Juvenile ossifying fibroma: an analysis of clinico-pathological features in a case series with a literature review

H G Ruwandi N Weerasinghe,Primali R Jayasooriya,Pubudu C Wijesuriya

doi:10.4038/jdp.v11i2.7705

H G Ruwandi N Weerasinghe, Primali R Jayasooriya + Show 1 more

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https://doi.org/10.4038/jdp.v11i2.7705

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Abstract

Juvenile Aggressive Ossifying Fibroma (JAOF) is divided into two entities namely Juvenile Psammomatoid Ossifying Fibroma (JPOF) and Juvenile Trabecular Ossifying Fibroma (JTOF). JAOFs are aggressive but benign tumours that require clinico-pathological correlation to arrive at the definitive diagnosis. We report nine new cases of JPOF and 6 cases of JTOF with a brief review of the literature to aid correct diagnosis of these two different entities. According to the clinico-pathological analysis both JPOF and JTOF had occurred in children and adults, with a mean age of 28.6 years and 21 years at presentation respectively. JPOF showed a male predilection while equal gender distribution was observed in JTOF. Both tumours occurred most often in the mandible. Regarding the histopathological features all tumours were unencapsulated. All cases of JPOF showed presence of psammoma bodies which can be considered as a main diagnostic feature. JTOF showed osteoid and immature woven bone trabeculae. Osteoblastic rimming was commonly observed among JTOF but absent in JPOF. Other histopathological features did not show any striking difference between the two lesions. In conclusion, the term “Juvenile aggressive ossifying fibroma” is a misnomer as it can occur in adults as well. Therefore, the word “Juvenile” should be excluded when renaming the tumour which is a “need of the hour”. Further, the study demonstrates the use of demographic, radiological and histopathological features with clinico-pathological correlation to diagnose and exclude mimics of JPOF and JTOF.

Highlights

The term Juvenile Aggressive Ossifying Fibroma (JAOF) describes two distinct histopathological entities of ossifying fibromas known as Juvenile Psammomatoid Ossifying
Juvenile Psammomatoid Ossifying Fibroma (JPOF) has been reported under many names, including juvenile active ossifying fibroma by Johnson et al in 1952, psammomatous desmoosteoblastoma by Makek and juvenile psammomatoid cemento ossifying fibroma which was used in the 2005 World Health Organization classification of odontogenic tumors [2]
When the current and initial diagnoses were compared a single case with the current diagnosis of conventional cemento-ossifying fibroma was excluded from the study, resulting in a study sample of 15 cases of JAOF

Summary

Introduction

The term Juvenile Aggressive Ossifying Fibroma (JAOF) describes two distinct histopathological entities of ossifying fibromas known as Juvenile Psammomatoid OssifyingFibroma (JPOF) and Juvenile Trabecular Ossifying Fibroma (JTOF).JPOF was first reported by Benjamins, in 1938, under the term “osteoid fibroma withWeerasinghe et al.atypical ossification” of the frontal sinus [1]. The term Juvenile Aggressive Ossifying Fibroma (JAOF) describes two distinct histopathological entities of ossifying fibromas known as Juvenile Psammomatoid Ossifying. Fibroma (JPOF) and Juvenile Trabecular Ossifying Fibroma (JTOF). JPOF was first reported by Benjamins, in 1938, under the term “osteoid fibroma with. Gogl described it in 1949 as psammomatoid fibroma of the nose and paranasal sinuses. JPOF has been reported under many names, including juvenile active ossifying fibroma by Johnson et al in 1952, psammomatous desmoosteoblastoma by Makek and juvenile psammomatoid cemento ossifying fibroma which was used in the 2005 World Health Organization classification of odontogenic tumors [2]. JPOF is commonly seen in children and young adults with predilection for paranasal sinuses, orbit and fronto-ethmoidal complex (1 – 16). Histopathology shows dense cellular fibrous stroma with characteristic spheroid calcifications called psammoma bodies [2,15,17]

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