Peripheral odontogenic fibroma

Peripheral odontogenic fibroma (WHO type) is an uncommon lesion of the gingiva; 18 well-documented cases have been published. It is considered to be the extraosseous counterpart of the central odontogenic fibroma. Because of the paucity of reported cases, the full histomorphologic spectrum of this lesion has not yet been established. This article presents nine cases of peripheral odontogenic fibroma that illustrate the variety of its histopathologic findings. The connective tissue ranged from loose (almost myxomatous) to markedly cellular to relatively acellular and well-collagenized. Islands and/or strands of odontogenic epithelium were present in all lesions. Matrix of mineralized material was present in three cases, and juxtaepithelial hyalinization was seen in one case. To avoid the introduction of additional diagnostic terms, we suggest that all these lesions be considered a spectrum of the peripheral odontogenic fibroma (WHO type). We also suggest that the term WHO type be used to distinguish peripheral odontogenic fibromas from the peripheral ossifying fibroma with which they have often been confused.     

Epulides in the dog: a review

This article is based on a review of the literature and the study of pathology sections obtained from various veterinary pathology laboratories. Epulis is a non-specific, clinical designation for a localized, exophytic growth on the gingiva. Four reactive epulides occur in human beings, namely focal fibrous hyperplasia (fibrous epulis). pyogenic granuloma. peripheral giant cell granuloma (giant cell epulis. and peripheral ossifying fibroma (calcifying fibrous epulisl). The first three also occur in dogs but only focal fibrous hyperplasia appears to be common. The peripheral ossifying fibroma has not yet been reported in dogs. Odontogenic tumors occurring on the gingiva (i.e., as epulides) are referred to as peripheral odontogenic tumors. Three types have been reported in dogs. One, the common fibromatous epulis. is equivalent to the rare peripheral odontogenic fibroma in human beings. Another, the acanthomatous epulis. appears to be a form of ameloblastoma but differs from the peripheral ameloblastoma in human beings in that it invades bone; its biological behavior is therefore that of the human intraosseous ameloblastoma. The third, a rare lesion, has been referred to in the veterinary literature as a calcifying epithelial odontogenic tumor, although it is not the canine counterpart of the human CEOT The term, amyloid-producing odontogenic tumor , has been suggested as being appropriate for this lesion.     

Peripheral odontogenic fibroma. Report of 5 cases

The peripheral odontogenic fibroma (WHO type) is a relatively rare, benign, unencapsulated, exophytic gingival mass of fibrous connective tissue. Odontogenic epithelium is found within the gingival mass, but usually appears to play a minor role when compared to the fibrous component. According to the present concept, cases reported in the literature under the terms "odontogenic gingival epithelial harmartoma" "hamartoma of the dental lamina" and "peripheral ameloblastic fibrodentinoma" are actually examples of peripheral odontogenic fibroma. Review of the literature revealed only 30 acceptable cases that fit the present concept of peripheral odontogenic fibroma. Because of the paucity of reported cases, the histomorphological spectrum and the clinical features of this lesion have not yet been fully established. This article presents five new cases of peripheral odontogenic fibroma. The connective tissue ranged from markedly cellular to relatively acellular well collagenized. Islands and strands of epithelium were present in all five cases: in four they were scanty and in one abundant. A matrix of mineralized material was present in four cases. The peripheral odontogenic fibroma must be differentiated histologically from peripheral ossifying fibroma, which is a reactive lesion, and from the peripheral ameloblastoma and the calcifying epithelial odontogenic tumour.     

Central odontogenic fibroma current concepts

The author reviews current knowledge concerning the central odontogenic fibroma, which at present is incompletely understood, and reaches the following conclusions. 1) The separation of this lesion into simple and WHO types remains valid because they exhibit different histologic features. However, more care should be taken in rendering the diagnosis of the WHO type than in the past; unlike the simple type, it is a fibroblastic lesion. 2) Complex central odontogenic fibroma is a more appropriate term than the WHO type because the WHO does not use the latter term in its 1992 manual. 3) The microscopic distinction of simple odontogenic fibroma from desmoplastic fibroma remains difficult in some cases. 4) The granular cell odontogenic tumor, which has sometimes been referred to as a type of odontogenic fibroma, is a separate entity, although some simple odontogenic fibromas exhibit scattered granular cells. 5) The separation of lesions that have been reported recently as odontogenic fibromas with giant cell reactions from central giant cell granulomas that exhibit foci of odontogenic epithelium requires further study.     

