CORTICAL DESMOID

Cortical Desmoid
Introduction :

- Also known as : femoral cortical irregularities / cortical avulsive injuries /

bufkin lesion.
- Classic “do not touch lesion”.
- Benign self-limiting fibrous or fibro-osseous lesion.
- No histologically correlate to true desmoid tumors.
- Most frequently occur in the posterior-medial condyle of the femur.

Epidemiology :

Male > female, 10 - 15 years of age.

Cortical Desmoid (2)
Clinical presentation :

- Usually asymptomatic.
- Discovered incidentally.

Pathology :

It is related to repetitive stress at the attachment of the medial head of

gastrocnemius or distal adductor magnus at posteromedial aspect of the distal
femoral metaphysis.
Cortical Desmoid (3)
Location :

- Classically seen at the posteromedial aspect of the distal femur. They can be
bilateral in approximately one-third of cases.
- Occasionally similar lesions have been described involving the humerus -
medially at the insertion of the pectoralis major muscle or laterally at the
insertion of the deltoid
Cortical Desmoid (4)
RADIOGRAPHIC FEATURES

Plain radiograph

Typically shows a saucer-shaped radiolucent

cortical irregularity involving the posteromedial
aspect of the distal femoral metaphysis at the
attachment of the adductor magnus tendon. The
lesion lacks an outer margin.
Cortical Desmoid (5)
MRI

Cortical desmoids classically appear on MR images as an area of cortical irregularity along the
posteromedial aspect of the distal femur. They are hypointense on T1-weighted images and
hyperintense on T2-weighted images.

On both types of images, the lesions have a dark rim at or near the sites of the bony attachment of the
medial head of the gastrocnemius muscle
Cortical Desmoid (6)
Histopathology Findings :

- Histology is strongly depending on the stage of evolution and on the

pathologist experience. It has been described as reactive fibrous
proliferation with mild inflammation originating from periosteal or
subperiosteal tissue and bony spicules to dense fibrous scar tissue

Differential Diagnosis :

- Fibrous cortical defect