Rare presentation of painful non-ossifying fibroma of the proximal tibia in an adult

Non-ossifying fibromas (NOFs) are usually seen in growing children and are often found incidentally. Their presence in adults, particularly when associated with pain, is highly uncommon and can lead to diagnostic uncertainty. This case report describes a 27-year-old female presenting with persistent pain in the right proximal part of the leg for 2 years. Despite conservative treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs) and zoledronic acid, the pain remained unresolved. Imaging revealed a small, eccentric, lytic lesion suggestive of an NOF, which was confirmed by histopathological examination. The patient underwent curettage and bone grafting with significant postoperative pain relief in proximal tibial metaphysis. This case highlights the diagnostic challenge of symptomatic NOFs in adults and emphasizes integrating clinical, radiological, and histological findings to arrive at an accurate diagnosis. Surgical intervention, although uncommon, can be considered in symptomatic cases and may yield excellent outcomes.