Paranasal ossifying fibroma: endoscopic resection or wait and scan?

The ossifying fibroma is a fibro-osseous lesion that rarely occurs in the paranasal sinuses. Due to its tendency to behave locally aggressively, complete resection is generally recommended. A subdivision into the aggressive juvenile ossifying fibroma (JOF) and the less aggressive cemento-ossifying fibroma of the adult (COF) is clinically reasonable. The objective of the study was to retrospectively analyze the management and follow-up of the patients diagnosed with ossifying fibroma at our ENT-department from 2006 to 2010. A total of five patients were included, thereby comprising one of the largest case series of paranasal ossifying fibromas. In three patients an exclusively endoscopically controlled resection was performed. Two patients with asymptomatic COF declined surgery. Within the 2-year follow-up, no progression was detected. While the JOF should always be surgically treated, for the asymptomatic paranasal ossifying fibroma of the adult (COF) a wait-and-scan strategy, similar to that recommended for osteomas or fibrous dysplasia, could be an option in selected cases.     

A huge chondromyxoid fibroma of the nasal cavity in a newborn baby

Chondromyxoid fibroma is a rare benign tumor that usually occurs in the long bones. A 2-month newborn presented with huge masses in the both nasal cavities, which turned out to be chondromyxoid fibroma. The masses originated from both inferior turbinates. Total turbinectomy on the left side and submucosal mass excision on the right side were performed. No recurrence or new lesion was observed during the 2 years of follow up. We report here on a rare case of nasal cavity chondromyxoid fibroma in a neonate and we review the relevant literature.     

Cemented fibroma of the maxillary sinus

Cementifying fibroma is a benign fibro-osseous lesion with dental origin. We describe a case of cementifying fibroma of the maxillary sinus, an unusual location for this tumor.     

鼻腔鼻窦骨化纤维瘤的螺旋CT诊断

目的探讨螺旋CT在鼻腔鼻窦骨化纤维瘤的诊断价值。方法回顾性研究本院行手术治疗并经病理确诊的鼻腔鼻窦骨化纤维瘤患者24例,分析其临床资料及螺旋CT影像学特征,探讨螺旋CT诊断程序。结果侵犯单个鼻窦的肿瘤12例,包括筛窦8例,上颌窦4例;其中6例伴有鼻腔侵犯。病变同时侵犯多个鼻窦和鼻腔者12例,包括上颌窦和筛实8例,筛窦和额窦4例。肿瘤的CT表现为鼻腔／鼻窦内单发类圆形或不规则形高密度肿块,部分区域可见低密度影,其周边显示完整的骨性包壳,呈膨胀性生长,周围组织受压变形但界限清晰。结论螺旋CT扫描是诊断鼻腔鼻炎骨化纤维瘤最常用和最有价值的影像学检查手段。     

Ossifying fibroma of the head and neck: Involvement of the temporal bone — an unusual and challenging site

Ossifying fibroma of the head and neck is most commonly described in the mandible and maxilla. A few isolated reports in the literature exhibit the rare existence of this lesion in the nasal bones, orbit, ethmoid sinus, sphenoid sinus, occiput, and in only two well-documented cases, the temporal bone. We present the case of an extensive ossifying fibroma of the temporal bone that presented as a suspected case of hypertosis of the external auditory canal and conductive hearing loss, without any cosmetic deformity. A review of the recent literature concerning the sites, radiologic presentation, difficulty of pathologic differentiation, and modality of therapy is discussed.     

Fibro-osseous lesions of the cranio-facial bones.

