Ossifying Fibroma Research Articles

Abstract Juvenile trabecular ossifying fibroma (JTOF) is a rare variant of ossifying fibroma, a benign fibro-osseous lesion. This entity is characterized by aggressive clinical behavior, predominantly affecting young individuals aged 8–12 years. A slight male predominance has been observed, and the lesion demonstrates a marked propensity for recurrence. Central giant cell granuloma (CGCG) is classified by the World Health Organization as a benign nonodontogenic lesion of the jaw, with unknown etiology. It is an uncommon, benign but aggressive osteolytic neoplasm of the craniomaxillofacial region. We report a case of a 6-year-old female child who presented with a painless, slow-growing swelling over her left cheek for 3 months. A large expansile lesion of neoplastic etiology of the left maxilla was suspected clinically and on radiological examination. A thorough histological examination revealed it to be a hybrid lesion of CGCG with JTOF, which in combination is extremely rare.

Ossifying fibroma and juvenile ossifying fibroma: A systematic review on clinical and radiological parameters, treatment modalities and recurrence

Teaching point: Osteofibrous dysplasia (OFD) is a rare benign fibro‑osseous lesion primarily affecting the tibial cortex in children and adolescents; simultaneous involvement of the fibula is exceptional and may mimic more aggressive tumors such as adamantinoma.

Juvenile Ossifying Fibroma of the Maxilla in Juvenile Paget’s Disease

Osteofibrous dysplasia, osteofibrous Dysplasia-Like adamantinoma, and adamantinoma: A Single-center retrospective analysis.

Juvenile ossifying fibroma (JOF) is a rare, benign fibro-osseous neoplasm exhibiting locally aggressive behaviour predominantly localized within the craniofacial bones. This distinct entity is distinguished from ossifying fibroma (OF) by its earlier age of onset and an increased propensity for recurrence. A comprehensive review of existing literature, supplemented by a case series, is presented to elucidate the clinical, radiological, and histopathological characteristics of JOF. Diagnostic challenges associated with JOF are often encountered due to its variable presentation and potential overlap with other fibro-osseous lesions. Treatment is by surgical resection, with a focus on obtaining total excision to reduce the chance of recurrence. Long-term follow-up is crucial for early detection of recurrence. This combined literature review and case series presentation aims to improve knowledge of JOF, enabling more accurate diagnosis and effective therapy.

Peripheral Ossifying Fibroma in the Posterior Mandible in a 12-Year-Old: A Case Report

Juvenile Ossifying Fibroma with Secondary Aneurysmal Bone Cysts: Diagnostic Challenges & Clinical Implications

An 11-year-old male presented to the hospital with severe headache, nausea, and proptosis of the OD. Imaging revealed a 4 × 3 × 1 cm mass originating in the right orbital roof with adjacent bony remodeling, a calcific rim along the inferior extent of the lesion, and a heterogenous central component with hyper- and hypo-dense components. An orbitotomy with biopsy with near-total resection was performed, which yielded a diagnosis of juvenile trabecular ossifying fibroma, a tumor rarely found in the orbit. Two months later, given the concern for residual/recurrent disease based on increased signal abnormality on MRI, resection of the residual mass was achieved via bifrontal craniotomy.

Ossifying fibroma (OF) is an uncommon benign fibro-osseous lesion commonly occurring in the jaws, particularly in the mandible. While OF is expected in the jaws, multiple lesions are extremely rare. This article provides a comprehensive review of all published cases of OF, including those reported from 1968 to the present. In addition, it provides a case report of bilateral OF in the mandible, an incidental finding in a 32-year-old female.

Osteofibrous dysplasia (OFD) and adamantinoma constitute rare bone tumors. Currently, the World Health Organization (WHO) classification of soft tissue and bone tumors stratifies adamantinoma into three main subtypes, namely OFD-like adamantinoma, classic adamantinoma, including its various growth patterns, and an extremely uncommon subtype, dedifferentiated adamantinoma. Given the wide clinicopathological spectrum of adamantinoma, several tumors constitute the differential diagnoses. An exact diagnosis in these scenarios has significant treatment-related implications, such as synovial sarcoma vs. spindle cell-type adamantinoma, and metastatic sarcomatoid carcinoma vs. adamantinoma, to name but a few. There have been studies attempting to explore the proximity/relationship between OFD, OFD-like adamantinoma, and classic adamantinoma. This review focuses on the clinical, radiological, and pathological features of OFD, as well as the histopathological spectrum of adamantinoma, including its updates and various subtypes and tumors that constitute its differential diagnosis.

