Non-ossifying fibroma: natural history with an emphasis on a stage-related growth, fracture risk and the need for follow-up
BACKGROUND To assess and describe the variability of radiological presentations of fibrous cortical defects and non-ossifying fibromas in children and young adults. MATERIAL/METHODS Medical records of 28 patients (15 males, 13 females, mean age of 17 years) with a radiological diagnosis of cortical fibrous defect or non-ossifying fibroma were reviewed retrospectively. The presentation of the lesion, its location and morphology according to Ritschl's classification, as well as the number and types of imaging studies performed in the study group were assessed. RESULTS Almost all lesions constituted an incidental finding discovered on plain films performed due to trauma. One lesion presented with a pathological fracture. There were 4 patients (mean age of 11 years) with stage A lesion, 9 patients (mean age of 16 years) with stage B lesion, 10 patients (mean age of 18 years) with stage C lesion, and 5 patients (mean age of 23 years) with stage D lesion. The lesions were located mostly in bones around the knee joint. In more than a half of the patients, further imaging was performed apart from plain films. Four lesions were biopsied (1 of stage B and 3 of stage C). CONCLUSIONS A considerable morphological variability of cortical fibrous defects and non-ossifying fibromas, especially of stage C, seems to be the main cause of unnecessary additional imaging and invasive diagnostic procedures in patients with this benign pathology. The knowledge of their age-related evolution and typical skeletal distribution should help in making a correct diagnosis.