pain or swelling of the joints, no muscle contractures, no soft tissue or skin changes.He underwent an arthroscopic proceed open biopsy of the lateral condyle of the right femur to exclude osteoblastic metastases. Arthroscopy revealed typical features of proliferative frond like synovial disease with associated loose bodies as seen in synovial chondromatosis. A synovial debridement with removal of the loose bodies was done. These were however not sent for histopathological analysis by the operating surgeon in order to reduce patient expenses and because the arthroscopic appearances were typical. Microscopic histopathology revealed few thickened trabeculae merging with normal surrounding bone with no evidence of metastases, which can be seen with osteopoikilosis. We do not have archived pathological images as the femoral condyle biopsy was done to exclude osteoblastic metastases. Images were not archived as it was a negative study for the diagnostic question i.e. metastases. Osteopoikilosis, also called osteopathia condensans disseminata, or "spotted bone disease" is an incidentally detected disorder characterized by an abnormality in enchondral bone maturation. There is no gender predilection, men and women are equally affected (1, 9). It is usually inherited as an autosomal dominant condition. Osteopoikilosis results in multiple small densities of oval or rounded shape that are symmetrically distributed within the metaphyses and epiphyses of the long bones, in periarticular osseous regions. On histology these foci are formed by dense trabeculae of spongious bone, occasionally forming a nidus without communication with bone marrow. These appear in childhood and persist thereafter (2, 5, 10). Sites of predilection include phalanges (100%), carpal bones (97.4%), metacarpals (92.5%), foot phalanges (87.2%), metatarsals (84.4%), tarsal bones (84.6%), pelvis (74.4%), femur (74.4%), radius (66.7%), ulna (66.7%), sacrum (58.9%), humerus (28.2%), tibia (20.5%), and fibula (2.8%) in one study of 4 families. The ribs, skull and vertebrae are spared (2).Some patients have associated connective tissue nevi called dermatofibrosis lenticularis disseminate, this is called Buschke-Ollendorff syndrome (11). Osteopoikilosis is also associated with keloid formation, dwarfism, spinal stenosis, dystocia, melorrheostosis, tuberous sclerosis and scleroderma (6, 7, and 13). Mixed sclerosing bone dystrophy comprises osteopathia striata and melorheostosis along with osteopoikilosis (2).Differential diagnoses include osteoblastic metastasis, tuberous sclerosis and mastocytosis (1, 9). Blood investigations like alkaline and acid phosphatase and bone scan are typically normal (1, 2, 14).The diagnosis of primary synovial osteochondromatosis is based on the rapid onset of monoarticular pathology in a young adult and on the gross histopathological appearance (3). The typical features are ectopic chondroid matrix formation under the synovium, synovial hyperplasia, multiple small loose bodies and the absence of articular cartilage destruction. However secondary synovial metaplasia occurs in the more common traumatic and degenerative joint disorders (3, 5, and 6). Radiographs may or may not reveal calcific densities.Synovial chondromatosis progresses through various stages of activity (4, 13). In the acute stage, the entire joint synovium is hypertrophied and hyperemic with numerous foci of cartilage formation. Small cartilaginous fragments are extruded into the joint and dystrophic calcification may occur. (3,6) During the intermediate stage, the acute synovial reaction gradually subsides (7,10,13, 15)The free cartilaginous loose bodies undergo degenerative, proliferative (enlargement on multiplication), or