Diagnostic challenges in osteosarcoma arise in small biopsies with under-representation of the lesion and scant or absent osteoid matrix. This study aimed to validate the utility of SATB2 antibody in the diagnosis of osteosarcoma and differentiate it from its histological mimics. A total of 70 histologically proven cases of osteosarcomas and 97 other histological mimics were included in the study. IHC was performed using SATB2 monoclonal antibody. SATB2 antibody revealed nuclear positivity in all 70 (100%) cases of osteosarcoma. The majority of the conventional osteosarcomas (30 cases, 55.6%) showed 5+ score with a strong-staining intensity. Parosteal osteosarcomas and low-grade central osteosarcoma displayed less extensive staining compared to conventional osteosarcomas. The benign bone-forming tumors (osteoid osteoma and osteoblastoma) showed intense nuclear staining in nearly 100% of the cells. Fibrous dysplasia, osteofibrous dysplasia, callus formation, and myositis ossificans also showed nuclear positivity predominantly along the osteoid. Enchondromas and grade 1 and 2 conventional chondrosarcomas were negative. Positive staining was observed in phosphaturic mesenchymal tumor, juvenile trabecular ossifying fibroma, and desmoplastic fibroma. The other tumors like Ewing sarcoma, lymphoma, chordomas, and undifferentiated sarcomas were negative. Thus, SATB2 can be used to differentiate small-cell osteosarcoma from round-cell sarcomas and enchondroma and chondrosarcomas (grade 1 and 2) from chondroblastic osteosarcoma. It can be used as a useful adjunct in specific settings where osteoid is equivocal.

Peripheral ossifying fibroma (POF) is a reactive, non-neoplastic gingival growth, commonly seen in adolescents and young children, occurring most often in girls. The World Health Organisation (WHO) categorises POF as a fibro-osseous lesion characterised by varied amounts of calcified particles scattered throughout fibrous connective tissue. It often arises in response to local irritants and typically occurs in the anterior maxilla. Although generally benign, POF is known for its potential for recurrence, especially if not completely excised. This is a case study of an eleven-year-old male child who presented with a recurrent, firm, gingival mass in the anterior maxillary region. This case emphasises how crucial the complete surgical removal of the lesion, including the periosteum and involved periodontal ligament, is to minimise the risk of recurrence. It was noted that about 60% of occurrences of this lesion occur in the anterior maxilla, with the incisor-cuspid region accounting for 55–60% of presentations. In clinical terms, POF is a slow-growing gingival lesion that is typically found in the interdental gingiva and is less than 2 cm in size. The study also highlights the need for long-term follow-up, especially in pediatric patients, where recurrence can affect oral development and function.

ABSTRACTBackgroundPeripheral ossifying fibroma (POF) is a benign reactive lesion that is proliferative in nature; it is composed of cellular fibroblastic spindle cell proliferation containing mineralised tissue such as bone and cementum‐like structures. It is commonly located in the anterior maxilla and appears as a gingival growth on the interdental papilla. The pathogenesis is unclear, but the aetiology involves chronic minor injury by irritants such as orthodontic appliances and plaque. Despite similarity in nomenclature, POF is a completely distinct entity from a cemento‐osseous fibroma. This case report explores the rare occurrence of a POF on the hard palate of a child. Although the term POF is commonly used in the United States, oral and maxillofacial pathologists in the United Kingdom often refer to it as fibrous hyperplasia with metaplastic bone or ossifying fibrous epulis.Case PresentationA 10‐year‐old female presented to the Oral and Maxillofacial clinic with an unusual 8 mm circular lesion on the hard palate that appeared coral pink with a pustulated yellow centre. The histology from the excisional biopsy reported a peripheral ossifying fibroma. Blood test results showed elevated parathyroid hormone and serum phosphate levels. Subsequent referral to the paediatric endocrinology consultant and a further hand X‐ray illustrated findings consistent with pseudohypoparathyroidism. There was no recurrence at the 6‐month follow‐up.ConclusionsPOF should be considered in the list of differentials for lesions on the hard palate. It can pose a challenge to confidently diagnose based on clinical findings alone due to it rarely presenting on the hard palate; hence, histology can be invaluable. This case also describes the co‐existence of endocrinological abnormalities and the presence of a POF; there is currently no evidence of a causal link between them.

