A 14-year-old boy undergoes a knee X-ray after a sports injury. It shows a small, sharply demarcated, eccentric lytic lesion in the distal femoral metaphysis abutting the cortex, with a thin sclerotic rim and slight cortical scalloping. He is asymptomatic apart from the injury. The most appropriate management is:
- A Wide excision with reconstruction
- B Observation, as the lesion usually resolves spontaneously after skeletal maturity ✓
- C Curettage and bone grafting
- D Radiotherapy to prevent growth arrest
Correct answer: B. Observation, as the lesion usually resolves spontaneously after skeletal maturity
Explanation
The appearance is classic for a non-ossifying fibroma (fibrous cortical defect when small), the most common benign fibrous lesion of bone, found incidentally in up to a third of children. It is asymptomatic, has a sclerotic rim, and ossifies and disappears spontaneously after skeletal maturity. Treatment is observation unless the lesion is large enough to threaten pathological fracture. Curettage is reserved for large symptomatic lesions.
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.