A nonossifying fibroma of the femoral neck treated with curettage and dynamic hip screw with free fibular bone graft: a case report.

Introduction and importance: Nonossifying fibroma (NOF) is a benign fibrogenic lesion that is related to dysfunctional ossification and one of the most common benign bone tumors in childhood with incidence rate of 30-40% of skeletally immature children. Presentation of case: A 25-year-old female with left hip pain for the past 2 months, which was treated conservatively, presented with severe pain in the hip. X-ray showed a pathologic fracture in the neck of the femur with underlying lesion. MRI showed an osteolytic lesion in neck of the femur. Curettage of the lesion was done with free fibular bone graft and stabilized by Dynamic Hip Screw and specimen sent to pathology. The pathology report consisted with NOF. No-weight bearing for 8 weeks with physical rehabilitation were ordered and six months later the patient had a full range of motion and healed fracture. Clinical discussion\Conclusion: This study revealed that the surgical treatment with bone graft for pathologic femoral neck fracture and underlying NOF allowed a quick return to mobility and can be fixed sufficiently to achieve excellent postoperative recovery.

Nonossifying fibroma of the lower femur with genu valgum: a case report.

BACKGROUND: Nonossifying fibroma is common in children and adolescents, and nonossifying fibroma with genu valgum is rare in the clinic. This article evaluated the effectiveness of treatment in a case of nonossifying fibroma of the lower femur with genu valgum. CASE PRESENTATION: A 16-year-old girl complained of pain in the lower part of her right thigh for one year. She was diagnosed as non ossifying fibroma of the right femur with secondary valgus deformity of the right knee, and was treated in our hospital. We performed curettage, bone grafting and internal fixation,and corrected the valgum deformity at the same time. The patient's incision healed well, the pain was disappeared, and the mechanical axis of lower limbs was corrected. No tumor recurrence was found on X- ray examination one year after operation, and the fracture end was healed. The patient could walk normally, and she was satisfied with her limb function. CONCLUSION: Nonossifying fibroma with genu valgum is rare in the clinic. The patient was satisfied with our treatment, which achieved a good curative effect.

Bilateral Nonossifying Fibroma of the Mandible: A case report of a rare entity.

Nonossifying fibroma (NOF) is a benign lesion confined to the bone marrow and connective tissues without exhibiting osseous metaplasia. NOF of long bones in children is more common than its gnathic counterpart. Mandibular NOF is rare, and there is a paucity of information in the literature. NOF of the jaws clinically presents as a nodular, fibrous, asymptomatic, gingival, or alveolar mucosal enlargement, with or without facial swelling. NOF differs from the ossifying type by the presence of metastatic woven bone in ossifying type. This article reports an example of bilateral, multilocular, NOF of the mandible in a 15-year-old female patient with unilateral, asymptomatic facial asymmetry. The radiographic features were characteristic of NOF. It was treated successfully with surgical excision and curettage. A 2-year postoperative follow-up showed recurrence of the right lesion and needed secondary surgical intervention, and the tumor on the left side, however, healed well without recurrence.

Comparison of MRI Findings among Osteofibrous Dysplasia, Fibrous Dysplasia, and NonOssifying Fibroma of the Long Bone.

Background The characteristics of magnetic resonance imaging (MRI) findings among osteofibrous dysplasia (OFD), fibrous dysplasia (FD), and nonossifying fibroma (NOF) have yet to be determined. Aims This study determines the differences of MRI features among OFD, FD, and NOF of the long bone. Patients and Methods This study included 39 patients including 10 OFD, 13 with FD, and 16 with NOF of the long bone. All patients underwent preoperative MRI and histological examination. We retrospectively reviewed the MRIs and compared the imaging findings among the three pathologies. Results The maximum diameter was significantly different among OFD (47.0 ± 18.6 mm), FD (59.0 ± 35.0 mm), and NOF (33.3 ± 15.0 mm) ( p < 0.05). Multiplicity (60%, p < 0.01), eccentric distribution (100%, p < 0.05), septation (70%, p < 0.01), homogeneous intensity on T2-weighted images (70%, p < 0.01), homogeneous contrast enhancement (63%, p < 0.05), and intense contrast enhancement (88%, p < 0.01) were significantly more frequent in OFD. Centric distribution (69%, p < 0.01), cyst formation (54%, p < 0.01), and fluid-fluid level formation (31%, p < 0.01) were significantly more frequent in FD. Eccentric distribution (100%, p < 0.01), heterogeneous on T2-weighted images (100%, p < 0.01), predominant hypointensity on T2-weighted images (44%, p < 0.01), and the presence of intralesional hypointensity on T2-weighted images (88%, p < 0.01) were significantly more frequent in NOF. Conclusion MRI features could differentiate OFD, FD, and NOF of the long bone.

