The diagnostic conundrum of Florid Reactive Periostitis: A case report and review of the literature

Ashton H. Goldman, Jessica A. Frankenhoff


We report on a case of digital benign fibroblastic proliferative lesion that aggressively recurred after multiple excisions and showed histologic progression from a Fibrosseous Pseudotumor (FOPT) to Florid Reactive Periostitis (FRP). We recommend caution on incisional biopsies that do not excise the lesion fully based on the clinical course, radiographic, and histologic findings. Our case demonstrates the protean nature of this entity and the difficulty in obtaining an accurate diagnosis based on the clinical course and radiographic and histologic findings.

Full Text:




Coleman R. Fibro-osseous pseudotumour of the digit–amputation for a benign but aggressive lesion. J. Hand Surg (Br and Eur Vol) 2005;30:504-506.

Craver R, Correa-Gracian H, Heinrich S. Florid reactive periostitis. Hu Path 1997; 28:745-747.

De Silva M, Reid R. Myositis ossificans and fibroosseous pseudotumor of digits: a clinicopathological review of 64 cases with emphasis on diagnostic pitfalls. Int J. of Surg Path 2003;11:187-195.

Dupree W, Enzinger F. Fibro‐osseous pseudotumor of the digits. Cancer 1986; 58:2103-2109.

Gao Z, Wang J, Wang Z, et al. Florid Reactive Periostitis of the Metacarpal and Phalanx: 2 Case Reports. J. Hand Surg 2013;38:2134-2137.

Howard R, Slawski D, Gilula L. Florid reactive periostitis of the digit with cortical erosion: a case report and review of the literature. J. Hand Surg 1996; 21:501-505.

Hutter R, Foote Jr F, Francis K, et al. Parosteal fasciitis: a self-limited benign process that simulates a malignant neoplasm. Am J. Surg 1962;104:800-807

Jambhekar N, Desai S, Puri, A, et al. Florid reactive periostitis of the hands. Skel Rad 2004;33:663-665.

Kovach J, Truong L, Kearns R, et al. Florid reactive periostitis. J. Hand Surg 1986;11:902-905.

McCarthy E, Ireland D, Sprague B, et al. Parosteal (nodular) fasciitis of the hand. A case report. J. Bone & Joint Surg 1976;58:714-716.

Moosavi C, Al-Nahar L, Murphey M, et al. Fibrosseous pseudotumor of the digit: a clinicopathologic study of 43 new cases. Ann. Diag. Path 2008;12:21-28.

Nalbantoglu U, Gereli A, Kocaoglu B, et al. Fibro-osseous pseudotumor of the digits: a rare tumor in an unusual location. J. Hand Surg 2008;33:273-276.

Patel M, Desai S. Pseudomalignant osseous tumor of soft tissue: a case report and review of the literature. J Hand Surg 1986;11:66-70.

Rogers G, Brzezienski M. Florid reactive periostitis of the middle phalanx: a case report and review of the literature. J Hand Surg 1999;24:1014-1018.

Schütte H, Van der Heul R. Pseudomalignant, nonneoplastic osseous soft-tissue tumors of the hand and foot. Radiology 1990;176:149-153.

Sleater J, Mullins D, Chun K, et al. Fibro‐osseous pseudotumor of the digit: a comparison to myositis ossificans by light microscopy and immunohistochemical methods. J. Cutaneous Path 1996;23:373-377.

Spjut H, Dorfman H. Florid reactive periostitis of the tubular bones of the hands and feet: a benign lesion which may simulate osteosarcoma. Am J. Surg Path 1981;5:423-434.

Sundaram M, Rotman M, Howard R, et al. Florid reactive periostitis and bizarre parosteal osteochondromatous proliferation: pre-biopsy imaging evolution, treatment and outcome. Skel Rad 2001;30:192-198.

Tang J, Yung Q, Ren G. Fibro-osseous pseudotumor that may be mistaken for a malignant tumor in the hand: a case report and review of the literature. J. Hand Surg 1996;21:714-716

Yuen M, Friedman L, Orr W, et al. Proliferative periosteal processes of phalanges: a unitary hypothesis. Skel Rad 1992;21:301-303.



  • There are currently no refbacks.

Case Studies in Surgery  ISSN 2377-7311(Print)  ISSN 2377-732X(Online)

Copyright © Sciedu Press

To make sure that you can receive messages from us, please add the '' and ‘’ domains to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', please check your 'spam' or 'junk' folder.