Discussion Author: Matthew Wilde
Nonossifying fibroma (NOF), also known as fibroxanthoma, is a benign proliferation of fibroblasts with unknown etiology.
Demographics: NOFs are very common and routinely found in asymptomatic children over age 2. Peak occurrence in between ages 10-15 years. They are rarely found in patients over 25 years of age.
Disease course: The most frequent presentation is a child with an unrelated injury whose NOF is found on plain radiographs. However, a child can sometime present with an NOF as the etiology for a primary complaint when the NOF causes noticeable deformity or pain. Rarely, an NOF presents as pathologic fracture, usually when the lesion occupies more than 50% of the bone diameter. NOFs of all presentations may increase or decrease in size before spontaneously resolving.
Dx: The diagnosis of NOF is usually made as an incidental finding on a radiograph obtained for other reasons. The diagnosis can be made on radiographs alone due to its characteristic appearance; a lucent, lobulated lesion that is well defined with an eccentric epicenter and defined, often sclerotic margin.
*Fibrous cortical defect (defined as 0-2 cm and confined to cortex)
*Osteoblastoma (suggested by ossification and calcification)
*Adamantinoma (suggested by medullary invasion)
*Osteoid osteoma (usually has a central nidus and is painful)
Treatment: Unless symptomatic, these lesions are managed conservatively and no work-up is indicated. If a malignant process is suspected, biopsy will yield the definitive diagnosis. In the case of larger lesions where pathologic fracture has occurred or because of the size of the NOF, the patient may be prone to pathologic fracture, curettage with bone graft is performed. Such intervention is usually reserved for cases in which the lesion occupies more than 50% of the diameter of a weight-bearing bone, or the lesion is greater than 33 mm in diameter.
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