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Old 04-09-2013, 07:09 PM   #1
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silvericewolf HB User
Question Multiple bone lesions in right femur

In September 2011, I fell down the stairs and bashed my knees and twisted an ankle. I ended up going to a convenient care to x-ray, since I was on Lupron for endometriosis and knew I was at increased risk for fracture, despite taking Add-Back to prevent bone issues. The x-ray showed no fractures, but they did find "at least two intramedullary radiolucent lesions of the distal femoral diaphysis." Also from the report: "These lesions show mild peripheral sclerotic changes without appreciable cortical erosion or soft tissue components." The doctor couldn't tell me there what the lesions were, though he said they appeared to be benign, and suggested I follow up with my GP, who had me get an MRI.

From the MRI report (10/2011): "The T1-weighted sequences demonstrate at least 3 well-defined intramedullary lesions of the distal femoral metadiaphysis, mostly located posteromedially adjacent to the endosteum. These lesions are of intermediate to low signal intensity in the T1-weighted sequences at homogeneously hyperintense and inversion recovery at T2-weighted sequences." AND "Based on the recent plain radiographs, there may be apparent in sclerotic halo surrounding the largest lesion, indicating a benign etiology. Based on the current MRI images, no evidence of endosteal scalloping, cortical erosion or soft tissue components are demonstrated. After infusion of the IV contrast, no suspicious enhancements are seen. The differential considerations therefore include eosinophilic granuloma , aneurysmal bone cysts and or osteoid osteomas. Other less likely lesions include fibrous dysplasia and giant cell tumor." Size: "The largest lesion measures approximately 7 x 5 x 4 mm."

Thing is, when I was referred to an orthopedic surgeon, he said he couldn't tell me what it was and referred me to an orthopedic oncologist, who barely looked at my images. So I found myself someone else to review, who said nonossifying fibroma...but my research suggests that NOF doesn't show up as multiple lesions, I had pain off and on around that time, and this wasn't one of the differential diagnoses on the x-ray or MRI reports.

I had a follow-up MRI (1/2012) that said: "The 3 lesions of in the distal femoral shaft are again demonstrated with the largest measuring about 7.8 mm." AND "This may be cystic although the differential diagnosis was described previously and included eosinophilic granuloma, osteoid osteoma and aneurysmal bone cyst. There is a is no evidence of a soft tissue mass in the adjacent soft tissue. There is no evidence of endosteal scalloping or permeative invasive characteristic." It recommended continued follow-up.

Now, it's over a year since I've had any imaging tests (the second opinion doctor I had been seeing left, and I have yet to find someone in the area who has the qualifications to review bone lesions reliably), and I've noticed the same kind of pain in the same areas as the bone lesions again...and it's gotten worse. Still off and on, but more intense at times, and often at rest.

So my question is: Could this really be nonossifying fibroma, even though there are at least three lesions in the right femur? Do NOFs present with pain? If it isn't NOF, what are other options? Is it more likely that the differential diagnoses from the reports are more likely? And what options are there to treat...whatever type of lesion these are?

Last edited by silvericewolf; 04-09-2013 at 07:15 PM.

 
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Old 04-09-2013, 08:37 PM   #2
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Re: Multiple bone lesions in right femur

Quote:
Originally Posted by silvericewolf View Post
In September 2011, I fell down the stairs and bashed my knees and twisted an ankle. I ended up going to a convenient care to x-ray, since I was on Lupron for endometriosis and knew I was at increased risk for fracture, despite taking Add-Back to prevent bone issues. The x-ray showed no fractures, but they did find "at least two intramedullary radiolucent lesions of the distal femoral diaphysis." Also from the report: "These lesions show mild peripheral sclerotic changes without appreciable cortical erosion or soft tissue components." The doctor couldn't tell me there what the lesions were, though he said they appeared to be benign, and suggested I follow up with my GP, who had me get an MRI.

From the MRI report (10/2011): "The T1-weighted sequences demonstrate at least 3 well-defined intramedullary lesions of the distal femoral metadiaphysis, mostly located posteromedially adjacent to the endosteum. These lesions are of intermediate to low signal intensity in the T1-weighted sequences at homogeneously hyperintense and inversion recovery at T2-weighted sequences." AND "Based on the recent plain radiographs, there may be apparent in sclerotic halo surrounding the largest lesion, indicating a benign etiology. Based on the current MRI images, no evidence of endosteal scalloping, cortical erosion or soft tissue components are demonstrated. After infusion of the IV contrast, no suspicious enhancements are seen. The differential considerations therefore include eosinophilic granuloma , aneurysmal bone cysts and or osteoid osteomas. Other less likely lesions include fibrous dysplasia and giant cell tumor." Size: "The largest lesion measures approximately 7 x 5 x 4 mm."

Thing is, when I was referred to an orthopedic surgeon, he said he couldn't tell me what it was and referred me to an orthopedic oncologist, who barely looked at my images. So I found myself someone else to review, who said nonossifying fibroma...but my research suggests that NOF doesn't show up as multiple lesions, I had pain off and on around that time, and this wasn't one of the differential diagnoses on the x-ray or MRI reports.

I had a follow-up MRI (1/2012) that said: "The 3 lesions of in the distal femoral shaft are again demonstrated with the largest measuring about 7.8 mm." AND "This may be cystic although the differential diagnosis was described previously and included eosinophilic granuloma, osteoid osteoma and aneurysmal bone cyst. There is a is no evidence of a soft tissue mass in the adjacent soft tissue. There is no evidence of endosteal scalloping or permeative invasive characteristic." It recommended continued follow-up.

Now, it's over a year since I've had any imaging tests (the second opinion doctor I had been seeing left, and I have yet to find someone in the area who has the qualifications to review bone lesions reliably), and I've noticed the same kind of pain in the same areas as the bone lesions again...and it's gotten worse. Still off and on, but more intense at times, and often at rest.

So my question is: Could this really be nonossifying fibroma, even though there are at least three lesions in the right femur? Do NOFs present with pain? If it isn't NOF, what are other options? Is it more likely that the differential diagnoses from the reports are more likely? And what options are there to treat...whatever type of lesion these are?
My new car was rear-ended three years ago while sitting at a Stop sign. I was leaning forward looking left and right waiting for traffic to clear and ended up with a WADII whiplash and severe pain in my left hip where the lap belt caught me. Three months later after enduring severe night time pain in my upper femur, it was discovered I had a fracture and the bone scan revealed a tumour called an Ostoid Osteoma had formed. My night time/at rest pain symptoms had clued the bone surgeon into the cause. I too went to several specialists for second opinions but there was such a variation in what each one diagnosed from the scans, I concluded they did not want to operate because my blood pressure has been unstable since the accident and I am 70 years old. I researched Radio Frequency Ablation which seems to have the best outcome over surgery; however, last year a Chiropractor asked if he could try using Ultra Sound to get the tumour to withdraw. After several months it seems to have gone but there is no guarantee it will not return. At least it is not as painful. Hope you find this helpful.

 
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