Multiple calcaneal fibrous dysplasia: A case report

Abstract

Rationale: Fibrous dysplasia (FD) is a benign bone tumor due to developmental failure in the process of primitive bone remodeling to mature lamellar bone. The most common locations of monostotic FD of the extremity bones are the proximal femur, tibia, humerus and the radius. FD in the calcaneus is extremely rare and usually manifests clinically as a single bone lesion. Moreover, no research has reported on multiple lesions in calcaneal FD.

Patient concerns: We report a 21-year-old man presented to our institution with pain upon walking for 2 months.

Diagnoses: We diagnosed the patient with multiple calcaneal FD through histologic examination of the excised biopsy that revealed cellular, spindly stroma and woven bone without osteoblastic rimming resembling Chinese characters INTERVENTIONS:: Plain X-ray, computed tomography, magnetic resonance imaging and histologic examination. An excisional biopsy with extended curettage and bone grafting with allogenous bone and autogenous bone marrow aspirate concentrate were performed.

Outcomes: No complications developed after surgery and during serial follow-ups at 3, 6 and 12 months. At a postoperative 12-month follow-up, a plain radiogram showed a well-consolidated bone graft in the lesions.

Lessons: Calcaneal FD is rare disease entity. This case can help guide clinical decision-making in the future.

Figure 1

Preoperative plain radiogram shows an ill-defined osteoblastic lesion around the subtalar joint in the body of the calcaneus measuring 2.5 cm × 3.0 cm.

Figure 2

CT scan shows a sclerotic and osteoblastic lesion under the subtalar joint with a cystic round hole in the calcaneal body (A: sagittal, B:coronal, C: axial). CT = computed tomography.

Figure 3

T2-weighted MR image shows 5 round-shaped lesions of high signal intensity with mixed low signal intensity (A: sagittal, B: coronal, C: axial).

Figure 4

Histologic findings of the excised biopsy revealed “cellular, spindly” stroma and “woven bone without osteoblastic rimming” resembling “Chinese letters” (left 100×, right 400×).

Figure 5

Twelve months postoperatively, a plain radiogram showed a well-consolidated bone graft in the lesions.