Difference between revisions of "Metaphyseal fibrous defect"

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Metaphyseal fibrous defect (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{Metaphyseal fibrous defect}}
| Name      = Metaphyseal fibrous defect
| Image      =  
| Image      = Bone Metaphyseal Fibrous Defect High Power.JPG
| Width      =
| Width      =
| Caption    =  
| Caption    =  
| Synonyms  = Nonossifying fibroma
| Synonyms  = nonossifying fibroma, fibrous cortical defect, fibrous metaphyseal defect, fibroxanthoma of bone
| Micro      =
| Micro      =
| Subtypes  =
| Subtypes  =
| LMDDx      =  
| LMDDx      = [[giant cell tumour of bone]], others
| Stains    =
| Stains    =
| IHC        =
| IHC        =
Line 15: Line 15:
| Gross      =
| Gross      =
| Grossing  =
| Grossing  =
| Site      =
| Site      = [[metaphysis]] of [[bone]] - usu. lower extremity
| Assdx      =
| Assdx      =
| Syndromes  =  
| Syndromes  =  
| Clinicalhx = Incidental radiograhic finding
| Clinicalhx = incidental radiograhic finding
| Signs      =
| Signs      =
| Symptoms  =
| Symptoms  =
| Prevalence =
| Prevalence = common
| Bloodwork  =
| Bloodwork  =
| Rads      = Lucent defect  
| Rads      = lucent defect  
| Endoscopy  =
| Endoscopy  =
| Prognosis  =  
| Prognosis  = benign
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    =
| Tx        =
| Tx        = none
}}
}}
{{ Infobox external links
| Name            = {{PAGENAME}}
| EHVSC          =
| EHVSC_mult      =
| pathprotocols  =
| wikipedia      = Nonossifying fibroma
| pathoutlines    =  {{Pathologyoutlines|topic/bonemetaphysealfibrousdefect}}
| rosaicollection =
}}
'''Metaphyseal fibrous defect''', abbreviated '''MFD''', is a common benign abnormality of the [[metaphysis]], classically seen in children and young adults.
They are also known as '''fibrous cortical defect''', '''fibrous metaphyseal defect''', and '''fibroxanthoma of [[bone]]'''. '''Nonossifying fibroma''' is a larger lesion but otherwise identical.


==General==
==General==
*Common
*Common.
*Non-neoplastic
*Non-neoplastic.
*Self-limited
*Self-limited.
*Skeletally immature individuals, children and adolescent
*Skeletally immature individuals, children and adolescents.
*Often small lesions discovered an radiographic incidentaloma
*Often small lesions discovered as an radiographic incidentaloma.
*Rarely seen as a pathologic specimen (should not be biopsied).
*May be seen in the context of ''Jaffe-Campanacci syndrome'' which may be a presentation of Neurofibromatosis Type 1.<ref>URL: [http://www.bonetumor.org/plasma-cell-tumors/jaffe-campanacci-syndrome http://www.bonetumor.org/plasma-cell-tumors/jaffe-campanacci-syndrome]. Accessed on: October 14, 2014.</ref><ref>{{Cite journal  | last1 = Stewart | first1 = DR. | last2 = Brems | first2 = H. | last3 = Gomes | first3 = AG. | last4 = Ruppert | first4 = SL. | last5 = Callens | first5 = T. | last6 = Williams | first6 = J. | last7 = Claes | first7 = K. | last8 = Bober | first8 = MB. | last9 = Hachen | first9 = R. | title = Jaffe-Campanacci syndrome, revisited: detailed clinical and molecular analyses determine whether patients have neurofibromatosis type 1, coincidental manifestations, or a distinct disorder. | journal = Genet Med | volume = 16 | issue = 6 | pages = 448-59 | month = Jun | year = 2014 | doi = 10.1038/gim.2013.163 | PMID = 24232412 }}
</ref>
*Radiographic diagnosis.
 
Clinical history:
*Incidental radiographic finding.
*Pathologic fracture.
 
Treatment:
*None (spontaneously resolve by ossification).
**Diagnosis is part of the ''skeletal do not touch list''.<ref>URL: [http://radiopaedia.org/articles/skeletal-do-not-touch-lesions-1 http://radiopaedia.org/articles/skeletal-do-not-touch-lesions-1]. Accessed on: October 14, 2014.</ref>


==Synonyms==
Notes:
*Nonossifying fibroma (larger but otherwise identical)
*May resolve into a ''bone island''.
*Fibrous cortical defect
*Fibrous metaphyseal defect
*Fibroxanthoma of bone


==Site==
Clinical DDx:
*Metaphysis of distal femur or proximal tibia (80%)
*''FOG MACHINES'' acronym for radiographically lytic bone lesions.<ref>URL: [http://radiopaedia.org/articles/lytic-bone-lesion-mnemonic http://radiopaedia.org/articles/lytic-bone-lesion-mnemonic]. Accessed on: October 14, 2014.</ref>
*Cortical
*Metaphysis
*Long bones
*Eccentric location


==Gross==
==Gross==
Firm, granular, brown to yellow to red
*Firm, granular, brown to yellow to red.
 
