A rare case report of craniofacial fibrous dysplasia

Fibrous Dysplasia Masquerading as Sternal Malignancy: A Rare and Challenging Presentation

This case report presents a rare and challenging manifestation of polyostotic fibrous dysplasia (FD), a skeletal developmental anomaly characterized by the proliferation of fibrous connective tissue intermingled with irregular bony trabeculae. While monostotic FD is more common, polyostotic FD can occur in the context of McCune-Albright syndrome, a multisystem developmental disorder. Our patient, a 55-year-old female with a history of diabetes, hypothyroidism, and dyslipidemia, presented with progressively worsening dysphagia, sternal pain, and swelling over three years. Clinical examination revealed a tender and hard swelling in the upper sternal area, prompting further evaluation. Laboratory results, including bone turnover markers, were unremarkable. Imaging studies unveiled a sizable anterior mediastinal lesion with heterogeneous enhancement and coarse calcifications, initially raising concerns of malignancy. Subsequent positron emission tomography scan findings confirmed FD involvement in both the sternum and right femur. Histopathology of the mediastinal mass revealed a spindle cell neoplasm with bony metaplasia, consistent with FD, supported by immunohistochemistry. A multidisciplinary team affirmed the diagnosis of polyostotic FD, and follow-up imaging after one year demonstrated no significant change in lesion size, confirming a benign etiology. While bisphosphonate therapy was planned, regrettably, the patient was lost to follow-up. This case underscores the importance of a comprehensive, multidisciplinary approach in diagnosing and managing complex presentations of FD, ultimately contributing to improved patient care and outcomes in such instances.

Nonspecific Cystic Degeneration in Craniofacial Fibrous Dysplasia: A Rare Finding

Fibrous dysplasia (FD) is a developmental pathology of the bones in which normal bone is replaced by fibrous tissue and immature bone. It can affect single bone (monostotic) or multiple bones (polyostotic), sporadically or in association with McCune-Albright syndrome, Jaffe-Lichtenstein syndrome, or Mazabraud syndrome. When multiple bones in the craniofacial region are affected, the term "craniofacial FD" is used. Nonspecific cystic degeneration occurring in FD of the jaws has rarely been reported in the literature. Here, we present a 52-year-old male patient who reported with a longstanding gradual expansion of the mandible unilaterally. Investigations revealed the presence of mixed radiolucent radioopaque appearance in the mandible and dense sclerotic multiple craniofacial bones. In addition, a lytic lesion in the mandible was appreciated. Histopathological examination of the mandible confirmed the diagnosis of FD with nonspecific cystic degeneration.

[Craniofacial fibrous dysplasia: about six cases]

La dysplasie fibreuse osseuse (DFO) est une maladie osseuse bénigne, congénitale et rare, dans laquelle l´os normal est remplacé par du tissu fibro-osseux entraînant des lésions osseuses déformantes. Tous les os peuvent être concernés, cependant la localisation crânio-faciale se particularise par ses manifestations cliniques, son évolution et ses difficultés thérapeutiques. L´objectif de notre travail était de décrire les aspects diagnostiques, thérapeutiques et évolutifs des DFO crânio-faciales. Nous rapportons six observations de patients suivis au service d´ORL de l´Hôpital Principal de Dakar pour DFO crânio-faciale. L´âge moyen des patients était de 26,16 ans avec des extrêmes de 11 et 58 ans. Le sexe féminin était prédominant dans 83% des cas. Les circonstances de découverte étaient dominées par la déformation osseuse. Un patient a consulté pour obstruction nasale unilatérale avec épistaxis. Le scanner a permis dans tous les cas de faire le diagnostic et le bilan topographique. Deux patientes ont bénéficié d´un traitement chirurgical. Un cas de récidive a été observé. La DFO crânio-faciale est une pathologie osseuse rare qui peut se manifester par de graves troubles sensoriels et fonctionnels. Elle pose de réelles difficultés thérapeutiques et fait appel à une bonne collaboration interdisciplinaire.