A brief review of cranio-facial fibro-osseous lesions is given and 15 cases of fibrous dysplasia and ossifying fibroma are presented with clinical, radiological and histomorphological findings. After histological verification of the fibro-osseous nature of the process, 5 lesions were diagnosed on an radiological basis as fibrous dysplasia exhibiting diffuse (blending) margins, while the diagnosis of ossifying fibroma was given to 10 radiologically sharply-demarcated lesions. Both groups of lesions presented the same histomorphological features, although to a varying degree. Spheroidal calcifications, however, were identified in ossifying fibroma only, but not in all of these. Thus, the differential diagnosis of fibrous dysplasia versus ossifying fibroma rests on a radiological criterion after the histopathologist has verified the fibro-osseous nature of a lesion. The observation times varied from 1 1/2 to 34 years. Two cases of fibrous dysplasia and 3 cases of ossifying fibroma recurred. In one case of fibrous dysplasia an osteosarcoma developed 33 years after irradiation. Pain was a common symptom in the present material.     

上颌骨成釉细胞纤维瘤1例

患者,女,22岁,以“右面部肿胀2个月”为主诉于2012年6月21日入院。专科查体：右侧面部膨隆,右上颌前庭沟膨隆,右侧硬腭膨隆（图1）,压痛（-）,上颌牙齿列齐,无缺损,无活动,无张口受限,眼球活动及视力正常,双侧鼻腔通畅。     

Alveolar pyogenic granuloma: review and report of a case

A large exophytic bone-resorbing lesion was discovered in the oral cavity of an institutionalized 33-year-old male. An excisional biopsy under general anesthesia was performed. Frozen and permanent histologic sections confirmed a reactive gingival fibroma consistent with a pyogenic granuloma. This lesion is unusual in that it attained a very large size and caused marked remodeling of the alveolar bone of the mandible. Of interest as well, this highly vascular lesion was found to have numerous feeding vessels from the alveolar bone. A retained tooth root was encountered within the lesion, presumably the etiologic factor producing this lesion. A differential diagnosis is presented and discussed. The lesion should be of particular interest to otolaryngologists who deal with intraoral lesions and their treatment, since it illustrates an extreme presentation of a totally benign process.     

Fibrous dysplasia and ossifying fibroma of the paranasal sinuses

Fibro-osseous lesions involving the paranasal sinuses, the mid-face and anterior skull base are uncommon. In addition, there appears to be no clear pathological or clinical classification that embraces the variety of lesions that exhibit such diverse pathological and clinical behaviour, yet may still be referred to as a fibro-osseous lesion. The diagnosis of fibrous dysplasia and ossifying fibroma is made on a combination of clinical, radiological and pathological criteria. This paper emphasizes the clinical and pathological differences between fibrous dysplasia and ossifying fibroma. The more aggressive clinical behaviour of the latter is highlighted and a more radical surgical approach is recommended. In contradistinction, fibrous dysplasia can exhibit a more benign behaviour and radical surgery is not always justified. A clinicopathological distinction between these two conditions is important from a management perspective despite the fact that they both may be encompassed under the 'umbrella' term fibro-osseous lesion.     

Congenital idiopathic gingival hyperplasia observed in a 6-year-old child

Congenital diffuse gingival hyperplasia is a rare entity. A case is presented for the first time in Senegal, the etiology of the affection being undetermined. The various pathogenic hypotheses for this lesion include: diffuse gingival fibroma, congenital, hereditary or idiopathic gingival fibromatosis, familial gingival elephantiasis and idiopathic or hereditary gingival hyperplasia.     

Chondromyxoid fibroma of the mastoid facial nerve canal mimicking a facial nerve schwannoma

Chondromyxoid fibroma of the skull base is a rare entity. Involvement of the temporal bone is particularly rare. We present an unusual case of progressive facial nerve paralysis with imaging and clinical findings most suggestive of a facial nerve schwannoma. The lesion was tubular in appearance, expanded the mastoid facial nerve canal, protruded out of the stylomastoid foramen, and enhanced homogeneously. The only unusual imaging feature was minor calcification within the tumor. Surgery revealed an irregular, cystic lesion. Pathology diagnosed a chondromyxoid fibroma involving the mastoid portion of the facial nerve canal, destroying the facial nerve. Laryngoscope, 2009     

