Adamantinoma is a rare, slow-growing, low-grade malignant bone tumour that classically affects the tibia. Although it accounts for less than 1% of primary bone tumours, its locally aggressive behaviour and risk of very late recurrence demand expert surgery and lifelong follow-up.
Adamantinoma is a rare bone tumour that originates from epithelial cells set within a fibrous bone background. It grows slowly but is locally aggressive and can recur many years after the original surgery. Distant spread is uncommon but possible — most often to the lungs.
Dull ache over the front of the leg lasting weeks to months, worse at night.
A slowly enlarging bony swelling or visible bowing of the tibia.
A pathological fracture after a trivial fall warrants urgent imaging.
Recurrent shin symptoms mistaken for chronic osteomyelitis should be reviewed by a bone-tumour specialist.
A combination of imaging and an image-guided biopsy at a specialist centre confirms the diagnosis and guides treatment planning.
Multiloculated lytic ‘soap-bubble’ lesion of the tibia with cortical thinning or disruption.
Defines tumour margins, intramedullary extent and soft-tissue involvement for surgical planning.
CT assesses bone architecture; chest CT or PET-CT rules out the rare metastases.
Confirms diagnosis — epithelial nests in fibrous stroma, positive for keratins and CD99.
Wide en-bloc resection with limb-preserving reconstruction is successful in the vast majority of patients with adamantinoma.
Surgery is the gold standard, with the aim of clear negative margins.
The defect after resection is rebuilt using a combination of biological and prosthetic options.
Both have very limited roles in adamantinoma.
A young man underwent extensive mid-tibial resection of an adamantinoma with reconstruction using a vascularised fibula graft. Despite the complexity of the surgery, at 5-year follow-up he demonstrated full functional recovery with no signs of disease recurrence — highlighting the importance of individualised treatment and multidisciplinary care.
