PMC6482954_01
A) X-ray of the right tibia; in the mid tibial diaphysis there is smooth circumferential cortical thickening and sclerosis. B) MRI of the right tibia showing circumferential cortical thickening and narrowing of the medullary canal by cortical bone in the mid diaphysis.
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F1
Radiographs and MRI showed a lesion in the right mid shaft tibia with significant cortical and periosteal reaction raising the possibility of a healing fracture with underlying pathologic process (Figures 1A and 1B).
Histopathologic images from Case 1. A) low power image (H&E, 200X) showing fragments of irregular, variably thickened, trabecular bone with intervening fibrotic marrow. B) Higher power (H&E, 400X) showing remodeling of the trabecular bone with fibrosis of the marrow. No acute inflammatory cells are seen.
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F2
An open biopsy of the lesion was performed, showing sclerotic lesions of the bone with non-specific fibrotic marrow findings without evidence of malignancy (Figure 2A) and negative microbiology cultures. Due to progressive pain, another open biopsy was performed three years after the initial biopsy (Figure 2B).
A,B) X-ray of the right tibia, ap and lateral view, showing intramedullary rod with one proximal screw. Slight lucency adjacent to the hardware in the mid tibial diaphysis; Unchanged diffuse cortical thickening in the mid tibial diaphysis consistent with chronic osteomyelitis; No radiographic evidence of acute osteomyelitis.
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F3
IMN removal and insertion of a new gentamicin-impregnated cement-coated IMN (Figures 3A and 3B). Intraoperatively, loose friable tissue was found without frank pus.
PMC6482954_02
A) X-ray of the right humerus; thickening in the midshaft of the bone. No periosteal reaction or acute fracture. B) MRI of the right humerus showing eccentric, relatively smooth cortical thickening along the midshaft with extensive edema.
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F4
X-ray and MRI of the right upper extremity demonstrated abnormal marrow infiltration of the humeral diaphysis with endosteal and periosteal reaction (Figures 4A and 4B).
Histopathologic images from Case 2. A) Low power image (H&E, 200X) showing fragments of trabecular remodeled bone with marrow showing non-specific changes and minimal fibrosis. B) Higher power image (H&E, 400X) showing non-specific fibrosis of the marrow.
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F5
An open biopsy was performed, revealing a fatty bone marrow with foci of increased vascularity, histiocytes and minimal chronic inflammatory cells (Figures 5A and 5B); cultures have been negative.