Giant Fibrous Dysplasia of the Sixth Rib Managed in a Rural, Resource-Limited Setting: A Case Report

Fibrous dysplasia (FD) is a benign bone disorder characterized by replacement of normal bone with fibrous tissue and immature woven bone. Although rib involvement is not uncommon, large symptomatic lesions are rare. We report a case of giant monostotic FD of the sixth rib managed successfully in a resource-limited rural setting. A 22-year-old man presented with a progressively enlarging, painful swelling over the left chest wall for 3 years. Examination revealed a hard, immobile mass measuring 10 × 6 cm. Imaging showed a well-defined expansile lytic lesion with ground-glass matrix arising from the left sixth rib without cortical breach. Core biopsy confirmed FD. Owing to the lesion size, symptoms, and limited access to thoracoscopic facilities, open posterolateral thoracotomy with en bloc rib resection was performed. The resulting 8 × 6 cm defect was reconstructed using rib approximation without prosthetic mesh and covered with a pedicled latissimus dorsi flap. The postoperative course was uneventful, with complete recovery and no recurrence at 1-year follow-up. This case highlights that complete surgical excision provides excellent clinical outcomes for symptomatic rib FD and demonstrates that effective, low-cost reconstruction without synthetic materials is feasible in selected patients in resource-constrained settings.