ARTICLE IN PRESS

The Spine Journal ■■ (2015) ■■–■■

Images of Spine Care

Polyostotic fibrous dysplasia
presenting with back pain
radiating to the ribs
A 21-year-old man presented with pain on his back radi-
ating to his ribs. Physical examination showed no significant
indications. Computed tomography showed a lytic lesion with
a non-expansile sclerotic ring on the right side of the seventh
vertebra (Fig. 1). The seventh and eighth ribs on the right side,
and the eighth and ninth ribs on the left side, had expansile
lesions with ground-glassdensities (Fig. 1). The complex- Fig. 1. Coronal computed tomography demonstrating lytic lesion with non-
ion and the dispersion of the lesions indicated fibrous dysplasia. expansile scletoric ring on the right side of the seventh vertebra (white
Positron emission tomography showed no other lesions and arrowhead) and expansile lesions with ground-glass densities on the right
the lesions had 18F-fluorodeoxyglucose uptake (Fig. 2). Biopsy seventh and left eighth ribs (white arrows).

Fig. 2. Positron emission tomography computed tomography demonstrating the lesions have 18F-fluorodeoxyglucose uptake (red arrows).

http://dx.doi.org/10.1016/j.spinee.2015.12.027
1529-9430/© 2015 Elsevier Inc. All rights reserved.
 ARTICLE IN PRESS
2 C. Ozturker et al. / The Spine Journal ■■ (2015) ■■–■■

was performed on the ninth rib on the left side, and the patient Coskun Ozturker, MDa
was diagnosed with polyostotic fibrous dysplasia. Fibrous dys- Ali Kemal Sivrioglu, MDb
plasia is a benign bone disease that can be seen at one or more Ersin Ozturk, MDa
focal points, characterized by replacement of bone tissue with Ozan Karatag, MDc
fibrous tissue and irregular bone trabeculation. Fibrous dys- Hakan Mutlu, MDa
a
plasia has three forms, and is primarily seen in its monostotic Department of Radiology
form (80%) and least seen in its polyostotic form (3%–5%). GATA Haydarpasa Training Hospital
Polyostotic fibrous dysplasia is rare in the spine [1,2]. Spinal Tibbiye caddesi, 34668 Uskudar/Istanbul, Turkey
b
lesions, in contrast to their typical expansile ground-glass ap- Department of Radiology
pearance, can rarely show up as lytic lesions. They can mimic Kasimpasa Military Hospital
metastasis by having 18F-fluorodeoxyglucose uptake and might Kadi Mehmet caddesi, 34440 Beyoglu/Istanbul, Turkey
c
sometimes cause compression fractures, depending on ver- Department of Radiology
tebral collapse [3,4]. COMU Faculty of Medicine
Sahil Yolu caddesi, 17100 Kepez/Canakkale, Turkey
References
[1] Cotran SC, Kumar V, Collins T. Robbins pathologic basis of disease.
Sixth ed. Philadelphia: W.B. Saunders Company; 1999. p. 1242–3.
[2] Gogia N, Marwaha V, Atri S, Gulati M, Gupta R. Fibrous dysplasia
localized to spine: a diagnostic dilemma. Skeletal Radiol 2007;36:S19–23. FDA device/drug status: Not applicable.
[3] Grabias SL, Campbell CJ. Fibrous dysplasia. Orthop Clin North Am Author disclosures: CO: Nothing to disclose. AKS: Nothing to dis-
1977;8:771–83. close. EO: Nothing to disclose. OK: Nothing to disclose. HM: Nothing to
[4] Park SK, Lee IS, Choi J-Y. CT and MRI of the fibrous dysplasia of the disclose.
spine. Br J Radiol 2012;85:996–1001. The authors indicate no potential conflicts of interest.