Review Article

Locally aggressive monostotic fibrous dysplasia of the cervical spine mimicking malignancy: a case report and literature review

¹ Department of Radiology, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France
² Department of Pathology, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France
³ Department of Pathology, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
⁴ Department of Neurosurgery, Fondation Ophtalmologique de Rothschild, 29 rue Manin, 75019 Paris, France
⁵ Department of Rheumatology, Hôpital La Croix Saint-Simon, 125 rue d’Avron, 75020 Paris, France

^* Corresponding author: audrey.milon.am@gmail.com

Received: 4 July 2019
Accepted: 7 July 2019

Abstract

We report the case of a 30-year-old woman with histologically proven monostotic fibrous dysplasia of C2 revealed by a pathological fracture of the odontoid process. Radiological investigations showed a ground-glass mineralization of the vertebral body, a centimetric lytic area with poorly defined margins involving the inferior part of the vertebral body and inferior endplate and a fracture through an osteolytic area in the base of the odontoid process.

Owing to the vertebral instability, a surgical procedure combining C0–C5 fixation and posterior bone grafting was performed. The surgical biopsy was inconclusive and pathological confirmation was finally obtained through a percutaneous needle biopsy under fluoroscopic guidance. At 26-month follow-up, the patient still experienced mild persistent cervical posterior neck pain and stiffness possibly related to a C5–6 laxity below the intervertebral fixation.

This case combines three radiological findings, which are unusual in fibrous dysplasia: monostotic presentation involving the spine, some aggressive radiographic features, and a pathological fracture.