Edema-like marrow signal intensity (ELMSI) associated with nonossifying fibroma (NOF) on MRI: an uncommon finding in a common bone lesion.

OBJECTIVE: To investigate the association between nonossifying fibroma (NOF) and perilesional edema-like marrow signal intensity (ELMSI) on MRI and discuss the clinical and diagnostic implications of this finding. MATERIALS AND METHODS: A retrospective search for "nonossifying fibroma" and "NOF" on knee MRI reports of patients up to 20 years of age over a 5-year period was performed. A total of 77 patients (34 males, 43 females, ages 11-20) were identified, and each MRI was reviewed to evaluate for ELMSI associated with the NOF. Statistical analysis was performed to determine if there was a correlation with the presence of perilesional ELMSI and age, gender, lesion size, or signal characteristics. RESULTS: Twelve patients out of 77 (16%) had ELMSI associated with a NOF. Excluding patients who had additional findings of pathologic fracture (n = 2), a known potential complication of NOFs, and edema related to an adjacent osteoid osteoma (n = 1), a total of 9 patients (12%) had otherwise unexplained perilesional ELMSI. There was no statistically significant difference between patients with vs. without perilesional ELMSI with respect to age (p = 0.08), gender (p = 0.28), lesion size (p = 0.52), or appearance on fluid-sensitive sequences (p = 0.81). CONCLUSION: ELMSI can be seen about NOFs encountered around the knee joint on MRI, which may represent active healing and/or involutional change of this "do not touch" lesion in cases where no other explanation is identified.

Possible Novel Treatment Modality for Non Ossifying Fibroma Neck of Femur.

Nonossifying fibromas (NOFs) are benign bone tumors occurring in the second decade of life. Most of the NOFs are diagnosed incidentally on the basis of its presentation on plain radiographs where they typically appear as small, cortical osteolytic lesions with sclerotic margin. They are mostly asymptomatic but can result in pathologic fractures if the lesion involves more than 50% of bone diameter. They are mostly treated with curettage and bone grafting. But in challenging situations where the classical surgery has failed or there is impending fracture of the neck of femur, bone structural support is needed. We are discussing two cases diagnosed as NOFs of intracapsular femoral neck. Both cases underwent curettage of tumor followed by free vascularized fibular graft. Results in both the cases were very gratifying, with complete resolution of symptoms during 1 year of follow-up.

Osteoglophonic Dysplasia: Phenotypic and Radiological Clues.

Osteoglophonic dysplasia (OD) is an extremely rare, skeletal dysplasia with an autosomal dominant mode of inheritance. Rhizomelic dwarfism, craniosynostosis, impacted teeth, hypodontia or anodontia, and multiple nonossifying bone lesions are the salient features of this condition. We report a 14-year-old girl with clinical and radiological features consistent with OD. She presented with disproportionate short stature, craniosynostosis, a prominent supraorbital ridge, delayed teeth eruption, hypodontia, and multiple nonossifying bone lesions in the femur, tibia, and fibula. She had hypophosphatemia, which is a known association in this dysplasia. She also had advanced bone age, which is an unreported feature of this dysplasia. This condition is caused by activating mutations in FGFR1 . A missense mutation was detected in the FGFR1 , NM_001174067 ( FGFR1 _v001):c.1115G > A [p.(Cys372Tyr)] confirming the diagnosis; this is the first mutation-proven case to be reported from India.

