Benign Fibro-osseous Lesion Research Articles

Evaluation and histological maturation characteristics of fibrous dysplasia and ossifying fibroma: a case series

Fibrous dysplasia (FD) and ossifying fibroma (OF) are benign fibro-osseous lesions (FOLS) that are generally considered to be separate entities distinguishable by histologic and radiographic features. The histological maturation of these lesions involves an initial fibrous state, an intermediate mixed and a final mineralised stage. To correlate the mineralisation of OF and FD with the duration of the lesion. A retrospective histopathological analysis of archival material including sixteen cases documented over a three-year period was performed to distinguish FD from OF. The relevant data of FOLs diagnosed as OF and FD were retrieved from the archival records of the Departments of Oral Surgery/Oral Pathology and Histopathology/Morbid Anatomy, Muhimbili University of Health and Allied Sciences. Remarkably, in this series, none of the FD and OF lesions occurred in patients aged below 10 or over 50 years. The histopathological comparison of the various non-mineralised components in both the lesions in relation to lesion age-maturity was not statistically significant (P>0.05). The histopathological ratio of the mineralised to non-mineralised components may not be directly indicative of the maturity of both OF and FD.

Fibro-osseous lesion of maxilla. Report of two cases in a family with review of literature

Fibrous dysplasia is a disturbance of bone metabolism that is classified as a benign fibro-osseous lesion. Fibrous connective tissue containing abnormal bone, replaces normal bone. The etiology of fibrous dysplasia is unknown. The radiographic appearance of the irregularly shaped trabeculae aids in the differential diagnosis. Occurring most commonly in the second decade of life, the lesions of fibrous dysplasia can be surgically recontoured for esthetic or functional purposes once they become dormant.

"Hybrid" lesion of the maxilla

Juvenile ossifying fibroma is an uncommon benign but aggressive fibroosseous lesion that affects the craniofacial skeleton. Their distinct clinical and histopathological features warrant the lesion to be considered as a separate entity from other fibro-osseous group of lesions such as fibrous dysplasia and cemento ossifying fibroma. Concomitant development of secondary aneurysmal bone cyst may rarely occur, which makes the lesion more aggressive and difficult to treat. We report a case of a 6 year old girl who was diagnosed with aneurysmal bone cyst during her earlier presentation at a private hospital and was treated for the same. The lesion recurred within 6 months. The second incisional biopsy specimen revealed features of trabecular variant of juvenile ossifying fibroma along with areas of aneurysmal bone cyst.

Fibrous Dysplasia and Ossifying Fibroma-an advent in their diagnosis

Objectives: Fibro-osseous lesions of the craniofacial complex comprise of a diverse, interesting and challenging group of conditions that pose difficulties in classification and treatment. The two most confused benign fibro-osseous lesions are fibrous dysplasia and ossifying fibroma. Sometimes, the classic clinical, radiologic or pathologic features of fibrous dysplasia or ossifying fibroma may not be evident, but overlapping features of both may be seen. The dilemma in diagnosis of these lesions rests in the bony trabeculae as well as in the fibrous stroma. Cases of fibrous dysplasia showing lamellated bony trabeculae and osteoblastic rimming have been reported which may confound diagnosis because of resemblance with ossifying fibroma. In the present study, an attempt has been made to demonstrate the fibrous element of these two lesions using histochemical stains. Study design: The sections of fibrous dysplasia & ossifying fibroma were stained with Haematoxylin and Eosin, Trichrome stain and Peracetic acid-aldehyde fuschin-modified Halmi stain. Result: The study revealed that the oxytalan fibers were more numerous in ossifying fibroma (seen with both Trichrome and modified Halmi stains). Conclusion: Although the ultimate diagnosis of fibrous dysplasia and ossifying fibroma is arrived at by correlating clinical, radiographic and routine histopathologic examination, the differences in the configuration of the stroma using histochemical stains may help in the diagnosis of these two lesions.

