Tumour iSAWE 15

Question

A 10 year old boy has an incidental lesion in his distal tibia after an ankle sprain. Radiographs are taken over several years.

Tumour iSAWE 15, serial radiographs of the tibia
Serial radiographs of the tibia. Image by Herget et Al., Wikimedia Commons, CC BY 4.0.
  1. Describe the radiographs and give the diagnosis.
  2. When does this lesion need treatment?
  3. What syndromes are associated with multiple lesions?

Answer

Radiographs

  • Eccentric, lobulated, lytic metaphyseal lesion with a sclerotic scalloped border
  • Moves away from the physis and ossifies over time
  • Non-ossifying fibroma (fibroxanthoma)
  • No biopsy needed with classic appearance

Treatment

  • Observe, most heal by skeletal maturity
  • Pathological fracture through lesions over 50% of the bone width and over 33 mm long (Arata criteria)
  • Curettage and bone grafting for large lesions in weight bearing bones or after fracture
  • Most fractures heal with casting, then the lesion is treated

Multiple lesions

  • Jaffe-Campanacci syndrome, cafĂ© au lait spots, intellectual disability and multiple NOFs
  • Neurofibromatosis type 1

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.