CEMENTO-OSSIFYING FIBROMA MIMICKING A CENTRAL GIANT CELL LESION

Abstract

<h3>BACKGROUND</h3> Many disease processes are capable of producing an anterior mandibular swelling in young patients. Two pathologic entities with this presentation are the central giant cell lesion and the cemento-ossifying fibroma. Despite their vastly different histopathologic appearances, the radiographic features of these 2 entities may overlap, making radiologic interpretation between them challenging. <h3>CASE REPORT</h3> A 15-year-old male patient presented to the Faculty of Dentistry, University of Toronto for evaluation of a painless, slowly enlarging bony swelling of the anterior mandible. The patient recently completed orthodontic treatment that included multiple surgical procedures for exposure and orthodontic traction of a deeply impacted left mandibular canine (tooth #22). Clinical examination revealed a bony-hard 5-cm-diameter lobulated swelling of the buccal and lingual mandible extending from teeth #21 to #23. Tooth #22 was fully erupted but labially displaced and detached from the bonded lingual retainer. Intraoral and cone beam computed tomography imaging demonstrated an expansile, well-defined, corticated, mixed low- and high-attenuation entity with both scattered high-attenuation granular foci and striations internally, some of which emanated at right angles from the cortex. Regions of cortical perforation, displacement, and tipping of the adjacent dentition and irregular root resorption were also observed. <h3>DISCUSSION/CONCLUSIONS</h3> The radiologic interpretation was that of a benign bone-containing entity, and the appearance was suggestive of a central giant cell lesion or a cemento-ossifying fibroma. Incisional biopsy revealed a cemento-ossifying fibroma. Complete excision was recommended. The radiologic features of this case are presented to compare and contrast features of central giant cell lesions and cemento-ossifying fibroma in young patients.