Fig. 2

Case 2. A 41-year-old woman with intramedullary osteosclerosis of the left femur. Preoperative radiography shows a massive sclerotic intramedullary lesion of the right femoral shaft and cortical bone thickening (white arrow). Left panel is the anteroposterior view. Right panel is the lateral view (a). Preoperative CT (sagittal) shows medullary cavity narrowing (white arrowhead) (b). Preoperative MRI of T1-weighted SE sequence (coronal) was hypointense, corresponding to the intramedullary sclerosis visualized on radiograph and CT (whiteline arrow) (c) and T2-weighted STIR sequence (coronal) showed high signal intensity in the medullary cavity and without soft tissue mass (whiteline arrowhead) (d). Whole-body 99mTc-MDP bone scan showed an abnormal tracer uptake in the left femur (black arrowhead) (e). Triphasic bone scan (f, g, h). The initial vascular phase (f) and blood pool images (g) at 2 min showed no evidence of increased vascularity or soft tissue tracer pooling. Delayed bone images (h) showed a fusiform-shaped intense area of the tracer uptake in the left femur diaphysis (black arrow). Postoperative radiography. Gray arrow indicates the biopsy hole (i). Hematoxylin-eosin staining of the specimen from an open biopsy showed the thickened trabecular bone and fibrous hyperplasia with little inflammatory cell infiltration. Scale bar indicates 100 μm (j). Radiography at 39 months postoperatively. The bone hole was completely repaired (gray arrowhead) (k)