Year: 2026 | Month: August | Volume: 13 | Issue: 8 | Pages: 352-361
DOI: https://doi.org/10.52403/ijrr.20260833
Melorheostosis with Giant Extraosseous Ossification of the Fibula Mimicking Malignancy: A Case Report
Almu Muhamad1, Pamelia Mayorita2, Trio Kurnia Putra3
1Orthopaedic Oncology and Reconstruction Division, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, West Sumatra, Indonesia
2Department of Anatomical Pathology, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, West Sumatra, Indonesia
3Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, West Sumatra, Indonesia
Corresponding Author: Trio Kurnia Putra
ABSTRACT
Melorheostosis is a rare sclerosing bone dysplasia characterized by segmental cortical hyperostosis, classically presenting with a “dripping candle-wax” appearance. We report a 52-year-old woman with a three-year progressive mass of the left lower leg associated with pain, numbness, and previous ulceration. A prior core biopsy suggested osteochondroma. However, radiographs demonstrated characteristic flowing cortical hyperostosis of the fibula with extensive adjacent extraosseous ossification, while cross-sectional imaging showed a mineralized mass without destructive features. Histopathology revealed woven and sclerotic bone trabeculae with osteoblastic rimming and vascular fibrous stroma without evidence of malignancy. The diagnosis of melorheostosis was established through clinicoradiological and histopathological correlation. The extensive extraosseous component obscured the typical presentation and mimicked a neoplastic process, highlighting the potential limitations of isolated biopsy interpretation. This case emphasizes the importance of recognizing imaging-pathology discordance and integrating clinical course, characteristic radiographic findings, and histopathology to avoid misdiagnosis and unnecessary oncological treatment.
Keywords: melorheostosis; extraosseous ossification; cortical hyperostosis; diagnostic challenge; osteochondroma
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