Benign Fibro-osseous Neoplasm Research Articles

Case report: Ossifying fibroma

Ossifying fibroma is a benign fibro-osseous tumor, also known as central fibro-osteoma, cementoossifying fibroma, cementing fibroma. This neoplasm arises from the periodontal ligament and shows slow growth and proliferation of cellular fibrous tissue with varying amounts of osseous products such as bone, cementum or a mixture of both. Ossifying fibroma is a localized, asymptomatic swelling with cortical expansion in the mandible rather than the maxilla in mandible in the premolar and molar region in the third to fourth decade of life with female predilection. Radiologically, the lesion shows a welldefined, mixed radiolucent-radiopaque internal structure. Ossifying fibromas can grow to large sizes resulting in aesthetic and functional deformities. Hence, we present a classic case of an 18-year-old male patient with ossifying fibroma on the left body of the mandible, with all clinical, radiological and histopathological features, along with a brief discussion. Keywords: ossifying fibroma, benign fibro-osseous tumor, central fibro-osteoma, cemento-ossifying fibroma, cementifying fibroma.

Management of ossifying fibroma of the bone of the maxilla: a case report and review of the literature

Abstract Ossifying fibroma (OF) is a slow-growing benign fibro-osseous neoplasm. It is mostly odontogenic in origin, and it arises in the jaws, particularly the mandible. OF is characterized by the production of bone and cementum-like calcifications in a fibrous stroma. OF reports of the bone of the maxilla are uncommon. Diagnosing OF can be challenging due to the considerable overlap of clinico-pathological characteristics with those of other neoplasms. Herein, the authors describe a case report OF in a 26-year-old male who presented with a huge fibro-osseous tumor of the maxilla. Histopathology established the diagnosis of maxillary OF. The tumor was surgically removed via a Weber–erguson approach with satisfactory functional and cosmetic results. No recurrence has been found after one year of follow-up. Clinical, radiological, and pathological characteristics, as well as surgical treatment approaches, are further discussed. This is one of a few documented cases of maxillary OF in our setting.

JUVENILE OSSIFYING FIBROMA: NOT SO JEJUNE

Juvenile ossifying fibroma (JOF) is a rare benign fibroosseous tumor which involves maxilla more than mandible. It usually occurs in children below 15 years of age. It is locally aggressive with significant growth potential which can raise fears of malignant pathology. This article reports a case of JOF occurring in the maxilla followed by surgical treatment.

CEMENTO-OSSIFYING FIBROMA ON THE MANDIBLE: A CASE REPORT

Cemento-ossifying fibroma is a benign fibro-osseous neoplasm that appears on the craniofacial region. A 43-year-old female patient was referred to the oral and maxillofacial pathology service of a university due to a mandible lesion. The clinical examination showed a bony hard swelling on the buccal cortical within the second premolar and first molar on the left side of the mandible. The patient denied pain or numbness. The panoramic x-ray showed a unilocular lesion with well-defined borders. The clinical diagnosis was an odontogenic keratocyst. An exploratory punction was performed, with a yellow fluid being collected from the lesion. An incisional biopsy was made, and the histopathology showed a benign neoplastic lesion comprised of the proliferation of spindle cells, resembling fibroblasts, as well as calcified matrix material resembling both bone and cementoid material. The final diagnosis was cemento-ossifying fibroma. The patient underwent surgery and is now under a 6-month follow-up without recurrence. Cemento-ossifying fibroma is a benign fibro-osseous neoplasm that appears on the craniofacial region. A 43-year-old female patient was referred to the oral and maxillofacial pathology service of a university due to a mandible lesion. The clinical examination showed a bony hard swelling on the buccal cortical within the second premolar and first molar on the left side of the mandible. The patient denied pain or numbness. The panoramic x-ray showed a unilocular lesion with well-defined borders. The clinical diagnosis was an odontogenic keratocyst. An exploratory punction was performed, with a yellow fluid being collected from the lesion. An incisional biopsy was made, and the histopathology showed a benign neoplastic lesion comprised of the proliferation of spindle cells, resembling fibroblasts, as well as calcified matrix material resembling both bone and cementoid material. The final diagnosis was cemento-ossifying fibroma. The patient underwent surgery and is now under a 6-month follow-up without recurrence.

