Paediatric oncology: non-ossifying fibroma in children and adolescents

By Cristiano Antonino On Aug 30, 2022

Non-ossifying fibroma is the most common bone tumour in children, usually causing no symptoms and requiring no treatment. It is benign and heals spontaneously

Non-ossifying fibroma is the most common benign bone tumour (or neoplasm)

It is also called fibrous defect, fibrous metaphyseal defect, fibrous cortical defect, non-osteogenic fibroma.

It occurs in children and adolescents from 2 to 18 years of age.

Its occurrence is very common (approximately 30% of the population under 20 years of age are carriers) and hardly ever causes any symptoms.

It occurs mainly in the metaphyses of the femur and tibia with a higher incidence in males than in females.

The metaphysis is the region of the long bones that connects the extremity or epiphysis to the central part or diaphysis.

In a small percentage of cases it may present with multiple localisations.

It is a collection of abnormal cells that remains in the bone from which it originated and does not metastasise.

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The cause of non-ossifying fibroma in children and adolescents is unknown

Usually those affected have no discomfort, except in rare cases where, because the mass is particularly large, there may be pain in the affected area.

It is rare for a non-ossifying fibroma to cause pain.

When it does cause it, the cause is minute fractures of the bone that can occur when the fibroma is large and can weaken the bone.

Evolution into aggressive lesions is highly unlikely, practically never happens!

The diagnosis of non-ossifying fibroma almost always occurs occasionally when such a lesion is found during an X-ray (Rx) examination performed for other reasons (usually trauma).

A conventional X-ray is usually sufficient to make the diagnosis of a non-ossifying fibroma.

On X-ray the lesion will be described as a clear bubble (a lacuna).

The bubble takes on a characteristic multilocular appearance, being formed by many small chambers communicating with each other, and is located on the periphery of the bone.

The bubble is usually small in diameter (less than 6 centimetres) and is surrounded by a thickened rim.

It may be reported on the radiology report as a fibrous defect, fibrous cortical defect or non-osteogenic fibroma.

The diagnosis may also require other instrumental investigations such as computed tomography (CT), nuclear magnetic resonance (NMR) and/or scintigraphy to exclude other types of bone lesions.

Bone biopsy is not indicated unless doubts remain about the nature of the lesion despite all radiodiagnostic examinations.

No treatment is required, but periodic follow-up to assess any tendency of the lesion to enlarge.

As a rule, non-ossifying fibroma undergoes progressive regression during growth until complete resolution, which generally occurs by the age of 30.

There is the possibility of fractures or microfractures associated with the non-ossifying fibroma

These fractures may cause pain on palpation or after physical activity.

In the very rare cases in which the lesion causes persistent pain, a surgical treatment of emptying the lesion (curettage), which is then filled (bordering) with bone grafts, may be considered.

In these cases, post-operative recovery is rapid with an almost zero risk of recurrence.

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