Board/OITE Review: Oncology 09 - Benign Histiocytic Lesions

·20 min·2 clips

A 15-year-old soccer player's ankle pain reveals an eccentric, bubbly lesion on x-ray—what's the diagnosis and treatment?

The episode is part of the Nailed It Ortho Podcast's board/OITE review series, focusing on oncology topics. Hosts Dr. Cole and Dr. Spencer Wohine guide listeners through benign fibrous and histiocytic lesions. They begin by listing common tumors: non-ossifying fibroma, fibrous dysplasia, osteofibrous dysplasia, and Langerhans cell histiocytosis. For non-ossifying fibroma, they describe its eccentric, lytic, metaphyseal 'bubbly' appearance on x-ray, typically in the distal tibia of adolescents, with observation as the standard treatment. They mention Jaffe-Campanacci syndrome, associated with multiple NOFs, café-au-lait spots, hypogonadism, and cognitive delay. Fibrous dysplasia is explained as a fibro-osseous proliferation with a 'ground glass' radiographic appearance, often in patients under 30. The GNAS1 gene activating mutation and its role in increased cyclic AMP leading to abnormal bone formation are detailed. Polyostotic fibrous dysplasia with café-au-lait spots and endocrine abnormalities like precocious puberty indicates McCune-Albright syndrome. Mazabraud's syndrome is noted for polyostotic fibrous dysplasia with soft tissue myxomas. Osteofibrous dysplasia is distinguished by intracortical lucencies in the anterior tibia and rimming osteoblasts on histology. The spectrum linking osteofibrous dysplasia (benign) to adamantinoma (malignant) is discussed, with adamantinoma characterized by nests of epithelial cells and a 25% rate of lung metastases at presentation. Throughout, the hosts emphasize board-relevant distinctions, such as histology patterns and syndrome associations, using analogies like 'Chinese characters' for fibrous dysplasia histology and 'crop circles' for non-ossifying fibroma patterns. The episode includes sponsor messages for the AAOS Resident Orthopaedic Core Knowledge (ROCK) program and promotions for the podcast's companion book and online course.

As heard by us

A practical, image-friendly board review that makes fibrous dysplasia easier to remember.

Nailed It Ortho keeps the discussion anchored on fibrous dysplasia, laying out the details residents need to hold onto: a GNAS1 mutation on chromosome 20Q13, increased cyclic AMP, and the practical point that allograft is the preferred graft when a fracture needs repair. Dr.

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If fibrous dysplasia keeps haunting your question bank, start here.

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