Desmoplastic ameloblastoma: a report of two clinical cases

Desmoplastic ameloblastoma is a relatively rare histological variant of ameloblastoma with specific clinical, radiological, and histological features. Although radiographic examination of ameloblastomas usually reveals unilocular or multilocular radiolucency, desmoplastic ameloblastoma may appear as a mixed radiopaque-radiolucent lesion resembling benign fibro-osseous lesions. Histologically, desmoplastic ameloblastoma is characterized by small nests and strands of compressed odontogenic epithelium supported by pronounced collagenized stroma. This report describes two cases of desmoplastic ameloblastoma in the anterior maxilla of a female patient and the anterior mandible of a male patient, mimicking clinically as an odontogenic cyst.

Well-differentiated Osteosarcoma of the Jaw Bones

Well-differentiated osteosarcoma of the jaw bones is rare, and is often confused with a variety of benign fibroosseous lesions. To better understand its clinicopathologic features, we reviewed our experience with 15 cases. The patients included 7 males and 8 females (age range 14 to 66 y; mean 42.8 y). Six of the tumors arose in the mandible, and 9 in the maxilla. Microscopically, the tumors were infiltrative, relatively hypocellular, and consisted of monomorphic, minimally atypical spindle cells that were usually arranged in fascicles. The tumor cells were intimately related to the surfaces of elongated trabeculae of neoplastic woven bone that lacked osteoblastic rimming. Nine patients were treated with wide excision, 2 patients with marginal excision, and 2 patients with excision and radiation therapy. After definitive therapy, there were no reports of recurrence or metastasis over an average follow-up of 34 months (range 1 to 80 mo). Well-differentiated gnathic osteosarcoma is a low-grade malignancy that may be successfully treated with wide local excision. The prognosis in our series was excellent.

Four Cases of Ossifying Fibromas: A Rural Medical College Hospital Experience

ABSTRACT Background Ossifying fibroma is an uncommon tumor of the craniofacial skeleton presenting in several variant histopathological subtypes. Ossifying fibroma is a benign fibro-osseous lesion that commonly involves the maxilla.1 Ossifying fibromas occur predominantly in women, frequently during the 3rd and 4th decades of life.1 The overlapping clinical and histopathological features of these subtypes have led to diagnostic dilemma and confusion.1 Complete excision of this tumor has become a necessity since it is notorious for recurrence.1 Aims To study and compare the clinical profiles of various types of ossifying fibroma and also the surgical approaches to the tumor. To discuss the diagnostic difficulties and controversies associated with the tumor. Setting Medical college referral hospital. Design Case reports of 4 patients presenting to our medical college OPD. Methods Planned surgical excision based on criteria. Results Four cases of different types of ossifying fibroma were successfully treated by various surgical approaches. 42 papers related to diagnostic and treatment aspects of ossifying fibroma were studied. Conclusion The diagnostic dilemma of ossifying fibroma can be overcome with a combination of clinical, radiological and pathological criteria. Complete surgical excision of the tumor is possible when surgery is based on preplanned criteria. Combination of 2 or more surgical approaches may be necessary in many cases in order to ensure complete clearance and prevent recurrence of the tumor.

Sclerosing odontogenic carcinoma with benign fibro-osseous lesion of the mandible: An extremely rare case report

A case of sclerosing odontogenic carcinoma (SOC) admixed with a benign fibro-osseous lesion (BFOL) is reported herein. A 67-year-old male had paresthesia in the mental region. Computed tomography detected an intragnathic mass that was focally expansile with disappearance of cortical bone, and contained admixed radiolucency and radio-opacity. Under the pathological diagnosis as benign fibro-osseous lesion, it was surgically removed by curettage. Microscopic analysis showed that a few parts of the resected materials contained dispersed thin cords and small nests of epithelial cells accompanied by fibrous stroma. Cellular atypia and mitotic figures were not evident. The diagnosis of BFOL with hyperplastic and metaplastic odontogenic epithelia was ultimately made. Eight months after the operation, the lesion recurred and segmental mandibulectomy was carried out. Histologically, the lesion was predominantly occupied by the fibro-osseous component with irregular-shaped foci of epithelial component. The epithelial component exhibited mostly thin cord or small nest patterns and showed definite perineural infiltration. Immunohistochemically, the epithelial cells were positive for p63, cytokeratin (CK) 6 and CK19, and focally positive for CK7 but negative for vimentin. MIB-1 positive nuclei were inconspicuous. To the best of our knowledge, this report is the first case of SOC with BFOL.

