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Fibrous Cortical Defect and Nonossifying Fibroma: Follow-up

Author: Stacy E Smith, MD, Associate Professor of Radiology, Division of Musculoskeletal Imaging, University of Maryland School of Medicine
Contributor Information and Disclosures

Updated: Aug 18, 2009

Intervention

No specific treatment or intervention is required for FCDs, and they are usually left alone. They may persist into adulthood without complications and eventually become fibroxanthomas. However, if they are removed at biopsy, they do not recur. With respect to fibroxanthomas, small asymptomatic lesions do not require biopsy or treatment. With larger lesions, careful radiographic observation and decreased vigorous activity of the patient are recommended. Curettage and bone graft procedures are performed to prevent a pathologic fracture if the lesion becomes larger than 33 mm in diameter or involves more than 50% of the transverse diameter of a critical weight-bearing bone.

Medicolegal Pitfalls

  • No specific pitfalls are relevant, unless the characteristic lesion is not detected or surgical intervention is needed for possible malignancy.

Special Concerns

  • While rare reports of malignant transformation of FCDs and fibroxanthomas exist, these have been the subjects of much criticism. No true association with malignancy has been shown at this time.
  • Nuova et al reported that tumor-induced osteomalacia and rickets were secondary to NOFs in their series.22 Although no ultrastructural hormone-secreting granules were identified, complete removal of the lesion resulted in a dramatic reversal of the signs and symptoms.
 


More on Fibrous Cortical Defect and Nonossifying Fibroma

Overview: Fibrous Cortical Defect and Nonossifying Fibroma
Imaging: Fibrous Cortical Defect and Nonossifying Fibroma
Follow-up: Fibrous Cortical Defect and Nonossifying Fibroma
Multimedia: Fibrous Cortical Defect and Nonossifying Fibroma
References
Further Reading
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References

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  4. Demiralp B, Kose O, Oguz E, Sanal T, Ozcan A, Sehirlioglu A. Benign fibrous histiocytoma of the lumbar vertebrae. Skeletal Radiol. Feb 2009;38(2):187-91. [Medline].

  5. Bufkin WJ. The avulsive cortical irregularity. Am J Roentgenol Radium Ther Nucl Med. Jul 1971;112(3):487-92. [Medline].

  6. Jaffe HL, Lichtenstein L. Solitary unicameral bone cyst with emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg. 1942;44:1004-25.

  7. Steiner GC. Fibrous cortical defect and nonossifying fibroma of bone. A study of the ultrastructure. Arch Pathol. Apr 1974;97(4):205-10. [Medline].

  8. Caffey J. On fibrous defects in cortical walls of growing tubular bones. Adv Pediatr. 1955;7:13-5.

  9. Fechner RE, Mills SE. Fibrous lesions. In: Atlas of Tumor Pathology: Tumors of Bones and Joints. 1993;145-71.

  10. Smith SE, Kransdorf MJ. Primary Musculoskeletal Neoplasms of Fibrous Origin. Semin Musculoskel Radiol. 2000;4 (1):73-88. [Medline].

  11. Mandell GA, Dalinka MK, Coleman BG. Fibrous lesions in the lower extremities in neurofibromatosis. AJR Am J Roentgenol. Dec 1979;133(6):1135-8. [Medline].

  12. Arata MA, Peterson HA, Dahlin DC. Pathological fractures through non-ossifying fibromas. Review of the Mayo Clinic experience. J Bone Joint Surg Am. Jul 1981;63(6):980-8. [Medline].

  13. Campanacci M, Laus M, Boriani S. Multiple non-ossifying fibromata with extraskeletal anomalies: a new syndrome?. J Bone Joint Surg Br. Nov 1983;65(5):627-32. [Medline].

  14. Mirra JM, Gold RH, Rand F. Disseminated nonossifying fibromas in association with cafe-au-lait spots (Jaffe-Campanacci syndrome). Clin Orthop. Aug 1982;(168):192-205. [Medline].

  15. Jee WH, Choe BY, Kang HS. Nonossifying fibroma: characteristics at MR imaging with pathologic correlation. Radiology. Oct 1998;209(1):197-202. [Medline].

  16. Kransdorf MJ, Utz JA, Gilkey FW. MR appearance of fibroxanthoma. J Comput Assist Tomogr. Jul-Aug 1988;12(4):612-5. [Medline].

  17. Resnick D, Greenway G. Distal femoral cortical defects, irregularities, and excavations. Radiology. May 1982;143(2):345-54. [Medline].

  18. Resnick D, Kyriakos M, Greenway GD. Tumors and tumor like lesions of bone: imaging and pathology of specific lesions. In: Diagnosis of Bone and Joint Disorders. 3rd ed. 1995: 3628-938.

  19. Lee SH, Baek JR, Han SB, Park SW. Stress fractures of the femoral diaphysis in children: a report of 5 cases and review of literature. J Pediatr Orthop. Nov-Dec 2005;25(6):734-8. [Medline].

  20. Burrows PE, Greenberg ID, Reed MH. The distal femoral defect: technetium-99m pyrophosphate bone scan results. J Can Assoc Radiol. Jun 1982;33(2):91-3. [Medline].

  21. Hod N, Levi Y, Fire G, Cohen I, Ayash D, Somekh M. Scintigraphic characteristics of non-ossifying fibroma in military recruits undergoing bone scintigraphy for suspected stress fractures and lower limb pains. Nucl Med Commun. Jan 2007;28(1):25-33. [Medline].

  22. Nuova MA, Dorfman HD, Sun CC. Tumor induced-osteomalacia and rickets. Am J Surg Pathol. 1989;13(7):588-99.

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Keywords

fibrous cortical defect, nonossifying fibroma, fibroxanthoma, NOF, FCD, benign fibrous histiocytoma, metaphyseal fibrous defect, metaphyseal supracondylar cortical defect, developmental defect, cortical avulsive irregularity, subperiosteal desmoid, periosteal desmoid, periostitis ossificans, cortical desmoid, cortical avulsive injury

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Contributor Information and Disclosures

Author

Stacy E Smith, MD, Associate Professor of Radiology, Division of Musculoskeletal Imaging, University of Maryland School of Medicine
Stacy E Smith, MD is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Medical Editor

Michael A Bruno, MD, Associate Professor, Departments of Radiology and Medicine, Pennsylvania State University College of Medicine; Director, Radiology Quality Management Services, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine
Michael A Bruno, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, Society of Nuclear Medicine, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Murali Sundaram, MBBS, FRCR, FACR, Consulting Staff, Department of Diagnostic Radiology, The Cleveland Clinic Foundation
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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