This 2010 JAAOS review examines osteofibrous dysplasia (OFD) and adamantinoma (AD) — two rare tibial lesions — along with the intermediate entity OFD-like adamantinoma. It addresses their epidemiology, radiographic and histologic features, histogenetic relationship, and management principles for each entity.
When you see an intracortical lytic tibial lesion in a child or adolescent, OFD is the likely diagnosis — but biopsy is still strongly recommended because sampling error can mask underlying AD; if keratin-positive epithelial nests are present, the lesion is OFD-like AD or classic AD and management shifts accordingly.
For proven classic adamantinoma, wide resection is non-negotiable: intralesional or marginal surgery drives local recurrence and subsequent metastasis, and surveillance must extend for decades given reports of recurrence 24–36 years after diagnosis.
This 2010 JAAOS review examines osteofibrous dysplasia (OFD) and adamantinoma (AD) — two rare tibial lesions — along with the intermediate entity OFD-like adamantinoma. It addresses their epidemiology, radiographic and histologic features, histogenetic relationship, and management principles for each entity.
When you see an intracortical lytic tibial lesion in a child or adolescent, OFD is the likely diagnosis — but biopsy is still strongly recommended because sampling error can mask underlying AD; if keratin-positive epithelial nests are present, the lesion is OFD-like AD or classic AD and management shifts accordingly.
For proven classic adamantinoma, wide resection is non-negotiable: intralesional or marginal surgery drives local recurrence and subsequent metastasis, and surveillance must extend for decades given reports of recurrence 24–36 years after diagnosis.