Myositis ossificans is a pseudoinflammatory tumour that originates from skeletal muscle and corresponds to a heterotopic, metaplastic, nonmalignant bone tumour. The purpose of this article is to report the case of myositis ossificans circumscripta (MOC) of the psoas muscle due to overuse in an adolescent gymnast. A 16-year-old female athlete presented at our outpatient orthopaedic clinic for evaluation of a 1-month history of low back pain. Initial plain radiographs were initially interpreted as negative, and laboratory values were normal. MRI imaging demonstrated a circumscribed mass with associated oedema in the psoas muscle. Computed tomography-guided percutaneous biopsy was performed and histology confirmed the diagnosis of MOC. Conservative treatment was initiated with rest and anti-inflammatory drugs (indomethacin). The patient had a resolution of pain and function after 3 months of conservative treatment. At 6 months' follow-up, MRI demonstrated complete resolution of the lesion and she gradually returned to her sports activity. At last follow-up she was asymptomatic. MOC is a rare lesion in the paediatric-adolescent population. To our knowledge, this is the first report of MOC in the psoas muscle produced by overuse. MRI is very sensitive in detecting oedema during the acute phase of the lesion. Conservative treatment should be considered, especially at the early stage of the disease. Spontaneous resolution can be expected in most cases.
Presentación de casos clínicos RESUMENEl mesenquimoma fibrocartilaginoso (MFC) es un tumor raro, que afecta principalmente a los huesos largos. Se han reportado pocos casos desde su descripción. Presentamos un caso de un niño de 4 años de edad con MFC situado en el húmero. Las radiografías mostraron una lesión lítica expansiva situada en la región metafisaria del húmero proximal. La resonancia magnética objetivó expansión del tumor a partes blandas. La anatomía patológica fue confirmatoria de MFC. El paciente fue tratado con curetaje, fenolización adyuvante y sustituto óseo mezclado con aspirado de médula ósea. A los dos años de seguimiento, no se evidenció recidiva. El MFC debe ser tenido en cuenta entre los diagnósticos diferenciales en lesiones óseas líticas en niños y adolescentes. Palabras clave: mesenquimoma fibrocartilaginoso, displasia fibrocartilaginosa, tumor, niño. Diseño del estudio: reporte de caso (nivel de evidencia IV). ABSTRACTFibrocartilaginous mesenchymoma (FCM) is a rare tumor that primarily affects the long bones. Few cases have been reported since its description. A case of a 4-year-old boy with FCM located in the humerus is presented. Radiological examination showed an expansive lytic lesion located in the metaphyseal proximal humerus. Magnetic resonance imaging showed soft tissue expansion. Histopathological diagnosis was confirmatory of FCM. Curettage, adjuvant phenolization, and bone grafting with bone substitute, and autologous bone marrow was performed. During a follow-up period of 2 years, there was no evidence of disease progression. FCM should be considered in the differential diagnosis of lytic bone lesions in children and adolescents.
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