Surgical and laser treatment for juvenile psammomatoid ossifying fibroma in an oncological patient: a rare case report

BackgroundJuvenile psammomatoid ossifying fibroma is a rare variant of conventional ossifying fibroma that affects the maxillofacial complex in children and adolescents. It is a benign fibro-osseous neoplasm with aggressive clinical behavior and high recurrence rates, confirming the importance of early diagnosis and intervention to minimize undesirable aesthetic and functional possibilities resulting from surgical management, and added to the use of laser therapy, it can bring a better postoperative prognosis.AimTo present the surgical removal of a juvenile psammomatoid ossifying fibroma, with the associated use of low-intensity laser and photodynamic therapy in a oncological patient.Case presentationThis case describes a senile cancer patient diagnosed with rapidly progressive and painful juvenile ossifying fibroma involving the inter-radicular region of the right maxilla. The treatment was excision with total tumor resection, photodynamic therapy and low-intensity laser follow-up of 48 months.ConclusionsJuvenile psammomatoid ossifying fibroma is a lesion with a high rate of recurrence and aggressive growth. Thus, early detection and treatment are essential. In this case, the use of photodynamic therapy after surgery and long-term follow-up with low-intensity laser brought a favorable prognosis in an oncology patient.

Maxillary cemento-ossifying fibroma – A rare occurrence

Cemento-ossifying fibromas are benign fibro-osseous neoplasm that involves the jaws. These tumors are a rare group of mesodermal odontogenic tumors occurring in the maxilla. Most of the lesions are centrally within the jaw as a slow and progressively growing lesion. If left untreated, they achieve vast size with consequent malformation. Radiographically, they are presented as well-defined unilocular or multilocular intraosseous masses. They are less sensitive to radiotherapy and recurrences are unusual. A rare occurrence of cemento-ossifying fibroma of the anterior maxilla is noted in a 42-year-old male patient. Clinically, they manifested as a well-demarcated swelling in the right anterior region of the maxilla. Radiographic characteristics, histological, and surgical findings are enlisted and the several differential diagnoses are mentioned.

Giant ossifying fibroma of the mandible treated with en bloc resection and reconstruction plate placement in pediatric patient: case report and literature review

Ossifying Fibroma is a benign fibro-osseous tumor, but osteolytic and invasive, as well as being a rare lesion. It manifests itself more frequently in the mandible than in the upper jaw, being located preferably in the molar (52%) or premolar (25%) region. It is most commonly diagnosed in women (5:1) between the 3rd and 4th decades of life. It is related to other pathologies such as bone dysplasia, florid cement-osseous dysplasia, among others. This lesion was called a tumor by the World Health Organization (WHO) in 1992 in its classification of Odontogenic tumors, because its possible etiopathogenesis is due to periodontal ligament cells. In 2003, the WHO called it a single entity, classified like a bone tumor. The following case that is presented is about a pediatric patient with a diagnosis of Ossifying Fibroma in the mandibular area of large size, which was treated surgically with an en bloc resection of the affected area due to the great extension of the lesion and the compromised tissue. and literature review.