Bilateral fibrous dysplasia of the mandible in a 7-year-old male patient-A rare case

Fibrous dysplasia is a disturbance of bone metabolism that is classified as a benign fibro-osseous lesion. Fibrous connective tissue, containing abnormal bone, replaces normal bone. The etiology of fibrous dysplasia is unknown. The radiographic appearance of the irregularly shaped trabeculae aids in the differential diagnosis. Occurring most commonly in the second decade of life, the lesions of fibrous dysplasia can be surgically recontoured for esthetic or functional purposes once they become dormant. Here, we report a case of bilateral fibrous dysplasia in a 7 year old male patient and its diagnostic work-up.

Diagnostic Challenges of Benign Fibro-Osseous Lesions and Psammomatous Meningiomas of the Craniofacial Region: A Comparative Review of their Clinico-pathological Features

Conventional ossifying fibroma (COF), juvenile psammomatoid ossifying fibroma (JPOF), juvenile trabecular ossifying fibroma (JTOF), fibrous dysplasia (FD), cemento-osseous dysplasia (COD) and psammomatous meningioma (PM) share overlapping clinico-pathologic characteristics. This can be diagnostically challenging for pathologists. Although remarkable progress has been made over the years using ancillary studies like immunohistochemistry and molecular cytogenetics to distinguish histologically similar diseases; such diagnostic aids are yet to be successfully employed within this group of lesions. The implication is that pathologists have to rely heavily on traditional H&E stained sections in differentiating these lesions. It is important to make the distinction because of differences in their clinical behavior, modes of treatment and prognosis. In this article, the clinico-pathologic features of each entity are reviewed.

Monostotic Fibrous Dysplasia of Inferior Turbinate

Fibrous dysplasia is a benign fibro-osseous lesion originally described by Lichtenstein in 1938. Currently, three general subtypes of disease are recognized: monostotic, polyostotic, and Mc-Cune-Albright syndrome. Fibrous dysplasia is not rare, with the incidence report being about 5% to 7%. Common sites of fibrous dysplasia are the skeletal system including long bones, ribs, craniofacial bones, and the pelvis. However, fibrous dysplasia is rare in the nasal cavity, especially involving the turbinate. In the review of literature over the past 50 years, we were able to discover only 4 cases in which the fibrous dysplasia involved inferior turbinate, with all of them being the polyostotic form found around the sinuses. There were only 4 cases in which monostotic fibrous dysplasia involved the middle turbinate, but none the inferior turbinate. We present this case, with a review of the relevant literature, as the first report on monostotic fibrous dysplasia of the inferior turbinate.

A case report of desmoplastic ameloblastoma

Ameloblastomas are the most common benign neoplasm of odontogenic nature. Desmoplastic ameloblastoma (DA) was included in the World Health Organization Classification of Head and Neck Tumors (WHO-2005) as a variant of ameloblastoma with specific clinical, image, and histological features. This case report focuses on a DA which occurred in the mandible of a 25 year-old man. The main signals and symptoms included painless swelling with buccal expansion and tooth displacement. Panoramic and periapical radiographs and cone-bean computed tomography demonstrated an image mimicking a benign fibro-osseous lesion. The lower border of the mandible was not involved, but tooth displacement could be observed. An incisional biopsy was performed, and the DA was diagnosed. A marginal resection, maintaining the lower border of the mandible, was performed on teeth 46 to 31. The post-operative period was uneventful. The patient is undergoing routine follow-up and is currently free of disease.