Calcifying (juvenile) aponeurotic fibroma of the scalp

Calcifying aponeurotic fibroma is a benign tumor with a predilection for distal parts of the extremities; it is very rare in the head and neck region. It commonly affects young patients-hence the term juvenile in the name. It is fibroblastic in origin and considered a cartilage analogue of fibromatosis, but its exact etiology remains unknown. Clinically, this tumor needs to be differentiated from fibromatosis, nodular fasciitis, chondroma, schwannoma, and rheumatoid nodule. A 24-year-old woman presented with swelling in the forehead for the previous 6 months. Wide surgical excision of the lesion was performed, and histopathologic examination revealed a calcifying aponeurotic fibroma. We reviewed the literature on this rare clinical entity and present our hypothesis on its etiology.     

Chondromyxoid fibroma of the nasal bone with extension into the frontal and ethmoidal sinuses: report of one case and a review of the literature

Chondromyxoid fibroma is a rare benign tumor that usually occurs in the long bones. A 50-year-old patient presented with chondromyxoid fibroma of the nasal bone with extension into the frontal and ethmoidal sinuses. This is the fourth case reported to date in the literature. The clinical manifestations of the tumor were very limited, and the appearance at rhinoscopy was misleading. Radiologic imaging showed a soft tissue lesion invading the adjacent bony structures and the dura mater. Surgery was performed by a combined team of otorhinolaryngologists and neurosurgeons, and total excision of the tumor was achieved. The histologic diagnosis of this tumor is difficult because of its similarities to chondrosarcoma. [Editorial comment: The authors concisely review management of this rare tumor, emphasizing that complete surgical excision, rather than curettage, is required for long term control.]     

A case of isolated ossifying fibroma of the mastoid cavity of the temporal bones

OBJECTIVES: To describe an isolated ossifying fibroma of the mastoid cavity that did not invade the inner ear and middle ear cavity. STUDY DESIGN: Case report. SETTING: Department of Otolaryngology, College of Medicine, Pusan National University, a tertiary care center in Busan, South Korea. PATIENTS AND INTERVENTION: A 34-year-old woman had an episode of acute right ear otalgia. A computed tomography scan and magnetic resonance imaging scan showed a well-circumscribed, lobulated, 3 x 3 x 3-cm sized tumor mass that was localized to the temporal bone with bony erosion including tegmen mastoid and partial bony destruction and no invasion of the middle and inner ear. A large tumor mass was removed through a simple mastoidectomy. The permanent pathological report confirmed the diagnosis of ossifying fibroma. The patient returned with complaints of recurring right otalgia, 3 years postsurgery. The previous mastoidectomy cavity was filled with a red sandpaperlike lesion; a 3 x 2-cm sized bony defect was also found,and the dura was exposed after removing the eroded tegmen mastoid. Permanent pathological diagnosis was again an ossifying fibroma,and there were no postoperative complications. CONCLUSION: To prevent clinically evident recurrences and potentially life-threatening complications, early complete resection is advised in aggressive and recurring ossifying fibroma involving the temporal bone. Close long-term postoperative follow-up with physical examinations and temporal bone computed tomography will offer the greatest chance of early detection of recurrence.     

Isolated cementoossifying fibroma of the ethmoid bulla: a case report

Cementoossifying fibroma is a rare nonodontogenic tumor of the periodontal membrane that arises from the mesodermal germ layer. This nonneoplastic, locally destructive tumor has occurred as an osseous lesion in the mandible, the maxilla, the zygoma, all the paranasal sinuses, and the orbital and petromastoid regions. It has occurred as an extraosseous lesion in the gingiva and the auricle. The diagnosis requires correlating a variety of clinical, radiologic, and histologic factors. The recurrence rate is high, particularly for lesions in the paranasal sinuses. Surgical management via a local excision as wide as possible is suggested. We describe the case of a 32-year-old woman with an isolated cementoossifying fibroma of the right ethmoid bulla, and we review the diagnosis, differential diagnosis, and management of this tumor     

Aggressive cementifying fibroma of the maxilla

The cementifying fibroma is a benign fibro-osseous lesion. Its usual location is in the mandible while rare sites of involvement have been the maxilla and ectopic locations. These tumors are generally believed to originate from the connective tissue of the periodontal ligament. Clinically, lesions are usually asymptomatic, slow-growing, and well-circumscribed. However, in very few cases, particularly in younger patients, these tumors have demonstrated and apparent aggressive course of development. We describe a case of an aggressive cementifying fibroma of the maxilla in a middle-aged male. The pathogenesis of the tumor is discussed, and the need for appropriate surgical management is emphasized.     

