Orthopaedic oncology Structured oral examination question 3: Non-ossifying fibroma
Orthopaedic oncology Structured oral examination question 3: Non-ossifying fibroma
EXAMINER: Tell me about this radiograph. (Figure 7.3.)
Figure 7.3 Non-ossifying fibroma.
CANDIDATE: This is an AP radiograph of a left lower leg of a child, which includes both the ankle joint and the knee joint. There is a lucent lesion, eccentrically placed in the metaphyseal region of the tibia. The lesion is well-demarcated and its margin is slightly sclerotic. These features are typical of a non- ossifying fibroma.
EXAMINER: Good. What else can you tell me about this lesion?
CANDIDATE: Non-ossifying fibromas are developmental or hamartomatous lesions. They are actually very common and some have suggested an incidence of up to 35% in normal
children. They are usually asymptomatic and are often discovered as an incidental finding. Occasionally they can present after a pathological fracture, after which they tend to heal up.
EXAMINER: How would you treat this lesion?
CANDIDATE: I can’t see any evidence of fracture. I would take a history and examine the patient to ascertain whether the lesion is painful or symptomatic and I would discuss the images with our local tumour MDT to make sure that they were in agreement with the diagnosis. That being the case this can be treated with observation only as these lesions normally resolve by adulthood. I would plan to keep the patient under review with surveillance radiography.
General advice: Again, you will not be criticized if you say that would take advice from the bone tumour MDT. You will, however, be in a very difficult situ- ation if you have not stated that you would take their advice and your diagnosis is wrong.
Orthopaedic oncology Structured oral examination question 3: Non-ossifying fibroma
EXAMINER: Tell me about this radiograph. (Figure 7.3.)
CANDIDATE: This is an AP radiograph of a left lower leg of a child, which includes both the ankle joint and the knee joint. There is a lucent lesion, eccentrically placed in the metaphyseal region of the tibia. The lesion is well-demarcated and its margin is slightly sclerotic. These features are typical of a non- ossifying fibroma.
EXAMINER: Good. What else can you tell me about this lesion?
CANDIDATE: Non-ossifying fibromas are developmental or hamartomatous lesions. They are actually very common and some have suggested an incidence of up to 35% in normal
Figure 7.3 Non-ossifying fibroma.
children. They are usually asymptomatic and are often discovered as an incidental finding. Occasionally they can present after a pathological fracture, after which they tend to heal up.
EXAMINER: How would you treat this lesion?
CANDIDATE: I can’t see any evidence of fracture. I would take a history and examine the patient to ascertain whether the lesion is painful or symptomatic and I would discuss the images with our local tumour MDT to make sure that they were in agreement with the diagnosis. That being the case this can be treated with observation only as these lesions normally resolve by adulthood. I would plan to keep the patient under review with surveillance radiography.
General advice: Again, you will not be criticized if you say that would take advice from the bone tumour MDT. You will, however, be in a very difficult situ- ation if you have not stated that you would take their advice and your diagnosis is wrong.