Psammomatoid Ossifying Fibroma Is Defined by SATB2 Rearrangement

Psammomatoid ossifying fibroma (PsOF), also known as juvenile PsOF, is a benign fibro-osseous neoplasm predominantly affecting the extragnathic bones, particularly the frontal and ethmoid bones, with a preference for adolescents and young adults. The clinical and morphologic features of PsOF may overlap with those of other fibro-osseous lesions, and additional molecular markers would help increase diagnostic accuracy. Because identical chromosomal breakpoints at bands Xq26 and 2q33 have been described in 3 cases of PsOF located in the orbita, we aimed to identify the exact genes involved in these chromosomal breakpoints and determine their frequency in PsOF using transcriptome sequencing and fluorescence in situ hybridization (FISH). We performed whole RNA transcriptome sequencing on frozen tissue in 2 PsOF index cases and identified a fusion transcript involving SATB2, located on chromosome 2q33.1, and AL513487.1, located on chromosome Xq26, in one of the cases. The fusion was validated using reverse transcription (RT)-PCR and SATB2 FISH. The fusion lead to a truncated protein product losing most of the functional domains. Subsequently, we analyzed an additional 24 juvenile PsOFs, 8 juvenile trabecular ossifying fibromas (JTOFs), and 11 cemento-ossifying fibromas (COFs) for SATB2 using FISH and found evidence of SATB2 gene rearrangements in 58% (7 of 12) of the evaluable PsOF cases but not in any of the evaluable JTOF (n = 7) and COF (n = 7) cases. A combination of SATB2 immunofluorescence and a 2-color SATB2 FISH in our index case revealed that most tumor cells harboring the rearrangement lacked SATB2 expression. Using immunohistochemistry, 65% of PsOF, 100% of JTOF, and 100% of COF cases showed moderate or strong staining for SATB2. In these cases, we observed a mosaic pattern of expression with >25% of the spindle cells in between the bone matrix, with osteoblasts and osteocytes being positive for SATB2. Interestingly, 35% (8 of 23) of PsOFs, in contrast to JTOFs and COFs, showed SATB2 expression in <5% of cells. To our knowledge, this is the first report that shows the involvement of SATB2 in the development of a neoplastic lesion. In this study, we have showed that SATB2 rearrangement is a recurrent molecular alteration that appears to be highly specific for PsOF. Our findings support that PsOF is not only morphologically and clinically but also genetically distinct from JTOF and COF.

RECURRENT CENTRAL OSSIFYING FIBROMA IN MANDIBLE ANGLE: A CASE REPORT

Central ossifying fibroma is an uncommon benign fibro-osseous neoplasm that affects the tooth-bearing areas of the jaw and shows a female predilection. The standard treatment is complete enucleation, with a high recurrence rate if not completely removed. Some evidence shows that the menopausal onset can lead to lesion growth. A 45-year-old female patient was referred for investigation of a recurrent painless lesion in the left mandible angle. Panoramic radiography revealed an expansile, mixed, well-circumscribed lesion with a radiopaque halo. The treatment of choice was en bloc resection. Histologic analysis showed a fibrocellular stroma with an amount of bone and cementum-like areas. Although considered less aggressive than their juvenile counterpart, central ossifying fibroma can cause consequences related to the great growth potential. It is important to perform periodic follow-up after surgical excision to rule out recurrence.

Cemento-ossifying fibroma

Cemento-ossifying fibroma is a rare benign fibro-osseous neoplasm commonly involving the jaws majority of lesions occur in mandible bone. It can be discovered as an incidental finding in radiological imaging. Symptomatic patients are presented with a slowly growing mass involving the jaws commonly in mandible bone and can attain a large size with the passage of time. It can cause facial deformity if left untreated. We present such a case of Cemento-ossifying fibroma involving the right hemi-mandible bone, and its radiological imaging findings, including X-ray (OPG), CT scan, and Histopathology.

A path less travelled — Short review on ossifying fibroma and osseous dysplasia

Fibro-osseous lesions (FOL) are characterized by replacement of normal bone by fibrous tissue containing a newly formed mineralized product. The mineralized product may be ossification (sometimes cementum formation) or calcification of fibrous tissue by metaplasia. These lesions have similar radiographic and histopathologic features hence the term fibre- osseous lesion is not a diagnosis, rather a description of the presence of fibrous and calcified tissue. They may be developmental (fibrous dysplasia), reactive (cemento-osseous dysplasia) or neoplastic (ossifying/cementifying fibroma). This article presents the commonly used classification for fibro-osseous lesions and an insight into a few changes that have been introduced in the recent past with emphasis on Ossifying Fibroma and Osseous Dysplasia.Ossifying fibromas are considered as benign fibro-osseous neoplasms which are principally encountered within the jawbones. Cemento-osseous dysplasias are non-neoplastic fibro- osseous lesion. Since 1971, the World Health Organization classified cemental lesions into 4 distinct entities, as follows: Periapical Cemental Dysplasia, Benign Cementoblastoma (true cementoma), Cementifying Fibroma and Gigantiform Cementoma (GC). The term, gigantiform cementoma, may imply a solitary process but it is misleading because the condition typically presents as slow-growing, multifocal/multiquadrant and expansile lesions involving both jaws. WHO classified it in Osseous dysplasia and El-Mofty et al. under Ossifying fibroma.

