The computed tomography (CT) and magnetic resonance imaging (MRI) revealed an expansive lytic lesion with surrounding areas of sclerosis involving the T5 vertebral body, the right costovertebral joint, and the right 5th rib. The lesion displayed a ground glass matrix with a few cystic areas and exhibited heterogeneous contrast enhancement (Fig. 1). Imaging differentials in this case were polyostotic fibrous dysplasia, expansile osteolytic metastasis, Paget’s disease, and Gorham-Stout disease (vanishing bone disease). A CT-guided biopsy was performed, and the histopathological examination indicated a cellular fibrous matrix within the trabecular bone structure (Fig. 2). Both imaging and histopathological findings aligned with the diagnosis of fibrous dysplasia. A skeletal survey subsequent to the diagnosis did not reveal any additional lesion.
Fig. 1
Axial CT image (A) in bone window shows lytic expansile lesion (white arrows) involving T5 vertebral body, right lamina, and extending into adjacent right costovertebral joint and rib. It shows ground glass matrix. Axial T2-weighted (B) and post-contrast T1-weighted (C) MR images show T2 heterogeneous, predominantly hypointense, lesion (white arrows) involving T5 vertebral body on the right side extending into costovertebral joint and right rib with heterogeneous enhancement and causing no obvious compromise of spinal canal. Sagittal T2W image (D) of the thoracic spine shows pathological compression fracture of T5 vertebral body (white arrow head)
Fig. 2
A Hematoxylin and eosin–stained section shows varying proportion of fibrous and osseous woven bone deposition (H&E; × 100). B Higher magnification shows “Sharpey-like fibers (growing collagen)” without nuclear atypia in between the irregular woven bone (H&E; × 400)
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