RESUMO
Post-traumatic fibro-osseous lesions (PTFOL) are a rare and benign tumor that typically affects the ribs and is probably caused by an excessive post-traumatic reactive process. PTFOL primarily affects the sixth, seventh, and eighth ribs. Here, we report a case of a PTFOL with an unusual location and expansion that simulated a malignant chest tumor. A 28-year-old male patient with a history of minor chest trauma presented with pain. Chest radiography revealed a large, well-defined lesion on the left fourth rib, and computed tomography (CT) of the chest revealed a lytic lesion-type IC on the posterior and middle arches of the left fourth rib with a cartilaginous matrix and discontinued periosteal reaction without soft tissue mass extension. Additionally, magnetic resonance imaging of the chest revealed an ovoid, expansive mass with cystic lobules and lobulated contours extending almost over the entire left fourth rib, measuring 134×47 mm in size. This mass has a low signal on T1-weighted images and a heterogeneous intermediate signal on T2-weighted images, with intense enhancement after gadolinium injection suggestive of a malignant chest tumor. A CT-guided bone biopsy confirmed the presence of an intramedullary lesion consisting of fibrous connective tissue with fusiform fibroblastic cells without atypical signs. The lesion was delimited by bone trabeculae with nibbled edges, indicating exaggerated osteoclastic activity compatible with a diagnosis of PTFOL. The patient was treated with simple analgesics, and chest pain was relieved, with an unchanged volume of the lesion at 1 year of follow-up.
RESUMO
BACKGROUND: Currently, for the diagnosis of osteoporosis, we search risk factors and measure bone mineral density (BMD) by DXA method. However, bone turnover markers, unused still in practice, have shown an interest especially in the prediction of fracture risk. aim: To determine the relationship between bone markers, BMD and osteoporotic fracture. methods: Prospective study of 65 women referred for measure of BMD during the period between May and August 2010. Each patient had a dosage of serum bone formation markers: osteocalcin (OC) and N-terminal propeptide of type I collagen (P1NP) and bone resorption markers: serum and urinary C-terminal telopeptide of type I collagen (ß-CTX or CrossLaps) as well as parathyroid hormone and calcium. Risk factors of osteoporosis were identified in each case. results: Our 65 women had a mean age of 58.6 ± 12.1 years. The majority (83%) were menopausal women. Osteoporosis was found in 52%, osteopenia 26% and normal BMD 22% of cases. An increase in bone turnover markers was correlated with menopause (p = 0. 001 for the OC, p = 0.016 for urinary CTX), a low body mass index (p = 0.015 for OC, p = 0.042 for serum CTX) and osteoporosis (p <0.001 for P1NP, p <0.001 for serum and urinary CTX). Corticosteroid therapy was correlated with a decrease in bone formation markers (p = 0.002 for P1NP). The presence of fracture was only associated with increased urinary CTX (p = 0.05). CONCLUSION: Bone turnover markers increase in menopausal women and in case of low BMD. However, their contribution in the diagnosis of osteoporosis is low. They are rather an interest in the prediction of fracture risk.
