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Age / Sex : 19 / M
Chief complaint : Shin splints
What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)
Courtesy: Chun, Tong
Jin, Eulji University Hospital
Diagnosis: OFD-like adamantinoma
Discussion
Findings: AP and lateral radiographs of tibia
of a 19-year-old male shows cortical-based several multilocular intracortical
osteolytic lesions with thickening of cortex in the anterior cortex of the
middle tibia. The lesion is mildly expansile and surrounded by sclerotic change
of the thick cortex.
MRI of lower
leg shows intermediate signal on T1WI, hypersignal on T2WI and strong
enhancement with unenhanced foci on T1W-CE image. No intramedullary involvement
or abnormal signal/enhancement is seen in the interspersed sclerotic thick
cortex.
Differential
Diagnosis:
Osteofibrous dysplasia, Adamantinoma
Diagnosis: OFD-like adamantinoma
(differentiated adamantinoma)
Discussion:
The
radiologic features of osteofibrous dysplasia, osteofibrous dysplasia (OFD)–like
adamantinoma, and adamantinoma are very similar and radiologically, OFD-like
adamantinoma is indistinguishable from adamantinoma.
Younger age
(<20), ground-glass attenuation, and absence of intramedullary involvement,
aggressive periosteal reaction or moth-eaten osteolytic lesion are more
suggestive of fibrous dysplasia.
The patient
age can be the best clue to diagnosis of OFD-like adamantinoma. OFD–like
adamantinoma, differentiated adamantinoma, regressive adamantinoma, juvenile
adamantinoma, or intracortical adamantinoma occurs before age 20 and
intracortical location without soft tissue or intramedullary involvement.
Histologically, OFD-like adamantinoma shows predominance of osteofibrous
tissues with very small number of epithelial cells.
References:
1. Khanna M, Delaney D, Tirabosco R, et
al. Osteofibrous dysplasia, osteofibrous dysplasia-like adamantinoma and
adamantinoma: correlation of radiological imaging features with surgical
histology and assessment of the use of radiology in contributing to needle
biopsy diagnosis. Skeletal Radiol. 2008; 37:1077-1084
2. .Jain D, Jain VK, Vasishta RK, et al.
Adamantinoma: a clinicopathologic review and update. Diagn Pathol. 2008;3:8-18.
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