A 16-year-old boy undergoes a knee radiograph after minor trauma. It shows a 3 cm eccentric lytic lesion with a scalloped sclerotic margin in the posteromedial metaphysis of the proximal tibia, abutting an intact overlying cortex. He is completely asymptomatic. The most appropriate management is:

• A Wide en bloc excision
• B Observation, as the lesion ossifies and resolves spontaneously ✓
• C Curettage and bone grafting
• D Radiotherapy to prevent fracture

Explanation

This is a non-ossifying fibroma, the larger symptomatic counterpart of a fibrous cortical defect, and it is the most common benign fibrous lesion of bone in children. It is a developmental aberration rather than a true neoplasm and requires no treatment when asymptomatic and small, as it fills in with sclerotic bone and disappears after skeletal maturity. Intervention is reserved only for large lesions threatening pathological fracture.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.