2. 5yrs old boy
Informant : mother
Presented with c/o swelling in left leg distal
third region incidentally noticed by mother
2yrs ago
Swelling gradually progressive in nature
not a/w pain
3. No other swelling in body/sudden increase
in swelling.
No significant family history
No other treatment history
No h/o pain, night cries
4. O/E:swelling present
over distal 3rd part of leg
lateral aspect
Skin normal over
swelling
No engorged veins
/deformity
O/p:
No local rise of
temperature/tenderness
swelling fixed to bone
No DNVD
5. Immature skeletal bone
It shows well defined
expansile lytic bone
lesion in diaphysis of tibia
and fibula
No break in cortex
No matrix calcification
14. Gross exmn.:
Well circumscribed
grey white mass of
size 6*4cm of distal
3rd fibula
15. Cut surface shows:
Grey white mass
Soft rubbery mass in
medullary canal of
fibula & tibia
No hemorrhagic
lesion/cysts.
16.
17. Wound inspection on post op day 2 with
a/k slab
Suture removal on 12th post op day and AK
cast for 1mth with non weight bearing
walking.
Further follow up yet to be awaited to see
radiological union of graft in tibia.
18.
19. We diagonsed this condition as
osteofibrous dysplasia (a rare condition)
20. A rare lesion occurs exclusively in tibia &
fibula.
In 1976, Campanacci introduced the term
Defn: Is a disorder c/by presence of fibrous
tissue & bone trabeculae rimmed by
osteoblasts.
Predominantly affects infants & children.
21. Its incidence is reported to be 0.2% of all
primary bone tumours.
Typically occurs in first 2 decades of life
male preponderance.
The etiology is unknown.
Osteofibrous dysplasia has been
postulated to arise from a fibrovascular
abnormality.
22. Due to high incidence (60-100%) of
recurrence, any surgical procedure is
recommended only after skeletal maturity.
Surgical options include extra periosteal
resection, autologous graft, limb
lengthening procedures etc.
23. Sakamoto et al. found that GSα mutation
at the Arg201 was seen in fibrous
dysplasia but this did not occur in
Osteofibrous dysplasia, and they
concluded that this could be useful for
distinguishing between the two lesions.
24. Histologically OFD is
characterized by a loose,
often storiform fibrous
background containing
spicules of woven bony
trabeculae that are lined
by a layer of osteoblasts.
fibrous dysplasia typically
lacks the distinctive
osteoblastic rimming of
the bony trabeculae.
25. OSTEOFIBROUS
DYSPLASIA ADAMANTINOMA
benign lesion composed
primarily of fibro-osseous
tissue.
slow-growing, low-grade,
malignant biphasic tumor
with intermingled epithelial &
fibro-osseous components.
aggressive tumor that is
locally invasive and can
metastasize.
26. Osteofibrous dysplasia–like adamantinoma
(a/k as differentiated or regressing
adamantinoma) is a benign lesion like
osteofibrous dysplasia but has features of
both osteofibrous dysplasia and
adamantinoma.
It may progress and become a malignant
adamantinoma.
27.
28.
29. As the lesion was in diaphyseal region of
tibia & fibula we suspected lesion to be
fibrous dysplasia/neurofibromatosis of long
bone so we did en bloc excision biopsy
and it turned out to be osteofibrous
dysplasia.
Waiting for further follow up