Post-traumatic fibro-osseous lesion of the rib

Post-traumatic fibro-osseous lesion of the rib (PTFOL) is a rare lesion that is most commonly noted incidentally. Ten incidence of PFOL is unknown but it is thought that it is underdiagnosed, as many of the cases are misdiagnosed as fibrous dysplasia. This could be attributed to the lack of familiarity of the lesion by radiologists, pathologists and orthopedic surgeons. PFOL is regarded as a reactive bony lesion which in most incidences is related to trivial trauma. However, in many of the reported cases similar to our case, no history of trauma is identified. It clinically, radiologically and sometimes histologically overlaps with some boney lesions including osteoid osteoma, fibrous dysplasia, Erdheim-Chester disease and eosinophilic granuloma (Table I). PFOL usually presents as well-defined nodule (Fig. 1) composed of intervening bland fibrous stroma and xanthomatous component (Fig. 2).
Our case interestingly showed significant xanthomatous component. The histological pattern of the lesion whether predominantly xanthomatous versus fibrotic has no clinical significance. The key histological feature of PFOL is transformation of anastomosing network of woven bony trabeculae (Fig. 3) noted centrally to mature lamellar bone noted peripherally which continue with the cortical bone (Fig. 4).
Most patients with PFOL show no recurrence and there is a controversy in the literature as regards their management, whether the lesion should be left and followed by imaging or it should be excised to rule out a more worrisome lesion, that may overlap clinically and on imaging. Our patient was well and did not show lesional recurrence, during the 7 years follow up period.

References

1. Smith SE, Keshavjee S. Primary chest wall tumors. Thorac Surg Clin 2010; 20: 495-507.
2. Hughes EK, James SL, Butt S, Davies AM, Saifuddin A. Benign primary tumors of the ribs. Clin Radiol 2006; 61: 314-322.
3. Sakellaridis T, Gaitanakis S, Piyis A. Rib tumors: a 15-year experience. Gen Thorac Cardiovasc Surg 2014; 62: 434-440.
4. Aubert S, Kerdraon O, Conti M, et al. Post-traumatic fibro-osseous lesion of the ribs: a relatively under-recognised entity. J Clin Pathol 2006; 59: 635-638.
5. Lichtenstein L, Jaffe HL. Fibrous dysplasia of bone. Arch Pathol 1942; 33: 777-816.
6. Johnson LC. Proceedings of Seminar of South-Eastern and South-Central Regions, College of American Pathologists; 1952 Nov. 12-13; Florida, United States.
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