PATHOLOGICAL AND CLINICAL ASPECTS OF SO-CALLED DIFFERENTIATED ADAMANTINOMA

In view of their disputed relationship, we present a case of so-called ''differentiated adamantinoma'' as a seperate entity with regard to t herapeutical approach. In a 24-year old woman an osteolytic lucent and cystic lesion of middle third tibia was dedected accidentally in an X -ray, without any clinical symptoms. On biopsy and resection material an osteofibrous dysplastic component with storiform stromal pattern pr edominated histologically, few small islets with epithelial cells were scattered throughout the lesion. Due to the diagnosis differentiated adamantinoma, surgical therapy was a wide resection with following dis traction concerning the Ilizarov-concept. The patient recovered satisf actorily without evidence of further disease. This rare bone lesion su ggests the existence of a separate clinicopathologic entity to be call ed ''differentiated adamantinoma''. The osteofibrous like lesion and t he bone remodeling is probably seen as a result of a secondary reparat ive process which would lead to elimination of most of the recognizabl e tumor cells. In dependence of variable radiologic findings the diagn osis can only performed by histological examination. Differentiated ad amantinoma can also be found without the main clinical symptom ''pain' ' and can be diagnosed also besides the first two life decades. Progno sis of this clinicopathologic entity is obviously better than that of classical adamantinoma. Radical therapy like amputation may be avoided .