Localized gingival enlargement associated with alveolar process expansion: peripheral ossifying fibroma coincident with central odontogenic fibroma

BACKGROUND: Despite the common occurrence of localized gingival enlargements, which often represent reactive lesions, the temporal and spatial association of such a lesion with a central jaw lesion has not been reported. The purpose of this case report is to present the exceptional combination of a peripheral ossifying fibroma and a central odontogenic fibroma. The differential diagnosis and management of each lesion is reviewed. METHODS: A 45-year-old black female presented with a chief complaint of a painless protuberance in the left mandible of 1-year duration. Clinical and radiographic examination revealed a gingival enlargement localized between teeth #21 and #23 and a multilocular radiolucent lesion with radiopaque foci in the same area. Excisional biopsy of the gingival lesion and incisional biopsy of the central lesion were performed, and specimens were submitted for histopathological analysis. RESULTS: Biopsy of the gingival lesion revealed stratified squamous epithelium and highly cellular fibroblastic component presenting central areas of calcification, features consistent with a diagnosis of peripheral ossifying fibroma. The central lesion was characterized by cellular fibrous tissue admixed with rests of odontogenic epithelium and few calcification areas, features consistent with a diagnosis of central odontogenic fibroma/World Health Organization type. Subsequently, the central lesion was enucleated. After 1-year follow-up, no recurrence has been observed. CONCLUSIONS: The combination of a rare central lesion with a common gingival lesion may present unique diagnostic and therapeutic challenges. Clinician awareness regarding the possibility of such a combined presentation and its implications will help to ensure optimal treatment outcomes.     

Recurrent peripheral odontogenic fibroma. Case report

Peripheral odontogenic fibroma (POF), an extraosseous variant of the central odontogenic fibroma, is considered an uncommon benign gingival lesion with a small recurrence rate. Clinically, it mimics a variety of benign neoplasms, metastases and reactive lesions, but it is most commonly confused with the peripheral ossifying fibroma. In this report, we describe a healthy 32-year-old male who was seen with a recurrent POF of the right maxilla. The surgical excision site was repaired using a free palatal graft, leading to a favorable outcome in an esthetic region of the oral cavity.     

Familial ossifying fibromas: report of two cases

Ossifying fibroma is a benign fibro-osseous lesion of the jaw containing varying amounts of calcified deposits such as bone, cementum or both. This type of lesion is referred to as dysplastic or neoplastic in nature. In 2000, a 52-year-old male patient was referred to our clinic complaining of a giant swelling in the mandibular premolar-molar region. A histopathological diagnosis of ossifying fibroma was made. Three months later, his daughter was admitted with a swelling on her mandible. Following biopsy, this patient was also diagnosed as having ossifying fibroma. The present report describes these two cases of familial and multiple ossifying fibromas.     

Central odontogenic fibroma, WHO type. A report of three cases with an unusual associated giant cell reaction.

Three cases of central odontogenic fibroma, WHO type, that exhibited a prominent giant cell granuloma-like histopathologic component are described in this report. All three lesions occurred in women, and all were located in the mandibular premolar-molar region. One lesion recurred after conservative excision, and the recurrence displayed the two histologically distinct tissues of the original lesion. The authors think that this pathologic process does not represent a "collision lesion" but, instead, is a unique presentation of a central odontogenic fibroma, WHO type.     

44例牙源性纤维瘤临床病理分析

目的 研究牙源性纤维瘤的临床病理特点。方法 按世界卫生组织（WHO）1992年牙源性肿瘤分类标准对44例牙源性纤维瘤的临床病理特点及生物学行为进行回顾性研究。结果 本组44例中，女31例，男13例。发病年龄2－70岁，平均29岁。中心型5例，周边型39例。上颌19例，下颌25例。X线及手术中见4例牙槽骨明显破坏。术后有4例复发。组织学上表现为WHO型39例、单纯型4例和牙源性颗粒细胞瘤1例。肿瘤无明显包膜，边界尚清。结论 牙源性纤维瘤不是单一性肿瘤，组织学上表现为WHO型、单纯型和牙源性颗粒细胞瘤。诊断时应与增殖性牙滤泡、粘液瘤等相鉴别。     

Peripheral odontogenic fibroma (WHO type) of the newborn: a case report

AIM: The present paper reports a case of peripheral odontogenic fibroma (POF) (WHO type) in a newborn. The differential diagnosis and treatment were discussed. BACKGROUND: POF is well described in the literature, but this is the first report in a newborn. PATIENT: A 4-month-old female newborn was referred to our department because of an exophytic, sessile, firm, and well-delimited lesion on the right upper alveolar ridge. The covering mucosa was apparently normal. The lesion measuring 10 x 3 mm was present since birth. The clinical diagnosis of congenital granular cell tumour (congenital epulis) or dental lamina cyst of the newborn was made. A conservative excisional biopsy was performed under local anaesthesia, and the specimen was submitted to histopathological examination. RESULTS: The microscopic examination revealed a pattern of POF (WHO type). Normal primary incisors teeth eruption, and no signs of recurrence were noted on 16 months follow-up. CONCLUSION: Despite the rarity of POF in a newborn, this lesion should be included as a possible diagnosis to focal gingival growth.     