Juvenile Ossifying Fibroma of a 15-Year-old Girl: A Case Report

Juvenile ossifying fibroma is a locally aggressive, benign fibro-osseous tumor. It usually occurs in young children and arises in the maxillofacial region. It has a high recurrence rate. This pathology would be diagnosed and treated as early as possible because of its rapidly progressive and osteolytic nature which may complicate the surgical removal if left untreated over a long period. The present case is diagnosed as Juvenile ossifying fibroma involving the maxilla causing facial deformity, proptosis, and nasal obstruction in a 15-year-old female child.

Ossifying Fibroma; A Case report and review of literature

Abstract Introduction/Objective Ossifying fibroma (OF) is a rare, benign, true neoplasm with growth potential, with the mandible involved more often than the maxilla. There is female predilection in the third and fourth decades of life, with the most common site being the premolar and molar area of the mandible. These lesions are characterized by the replacement of endogenous bone with a highly cellular fibrous neoplasm containing varied amounts of bony trabeculae, and/or cementum-like spherules. Radiographically they present as well defined, unilocular, most are mixed lucent, opaque, some with sclerotic border and root divergence may be seen. Histologically most of the lesions are not encapsulated but are well demarcated from the adjacent bone. Thus radiographic, surgical and histological findings help distinguish OF from other benign fibro-osseous lesions such as fibrous dysplasia and cemento-osseous dysplasia. Distinguishing an accurate diagnosis between the above fibro-osseous neoplasms becomes significant as prognosis and treatment differ. Methods/Case Report Herein we report a case of a 59-year-old female who presented with a symptomatic mandibular lesion that radiographically illustrated a midline well-circumscribed expansile mass of the mandibular symphysis with a sclerotic margin and ground-glass internal matrix measuring 3.1 x 4.9 x 3.9 cm, favored to represent pagetoid changes more likely than neoplastic process. Microscopic examination revealed numerous variably sized islands of ossification within a hypercellular fibrous stroma. Based on the clinical, radiographic and histologic findings, a diagnosis of benign fibro-osseous lesion, favor ossifying fibroma was given. Results (if a Case Study enter NA) NA Conclusion Microscopic examination, as in our case, can resemble a variety of benign fibro-osseous neoplasms. Radiographic and clinical correlation, along with microscopic evaluation, help solidify the accurate diagnosis.

Ossifying Fibroma of the Maxilla: A Case Report and Literature Update

Ossifying fibroma is a rare benign fibro-osseous neoplasm of the jaw characterized by the replacement of normal bone tissue by a combination of fibrous tissue and newly formed calcified tissues of bone and/or cementum-like material. Lesions often manifest at the 2nd to 4th decades of life with a predominant female predilection. The tumor is usually slow-growing and asymptomatic but can cause notable expansion of the jawbones. Definitive diagnosis of OF can be challenging and usually requires careful clinical, radiographic and histologic assessments. Treatment commonly depends on the size, location and aggressiveness of tumor and can accordingly vary from enucleation and curettage to resection and bone grafting. The prognosis is generally good when the lesion is completely removed, but recurrence is possible in some circumstances. The aim of this article is to present a case report of a recurrent ossifying fibroma in a 28-year-old female patient and to provide an update of the literature.