Top five lesions that do not need referral to orthopedic oncology.

Patients with potential bone and soft tissue tumors can be challenging for orthopedic surgeons. Lesions that appear benign can still create anxiety for the clinician and patient. However, attention to a few key imaging and clinical findings is enough to correctly diagnose five of the most common bone and soft tissue lesions: lipoma, enchondroma, osteochondroma, nonossifying fibroma, and Paget disease. Accurate identification of these lesions should be within the scope of most orthopedic surgeons and, because most of these patients will not need surgical treatment, referral to orthopedic oncology will not typically be required.

X-ray and CT Features and Its Pathologic Basis of Nonossifying Fibroma of Long Bone:A Report of 17 cases / 实用放射学杂志

Objective To investigate the relationship between the X-ray,CT findings and its pathological basis of nonossifying fibroma(NOF).Methods X-ray and CT features of NOF confirmed by surgical pathology in 17 cases,and correlative study of imaging andpathology was done.Results 17 lesions were showed as eccentric and expanded destruction located in the cortex,and the remains of bone could be found inside the tumor,the lesions projecting into marrow cavity with a thin bone between the tumor and marrow.The tumors were grey-yellow or brown tissue around by the thin bone found in operation.NOF was consisted of a lot of shuttle cell and collagen fiber under microscope,some of macrophagocyte with multiple nucleuses and foam cell dropped disseminating in them,and there was not osteogenesis in the tumor.Conclusion The pathological changes of NOF can be reflected by X-ray and CT.

X-ray and CT Diagnosis and Differential Diagnosis of Nonossifying Fibroma:A Report of 29 Cases / 实用放射学杂志

Objective To study X-ray and CT diagnosis and Differential diagnosis of nonossifying fibroma.Methods 29 cases of nonossifying fibroma proved by pathology were included in this paper.29 cases underwent radiography and 12 cases underwent CT scan.There were 22 male and 7 female,with age ranged from 5~59 years(mean age 21.3 years),X-ray and CT findings of tumors were analysed.Results The tumors were located in long bone in 27 cases,in which 17 cases were located in metaphses,2 cases in diaphyses,8 cases in bone end and 2 cases in irregular bone.The maximum diameter of tumors ranged from 0.5~7 cm.The tumors were round,oral or mild lobular in 21 cases,the tumors were showed sclerotic borders in 26 cases.Septum was demonstrated in 22 cases on X-ray plain films,but only 2 cases on CT.Bone expansion was showed in 13 cases.Conclusion Most of nonssifying fibroma have characteristic X-ray and CT findings,the diagnosis be identified by X-ray and CT before operation.

Image Diagnosis and Differential Diagnosis of Nonossifying Fibroma / 实用放射学杂志

Objective To study image findings of nonossifying fibroma.Methods The pathological and image findings fo 22 cases of nonossifying fibromas proved by operation were analysed.There were 12 cases of male and 10 cases female,with age ranging from 10 to 35 years(mean age 17 years).X-ray plain films were obtained in all 22 cases,CT images in 7 cases,and MRI in 2 cases.Results The tumors were located in long bone in 19 cases,in which 14 cases were located in metaphyses,2 cases in diaphyses and 2 cases in bone end,and 4 cases in irregular bone,which was seen in clavicle,rib,illum and maxilla respectively.The tumor maximum diamneter ranged from 2 to 6.5 cm,with mean diameter of 3.2 cm,and the ratio of longitudinal to transverse diameter was 2.51.The tumors were round,oral or mild lobular in 17 cases.The tumors were showed sclerotic borders in 20 cases,and no sclerotic border in 2 cases(clavicle and rib).Septum was demonstrated in 19 cases.Bone expasion was showed in one case.Conclusion If a tumor is located in cortex or marrow of long or irregular bone which is showed a welldefined lytic lesion with sclerotic rim,the diagnosis of nonossifying fibroma will be considered.