Dr. Saumya Agarwal presented on a 20-year-old male farmer with a 4-month history of right hip pain aggravated by work. Imaging showed a lytic lesion in the right femoral neck. Differential diagnoses included fibrous dysplasia and other bone cysts/tumors. Fibrous dysplasia is a benign bone disorder characterized by fibro-osseous tissue growth. It typically affects long bones in the first three decades and can be monostotic or polyostotic. Treatment involves fixation of fractures or deformity correction.

1. ORTHO PATHO MEET
PRESENTER : Dr. SAUMYA AGARWAL
Junior resident Dept of Orthopaedics
J.N.Medical College and Dr. Prabhakar
Kore Hospital and MRC, Belgaum

2. NAME : XYZ
AGE : 20 Yrs
SEX : MALE
I.P NO. : 659161
ADDRESS : RESIDENT OF BELGAUM
OCCUPATION : FARMER

3. CHIEF COMPLAINTS
 Patient complaints of pain at right hip while
working for a long time since 4 months.

4. HISTORY OF PRESENTING ILLNESS
• Patient was apparently alright 4 months back
when he started complaining of pain in right hip.
• Pain was insidious in onset, gradually progressive,
aggravated on working and relieved on rest.

5. • No history of :
1) Trauma / injury at the site of deformity
2) Fever
3) Significant Loss of body weight
4) Steroid intake
5) Other joint pain

6. PAST HISTORY
• No history of similar complaints in the past.
• Not a Known case of Diabetes Mellitus,
Hypertension and Ischemic heart disease.
• Not a known case of Tuberculosis,
hyperthyroidism and other chronic illness.
FAMILY HISTORY
• Nothing significant

7. PERSONAL HISTORY
• Diet : Mixed
• Appetite : Not decreased
• Sleep : Undisturbed
• Bowel & Bladder : Normal and regular
• Takes alcohol occasionally , non smoker

8. GENERAL EXAMINATION
• Patient is conscious, cooperative and well
oriented to time , place and person .
• Moderately built
• Afebrile
• Pulse – 76 /min
• Blood pressure - 116/80 mmHg
• Respiratory rate – 20 / min
• No pallor / cyanosis / edema / icterus / clubbing
/ lymphadenopathy

9. SYSTEMIC EXAMINATION
• CVS : S1 S2 heard, No murmurs
• RS : Air entry equal on both sides
• PA : Soft, Non tender, no organomegaly, Bowel
. sounds heard
• CNS : No focal neurological deficit

10. LOCAL EXAMINATION
• Gait – normal
• Attitude – neutral
• INSPECTION – Left Hip – normal
• Right hip -
• No any swelling / sinus / scar / discharge /
inflammatory changes
• No evidence of shortening of both lower limbs.

11. • PALPATION –
• No any local rise of temperature
• No Tenderness – present over the right hip
• Range of movement of right hip – normal
• Range of movement of right knee – normal
• No muscle wasting
• Toe movements – present
• Distal pulses – felt on both sides
• No neurological deficit

12. INVESTIGATIONS
• Hb – 12.4 gm%
• TLC – 8920/ cumm
• RBC - 4,50000 / cumm
• ESR – 14
• Platelet count – 2,53000/ cumm
• PCV - 36.3
• Blood Group – B +

13. • S. Creatinine – 0.9
• Blood Urea – 19
• S. Sodium – 138 meq/l
• S. Potassium – 4.8 meq/l
• S. Calcium - 9.8
• S. Alkaline phosphatase – 300

14. X-Ray Pelvis AP view Showing Right Hip

15. X-Ray Right Hip lateral view

16. X-Ray Findings
• A lytic lesion seen in neck of femur showing
well defined geographic type of destruction
with sclerotic rim.
• Intramedullary radiolucencies with haziness
seen.

