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The Atraumatic Circumscribed Ossifying Myositis

*A. Elmrini, +S. Boujraf, *O. Agoumi, *A. Daoudi, #A. Afifi, *F. Boutayeb, *A. Marzouki

*Department of Orthopedic and Traumatic Surgery, University Hospital Hassan II, Fez.
+Department of Biophysics and MRI Methods, Faculty of Medicine and Pharmacy, University of Fez
#Department of Pediatric Surgery, University Hospital Hassan II, Fez.

Address for Correspondence

Dr. A. Elmrini,
Department of Orthopedic and Traumatic Surgery,
Al Ghassani Hospital, University Hospital Hassan II, Fez 30000. Morocco.
Phone: +212 61 107 741,
Fax: 00 212 55 619 321


We report one case of a traumatic circumscribed ossifying myositis developed from the vastus medialis muscles, in an 18 years old male. Six months after surgical treatment, we obtained results consisting of an excellent functional outcome without recurrence.
Key words: ossifying myositis ; Vastus Medialis

J.Orthopaedics 2006;3(3)e8


The confined ossifying myositis is a pseudo tumoral affection. It consisted of none neoplastic and heterotopic site of bone or cartilage. This develops in soft tissues.

We report a case of ossifying myositis in the vastus medialis muscles of the thigh, which adhered to the member in the pediculosis femora. The surgical resection was complete.

Case Report:

The patient R. M of 18 year-old, without particular antecedent. He presented with pain of 6 months at the level of the medial side of the thigh; with a swelling at the same level, which has had a gradual increasing size. No change of the general status was noticed, and no infectious signs were present.

The clinical examination revealed a hard swelling of 4 centimeters diameter that has not inflammatory character, but sensitive squeeze; it was adhering to the deep structures but movable with regard to the superficial plane. There was neither the cutaneous modification, nor vascular-nervous disorder. The femoral radiography showed a fan-shaped calcification. The MRI showed a hyper signal mass of the vastus medialis muscle,(fig. 1). From these two examinations we concluded ossifying myositis. The surgical process consisted of, dissecting the tumor and the femoral artery; this last one was whitish, rigid and calcified by lay which required the resection its entirety (fig.2). The histological study confirmed the diagnosis of ossifying myositis. The evolvement after a recession in period of 6 months did not show any recurrence.

Discussion :

The term of confined ossifying myositis or pseudo tumor denote a clinical entity characterized by histological lesions consisting of muscular and conjunctival progressive ossifications [1]. It is a rare affection of the childhood [2, 3]. Only 25 cases were assessed in the literature [2]. Sometimes an acquiescent ground is found such as paraplegia, burn, tetanus [4]. This occurs in young adults, and in equal way in both sexes [1, 5, 6]. The diagnosis is approved at the stage of calcification [3, 6]. It is suspected of a tumor of hard consistency in the lower limb; it is evoked in the radiography, given that the existence of a clear zone separating the adjacent bone lesion with cortical integrity. The periosteal reaction could lead to confusion. In contrast, Battistelli et al [7], Brofen et al [2], Crouzet et al [8], Goldman [9], Gougeon et al [10], underline the complexity to diagnose, especially in the early stage where the pathology simulate malignant lesion. The diagnosis is based on clinical, ultrasound, CT-scan, MRI and anatomic-pathology examination. The CT-scan shows compatible hyper-dense sectors with beginning calcifications, it allows also pointing the integrity of the primary cortical bone. The MRI allows checking the integrity of the neighborhood structures including muscle, vascular-nervous pedicle; it could eliminate in certain cases the diagnosis of tumor. The injection of gadolinium seems to be very useful to judge the extension and the heterogeneity of the lesion in T1 images [4, 11]. The histological exam confirms the diagnosis of ossifying myositis, this shows typical lesion formed in three concentric layers: the centre constituted of undifferentiated mesenchymal cells, surrounded by intermediate zone that is affluent of osteoid, limited by a line of osteoblast. The final layer is composed of mature bone which encircles the lesion; where the muscular fibers and the soft tissues are intact [6-8, 10-12].