The Spectrum of Ossifying Fibroma

An ossifying fibroma is a monostotic lesion that occurs in craniofacial bones.  It usually presents as a painless well-circumscribed, slow-growing mass in the 3rd and 4th decade.  It is a benign fibro-osseous lesion that is part of the bigger spectrum of fibro-osseous lesions which includes fibrous dysplasia, juvenile active ossifying fibroma, psammomatous ossifying fibroma, and extragnathic ossifying fibroma of the skull.    An ossifying fibroma, because of its well-circumscribed nature, lends itself to surgery better than does fibrous dysplasia.  Simple enucleation is usually sufficient for ossifying fibromas whereas curettage is probably better suited for fibrous dysplasia.    Radiographically, it is seen as a well-demarcated radiolucency in the mandible or maxilla, more common in the former than the latter.  It typically measures anywhere from 1 to 5 cm.  There may or may not be a central opacity or calcification, depending on the maturity of the lesion.  An immature lesion may present as completely radiolucent whereas a mature lesion may be completely radiopaque, although most lesions demonstrate varying degrees of radiopacity.  The images above show 2 samples of the same lesion on opposite sides of the spectrum.  Both are well-circumscribed but one is relatively radiolucent while the other is floridly sclerotic.   Is there a pathognomonic finding on x-ray?  Unfortunately, there is not one single finding that will distinguish an ossifying fibroma from other fibro-osseous lesion.  Does it matter?  Yes.  X-rays will lead the clinician to one diagnosis or the other and help plan the intended surgery.        

Hybrid lesion: central giant cell granuloma and benign fibro-osseous lesion

Hybrid lesions comprise elements of different pathologies in one lesion. Hybrid lesions comprising central giant cell granulomas (CGCG) with fibro-osseous components are rare, with only six maxillomandibular cases reported in the literature. We report a case of a hybrid lesion in a 38-year-old woman who presented with a swelling in the mandibular parasymphysis, on the left side. Panoramic and occlusal radiographs and CT showed a mixed lesion with expansion of the buccal cortical plate that pointed to the diagnosis of ossifying fibroma (OF). Complete excision of the lesion was performed, and the anatomopathological examination showed features of both CGCG and a fibro-osseous lesion. Clinical, imaging and histopathological features indicate a hybrid lesion of CGCG and OF. The patient remains asymptomatic after 30 months of follow-up.

Fibrome cémento-ossifiant psammomateux nasoéthmoïdal à extension orbitaire

Psammomatoid cemento-ossifying fibroma (PCOF) is a rare benign fibro-osseous lesion. It affects the maxilla, the nasal cavity, paranasal sinuses, and the ethmoid. It is slow-growing, progressive, and benign but it can be locally extended and mimic a malignant tumor. We report the unusual case of a 36-year-old woman with a nasal and ethmoid PCOF with orbital and endocranial extension. The tumor was revealed by exophthalmia and nasal obstruction. The diagnosis was proven histologicaly on biopsies. The treatment was transfacial surgery. There was no recurrence 1 year later. Intraorbital and endocranial extension of PCOF are rare aggressive behaviours. Histologically, the differential diagnosis is difficult between fibrous dysplasia or psammomatoid meningioma. Complete surgical excision is necessary to prevent recurrence.

Cemento-ossifying Fibroma Of Paranasal Sinus Presenting Acutely As Orbital Cellulitis

Fibro-osseous lesions of the face and paranasal sinuses are relatively uncommon. These lesions have overlapping clinical, radiologic and pathologic features causing difficulty in diagnosis. Neoplastic fibro-osseous paranasal sinus lesions can be benign or malignant. The benign fibro-osseous lesions described are: ossifying fibroma (and its histologic variants) and fibrous dysplasia. The variants of ossifying fibroma differ in the nature of calcified material (i.e. cementum versus bone), in the location of the lesion (oral versus paranasal sinus or orbital), other morphologic variations (presence of psammomatoid concretions) and biologic behavior (aggressive versus stable). Presence of cementum or bone classifies the lesion as cementifying fibroma or ossifying fibroma respectively while lesions with mixture of both cementum and bone are called cemento-ossifying fibroma. We describe a case of a young adult male with cemento-ossifying fibroma of paranasal sinus presenting acutely as left orbital cellulitis with proptosis.