Massive expansile ossifying fibroma of the mandible with osteomyelitis

An ossifying fibroma is a benign odontogenic tumor of mesenchymal origin that belongs to the spectrum of fibro-osseous lesions afflicting the craniofacial complex. Although benign, it can be potentially aggressive, reaching very large sizes. The authors report a rare case of an aggressive ossifying fibroma in the mandible of a 30-year-old male patient that reached gigantic proportions with superimposed osteomyelitis, mimicking a malignancy. Differentiation of ossifying fibroma from other fibro-osseous lesions and benign and malignant neoplasms is important for the correct management of this lesion. Proper radiological evaluation and interpretation aids for arriving at a definitive diagnosis are required. The paper also highlights the radiological features of this entity.     

Trabecular juvenile ossifying fibroma with aneurysmal bone cyst: a rare presentation

Juvenile ossifying fibroma is an uncommon, benign, bone-forming neoplasm that is distinguished from other fibro-osseous lesions primarily by its age of onset, clinical presentation, and potential behavior. It mainly occurs in juveniles and has a slight male predilection and more aggressive behavior than a common ossifying fibroma. There are 2 distinct histopathological variants of this lesion: (1) psammomatoid pattern and (2) trabecular pattern. An aneurysmal bone cyst may occur in association with other bone lesions, such as fibrous dysplasia, ossifying fibroma, and giant cell lesion. The clinical management and prognosis of juvenile ossifying fibroma is somewhat uncertain, and this tumor has high rates of recurrence. Such behavior may be related to younger patient age and the concurrent development of aneurysmal bone cyst. The purpose of this paper was to report a case of trabecular juvenile ossifying fibroma in a 9-year-old girl associated with an aneurysmal bone cyst, presenting an aggressive behavior, and causing significant facial asymmetry.     

周边型牙源性纤维瘤35例临床病理研究

目的 :总结周边型牙源性纤维瘤的临床病理特点。方法 :按WHO(1992 )牙源性肿瘤分类标准对 35例周边型牙源性纤维瘤的临床病理资料进行回顾性分析。结果 :35例中 ,男性 14例 ,女性 2 1例 ;平均年龄 31岁 ;上颌牙龈 14例 ,下颌牙龈 2 0例。肿块为局部软组织突出表现。X线片和手术中见五例牙槽骨有吸收改变。三例术后复发。组织学上 ,肿瘤由致密结缔组织组成 ,含数量不等的成纤维细胞 ,一例伴有颗粒细胞。肿瘤边界尚清 ,缺少明显包膜。结论 :周边型牙源性纤维瘤临床表现与龈瘤不能区分 ,组织学主要为WHO型牙源性纤维瘤 ,手术切除不彻底易复发。     

Peripheral ossifying fibroma in the maxillary arch

Many types of localized reactive lesions may occur on the gingiva, including focal fibrous hyperplasia, pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying fibroma. Peripheral ossifying fibroma is a gingival growth, usually arising from interdental papilla and represents up to 2% of all lesions that are biopsied. Other terms used to describe this lesion include peripheral cementifying fibroma, peripheral fibroma with cementogenesis, peripheral fibroma with osteogenesis, peripheral fibroma with calcification, calcified or ossified fibrous epulis and calcified fibroblastic granuloma. This article reports a case of a 10 year old male child with an unusually large peripheral ossifying fibroma in the left maxillary alveolar ridge which showed recurrence after the surgical treatment.     

Cellular proliferation markers in peripheral and central fibromas: a comparative study

Objective:

To perform a comparative study of the cellular proliferation in the peripheral and central fibromas.

Material and Methods:

Immunohistochemistry for PCNA and the AgNOR technique were performed in 9 cases of peripheral odontogenic fibroma (POF), in 4 cases of odontogenic fibroma (OdF), in 8 cases of peripheral ossifying fibroma (PEOF) and 7 cases of ossifying fibroma (OsF). The Kruskal-Wallis and Mann-Whitney tests were used for the statistical analyses.

