Surgical Management of Symptomatic Progressive Monostotic Fibrous Dysplasia of the Rib: A Case Report.

Fibrous dysplasia is a benign skeletal disorder characterized by replacement of normal bone with fibrous tissue and immature bone, leading to bone fragility, deformity, and pain. The most common presentation is the monostotic form, which is frequently asymptomatic, whereas the polyostotic form is typically more extensive and symptomatic. Management is usually conservative, consisting of clinical and imaging surveillance and pain control, although selected symptomatic cases may benefit from surgical intervention. We report the case of a 33-year-old male who previously underwent partial resection of the left sixth rib due to an expansile bone lesion. Histopathological examination confirmed fibrous dysplasia, and the patient was discharged after one year of follow-up. Fifteen years later, he was referred to thoracic surgery due to persistent left-sided chest pain. Computed tomography demonstrated progression of fibrous dysplasia in the remaining segments of the left sixth rib. Given persistent symptoms, complete surgical excision of the affected rib was performed, resulting in full resolution of symptoms. This case highlights the potential for late disease progression in fibrous dysplasia, even after partial surgical resection, and underscores the importance of long-term follow-up. It also demonstrates that surgical excision can be an effective treatment option in selected symptomatic patients, including those with costal involvement.