Right proximal femoral expansile osseous lesion. The diagnostic possibilities include liposclerosing myxo-fibrous tumor, aneurysmal bone cyst, intra-osseous lipoma and less likely fibrous dysplasia. 

Fibrous dysplasia may have less sclerosis, intraosseous lipoma has macroscopic fat on CT or MRI and aneurysmal bone cyst (ABC) is usually more expansive and may show fluid/fluid levels.

In a liposclerosing myxofibrous tumor. The lipomatous component is usually too small and mixed with other more prominent myxofibrous or fibro-osseous tissue.

A biopsy was done with the microscopic picture showing sclerotic bone trabeculae with intervening fibrotic stroma and wide areas of hemorrhage, dense fibrosis, and focal fat necrosis. No atypia of malignancy. Pathological findings matched the radiological diagnosis of liposclerosing myxo-fibrous tumoor.

‘LSMFT’ was the acronym for an old American tobacco commercial ‘Lucky Strike Means Fine Tobacco’, whose name is equally applicable to the liposclerosing myxo-fibrous tumor. The large lesion of the femoral neck with a sclerotic margin, no capsule, no communicating channel, containing ‘myxoid type tissue with adipose elements and some atypical features’. The multilobular character, transversely intact trabeculae and areas of micronodular bone formation are features of LSMFT ¹.

LSMFT is a benign, indolent fibro‐osseous lesion with sclerotic margins that has a striking predilection for the femoral neck (90%). LSMFT complications are uncommon with reported pathological fracture about 10% and rarely malignant transformation into osteosarcoma ².