Results:

Mesenchymal component of the central lesions presented a higher mean number of AgNOR per nucleus and PCNA index than did the peripheral lesions (P≤0.05). The mean number of AgNOR per nucleus in the epithelial component proved to be higher in the OdF than in the POF (P≤0.05). The mesenchymal and epithelial components presented similar mean numbers of AgNOR per nucleus and PCNA index in the OdF, as well as a similar mean number of AgNOR per nucleus in the POF.

Conclusions:

The mesenchymal component may well play a role in the differences between the biological behaviour of the central lesions as compared to the peripheral lesions. Moreover, considering that the epithelial and mesenchymal components in odontogenic fibromas presented a similar proliferation index, more research is warranted to understand the true role of the epithelial components, which are believed to be inactive in nature, as well as in the development and biological behaviour of these lesions.     

Peripheral ameloblastic fibroma of the maxilla: report of a case and review of the literature

Peripheral odontogenic lesions are considered to be rare within the classification of odontogenic tumors. Also referred to as extraosseous or soft tissue odontogenic tumors, peripheral odontogenic tumors share the same histopathologic characteristics of their central or intraosseous counterparts. Ameloblastic fibroma is a rare odontogenic tumor that arises from both odontogenic epithelium and connective tissue. Only 2 cases of peripheral ameloblastic fibroma have been reported in the English-language literature, one of which did not show the classic features of an ameloblastic fibroma. In this report, we describe a rare case of a peripheral ameloblastic fibroma in the maxilla of a 3-year-old girl.     

Mandibular mass in pediatric patient: A diagnostic dilemma

A case of aggressive Juvenile ossifying fibroma in a child has been discussed. The unique appearance of this particular lesion demonstrates a close relationship between aggressive ossifying fibroma and well-differentiated osteogenic sarcoma. The age of the patient and the location of the tumor in the case presented made it mandatory to utilize multiple diagnostic parameters and adjunctive diagnostic help to resolve the dilemma posed by this tumor. Differentiation of ossifying fibroma from other benign and malignant neoplasms as well as fibrous dysplasia is important in correct management of the lesion.     

Adenomatoid odontogenic tumour (adenoameloblastoma).

Two cases of adenomatoid odontogenic tumour affecting the jaws of two young Nigerian Africans are described. One was diagnosed clinically as a cyst, the other as an ossifying fibroma, but their true nature was later unmasked by histopathological studies. Although considered rare, the adenomatoid odontogenic tumour should be borne in mind in the differential diagnosis of radiolucent lesions of the jaws since an incorrect diagnosis may lead to mutilating surgery whereas the lesion is amenable to a conservative surgical approach. It is also important to examine histologically all excised specimens from the jaws even in the so-called 'obvious cases.     

Cemento ossifying fibroma.

Cemento ossifying fibroma is a benign, non odontogenic tumour of the jaw, a subdivision of fibro-osseous lesions. The age of occurrence is between 20 and 40 years. It has a female to male predilection of 2:1. A rare case of cemento ossifying fibroma involving maxilla and mandible in a 30 years old female is presented with a discussion on its clinical and radiographical features, computed tomograph scan findings, histopathological presentation with a review of literature.     

Odontogenic fibroma like lesions: Clinico-pathological considerations

Radiographically enlarged dental follicle is observed in many cases associated with delayed tooth eruption. Pericoronal radiolucencies are seen in neoplasms (odontogenic fibroma), developmental anomalies (regional odontodysplasia), hamartomatous lesions (odontogenic epithelial hamartoma), opercula of third molars, in follicles associated with unerupted third molars, regional odontodysplasia, in dental follicles around impacted teeth of enamel dysplasia with hypodontia syndrome and amelogenesis imperfecta cases with multiple impactions. Interestingly, operculum and the follicle of these lesions histopathologically are identical to odontogenic fibroma (WHO) type. However, the lack of universally accepted clinic-pathological features for such lesions may hinder their recognition. We report a case of regional odontodysplasia wherein (in which) the impacted canine is surrounded by radiolucency measuring about 1.5–2 cm, histopathologic examination of the excised opercula revealed features reminiscent of central odontogenic fibroma (WHO type) with an abundance of odontogenic epithelium and calcifications. The aim of this paper is to discuss various lesions exhibiting histopathological features similar to odontogenic fibroma, as awareness of the clinicopathological features of such lesions is very important to plan proper treatment.