17. DIFFERENTIAL DIAGNOSIS
1) Osteo fibrous dyspalsia
2) Osteoid Osteoma
3) Osteochondroma
4) Non Ossifying Fibroma
5) Fibrous Dysplasia
6) Unicameral bone cyst
7) Aneurysmal bone cyst

18. 1) Osteo fibrous dyspalsia
Points in Favour :
Age : 1st and 2nd decades
Male preponderence
Imaging : eccenteric intracortical osteolysis with
expansion of cortex
Points Against :
pain is absent
Site : diaphysis of long bones

20. 2) Osteoid Osteoma
Points in Favour :
• Age : 2nd and 3rd decades
• Male : female :: 3:1
• Site : lower extremity, long bones,
diaphyseal/ metaphyseal
• Pain
Points Against :
• Imaging : cortical radiolucent nidus <1.5cm
with marked cortical thickening

22. 3) Oteochondroma
Points in Favour :
Age : 2nd and 3rd decades
Male preponderence
Site : metaphysis of long bones
Points Against :
Mass is present
Imaging : pedunculated or sessile bone
lesion that communicates with intramedullary
canal

24. 4) Non Ossifying Fibroma
Points in Favour :
• Age : 1st and 2nd decades
• Site : Metaphysis of long bones
• Asymptomatic
Points Against :
• Imaging : geographic , eccentric lesion located
in metaphysis of long bones well defined
sclerotic margins.

26. 5) Fibrous Dysplasia
Points in Favour :
• Age : 1st to 3rd decades
• Male : female :: 1:1
• Site : femur, tibia
• Pain
• Imaging : ground glass appearance with well
defined sclerotic rim

28. 6) Unicameral Bone Cyst
Points in Favour :
• Age : 1st and 2nd decades
• Male : female :: 2:1
• Site : proximal femur, proximal humerus
• Asymptomatic unless pathological fracture
Points against:
• Imaging : centrally located , purely radiolucent
lesion , no cortical destruction.

30. 7) Aneurysmal Bone Cyst
Points in Favour :
• Age : 1st – 2nd decades
• Pain
Points Against :
• Female preponderence
• Site: proximal humerus, distal femur, proximal
tibia, spine
• Imaging : eccentric expansile radiolucent
lesion

32. Fibrous Dysplasia
HISTORY :
• The term fibrous dysplasia was originally
proposed by Lichtenstein in 1938.
• He along with Jaffe, McCune, and Albright,
described this disorder of bone, as well as other
extra skeletal abnormalities with which it is
occasionally associated.

33. DEFINITION :
• Fibrous Dysplasia is a benign, nonfamilial
disorder characterized by the presence of
expanding intramedullary fibro-osseous tissue in
one or more bones.
INCIDENCE :
• Not known
• Accounts for 5-7% of clinical benign tumors
• Occur more frequently in girls than boys

34. AGE :
• Affects 1st - 3rd decades
SITE :
• Fibrous dysplasia can affect any bone
• Femur and Tibia being most common

35. HISTOPATHOLOGY
• Irregular woven bone spicules with a fibrous
stroma.
• Trabeculae of woven bone surrounded by
cellular fibroblastic tissue.
• There is no osteoblastic rim at the bone-
stromal interface.

37. • Fibrous Dysplasia can be classified into one of
four categories :
1. Monostotic : single bone
2. Polyostotic : multiple bones
3. Craniofacial fibrous dysplasia : skull and facial
bones alone
4. Mandible and maxilla alone

38. CLINICAL PRESENTATION
• Pain
• Deformity
• Cutaneous pigmentation
• Endocrine abnormalities

39. IMAGING
• Ground glass appearance with well defined
sclerotic rim
• may be completely lucent (cystic) or sclerotic
• well circumscribed lesions
• no periosteal reaction

41. TREATMENT
• Prophylactic fixation of impending fractures
• Correction of deformity
• Bisphosphonates for severe cases

42. McCune-Albright Syndrome
• The triad of :
• precocious puberty (endocrinopathy),
• Café au lait spots, and
• polyostotic bone involvement

43. Mazabraud syndrome
• Mazabraud’s syndrome is a rare disorder
characterized by fibrous dysplasia, which can
develop in a single bone (monostotic) or in
multiple bones (polyostotic), associated with
one or more soft-tissue myxomas.