Site:
*[[Metaphysis]] of distal femur or proximal tibia (80%).
*Cortical.
*Metaphysis.
*Long bones.
*Eccentric location.
 
===Radiology===
*Sharply demarcated, lucent, loculated, meta-diaphyseal lesion.
*Surrounded by a rim of sclerotic bone.
 
<gallery>
Image:NOF 1.jpg|Nonossifying fibroma. (WC)
</gallery>


==Microscopic==
==Microscopic==
Spindle cells without cytologic atypia are arranged in a storiform pattern with scattered chronic inflammatory cells and benign giant cells.  Foam cells and hemosiderin deposition are present.  Mitoses are seen but cytologic atypia is absent.
Features:
*Spindle cells without cytologic atypia are arranged in a storiform pattern.
*Scattered chronic inflammatory cells and benign [[giant cell]]s.   
*Foam cells and hemosiderin deposition are present.   
*Mitoses are seen but cytologic atypia is absent.


==Differential Diagnosis==
DDx (microscopic):
*Giant cell tumor of bone (epiphyseal location, occurs in adults)
*[[Giant cell tumour of bone]] - [[epiphysis|epiphyseal]] location, occurs in adults.
 
*Other [[giant cell lesions]] of bone.
==Relevant Diagnostic Groups==
*[[Spindle cell lesion]]s of bone.
*FOG MACHINES - acronym for radiographically lytic bone lesions <ref {{http://radiopaedia.org/articles/lytic-bone-lesion-mnemonic}} /ref>
*Giant cell lesions of bone.
*Spindle cell lesions of bone.


==Images==
==Images==
*http://njms2.umdnj.edu/tutorweb/casegifs/nofhe1.jpg
<gallery>
*http://njms2.umdnj.edu/tutorweb/casegifs/nofhe2.jpg
Image:Bone Metaphyseal Fibrous Defect Medium Power.JPG|Metaphyseal fibrous defect - intermediate magnification.
*http://njms2.umdnj.edu/tutorweb/casegifs/nofhe1.jpg
Image:Bone Metaphyseal Fibrous Defect High Power.JPG|Metaphyseal fibrous defect - high magnification.
*http://pathologyoutlines.com/wick/non-ossifying%20fibroma%20(metaphyseal%20fibrous%20defect)%20micro.jpg
</gallery>
www:
*[http://njms2.umdnj.edu/tutorweb/casegifs/nofhe1.jpg MFD (umdnj.edu)].
*[http://njms2.umdnj.edu/tutorweb/casegifs/nofhe2.jpg MFD (umdnj.edu)].
*[http://njms2.umdnj.edu/tutorweb/casegifs/nofhe1.jpg MFD (umdnj.edu)].
*[http://pathologyoutlines.com/wick/non-ossifying%20fibroma%20(metaphyseal%20fibrous%20defect)%20micro.jpg MFD (pathologyoutlines.com)].


==Stains==
==Stains==
Not relevant.
*Not relevant.


==IHC==
==IHC==
Not relevant
*Not relevant.


==Molecular==
==Molecular==
Not relevant
*Not relevant.
 
==Syndromes==
Jaffe-Campanacci syndrome <ref{{http://www.bonetumor.org/plasma-cell-tumors/jaffe-campanacci-syndrome}}/ref>
 
==Clinical history==
*Incidental radiographic finding
*Pathologic fracture
 
==Radiographic findings==
Sharply demarcated, lucent, loculated, meta-diaphyseal lesion surrounded by a rim of sclerotic bone


==Sign out==
==Sign out==
BONE; CURETTAGE: METAPHYSEAL FIBROUS DEFECT.
<pre>
BONE, CURETTAGE:  
- METAPHYSEAL FIBROUS DEFECT / NONOSSIFYING FIBROMA.
</pre>


==See also==
==See also==
*http://njms2.umdnj.edu/tutorweb/case8.htm
*[[Bone]].
*http://www.pathologyoutlines.com/topic/bonemetaphysealfibrousdefect.html
*http://radiopaedia.org/articles/fibrous-cortical-defect
*http://radiopaedia.org/articles/non-ossifying-fibroma-1


==References==
==References==
{{Reflist|1}}
{{Reflist|1}}
==External links==
*[http://njms2.umdnj.edu/tutorweb/case8.htm A case of MFD (umdnj.edu)].
*[http://radiopaedia.org/articles/fibrous-cortical-defect Fibrous cortical defect (radiopaedia.org)].
*[http://radiopaedia.org/articles/non-ossifying-fibroma-1 Non-ossifying fibroma (radiopaedia.org)].


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Bone]]
Sarah
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