Juvenile psammomatoid ossifying fibroma with fluid\u2013fluid levels: an unusual presentation

BackgroundJuvenile ossifying fibroma is an uncommon benign fibro-osseous tumor commonly involving the craniofacial skeleton of young patients with locally aggressive behavior and a high recurrence rate. Depending on the site of involvement it can present clinically as nasal obstruction, facial swelling, or proptosis.Case presentationHere we present a case of juvenile ossifying fibroma with an aneurysmal bone cyst component in the left nasal cavity in a 15-year-old boy who presented with gradually progressing left-sided nasal obstruction. Imaging findings were consistent with juvenile ossifying fibroma. Endoscopic resection of the tumor was done, and histopathological examination revealed it to be a psammomatoid variant of juvenile ossifying fibroma. Here we discuss its imaging findings, differential diagnosis, treatment options, and histopathological features.ConclusionDespite being a slow-growing benign tumor, early diagnosis and treatment are necessary due to its locally aggressive nature and invasion of adjacent structures. Complete surgical resection is the mainstay of treatment because of the high recurrence rate.

Fibrous Dysplasia at Unusual Anatomic Sites: A Series of 86 Cases With Emphasis on Histologic Patterns.

Aims. Fibrous dysplasia (FD) is a benign fibro-osseous neoplasm that most commonly arises in the ribs, femur, and craniofacial bones. We analyzed features of FD arising in the spine/short tubular/small bones of the hands/feet (STSBHF), specifically assessing for pattern of bone formation (conventional, complex/anastomosing, psammomatoid/cementum like), myxoid change, and presence of osteoclast-type giant cells. Materials and methods. A total of 1958 cases of FD were reviewed, of which 131 arose in the spine/STSBHF representing 2.5% of institutional and 10% of consultation cases, respectively. Eighty-six cases had material available for review. Anatomic sites included vertebrae (n = 58, 67%), short tubular bones (n = 20, 23%), and small bones of the hands/feet (n = 8, 9%). The most common morphologic pattern of bone identified was conventional (n = 77, 90%), followed by complex/anastomosing (n = 22, 26%) and psammomatoid/cementum like (n = 22, 26%). Eighteen cases (21%) had matrix-poor areas. Hypercellular areas were identified in 6 cases, 2 cases of which showed matrix-poor areas. Osteoclast-type giant cells were noted in 9 cases and myxoid change was present in 3 cases. Radiologic imaging studies available for 41 cases nearly all demonstrated features typical of FD, but the diagnosis was not predicted due to the unexpected location. Conclusions. FD arising in the spine/STSBHF is rare and frequently results in expert consultation. A significant number of cases exhibited less commonly recognized patterns of bone formation, and stromal changes including osteoclast-type giant cells, and matrix poor areas. Furthermore, imaging features in the STSBHF are often less specific. Awareness of the morphologic spectrum at these locations coupled with radiologic correlation should aid in accurate classification.

Ossifying Fibroma of the Mandible – Benign Tumor with Aggressive Presentation

Abstract Introduction/Objective Ossifying fibromas are rare benign fibro-osseous lesions of mesenchymal origin affecting the craniofacial bones. Less than 60 cases have been reported in the literature. These tumors are more commonly seen in women and are usually slow growing. Most lesions are incidental, small and treated with curettage or enucleation. Rarely, ossifying fibromas can show a rapidly growing aggressive course that require radical resection. Methods We present a case of a 63-year-old man who presented with an enlarging left mandible lesion that was first noticed two years prior. We discuss the clinical presentation, prognostic factors and management of this rare disease based on the current literature. Results The patient presented with a left mandible mass that had recently grown, caused significant pain and affected chewing. The computed tomography showed a heterogeneous sclerotic lesion with periosteal reaction of the left mandible, but no evident mass. Initial biopsy showed a bland spindle cell proliferation admixed with fragments of woven bone. Due to clinical presentation the patient underwent left hemimandibulectomy with left neck dissection. The gross examination revealed 3 x 1.5 x 0.8 cm tan-pink tumor located at the junction of the mandible body and ramus, abutting the outer bone surface. Microscopic examination showed various shaped spicules of woven bone lined by osteoblasts in a vascularized, cellular, fibroblastic and spindled cell stroma consistent with aggressive ossifying fibroma. The tumor extended into the anterior and posterior bone resection margins. All the examined lymph nodes were negative for malignancy. No adjuvant radiation or other treatment was administered. The patient is alive without evidence of disease after 7 months of follow up. Conclusion The ossifying fibroma is a rare benign fibro-osseous tumor that can rarely have an aggressive behavior. Clinical, imaging and histopathological correlation are crucial to establish the correct diagnosis. Aggressive ossifying fibromas may require radical resection to prevent recurrence.

