Unusual bone tumor in a hemophiliac patient. Diagnosis using aspiration biopsy of the lesion

: Bone tumors due to repeated haemorrhages in haemophiliacs (haemophilic pseudotumours) usually are no diagnostic trouble. However, when x-ray findings are not conclusive, the differential diagnosis with malignant tumours may be difficult as bleeding complications hinder invasive diagnostic procedures. A fifteen year-old patient with severe haemophilia A is presented, who had a tumor in his left fibula with no previous traumatism. X-ray and CT scan images showed a broken cortical substance with reactive sclerosis and no alteration of the soft tissues. In order to establish the diagnosis and choose the adequate surgical management, aspiration with thin needle was performed through the cortical hole, under visual control with CT scan. A benign lesion was found upon study of the aspirate. No haemorrhagic or infectious complications developed after tumor dissection and filling with heterologous lyophilized bone. The final diagnosis was "giant cell reparative granuloma", an uncommon lesion in the fibula not previously reported in haemophiliacs. It was concluded that aspiration, when appropriately applied, may be a useful diagnostic procedure which should be borne in mind for the diagnosis of bone tumors in haemophiliacs.