J Korean Med Sci.  2013 Apr;28(4):631-635. 10.3346/jkms.2013.28.4.631.

Fibrocartilaginous Intramedullary Bone Forming Tumor of the Distal Femur Mimicking Osteosarcoma

• Song SH
• Lee H
• Song HR
• Kim MJ
• Park JH

• KMID: 1786976
• DOI: http://doi.org/10.3346/jkms.2013.28.4.631

Abstract

Fibrocartilaginous dysplasia (FCD) has occasionally led to a misdiagnosis and wrong decision which can significantly alter the outcome of the patients. A 9-yr-old boy presented with pain on his left distal thigh for 6 months without any trauma history. Initial radiographs showed moth eaten both osteolytic and osteosclerotic lesions and biopsy findings showed that the lesion revealed many irregular shaped and sclerotic mature and immature bony trabeculae. Initial diagnostic suggestions were varied from the conventional osteosarcoma to low grade central osteosarcoma or benign intramedullary bone forming lesion, but close observation was done. This study demonstrated a case of unusual fibrocartilaginous intramedullary bone forming tumor mimicking osteosarcoma, so that possible misdiagnosis might be made and unnecessary extensive surgical treatment could be performed. In conclusion, the role of orthopaedic oncologist as a decision maker is very important when the diagnosis is uncertain.

Keyword

Fibrocartilaginous Dysplasia; Osteosarcoma; Orthopaedic Oncologist; Diagnosis

MeSH Terms

Bone and Bones/*radiography
Child
Diagnosis, Differential
Femur/radiography
Fibrocartilage/*radiography
Humans
Magnetic Resonance Imaging
Male
Osteosarcoma/diagnosis/radiography

Figure

• 

  Fig. 1 Initial anterior-posterior and lateral plain radiographs show moth eaten both osteolytic and osteosclerotic lesions in the metaphysis without definite sign of periosteal reaction or cortical destruction. (A) anterior-posterior and (B) lateral radiograph at initial visit. Magnetic resonance imaging showed T1 low and T2 heterogenous signal intensity intramedullary lesion in the metaphysis which had not crossed the growth plate and no definite cortical destruction was also identified. (C) T1-axial cut, (D) T2-axial cut, (E) T1-sagittal cut and (F) T2-coronal cut. AXI, axial; FS, fat suppression; SAG, sagittal; COR, coronal.

• 

  Fig. 2 Initial whole body bone scan showed mild increased uptake in the left distal femur. Whole body bone scan at the time of 36 months after the initial visit shows no definite interval changes of extent and morphology. (A) whole body bone scan at initial presentation and (B) whole body bone scan at 36 months after the initial visit.

• 

  Fig. 3 Inicisional biopsy was done and pathologic specimen showed irregular shaped and scletoric mature and immature bony trabeculae with relatively uniform spindle cells and cartilaginous components without significant cellular atypia. Hematoxylin and eosin stained (A) low- (original magnification, ×400) and (B) high-power (original magnification, ×1,000)

• 

  Fig. 4 Plain radiograph at the time of 36 months after the initial visit shows no definite interval changes of extent and morphology. (A) anterior-posterior and (B) lateral radiograph at the time of 36 months after the initial visit. Magnetic resonance imaging at the time of 36 months after the initial visit shows no definite interval changes of extent and morphology. (C) T1-axial cut, (D) T2-axial cut, (E) T1-sagittal cut and (F) T2-coronal cut. AXI, axial; SAG, sagittal; COR, coronal.

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