Brahem Mouna, Jomaa Olfa, Abdelali Mabrouk, Sarraj Rihab, Bayoudh Amine, Njim Leila, Zrig Ahmed, Zakhama Abdelfatteh, Hachfi Haifa, Younes Mohamed
Rheumatology Department, Taher Sfar University Hospital, Mahdia, Tunisia.
Faculty of Medicine of Monastir, Monastir, Tunisia.
Korean J Fam Med. 2023 Sep;44(5):295-298. doi: 10.4082/kjfm.22.0223. Epub 2023 Jun 20.
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.
创伤后纤维骨性病变（PTFOL）是一种罕见的良性肿瘤，通常累及肋骨，可能由创伤后过度的反应性过程引起。PTFOL主要累及第六、七和八肋骨。在此，我们报告一例PTFOL，其位置和扩展情况不寻常，类似恶性胸部肿瘤。一名有轻微胸部创伤史的28岁男性患者出现疼痛。胸部X线检查显示左第四肋骨有一个大的、边界清晰的病变，胸部计算机断层扫描（CT）显示左第四肋骨后弓和中弓有一个溶骨性IC型病变，伴有软骨基质和间断的骨膜反应，无软组织肿块延伸。此外，胸部磁共振成像显示一个椭圆形、膨胀性肿块，有囊性小叶和分叶状轮廓，几乎延伸至整个左第四肋骨，大小为134×47 mm。该肿块在T1加权图像上呈低信号，在T2加权图像上呈不均匀中等信号，钆注射后强化明显，提示为恶性胸部肿瘤。CT引导下骨活检证实存在骨髓内病变，由纤维结缔组织和梭形成纤维细胞组成，无非典型征象。病变由边缘呈蚕食状的骨小梁界定，表明破骨细胞活性增强，符合PTFOL的诊断。患者接受了简单的镇痛药治疗，胸痛缓解，随访1年时病变体积无变化。
