Ossifying fibroma with non-specific cystic degeneration: a case report

Background

Fibro-osseous lesion are a group histologically similar lesions but with characteristic clinical and radiographic features. The definitive diagnosis of these lesions requires integration of clinical, radiological, histological, and gross surgical features. Ossifying fibroma is an encapsulated lesion that is often found in the mandible of middle-aged females.

Case report

We report a case of ossifying fibroma in a 25-year-old female with associated non-specific cystic changes and mimicking simple bone cyst.

Conclusion

The case reported here is diagnostically challenging and requires proper integration of clinical, radiological, histological, and gross surgical features to reach definitive diagnosis.     

Ossifying fibroma of the maxillary sinus: a case report

A case of ossifying fibroma of the maxillary sinus that occurred in a 45-year-old white female is reported. The lesion's radiographic, histologic and clinical behavior are examined. The clinical and radiographic features of ossifying fibroma distinguish it from monostatic fibrous dysplasia despite histologic similarities. The uncommon location of this ossifying fibroma in the maxillary sinus accounts for its large size, aggressive behavior and widespread osseous destruction. The prognosis is excellent after complete enucleation of the ossifying fibroma has been achieved. The benign fibro-osseous lesions of the jaws share similarities in radiographic and clinical appearance, histogenesis and histopathology, and consequently, pose difficulty in classification and treatment. Common histologic features of these lesions include an active proliferation of fibroblats, young and mature collagenous connective tissue, focal areas of mineralization which may resemble small cemeticles and/or irregular bone trabeculae, and multinucleated giant cells. Differential diagnosis of benign fibro-osseous lesions can therefore be made if clinical behavior, radiographic features, and hematologic changes are correlated with the histologic picture. Representatives of this group include true fibrous dysplasia, ossifying fibroma (both central and peripheral types), osteoid osteoma, osteoblastoma, cementifying fibroma, florid osseous dysplasia, proliferative periostitis of Garré, focal sclerosing osteomyelitis and osteitis deformans (Paget's disease).     

Ossifying fibroma in maxilla. Report of case

Since first reported by Montgomery in 1927, ossifying fibroma, a benign neoplasm of bone or bone tissue, has been the subject of numerous studies. In the present paper, a case of ossifying fibroma in a woman is presented. The woman was 49 years old. She visited our clinic with a complaint of swelling in the right maxillary region. Thorough examinations were conducted. From X-ray, CT, scintigraphy and biopsy findings, the case was diagnosed as ossifying fibroma. Under a general anesthetic, the tumor was extirpated. It measured 40 x 40 x 60mm. It's weight, including that of teeth, was 60.5 g. Histopathological examination revealed fibroblasts and hard, bone-like masses of varying shapes in the connective tissue. Nearly one year has elapsed since the surgical operation. The patient is doing well. Since 1957, a total of 107 cases of ossifying fibroma have been reported in Japan. The ages of the patients were mostly between 10 and 49. By sex, 42 were male and 65 female. By region, in 28 case, fibroma occurred in the maxillary part, 68 in the mandibular part, and 11 in the region extending from maxillary to mandibular area. More 70% of the cases were fibroma originating in the molar area.     

Ossifying fibroma: a clinicopathologic study of sixty-four cases

Sixty-four cases of neoplastic benign fibro-osseous lesions are presented, with clinical and radiographic follow-up in 23 instances. A marked predilection for female patients was observed, with the majority or cases arising in the molar-premolar region of the mandible. Radiographically, these neoplasms are well demarcated and may be radiolucent, radiolucent with central opacification (target appearance), or multilocular radiolucent. A benign fibro-osseous histopathologic pattern is observed with osseous, cemental, and/or ovoid-curvoid calcified deposits. This feature, along with confinement to tooth-bearing regions, supports a periodontal ligament origin. It appears that the distinction between cementifying and ossifying variants is academic, as no behavioral differences exist. The recurrence rate following curettage was found to be 28%.     

