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Brahem M, Jomaa O, Abdelali M, Sarraj R, Bayoudh A, Njim L, Zrig A, Zakhama A, Hachfi H, Younes M. Post-traumatic Fibro-Osseous Lesion of the Fourth Rib Simulating a Chest Wall Tumor: A Case Report. Korean J Fam Med 2023; 44:295-298. [PMID: 37337742 PMCID: PMC10522475 DOI: 10.4082/kjfm.22.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 06/21/2023] Open
Abstract
Post-traumatic fibro-osseous lesions (PTFOL) are a rare and benign tumor that typically affects the ribs and is probably caused by an excessive post-traumatic reactive process. PTFOL primarily affects the sixth, seventh, and eighth ribs. Here, we report a case of a PTFOL with an unusual location and expansion that simulated a malignant chest tumor. A 28-year-old male patient with a history of minor chest trauma presented with pain. Chest radiography revealed a large, well-defined lesion on the left fourth rib, and computed tomography (CT) of the chest revealed a lytic lesion-type IC on the posterior and middle arches of the left fourth rib with a cartilaginous matrix and discontinued periosteal reaction without soft tissue mass extension. Additionally, magnetic resonance imaging of the chest revealed an ovoid, expansive mass with cystic lobules and lobulated contours extending almost over the entire left fourth rib, measuring 134×47 mm in size. This mass has a low signal on T1-weighted images and a heterogeneous intermediate signal on T2-weighted images, with intense enhancement after gadolinium injection suggestive of a malignant chest tumor. A CT-guided bone biopsy confirmed the presence of an intramedullary lesion consisting of fibrous connective tissue with fusiform fibroblastic cells without atypical signs. The lesion was delimited by bone trabeculae with nibbled edges, indicating exaggerated osteoclastic activity compatible with a diagnosis of PTFOL. The patient was treated with simple analgesics, and chest pain was relieved, with an unchanged volume of the lesion at 1 year of follow-up.
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Affiliation(s)
- Mouna Brahem
- Rheumatology Department, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Olfa Jomaa
- Rheumatology Department, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Mabrouk Abdelali
- Faculty of Medicine of Monastir, Monastir, Tunisia
- Radiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Rihab Sarraj
- Rheumatology Department, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Amine Bayoudh
- Rheumatology Department, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Leila Njim
- Faculty of Medicine of Monastir, Monastir, Tunisia
- Anatomo-pathology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Ahmed Zrig
- Faculty of Medicine of Monastir, Monastir, Tunisia
- Radiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Abdelfatteh Zakhama
- Faculty of Medicine of Monastir, Monastir, Tunisia
- Anatomo-pathology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Haifa Hachfi
- Rheumatology Department, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Mohamed Younes
- Rheumatology Department, Taher Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine of Monastir, Monastir, Tunisia
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Mottola E, Adotti F, Pernazza A, Della Rocca C, D'Amati G, Nardis P, Vannucci J, Bassi M, Venuta F, Anile M. Xanthoma of rib: a case report and review of the literature. J Cardiothorac Surg 2023; 18:205. [PMID: 37400894 PMCID: PMC10318816 DOI: 10.1186/s13019-023-02315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/28/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Xanthomas are well-circumscribed benign proliferative lesions seen mainly in soft tissues. Usually, they are found in hyperlipidemia and familial hyperlipoproteinemia. Histologically, are characterized by macrophage-like mononuclear cells, multinucleated giant cells and abundant foam cells. The bone involvement, however, is notoriously rare and rib localization is extremely rare. CASE PRESENTATION A 55-year-old man performed a chest X-ray and a subsequent chest Computed Tomography scan showing a rib lesion that was surgically removed and a diagnosis of rib xanthoma was made. The patient presented an unknown condition of hyperlipidemia. CONCLUSION Rib xanthoma can be discovered accidentally and can be helpful in identifying an unrecognized condition of hyperlipidemia.