Aggressive cementifying fibroma of the maxilla

Summary The cementifying fibroma is a benign fibro-osseous lesion. Its usual location is in the mandible while rare sites of involvement have been the maxilla and ectopic locations. These tumors are generally believed to originate from the connective tissue of the periodontal ligament. Clinically, lesions are usually asymptomatic, slow-growing, and well-circumscribed. However, in very few cases, particularly in younger patients, these tumors have demonstrated and apparent aggressive course of development. We describe a case of an aggressive cementifying fibroma of the maxilla in a middle-aged male. The pathogenesis of the tumor is discussed, and the need for appropriate surgical management is emphasized.     

Endoscope assisted removal of cementoossifying fibroma in the paranasal sinuses in a five-year-old girl

We report a five-year-old girl with a sinonasal cementoossifying fibroma with CT findings that reveal the invasion of all paranasal sinuses and the remodeling of facial bones. It was possibly a congenital lesion and caused a slowly progressive nasal obstruction and anosmia. Tumor removal with transnasal endoscopic approach was applied and total removal of the mass was accomplished. It was found out to be the cementoossifying fibroma of the paranasal sinuses when the results of the pathological examinations were obtained.     

累及鼻颅底区域鼻腔鼻窦骨源性良性肿瘤的鼻内镜手术治疗

目的 探讨包括骨瘤、骨化纤维瘤、骨纤维异常增殖症在内的累及鼻颅底区域鼻腔鼻窦骨源性良性肿瘤鼻内镜手术治疗策略。 方法 经鼻内镜治疗鼻腔鼻窦骨源性良性肿瘤140例,包括骨瘤116 例,骨化纤维瘤14例,骨纤维异常增殖10例。手术方式包括:单纯鼻内镜手术95例,影像导航辅助鼻内镜手术24例,鼻内镜联合鼻外入路21例。 结果 患者均顺利完成手术,未发生严重并发症。骨瘤均彻底切除。骨化纤维瘤12例得到彻底切除,2例有病变残留。骨纤维异常增殖症10例采取姑息性手术,术后面部外观得以恢复,病变对周围组织地压迫症状得以缓解。术后随访6~36个月,骨瘤术后无复发,骨化纤维瘤术后复发2例,骨纤维异常增殖症1例术后视力无改善,其余患者症状得到不同程度的缓解。 结论 骨瘤、骨化纤维瘤及骨纤维异常增殖是鼻窦常见的良性纤维骨性病变。三者临床症状相似。高分辨率CT和(或)MRI是早期诊断的重要手段。影像导航引导鼻内镜并必要时联合鼻外入路手术是治疗该类疾病的有效方法。手术时机及手术方式的选择应依据病变类型、患者症状、肿瘤位置及范围综合考虑。     

Nuchal fibroma: a clinicopathological review

Nuchal fibroma, or collagenosis nuchae, is a benign soft tissue tumor that arises from the posterior cervical subcutaneous tissue, with a predilection for the interscapular and paraspinal regions. Because of its benign clinical course and its close histopathologic similarity to other benign head and neck lesions, this lesion may be misdiagnosed and underreported. The purpose of this paper is to review the histopathologic and radiologic findings unique to nuchal fibroma, and compare and contrast it to the other soft tissue neoplasms within the clinical differential diagnosis. These include several benign (elastofibroma, lipoma, fibrolipoma, nodular fasciitis) and rare malignant entities (fibrosarcoma, liposarcoma, fibromatosis).