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Benign Cortical Defect
Fibrous Cortical Defect, Non-ossifying fibroma
General Considerations
- Also called a non-ossifying fibroma or fibrous cortical defect
- Non-ossifying fibroma frequently reserved for lesions > 2cm in size in older children
- Usually arises in metaphysis of distal femur or tibia
- Solitary lesion (75%) or multiple (25%)
- Most commonly seen in children 2-15 years of age
- May be secondary to a prior trauma injury (traction) as they tend to occur at sites of insertion of tendons and ligaments
Clinical Findings
- Usually asymptomatic
- Found serendipitously
Imaging Findings
- Geographic lytic lesion
- Septated
- Metaphyseal
- Eccentric
- Well-marginated
- Sclerotic rim
- Endosteal scalloping
- On healing
- Marginal sclerosis increases
- Lesions “fill-in” from diaphyseal side of bone
- Bone scan
- May show increased activity on healing of the lesion
- MRI
- Variable signal intensity depending on healing stage
- Central decreased T2-W signal
- From collagen and hemosiderin deposits
Differential Diagnosis
- Image on conventional radiography is usually diagnostic
Treatment
Complications
- Rarely may undergo pathologic fracture
- Do not undergo malignant transformation
Prognosis
- Migrate away from epiphysis towards diaphysis with age
- Most lesions heal spontaneously by being replaced with normal bone
Benign Cortical Defect. White arrow (top) points to a well-circumscribed, lytic lesion in the metaphysis of this child's distal femur. It has a sclerotic rim. On the lateral view, its cortical nature is again demonstrated (yellow arrow).
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