A 14-year-old boy has an X-ray of the knee taken after trauma. It incidentally shows a lobulated radiolucent lesion in the posteromedial metaphysis of the distal femur, eccentric, with a scalloped sclerotic margin and no periosteal reaction. The correct management is:

• A Wide surgical excision with margin
• B Reassurance and observation, no treatment ✓
• C Curettage and bone grafting
• D Radiotherapy to prevent malignant change

Explanation

This is a non-ossifying fibroma (fibrous cortical defect when small), the commonest benign fibrous lesion of bone in children. It is asymptomatic, found incidentally, heals spontaneously by sclerosis as skeletal maturity approaches, and virtually never requires surgery unless large enough to threaten pathological fracture. Radiotherapy has no role in this benign self-limiting lesion, and curettage or wide excision would be overtreatment of a lesion that regresses spontaneously.

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.