The overlying cortex may be expanded and thinned out. The lesion is well defined by a rim of sclerosis. The most frequent radiographic picture of osteofibrous dysplasia is that of an eccentric intracortical lytic lesion in tibia without any associated periosteal reaction or soft tissue extension. As the entire clavicle was found involved by the disease process, excision of the lesion en masse with the clavicle in toto was done. The patient had progressive worsening of symptoms-increase in swelling size along with active signs of inflammation in spite of starting empirical antibiotics -warranting a surgical intervention. Both histopathology and immunohistochemistry helped in clinching the final diagnosis-ossifying fibroma. On immunohistochemistry utilizing pan cytokeratin antibody stain, isolated cells in the fibrous stroma were cytokeratin (AE1/AE3 + CK-1) positive. A repeat biopsy showed immature woven bone with characteristic osteoblastic rimming in a background of fibrovascularstroma. Tc99m labeled methylene diphosphonate (MDP) bone scan showed evidence of active bony inflammation in the left clavicle. The cortical delineation was ill-defined at places with gross periosteal thickening. Magnetic resonance imaging (3.0 Tesla MR scanner, MagnetomVerio, Siemens, Erlangen, Germany) showed altered heterogeneous T2 signal within the marrow of the clavicle. Computed tomography (64-detector CT scanner, Lightspeed ® VCT, GE Healthcare, Buckinghamshire, UK) showed irregularity and sclerosis of left clavicle along with heterogeneous ossification. Plain radiographs revealed a diffuse periosteal thickening encircling the clavicle extending from its sternal end to lateral third. The wound discharge was subjected to bacterial and acid-fast bacilli staining and culture, which subsequently turned out to be sterile, adding on to the diagnostic dilemma. The total and differential blood leukocyte countsrevealed leukocytosis with a neutrophilic preponderance. The erythrocyte sedimentation rate was high (40 mm/h). A provisional diagnosis of acute on chronic osteomyelitis was made. Left shoulder range of motion was painful and globally restricted. There were four discrete, non-tender lymph nodes palpable, two each, in the axillary group and the cervical group, largest of them measuring 0.5 cm × 0.5 cm in dimension. The swelling was tender, ill-defined with bony hard consistency. On palpation, there was local rise of temperature. There was a discharging sinus adjacent to the scar mark. Skin over the swelling showed a healed biopsy scar mark. There was a diffuse swelling of the left clavicle extending from the sternal end up to the left shoulder. There was a history of biopsy being done outside which was an inadequate sample to be commented upon. There was history of fever on and off, along with history of intermittent serous discharge from a wound over the swelling over the past 6months. This case report brings forth the unusual presentation of osteofibrous dysplasia of the clavicle mimicking a case of chronic osteomyelitis clinically, which was successfully treated by en bloc excision of clavicle.Ī 14-year-old post-pubertal girl presented with complaints of pain and swelling of her left collar bone which was of insidious onset and gradually progressive over a period of 1 year. Surgery, if required, is delayed until puberty and it usually requires nothing more than marginal excision and bone grafting. There has been no report of this lesion mimicking osteomyelitis clinically. The usual clinical presentation is that of a painless swelling, incidentally noticed by the parents, along the shin bone or abnormal bowing of tibia. Its occurrence in clavicle has never been reported. Among the latter, tibia is the most common site of its occurrence, followed by fibula, radius, ulna, and humerus. These lesions are more frequent in the maxilla and mandible than in long bones. This distinct entity is commonly seen in the first two decades almost always before puberty, with a slight male predilection. The exact cause of this rare benign fibro-osseous lesion is still an enigma. It is not considered as a true neoplasm, but rather as a fibrovascular defect. The term “osteofibrous dysplasia” is synonymous with ossifying fibroma and Campanacci's disease.
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