JUVENILE OSSIFYING FIBROMA IN CHILDREN: A CASE REPORT

Juvenile ossifying fibroma is a benign fibro-osseous neoplasm of mesenchymal origin that affects young individuals and has an aggressive clinical behavior with high rates of recurrence. A 5-year-old female patient presented intraosseous growth, approximately 1.5 cm in size, normochromic, hard in consistency, sessile, with painful symptoms and 1-month of evolution. Imaging examination revealed well-delimited hypodense lesion and buccal and lingual cortical expansion. The patient had already performed an incisional biopsy with ossifying fibroma diagnosis. Then, an excisional biopsy was accomplished in association with local bone curettage. Microscopic examination showed fusiform and oval mesenchymal cell proliferation. There was deposition of numerous bone trabeculae with varying degrees of maturation, exhibiting prominent osteoblastic paving. After 1 year, the patient is still on regular follow-up, with no signs of recurrence.

JUVENILE TRABECULAR OSSIFYINGFIBROMA: A CASE REPORT

Juvenile ossifying fibromas are aggressive benign fibro-osseous neoplasms that present 2 distinctive histologic variants, trabecular and psammomatoid. The trabecular variant occurs most commonly in the maxilla and affects younger patients, children and adolescents, with a mean age of 8.5 to 12 years. A 9-year-old girl presented with an asymptomatic swelling in the left maxilla. Computed tomography showed a well-circumscribed, expansive, unilocular, mixed hypodense/hyperdense lesion in the left maxilla and nasal cavity. The incisional biopsy confirmed the diagnosis of juvenile trabecular ossifying fibroma. After surgical excision with peripheral ostectomy under general anesthesia, prosthetic rehabilitation with removable partial dental prosthesis was performed. One year and 3 months later, computed tomography images were suggestive of recurrence. The recurrent lesion was treated by surgical excision with peripheral ostectomy followed by another prosthetic rehabilitation. At the moment, no sign of recurrence was noted in 5 years’ of follow- up after the second surgery.

EXUBERANT CEMENTO-OSSIFYING FIBROMA OF THE MAXILLA

Cemento-ossifying fibroma (COF) is a benign fibro-osseous neoplasm that commonly presents as a slow-growing, well-defined mixed radiolucent-radiopaque lesion, located in the posterior mandible of women in their third and fourth decades of life. A 59-year-old male patient was referred complaining of an asymptomatic 8 × 7 cm swelling of progressive growing in the last 5 years located in the posterior region of the maxilla. Panoramic radiograph showed a well-defined, predominantly radiopaque lesion with marked cortical bone expansion and maxillary sinus involvement. Microscopic evaluation showed proliferation of cellular fibroblastic stroma containing mineralized trabeculae of varying size and occasional concentric calcifications. There was no continuity between the tumor and surrounding normal cortical bone. The final diagnosis was COF. The patient was submitted to conservative surgery, and no recurrence was observed after 6 months of follow-up. COF of the maxilla may present as a painless and well-defined fibro-osseous tumor of large size. Cemento-ossifying fibroma (COF) is a benign fibro-osseous neoplasm that commonly presents as a slow-growing, well-defined mixed radiolucent-radiopaque lesion, located in the posterior mandible of women in their third and fourth decades of life. A 59-year-old male patient was referred complaining of an asymptomatic 8 × 7 cm swelling of progressive growing in the last 5 years located in the posterior region of the maxilla. Panoramic radiograph showed a well-defined, predominantly radiopaque lesion with marked cortical bone expansion and maxillary sinus involvement. Microscopic evaluation showed proliferation of cellular fibroblastic stroma containing mineralized trabeculae of varying size and occasional concentric calcifications. There was no continuity between the tumor and surrounding normal cortical bone. The final diagnosis was COF. The patient was submitted to conservative surgery, and no recurrence was observed after 6 months of follow-up. COF of the maxilla may present as a painless and well-defined fibro-osseous tumor of large size.