At the calcification stage, the significant ossification could let to critical situation of a chondrosarcoma or an osteosarcoma of soft parts. Mostly, the clinical context and the appropriate para-clinical examinations allow eliminate any doubt. The disease of Münchmeyer shows the same histological characteristics of the ossifying myositis, it is different by its hereditary character, the accompanying osseous alteration (absence or shortening of a phalanx of the big toe, of the thumb), and it has critical prognostic [1]. The prognostic is excellent. Indeed, recurrence is exceptional and always followed by cure after re-intervention [6, 7, 12]. 12 months after surgery, our patient did not show any recurrence. Masquelet [5] and Serratrice [1] suggest a medical treatment by anti-inflammatory drugs and diphosphonates. This medical treatment would minimize the risk of ossification appearance. Brofen [2] also finds that the ossifying myositis has a spontaneous favorable evolution, he recommends the ablation only in two cases: severe pains and\or important and extended functional impairment, and in case of diagnostic doubt.


None traumatic ossifying myositis presents an excellent prognostic. However, it is difficult to diagnose with certainty, especially in the late stages, this to not underestimate a malign tumor. In spite of the contribution of the CT-scan and MRI that is incontestable; the histology examination is still establishing the diagnosis.


Reference :

  1. Serratrice G. Pathologie médicale des muscles striés du squelette. Encycl Méd Chir (Paris-France), Appareil Locomoteur, 15151A 20, 10-1988, 12 p.
  2. Brofen. C, Touzet PH, Peuchmor M et al. Myosite ossifiante circonscrite non traumatique chez l'enfant. Revue de la littérature: à propos d'un cas simulant une tumeur maligne. Rev Chir Orthop, 1993: 229-234.
  3. Diaine B, Kurzenne JY, Hofman P et al. Myosite ossifiante circonscrite pseudo-tumorale de la paroi thoracique. Apport respectif de l'échographie, de la tomodensitométrie et de l'I.R.M. Radiol, 1993: 87-90.
  4. Bouchardy L, Garcia J. Apport de l'imagerie par résonance magnétique (I.R.M) dans le diagnostic de la myosite ossifiante circonscrite (M.O.C). Radiol, 1994: 101-110.
  5. Masquelet AC. Ossifications et tumeurs musculaires, In: Pathologie chirurgicale, tome 3, Nordin JY, Masquelet AC. Masson, Paris, 1992.
  6. Ogilvie-Harris DJ, Hons ChB. Pseudomalignant myositis ossificans: heterotopic new-bone formation without a history of trauma. J Bone Joint Surg, 1980: 1274-1283.
  7. Batistelli JM, Pauline-Balas D: Myosite ossifiante circonscrite non traumatique à localisation cervicale. Apport de la tomodensitométrie. Ann Péd, 1988: 59-63.
  8. Crouzet J, Chomette G. Myosite ossifiante circonscrite non traumatique. Difficultés diagnostiques. À propos d'une observation. Rev Rhum, 1983: 213-216.
  9. Goldman AB. Myositis ossificans circumscripta: a benign lesion with a malignant differential diagnosis. A.J.R., 1976:32-40.
  10. Gougeon J, Dousset M. La myosite ossifiante circonscrite non traumatique. Observation anatomo-clinique d'un cas et revue générale. Rev Rhum, 1970: 367-373.
  11. Mathonnet M, Longis B, Moulies D. Myosite ossifiante circonscrite non traumatique. Problème diagnostique. Ann Orthop Ouest, 1992: 91-94.
  12. Anglejean G, Perez C. Myosites ossifiantes circonscrites. Actualités rhumatologiques, 1984: 153-159.


This is a peer reviewed paper 

Please cite as : A. Elmrini: The Atraumatic Circumscribed Ossifying Myositis

J.Orthopaedics 2006;3(3)e8





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