Peripheral ossifying fibroma: A 20-year retrospective study with focus on clinical and morphological features

Background Peripheral Ossifying Fibroma (POF) is a reactive hyperplastic lesion that exclusively occurs in the gingiva and is characterized by the deposition of dystrophic calcification, cementum-like tissue, and immature and mature bone within the connective tissue. The objective of the present study was to perform a retrospective analysis of clinicopathologic features of POF.Material and Methods Clinical and histopathological data were obtained from biopsy records and histopathological reports from a Brazilian reference service in Oral Pathology (1999 - 2020). Morphological analysis was performed to evaluate features related to the mesenchymal component, inflammatory infiltrate, ulceration, and mineralized tissue.Results A total of 270 POFs were diagnosed during the study period. A higher frequency was observed in females (71.9%) between the third (22.9%) and fourth (23.3%) decades of life. The anterior upper gingiva (29.1%) was the most affected region. Mature (86.7%) and immature (52.6%) bone tissue were the most frequent. There was a significant association between immature bone deposition and lesions with size ≤ 1.7 cm (p = 0.041); immature bone and cement-like tissue deposition with an evolution time ≤ 16 months (p < 0.001); deposition of immature bone and mesenchymal hypercellularization (p < 0.001); deposition of dystrophic calcification and the presence of ulceration (p < 0.001).Conclusions The clinical characteristics corroborate the findings in the literature. The heterogeneous distribution and quantity of mineralized tissues found in the analyzed cases support the theory that the different mineralized tissues constitute a spectrum of clinical maturation of POF. Key words:Gingiva, gingival diseases, gingival hyperplasia, oral pathology, diagnosis.     

Ossifying fibroma of the mandible and maxilla: review of 18 cases

A clinical, radiographic, histologic and follow up study of 18 cases of ossifying fibroma involving the mandible and maxilla was performed. Differences in behavior and management according to age, location, radiographic appearance and histopathology were not evident. A wide range of microscopic findings within and between cases was evident, while the radiographic finding consisting of sharp delineation was consistent in all cases. The presence or absence of cementum or cementum-like material and various types of formed elements was likewise of little clinical significance. Finally, a potential source of the neoplastic cell from the periodontal apparatus may help explain the range of histologic findings.     

Ossifying fibroma of the skull: interactive image-guided minimally invasive localization and resection

Ossifying fibroma is a benign fibro-osseous tumor commonly affecting the craniofacial bones. It is considered to be a locally aggressive and quickly expansible bone lesion. Because of its aggressive nature and high recurrence rate, early detection and complete surgical removal are essential. Usually, these lesions are excised extensively by craniectomy, and bone loss is reconstructed by cranioplasty using acrylic resin or titanium implants. Alternatively, in the management of skull-ossifying fibroma, an image-guided technique using surgical navigation may provide precise information about localization, enabling complete removal, thereby operating with minimal exposure and within narrow resection borders and avoiding significant bone deformity. A 39-year-old male patient with a history of renal cell carcinoma was admitted to our hospital because a radionuclide scintigraphic bone scan revealed increased uptake in a small area located at the left lateral skull bone. The high-resolution computed tomography scan showed that the lesion was located inside the diploe, destroying the inner table of the calvarium. The patient underwent minimally invasive bone lesion removal using an interactive image-guided approach. Complete resection of the neoplastic lesion was achieved. The histopathological examination revealed an ossifying fibroma. The postoperative course was uneventful, and the patient was discharged 3 days after intervention. To date, there has been no evidence of local recurrence. Interactive multimodal planning and intraoperative image guidance offer an interesting approach for biopsy and minimally invasive removal of small ossifying fibroma lesions of the skull, especially in less accessible locations.     

Juvenile ossifying fibroma: a case study

We present the case of an 8-year-old patient with a juvenile ossifying fibroma in the right mandibular angle and a radicular cyst in the left mandibular angle, which produced a major swelling at the level of the mandibular angles and prevented the correct eruption of the lower first molars. After the clinical and radiological (panoramic X-ray and dental scan of the mandible), the corresponding surgical treatment (cystectomy and remodelling) and histopathological study were carried out. Although juvenile ossifying fibroma is an uncommon clinical entity, its aggressive local behaviour and high recurrence rate mean that it is important to make an early diagnosis, apply the appropriate treatment and, especially, follow the patient up over the long term.     

Cemento-ossifying fibroma: a case report.

Cemento-ossifying fibroma is a mesodermal, slow-growing, benign fibro-osseous lesion of the jaws. A case of mandibular molar enlargement that was treated previously by other surgeons and diagnosed as cemento-ossifying fibroma, is presented. Two recurrences occurred 4 and 8 years after surgery due to incomplete surgical removal.