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Affiliation(s)
- Emilia Mottola
- Division of Thoracic Surgery and Lung Transplant, AOU Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Flavia Adotti
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza, Rome, Italy
| | - Angelina Pernazza
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino-Sapienza University, Latina, Italy
| | - Carlo Della Rocca
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino-Sapienza University, Latina, Italy
| | - Giulia D'Amati
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza, Rome, Italy
| | - Piergiorgio Nardis
- Interventional Radiology Section of Department of Radiological, Oncological, and Anatomopathological, Sciences of Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
| | - Jacopo Vannucci
- Division of Thoracic Surgery and Lung Transplant, AOU Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
| | - Massimiliano Bassi
- Division of Thoracic Surgery and Lung Transplant, AOU Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery and Lung Transplant, AOU Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Anile
- Division of Thoracic Surgery and Lung Transplant, AOU Policlinico Umberto I, University of Rome Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
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Nassereddine H, Larousserie F, Campagna R, Castier Y, Couvelard A, Choudat L, Sannier A. Xanthomatous Posttraumatic Fibro-Osseous Lesion of the Rib: A Rare and Underrecognized Entity. Case Report and Literature Review. Int J Surg Pathol 2017; 25:640-643. [PMID: 28580818 DOI: 10.1177/1066896917712455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Posttraumatic fibro-osseous lesion (PTFOL) is a rare lesion that typically affects the ribs and is probably a posttraumatic reactive process. Because PTFOL is often misdiagnosed as fibrous dysplasia, osteoid osteoma, benign fibrous histiocytoma or rib metastases, chest wall resection, leading to a significant morbidity, is the main treatment modality. We report the case of a 30-year-old male patient with no history of previous trauma presenting with chest pain. Computed tomography scan showed an eighth left rib well-defined ovoid and hypodense lesion with circumferential sclerotic margin and no cortical breakthrough. Posterolateral thoracotomy was performed and a histological diagnosis of xanthomatous posttraumatic fibro-osseous lesion of the rib was made. PTFOL is a benign lesion that should be recognized to avoid unnecessary surgical treatment and complications. We provide a summary of clinical, histopathological, and radiological aspects of PTFOL and discuss differential diagnoses.
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Affiliation(s)
- Hussein Nassereddine
- 1 Bichat Hospital, AP-HP, Paris, France.,2 Paris Descartes University, Paris, France
| | | | | | - Yves Castier
- 1 Bichat Hospital, AP-HP, Paris, France.,4 Paris Diderot University, Paris, France
| | - Anne Couvelard
- 1 Bichat Hospital, AP-HP, Paris, France.,4 Paris Diderot University, Paris, France
| | | | - Aurélie Sannier
- 1 Bichat Hospital, AP-HP, Paris, France.,4 Paris Diderot University, Paris, France
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Sclerosing xanthofibroma of the rib that mimics a very aggressive malignant tumor of the thoracic wall. Case Rep Pulmonol 2014; 2014:894167. [PMID: 25328747 PMCID: PMC4189938 DOI: 10.1155/2014/894167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/14/2014] [Indexed: 12/02/2022] Open
Abstract
Sclerosing xanthofibroma is a benign lesion generally of flat bones that is thought to be caused by a reactive response to intramedullary hemorrhage following chest wall trauma. We are reporting a case of a 56-year-old man that was complaining of a dump pain on the right back and a swelling right in this place for several weeks. The radiology was suggesting an aggressive malignant tumor of the chest wall and probably metastasis in both lungs meanwhile the patient was in good state and very active. The surgery was decisive for the diagnosis that, to the fortune of the patient, it was sclerosing xanthofibroma.
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Pfeiffer J, Kayser G, Boedeker CC, Ridder GJ. Posttraumatic reactive fibrous bone neoformation of the anterior skull base mimicking osteosarcoma. Skull Base 2011; 18:345-51. [PMID: 19240834 DOI: 10.1055/s-0028-1086058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Malignant bone tumors and fibro-osseous bone lesions of the skull base are uncommon, although fibrous dysplasia in this anatomic location is not a rare condition. In general, fibro-osseous lesions of the skull are often difficult to classify on either clinical presentation, radiological findings, or histological presentation alone. The objective of this article is to present a probably important differential in the management of bony neoformations of the skull and to highlight the diagnostic difficulties when dealing with osseous and fibro-osseous conditions affecting the craniofacial bones. DESIGN We present here a novel case of posttraumatic reactive fibrous bone neoformation of the anterior skull base mimicking osteosarcoma in a 16-year-old boy. RESULTS Diagnostic steps, clinical, histological, and radiological presentation, as well as surgical treatment are described in detail. The international medical literature concerning reactive fibrous bone neoformations is reviewed, and the problem of adjusting the correct differential diagnosis when dealing with fibro-osseous bone lesions of the skull base is discussed. CONCLUSIONS The highlights of this case are an uncommon location of a rare pathological entity, which might constitute an important differential of fibro-osseous conditions affecting the craniofacial bones.
