“Stump the Teacher”: Non-Ossifying Fibromas
Kaiser Permanente School of ALlied Health Science
March 14, 2013
The patient arrived to radiology on August 5, 2012. The patient was a 10 year old hispanic male whom presented to the hospital with pain in his right ankle. Prior to coming into the radiology department he had fallen on a play structure at his school. Immediately after his fall he was brought to the hospital by his parents. As a result the patient was x-rayed on August 5, 2012. An ankle complete series was performed which consisted of an AP, Oblique, and Lateral view. However, due to his age comparison films were also taken of ...view middle of the document...
(Boston Children's Hospital, 2011) In fact, the lesions associated with non-ossifying fibromas are more likely found accidentally on x-rays.
The prevalence of occurrence in male versus female for non-ossifying fibromas are twice more often for males than in females. According to research, it has been estimated that 30-40 percent of people 20 years of age and younger have non-ossifying fibroma’s. However, although many people will have non-ossifying fibroma’s, studies show that few of these people will have any symptoms. Non-ossifying fibroma’s do not become cancerous and they do not metastasize. However, there is an approximate 8 percent of people with non-ossifying fibroma that will have more than one tumor. (2) Smaller non-ossifying fibromas generally are asymptomatic. These smaller lesions are usually found incidentally in children. On the other hand, larger lesions are uncommon. Nonetheless, the larger lesions can be associated with pathological fractures leading to pain and swelling. (Kalish, S., Lebman, B., LaVoice, M., 2013)
There are several exams done in different imaging modalities to find non-ossifying fibromas. The diagnostic procedures for non-ossifying fibroma’s are used to determine the exact type of tumor present and whether or not the tumor has spread. X- rays are used to produce images of internal tissues, bones and organs onto film. (1) On an x-ray image, the tumor will appear dark with a thin surrounding white rim.(2) Another modality that is used is CT and MRI. These two modalities have the ability to capture a more detailed view of the body. (Boston Children's Hospital, 2011) In addition, a CT scan or MRI can show the exact size of the tumor. It can also show if there has been any change in the appearance over time. Furthermore, the images form these modalities can also show cortical integrity, or in other words how thin the strong outer portion of the bone is in the region of the non-ossifying fibroma, or pathologic fracture. Generally, a bone scan is sometimes more helpful and preferred than general x-ray because it allows the ability to see if there is more than one tumor. (2)
Aside from imaging modalities used to diagnose non-ossifying fibromas physical exams can be done as well. Although this is very uncommon it is an alternative and is sometimes done. Generally the physical exam is done in combination with one of the three imaging modalities of choice; x-ray, CT, or MRI. If a physical exam is done it would also include a neurologic function tests to measure reflexes, muscle strength, eye and mouth movement, coordination and alertness.
Treatment options for people with non-ossifying fibromas can vary. Typically these tumors resolve on their own. This occurs usually when skeletal maturity has occurred or when the bones stop growing. The tumor is only a problem if it causes a fracture while active. Yet, the good thing is once the tumor has resolved itself it rarely comes back. Thus, the primary reason to...