Benign Fibro-Osseous Lesions of the Jaws: A Study of 127 Chinese Patients and Review of the Literature

The aim of this study is to analyze all the cases of benign fibro-osseous lesions treated at School and Hospital of Stomatology, Wuhan University, to compare the results obtained in this study with those previously documented by other authors. The 127 cases diagnosed as a fibro-osseous lesion were retrieved, and information about these lesions was documented. In all, 127 cases of benign fibro-osseous lesions were surgically treated. Of these, 55 were cemento-ossifying fibroma, 43 ossifying fibroma, and 29 fibrous dysplasia. Cemento-ossifying fibromas mostly occur in men of the second decades, mostly in the mandible. Ossifying fibromas had almost equal sex predilection and age distribution peaked in the second decades, mostly in the mandible. Fibrous dysplasia also had equal sex predilection, and age distribution peaked in the second and third decades, with equal occurrence in both jaws. The tumors needed to have a regular follow-up after the surgery.

Ossifying fibroma of the occipital bone—A case report and literature review

Ossifying fibroma (OF) is one of the benign fibro-osseous lesions (BFOLs) affecting the craniofacial bones. Involvement of the skull bones specifically the occipital bone is especially rare. We report a case of a 49-year-old adult male with incidental finding of an ossifying fibroma arising from the right occipital bone with transverse sinus involvement.

Benign fibro-osseous lesions of the craniofacial complex. A review.

Benign fibro-osseous lesions of the craniofacial complex are represented by a variety of disease processes that are characterized by pathologic ossifications and calcifications in association with a hypercellular fibroblastic marrow element. The current classification includes neoplasms, developmental dysplastic lesions and inflammatory/reactive processes. The definitive diagnosis can rarely be rendered on the basis of histopathologic features alone; rather, procurement of a final diagnosis is usually dependent upon assessment of microscopic, clinical and imaging features together. Fibrous dysplasia and osteitis deformans constitute two dysplastic lesions in which mutations have been uncovered. Other dysplastic bone diseases of the craniofacial complex include florid osseous dysplasia, focal cemento-osseous dysplasia and periapical cemental dysplasia, all showing a predilection for African descent individuals; although no specific genetic alterations in DNA coding have yet to be uncovered and most studies have been derived from predominant high African descent populations. Ossifying fibromas are neoplastic lesions with four subtypes varying with regard to behavior and propensity for recurrence after surgical excision. The clinicopathologic and molecular features of this unique yet heterogeneous group of diseases are reviewed.

Central Ossifying Fibroma: A Clinicopathologic Study of 28 Cases

Central ossifying fibroma (COF) is the most common benign fibro-osseous lesion of the jaw. This retrospective study evaluated the clinical and histopathologic features of 28 COFs in Taiwanese patients. Twenty-eight consecutive cases of COF were collected from 1988 to 2006. The clinical data and microscopic features of these cases were reviewed and analyzed. The mean age of patients at the time of diagnosis was 34 years. There were six male and 22 female patients. Twenty-six (93%) cases were found in the mandible and two (7%) in the maxilla. The most common sites for COFs were the molar region (17 cases, 61%), followed by the premolar (8 cases, 28%), and incisor/canine (3 cases, 11%) regions. Bone swelling or expansion (96%, 26/27) was the most frequent clinical presentation. Six (21%) COFs presented as a radiolucent lesion, 17 (61%) as a mixed lesion, and five (18%) as a radio-opaque lesion. No recurrence of the lesion was found after surgical excision in this series. Microscopically, COFs showed trabeculae of woven bone (25 cases) and/or lamellar bone (5 cases) and/or spherules of cementoid (19 cases) in a cellular fibrous connective tissue stroma. The stromal component was highly cellular in 21 cases, moderately cellular in seven cases, prominently vascular in 11, and collagenous in six. COFs occur more frequently in female patients and in those in the second to fourth decades of life. The most commonly affected site is the mandible, especially the molar region. The majority of COF lesions present as a well-defined, mixed lesion radiographically. Most COFs can be treated by conservative surgical excision without subsequent recurrence.