Osteo-fibrous Dysplasia like Adamantinoma: A Diagnostic Dilemma

Abstract Osteofibrous dysplasia-like adamantinoma is a rare, intermediate grade primary bone tumour of unknown aetiology, which typically involve mid-tibia diaphyseal region. We present a case which was initially suspected as metastasis as patient had underlying colonic cancer. Biopsy was taken twice for confirmatory diagnosis. Patient had an atypical imaging presentation of OFD-like adamantinoma, as the age of the patient and radiographical presentation were more of a classic adamantinoma. The ability to recognize the pattern and distribution and keeping it as a differential is important. MRI findings would be non-specific, but useful in term of locoregional staging. Even though histopathological examination provides definite diagnosis, it may sometimes yield false negative. Bone scan can be useful in detecting primary and metastatic osteoblastic bone tumour. Imaging findings and its closest differentials were discussed.