Tumour iSAWE 16

Question

A 25 year old man has anterior shin swelling and aching for a year.

Tumour iSAWE 16, AP and lateral radiographs of the tibia
AP and lateral radiographs of the tibia. Image by T-rex89 (Original) and Hellerhoff (cutting part of image and retouching), Wikimedia Commons, CC BY-SA 4.0.
  1. Describe the radiographs.
  2. What is the differential diagnosis and how are they related?
  3. Outline treatment.

Answer

Radiographs

  • Multiloculated, lytic lesion of the anterior tibial diaphysis
  • Soap bubble appearance with sclerotic margins
  • Cortical expansion
  • Adamantinoma, a low grade malignant tumour

Differential diagnosis

  • Osteofibrous dysplasia, in children under 10, intracortical, benign
  • Fibrous dysplasia
  • Non-ossifying fibroma
  • Adamantinoma shows keratin positive epithelial cells
  • Osteofibrous dysplasia like adamantinoma may sit between them in a spectrum

Treatment

  • Biopsy at a sarcoma centre
  • CT chest, metastasis to lungs in about 15 to 20%
  • Wide resection with intercalary reconstruction (allograft or vascularised fibula)
  • Insensitive to chemotherapy and radiotherapy
  • Local recurrence high after intralesional surgery
  • Long term follow up for late metastasis

Related pages

Author Contributions

Orthofracs team

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