PMC5585455_01
Pre-operative radiograph showing expansile osteolytic lesion of proximal radius, benign in nature with differential diagnosis of aneurysmal bone cyst or simple bone cyst.
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F1
Plain radiograph showed huge cystic bony lesion with multiple septae (Fig. 1) and CT scan images showed markedly expansile lytic lesion measuring 4.5 cm X 3.8 cm in transverse diameter at proximal radial shaft with thinning of cortex, short trasitional zone, without periosteal reaction or surrounding soft tissue involvement (Figs. 2A, B).
Pre-operative CT scan images showing markedly expansile lytic lesion measuring 4.5 cm X 3.8 cm in transverse diameter at proximal radial shaft with thinning of cortex, short trasitional zone, without periosteal reaction or surrounding soft tissue involvement.
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F2
Plain radiograph showed huge cystic bony lesion with multiple septae (Fig. 1) and CT scan images showed markedly expansile lytic lesion measuring 4.5 cm X 3.8 cm in transverse diameter at proximal radial shaft with thinning of cortex, short trasitional zone, without periosteal reaction or surrounding soft tissue involvement (Figs. 2A, B).
Numerous spindle-shaped cells arranged in fascicular storiform pattern (asterix) with irregular strands of trabeculae with plump osteoblast, spheroidal ossicles with basophilic center and eosinophilic periphery resembling psammoma-like bodies (arrow). H & E X 40X.
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F3
After getting informed consent, we performed needle biopsy and histopathologically it was reported as Psammomatoid type juvenile ossifying fibroma (JPOF) of proximal radius (Fig. 3).
Immediate post op radiograph showing completely curetted cystic bony lesion with filled allograft granules, bridging fibular strut graft and transfixing intra-medullary titanium elastic nail insitu.
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F4
We later filled the cavity with allograft bone granules and intramedullary titanium elastic nail through autologous fibular strut graft, bridging the cystic lesion (Fig. 4).
One year follow up clinical pictures showing range of motion of elbow joint movement.
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At 18 months follow up, she was symptom free with almost full range of active elbow motion, without any functional limitation (Figs. 5A, B, C) and follow up radiograph shows incorporation of allograft and fibular strut graft without any signs of recurrence (Fig. 6).