Florid reactive periostitis

Some Reactive Lesions of Bone Are Probably Neoplasms: A Review

CONTEXT.—

A number of fibro-osseous and osteocartilaginous lesions, especially common in the small bones of hand and feet, pose a diagnostic challenge and have historically been thought to be reactive lesions. However, modern molecular techniques when supplementing clinical, radiographic, and histologic evaluation suggest they may, in fact, be neoplasms.

OBJECTIVE.—

To review the clinical presentation and histopathologic, molecular, and radiologic features of selective bone lesions, focusing most specifically on subungual exostosis, florid reactive periostitis, and bizarre periosteal osteochondromatous proliferation.

DATA SOURCES.—

Literature review and personal experience are the source of this review.

CONCLUSIONS.—

Some lesions previously thought to be reactive are locally aggressive and demonstrate reproducible molecular abnormalities, and thus may be neoplasms. Although most common in the bones of the fingers and toes, these lesions also occur in long and other bones. The clinical presentations, radiologic appearances, and histopathologic features often overlap, making the diagnosis challenging, and these lesions may require molecular evaluation to maximize accurate prognostication.

Florid reactive periostitis of the long bone: A case series of seven patients

BACKGROUND

Florid reactive periostitis (FRP) is a rare benign periosteal lesion, which mostly involves the tubular bones of the extremities. FRP of the long bone is especially rare. We here report a case series of long bone FRP and also discuss the differential diagnosis and clinical outcome of our series.

PATIENTS AND METHODS

In total, four female and three male patients with long bone FRP and a mean age of 25.1 years were evaluated for this study, from which four upper extremity and three lower extremity FRP lesions were identified. Patients were classified according to the clinical, radiological and pathological manifestations of the lesion.

RESULTS

Periosteal reaction and edema around the lesions were observed in all cases. Calcified mass, bone marrow edema and cortical erosion were observed in six out of seven patients. Moreover, two lesions with peripheral mineralization and zoning appearances were observed. Limb rest and anti-inflammatory therapy proved to be sufficient treatment in all cases. The lesions were spontaneously resolved in all cases, leaving a residual exostosis.

CONCLUSION

Our report indicates that short bone and long bone FRP could reveal different characteristics in some aspects, including the choice of the therapeutic approach. In spite of the favorable clinical outcome of long bone FRP, its differentiation from more aggressive lesions, especially osteosarcoma and osteomyelitis, should still be taken into consideration. In addition, according to our evidence, the implication of the zonal pattern in differential diagnosis of FRP and myositis ossificans (MO) could be re-evaluated.

Florid reactive periostitis in the fifth phalange of a professional boxer: A case report

RATIONALE

Florid reactive periostitis is a rare, benign bone and chondrogenic lesion that develops most frequently in the phalanges of the hands. Although the definitive cause of florid reactive periostitis is unknown, the major inciting factor is generally considered to be trauma, including repetitive minor trauma.

PATIENT CONCERNS

We present a case of florid reactive periostitis affecting two contiguous phalangeal bones of the left fifth phalange of a 23-year-old male professional boxer. The patient had experienced chronic pain around the metacarpophalangeal joint of the left fifth phalange when punching with the left hand; this pain was improved but not resolved after conservative treatment.

INTERVENTIONS

Plain radiography of the fifth phalange revealed a bulging bone lesion on the volar side of the proximal phalanx and metacarpal of the left fifth phalange. Computed tomography also showed raised bony lesions on the volar side of these bones without bony destruction or intraregional calcification. Surgery was performed and histopathology revealed that the bone specimens comprised a mixture of fibrous connective tissue and relatively immature bone covered by bland osteoblasts.

DIAGNOSES

These findings were suggestive of a benign bone formation process, and the lesion was diagnosed as florid reactive periostitis.

OUTCOMES

The pain and tenderness in the left fifth phalange experienced during boxing had completely resolved by 6 months postoperatively, and 12 years postoperatively the patient had full range of motion and no recurrence of pain.

LESSONS

Traction force, such as those associated with "leading jabs," may induce repetitive minor trauma and subsequent periosteal damage, resulting in the gradual development of bulging bone ridges on the volar surface of the proximal fifth phalange and metacarpus of the hand.

Florid reactive periostitis of the thumb: a case report and review of the literature

Florid reactive periostitis is a rare benign bone lesion that occurs most often in the phalanges of hands and feet. Histologic evaluation is commonly required to distinguish this benign lesion from clinically indistinguishable malignant and infectious disorders. The lesion is typically self-limiting or cured by local excision; however, in very aggressive cases ray amputation may be indicated. The authors report a case of florid reactive periostitis affecting the thumb with satisfactory outcome and without recurrence at 2-year follow-up.

Florid reactive periostitis of the middle phalanx: a case report and review of the literature

Florid reactive periostitis is an uncommon bone lesion that occurs most often in the phalanges of the hands and feet. Histologic evaluation is commonly required to distinguish this benign lesion from clinically indistinguishable malignant and infectious etiologies. While the lesion is typically self-limiting or cured by simple excision, we report a case of aggressive recurrence following an excisional biopsy that ultimately led to ray amputation.