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Case Reports
. 2014 Dec 20:8:452.
doi: 10.1186/1752-1947-8-452.

Monostotic fibrous dysplasia in the proximal tibial epiphysis: a case report

Ji-Yong Gwark, Jin-Hoon Jeong, Sun-Chul Hwang, Dae-Cheol Nam, Jeong-Hee Lee, Jae-Boem Na, Dong-Hee Kim  1
Affiliations
Case Reports

Monostotic fibrous dysplasia in the proximal tibial epiphysis: a case report

Ji-Yong Gwark et al. J Med Case Rep. .

Abstract

Introduction: Fibrous dysplasia is one of many well-known disorders in which there is a defect in the remodeling process of immature bone to mature into lamellar bone, and it often exists in metaphyseal and diaphyseal parts of the long bone. In this report, we describe a rare case where fibrous dysplasia was found only in the proximal part of the epiphysis of the tibia without other bony lesions.

Case presentation: A 14-year-old Asian girl was referred to our hospital after slipping down with pain on the left knee. A radiograph showed an abnormal finding of a central radiolucent lesion with a marginal sclerotic border near the proximal tibial spine. A magnetic resonance image showed the lesion at low signal intensity on a T1-weighted image and at high signal intensity on a T2-weighted image. The biopsy results led us to conclude that the lesion was a fibrous dysplasia.

Conclusion: If an abnormal lesion on the epiphysis, especially in long bones, is detected on a radiograph, several differential diagnoses can be made. Although fibrous dysplasia is usually not encountered as an epiphyseal lesion, it is important to incorporate all the clinical, radiographic and pathologic features to diagnose monostotic fibrous dysplasia when the lesion is located at the epiphyseal location.

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Figures

Figure 1
Figure 1
Plain radiographic images and computed tomograhic scan. (A) Anteroposterior (left) and lateral (right) radiographs show the proximal tibial epiphyseal osteolytic lesion with marginal sclerosis and a matrix with a ground glass appearance and without periosteal reaction. (B) Coronal (left) and sagittal (right) computed tomographic scans show the absence of cartilage matrix and dense marginal sclerosis without cortical disruption.
Figure 2
Figure 2
Magnetic resonance imaging and scintigraphic images. Magnetic resonance imaging scans show no peripheral bone edema and no fluid-fluid level. (A) T1-wieghted coronal magnetic resonance image (echo time/repetition time, 12/566ms) shows hypointensity of a proximal tibial lesion. (B) T2-weighted image (echo time/repetition time, 50/3660ms) shows hyperintensity. (C) Enhanced image (echo time/repetition time, 12/584ms) shows homogeneous enhancement. (D) Whole-body bone scan shows increased focal uptake only at the proximal epiphysis of the left tibia.
Figure 3
Figure 3
Histopathologic findings and post-operative radiographs. (A) Bone tissue is replaced by loose fibrous tissue with irregular spicules of immature bone (hematoxylin and eosin stain; original magnification, ×100). (B) The immature bone is formed from fibrous stroma without osteoblasts rimming (original magnification, ×400). (C) Simple radiographs obtained 2 years after surgery show bone formation with well-sustained screw fixation.
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