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Affiliation(s)
- Jens Pfeiffer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical School Freiburg, Freiburg, Germany
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Lee SJ, Baek KS, Lee SY, Lee CS, Cho HD. Xanthoma of the Rib without Hyperlipoproteinemia-A case report-. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.2.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seong Jin Lee
- Department of Thoracic and Cardiovascular Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine
| | - Kang-Seok Baek
- Department of Thoracic and Cardiovascular Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine
| | - Seock-Yeol Lee
- Department of Thoracic and Cardiovascular Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine
| | - Chol-Sae Lee
- Department of Thoracic and Cardiovascular Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine
| | - Hyun Deuk Cho
- Department of Pathology, Cheonan Hospital, Soonchunhyang University College of Medicine
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Rib xanthoma resected by video-assisted thoracoscopic surgery using a bone punch. Surg Laparosc Endosc Percutan Tech 2009; 19:e15-6. [PMID: 19238049 DOI: 10.1097/sle.0b013e318188c2f3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Xanthomas of the rib are extremely rare benign neoplasms, most commonly reported in soft tissue, but rarely in bone. We report a case of a 4-cm xanthoma of the rib resected by video-assisted thoracoscopic surgery and pulled through a 2-cm port incision around the patient's areola. To the best of our knowledge, there are only 8 other such cases, and none of which were removed by thoracoscopic surgery.
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Bacha D, Ayadi-Kaddour A, Marghli A, Djilani H, Mezni FE. [Post-traumatic fibro-osseous lesion of the rib]. Ann Pathol 2009; 29:36-8. [PMID: 19233093 DOI: 10.1016/j.annpat.2008.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
Abstract
Post-traumatic fibro-osseous lesion is a rare benign osseous lesion usually affecting the ribs and relatively under-recognised. Histologically, it showed a bland fibrous stroma in which resided an anastomosing network of bone trabeculae, having a zonal pattern of maturation from metaplastic woven to mature lamellar bone, with or without an associated xanthomatous component. We report a well-documented case of mixed variant post-traumatic fibro-osseous lesion of the sixth rib, which was initially misdiagnosed as particular form of fibrous dysplasia associated with a xanthoma.
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Affiliation(s)
- Dhouha Bacha
- Service d'anatomie pathologique, hôpital Abderrahmen Mami, 2080 Ariana, Tunisie.
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Aubert S, Kerdraon O, Conti M, Buob D, Petit S, Leroy X. Post-traumatic fibro-osseous lesion of the ribs: a relatively under-recognised entity. J Clin Pathol 2006; 59:635-8. [PMID: 16467162 PMCID: PMC1860389 DOI: 10.1136/jcp.2005.031906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To report the description of a rare benign osseous lesion affecting the ribs entitled post-traumatic fibro-osseous lesion (PTFOL). METHODS Seven cases of PTFOLs were retrieved from the archives of the University Hospital of Lille. Histological slides were reviewed and lesions were classified according to the histological patterns described by McDermott et al. Clinical and follow-up data were obtained from the patients' charts. RESULTS PTFOLs occurred principally in men (mean age 31.8 years) with a known or suspected previous chest injury for four of them. No previous cancer was noted. Radiologically, PTFOLs readily presented as an isolated expansive lucency with a sclerotic rim located on the last five ribs. A constant increased uptake of radionucleotide was noted on bone scan. Microscopically, two fibro-osseous, four xanthomatous and one mixed pattern were individualised. Lesions were characterised by a network of anastomosing bone trabeculae without osteoblast lining within a fibrous stroma. A zonal maturation from woven to peripheral lamellar bone was characterised. Central sheets of lipid-laden histiocytes were conspicuous in the xanthomatous type. For each patient, clinical follow-up was excellent, without any recurrence. CONCLUSIONS This is the second largest series of PTFOLs, which is considered to be a dysplastic healing process after trauma. It may be symptomatic or shown by imaging studies realised for unrelated reason. PTFOL is regularly misdiagnosed with other more common lesions of the ribs, such as fibro-osseous dysplasia, osteoma osteoid and benign fibrous histiocytoma. Its recognition is of importance because no follow-up is needed after resection.
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Affiliation(s)
- S Aubert
- Department of Pathology, University Hospital, CHRU, Lille, France.
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