Post-traumatic fibro-osseous lesion of the ribs and scapula (sclerosing xanthofibroma)

Fibrous lesions of bone may be difficult to classify. Their etiology is controversial, most being considered to be developmental lesions rather than true neoplasms. We describe a patient with post-traumatic fibro-osseous lesion of the ribs, also known as sclerosing xanthofibroma; a lesion believed to be a reactive response to intramedullary hemorrhage following chest wall trauma. Clinically, the lesions in our patient were thought to be metastatic disease because of their multifocal appearance. An extensive clinical and laboratory metastatic evaluation with surgical resection of one of the lesions using intraoperative gamma probe was undertaken. In addition to the multiple rib involvement, our case also showed a lesion in the scapula. The pathologic and radiologic features of this entity are reviewed along with the summary of the differential diagnosis.     

Scoliosis secondary to an unusual rib lesion

Tumours of the chest wall are uncommon and are usually malignant. A bone haemangioma is a rare benign vascular neoplasm, which more commonly occurs in middle-aged patients. We present the case of a scoliosis caused by a rib haemangioma in an adolescent male. Other causes of scoliosis secondary to rib lesions are discussed.     

Slipping rib syndrome.

Three cases of slipping rib syndrome are presented. The pertinent anatomy of the costal margin and nerve supply are reviewed. The treatment of the disease is presented along with case histories. This entity is little known to the medical profession, although first described in 1919. Probably far more common than is realized, it should always be included in the differential diagnosis of thoracic and abdominal pain.     

An unusual fibro-osseous component in intracranial lesions

An unusual fibro-osseous component has been identified in intracranial lesions. Ultrastructurally this component appears to represent stages of membranous bone formation, but of an atypical and incomplete sort. The fibroosseous component may be an aberrant type of bony metaplasia and is seen in several lesions all of which probably do not share the same etiology although in each case meningeal or choroid plexus stroma appears to be involved.     

Histopathology of fibro-osseous and cystic tumors of bone

Fibro-osseous and cystic tumors are some of the more common tumors encountered in bone pathology. Although there is significant histologic overlap, fibro-osseous tumors of bone have distinct clinical, radiologic and pathogenetic features. Similarly, cystic lesions have characteristic radiologic and pathologic features that help distinguish them from tumor of bone that can have secondarily cystic components. More recently, specific genetic abnormalities have been identified in a subset of fibro-osseous and cystic tumors, such as fibrous dysplasia and aneurysmal bone cyst. Herein we discuss the clinical, radiologic, pathologic and genetic features of fibro-osseous and cystic tumors of bone.     

Well-differentiated osteosarcoma of the rib.

Well-differentiated osteosarcoma is extremely rare, there is no sex predominance and the mean age is in the third decade. The tumor has a strong predilection for the long bones of the extremities, especially the metaphysis but may also occur in the diaphysis. Radiologically, the lesion shows no distinctive features, often simulating fibrous dyplasia or desmoplastic fibroma. We report a case of well-differentiated osteosarcoma involving the rib of a 45-year-old female. This is a peculiar case of well differentiated osteosarcoma involving an unusual site and older patient. We also discuss histological differential diagnosis as well as clinical features of this rare disease.     

指(趾)纤维骨性假瘤临床病理分析

目的 探讨指(趾)纤维骨性假瘤(fibroosseous pseudotumor,FP)的临床病理特点、诊断、鉴别诊断及生物学特征.方法 收集9例指(趾)FP资料,进行组织病理学和免疫表型观察.结果 9例FP男女比为7:2,平均年龄为24.8岁,部位分别为指2例、掌2例、趾3例和足跟2例.临床上以局部肿胀或肿块伴疼痛为主.镜检:病变主要由增生的梭形细胞及散在的不规则骨组织构成且伴间质胶原化.梭形细胞形态较温和,偶见核分裂象.其中2例梭形细胞丰富,细胞肥胖,轻度异型性,核较大,卵圆形或梭形,见较多核分裂象.免疫表型:梭形细胞及骨母细胞表达vimentin,Ki-67<1%+,α-SMA、actin、S-100、desmin、cK和EMA均阴性.9例FP患者术后随访,一般情况良好,未见复发.结论 指(趾)FP是一种罕见的、好发于指(趾)的良性增生性病变.熟悉FP的临床病理学特征对避免将其误诊为恶性肿瘤具有重要的意义.     

Benign fibro-osseous lesions: a review of current concepts

The benign fibro-osseous lesions (BFOL) represent a clinically diverse group of disorders of bone that share similar histopathologic features. As a group, they are relatively common in the craniofacial complex, especially the jaws. Although the general concept of BFOL is relatively well known, specific diagnostic interpretation of individual cases is often challenging. New concepts and controversies have arisen over the past 10 to 15 years regarding classification and diagnostic criteria. However, among the new theories and contentions, there is now essential agreement that the osseous dysplasias represent a single disease process, while the so-called "juvenile active ossifying fibroma" and other "aggressive," "active," "psammomatoid" ossifying/cementifying fibromas remain controversial. This review is presented to update the surgical pathologist on the various entities comprising the spectrum of BFOL and to examine the criteria for their diagnosis.     

Symmetrical fibro-osseous dysplasia of rib–post-traumatic dysplasia?

We describe two patients with a distinctive histological condition which clinically and radiologically mimics fibrous dysplasia of the rib. Both patients presented with chronic pain confined to one rib. In each case their radiographs showed a solitary, fusiform expansion of a rib with variable calcification. Histologically the lesions were characterized by a central core of xanthomatous macrophages surrounded by cancellous bone that showed symmetrical and progressive maturation centrifugally towards the cortex, a pattern which distinguishes these lesions from the irregular pattern of fibrous dysplasia.     

Benign fibro-osseous tumors of bone: clinicopathological findings and differential diagnosis

Benign fibro-osseous tumors of the skeleton are a diverse group of neoplasms with overlapping histologic features. They are characterized by an admixture of fibroblast-like spindle cells enmeshed in a collagenous stroma admixed with varying quantities of bone that can be deposited in different configurations. Some fibro-osseous tumors are predisposed to develop in specific bones, while others can arise in any bone; they may be solitary or multicentric. The treatment is based on their biological behavior and ranges from observation and medical therapy to surgical removal. Prognosis depends on the extent of the disease and the biological potential of the neoplasm. Because of overlapping clinicopathological features distinguishing one fibro-osseous tumor from another can be difficult and requires correlation with the imaging and clinical findings. This review discusses the features of benign fibro-osseous tumors of the skeleton and their important differential diagnoses.     

A lethal short rib syndrome without polydactyly.

A female infant is described with a lethal short rib syndrome, similar to a form of short rib-polydactyly syndrome but without polydactyly. It is felt that this infant has the same condition as that described by Beemer et al.