating multiple fibrous cortical defects in multiple bones.
Plain radiograph of fibrous cortical defect of the proximal tibia.
Lateral radiograph demonstrating a solitary fibrous cortical defect in the proximal tibia.
CT scan of the fibrous cortical defect shown in the plain radiographs in Images 2-3; note the cortical location and the sclerotic rim around the central lucency.
Methylene diphosphonate technetium bone scan of the fibrous cortical defect in Images 2-4; uptake is minimally increased at the site of the lesion.
Histologic section of a fibrous cortical defect demonstrating a bland fibrous stroma in the absence of nuclear atypia or mitoses; a few giant cells are scattered within the stroma.
 
 
 
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