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Fibroxanthoma
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Nonossifying fibroma (NOF), fibrous cortical defect (FCD)
        • Definitions

          • Very common benign fibrous lesion of pediatric bone, usually asymptomatic
          • Term fibroxanthoma includes
            • NOF
              • > 2-cm length
              • Encroachment on medullary cavity
            • FCD
              • < 2-cm length
              • Essentially isolated to cortex

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Wodajo FM: Top five lesions that do not need referral to orthopedic oncology. Orthop Clin North Am. 46(2):303-314, 2015
                                        2. Jagtap VS et al: Tumor-induced osteomalacia: a single center experience. Endocr Pract. 17(2):177-84, 2011
                                        3. Leong NL et al: Computed tomography-based structural analysis for predicting fracture risk in children with benign skeletal neoplasms: comparison of specificity with that of plain radiographs. J Bone Joint Surg Am. 92(9):1827-33, 2010
                                        4. Shimal A et al: Fatigue-type stress fractures of the lower limb associated with fibrous cortical defects/non-ossifying fibromas in the skeletally immature. Clin Radiol. 65(5):382-6, 2010
                                        5. Wootton-Gorges SL: MR imaging of primary bone tumors and tumor-like conditions in children. Magn Reson Imaging Clin N Am. 17(3):469-87, vi, 2009
                                        6. Hetts SW et al: Case 110: Nonossifying fibroma. Radiology. 243(1):288-92, 2007
                                        7. Hod N et al: Scintigraphic characteristics of non-ossifying fibroma in military recruits undergoing bone scintigraphy for suspected stress fractures and lower limb pains. Nucl Med Commun. 28(1):25-33, 2007
                                        8. Goodin GS et al: PET/CT characterization of fibroosseous defects in children: 18F-FDG uptake can mimic metastatic disease. AJR Am J Roentgenol. 2006 Oct;187(4):1124-8. Erratum in: AJR Am J Roentgenol. 187(5):1146, 2006
                                        9. Iagaru A et al: PET/CT follow-up in nonossifying fibroma. AJR Am J Roentgenol. 187(3):830-2, 2006
                                        10. Huzjan R et al: The value of ultrasound in diagnosis and follow-up of fibrous cortical defect. Ultraschall Med. 26(5):420-3, 2005
                                        11. Colby RS et al: Is Jaffe-Campanacci syndrome just a manifestation of neurofibromatosis type 1? Am J Med Genet A. 123(1):60-3, 2003
                                        12. Levine SM et al: Cortical lesions of the tibia: characteristic appearances at conventional radiography. Radiographics. 23(1):157-77, 2003
                                        13. Loberant N et al: Gray-scale and Doppler characteristics of fibrous cortical defects in a child. J Clin Ultrasound. 31(7):369-74, 2003
                                        14. Yanagawa T et al: The natural history of disappearing bone tumours and tumour-like conditions. Clin Radiol. 56(11):877-86, 2001
                                        15. Smith SE et al: Primary musculoskeletal tumors of fibrous origin. Semin Musculoskelet Radiol. 4(1):73-88, 2000
                                        16. Suginoshita T et al: Case report: natural development of osteosarcoma from precancerous lesion. Anticancer Res. 20(1B):511-4, 2000
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Synonyms

                                                • Nonossifying fibroma (NOF), fibrous cortical defect (FCD)
                                              • Definitions

                                                • Very common benign fibrous lesion of pediatric bone, usually asymptomatic
                                                • Term fibroxanthoma includes
                                                  • NOF
                                                    • > 2-cm length
                                                    • Encroachment on medullary cavity
                                                  • FCD
                                                    • < 2-cm length
                                                    • Essentially isolated to cortex

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Ultrasonographic Findings

                                                        • Nuclear Medicine Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Wodajo FM: Top five lesions that do not need referral to orthopedic oncology. Orthop Clin North Am. 46(2):303-314, 2015
                                                                              2. Jagtap VS et al: Tumor-induced osteomalacia: a single center experience. Endocr Pract. 17(2):177-84, 2011
                                                                              3. Leong NL et al: Computed tomography-based structural analysis for predicting fracture risk in children with benign skeletal neoplasms: comparison of specificity with that of plain radiographs. J Bone Joint Surg Am. 92(9):1827-33, 2010
                                                                              4. Shimal A et al: Fatigue-type stress fractures of the lower limb associated with fibrous cortical defects/non-ossifying fibromas in the skeletally immature. Clin Radiol. 65(5):382-6, 2010
                                                                              5. Wootton-Gorges SL: MR imaging of primary bone tumors and tumor-like conditions in children. Magn Reson Imaging Clin N Am. 17(3):469-87, vi, 2009
                                                                              6. Hetts SW et al: Case 110: Nonossifying fibroma. Radiology. 243(1):288-92, 2007
                                                                              7. Hod N et al: Scintigraphic characteristics of non-ossifying fibroma in military recruits undergoing bone scintigraphy for suspected stress fractures and lower limb pains. Nucl Med Commun. 28(1):25-33, 2007
                                                                              8. Goodin GS et al: PET/CT characterization of fibroosseous defects in children: 18F-FDG uptake can mimic metastatic disease. AJR Am J Roentgenol. 2006 Oct;187(4):1124-8. Erratum in: AJR Am J Roentgenol. 187(5):1146, 2006
                                                                              9. Iagaru A et al: PET/CT follow-up in nonossifying fibroma. AJR Am J Roentgenol. 187(3):830-2, 2006
                                                                              10. Huzjan R et al: The value of ultrasound in diagnosis and follow-up of fibrous cortical defect. Ultraschall Med. 26(5):420-3, 2005
                                                                              11. Colby RS et al: Is Jaffe-Campanacci syndrome just a manifestation of neurofibromatosis type 1? Am J Med Genet A. 123(1):60-3, 2003
                                                                              12. Levine SM et al: Cortical lesions of the tibia: characteristic appearances at conventional radiography. Radiographics. 23(1):157-77, 2003
                                                                              13. Loberant N et al: Gray-scale and Doppler characteristics of fibrous cortical defects in a child. J Clin Ultrasound. 31(7):369-74, 2003
                                                                              14. Yanagawa T et al: The natural history of disappearing bone tumours and tumour-like conditions. Clin Radiol. 56(11):877-86, 2001
                                                                              15. Smith SE et al: Primary musculoskeletal tumors of fibrous origin. Semin Musculoskelet Radiol. 4(1):73-88, 2000
                                                                              16. Suginoshita T et al: Case report: natural development of osteosarcoma from precancerous lesion. Anticancer Res. 20(1B):511-4, 2000