Ossifying fibroma is a rare benign fibro-osseous tumor that usually involves the maxilla or the mandible. X-ray and computed tomography (CT) is indispensable in characterizing these tumors and determining their extent of involvement. Magnetic resonance imaging (MRI) is useful in assessing orbital and intracranial extension. In this case report, we describe a rare giant juvenile variant of ossifying fibroma of the sinonasal tract in a 17-year-old boy, spanning across the nasal cavity, frontal, ethmoid and maxillary sinuses, and even extended posteriorly through the choana into the nasopharynx.

Introduction: The group of so-called "sellar-region masses" consists of a heterogeneous group of neoplasms and tumor-mimicking lesions, whose differential diagnosis may be challenging due to the overlapping of clinical and radiological features, which can be found both in "common" and "uncommon" lesions. The choice of a correct treatment strategy is still arduous and requires histological analysis. Gamma Knife Radiosurgery (GKRS) has already been reported as a safe and effective treatment in these cases. The objective of this study is to evaluate single-center pre-operative data, post-operative outcomes, and long-term follow-up in patients treated with GKRS for unusual sellar tumors. Methods: We retrospectively identified and analyzed nine patients treated with GKRS from 2004 to 2015, according to a standard protocol. Lesions consist of hypothalamic hamartoma (HH), Rathke's cleft cist (RCC), Langerhans cell histiocytosis (LCH), spindle cell oncocytoma (SCO), choroid plexus papilloma (CPP), and ossifying fibroma (OF). The diagnosis was histologically confirmed in six patients that underwent surgery, while in three patients, diagnosis was based on characteristic clinical and radiological findings (two HH and one RCC). Pre-operative and post-operative data were retrieved from medical archives, and long-term follow-up was obtained through clinical and neuroradiological periodic examination. Results: In our series, all the "rare" sellar lesions treated, had a successful radiographic and clinical response in a medium-long follow-up period. Conclusions: The long-term follow-up results suggest that GKRS is a safe and effective treatment in rare sellar lesions, with very low toxicity. To the best of our knowledge, this report represents the largest series of unusual sellar lesions treated with GKRS in a single high-volume center, suggesting that GKRS might be an effective non-invasive adjuvant treatment option. Further studies and a larger number of patients are needed to confirm if residuals of these rare sellar lesions might regress on their own without treatment or if other non-invasive treatments could be as effective as GKRS.

Background: Ossifying fibroma (OF) is a benign bone neoplasm that mostly appears in the jaw. OF generally occurs between the second and fourth decades of life. OF can be challenging for clinicians, especially if the patient is in a vulnerable state. This case is particularly significant as it presents OF in a pediatric patient with developmental delay, which can complicate the diagnostic process and affect the accuracy of the patient's complaints. Purpose: This article presents a pediatric patient with developmental delay, which shows evidence of a jaw tumour. Case: A 12-year-old male patient with a chief complaint of swelling that gradually increased in size on the left lower jaw three months ago reported to the Department of Oral and Maxillofacial Surgery Mardi Rahayu Hospital Kudus and later on was diagnosed with OF. This case presents the management of OF in a patient with a particular condition of developmental delay, specifically in socioemotional delay. Case Management: Management of OF may need comprehensive treatment, including pre-operative preparation, supporting examination through radiographic and microscopic imaging, consideration of excision technique, and post-surgery follow-up. Conclusion: The unique challenges presented by the patient's developmental delay highlight the need for careful and clear communication of the treatment plan to ensure a good prognosis.

Osteofibrous dysplasia with obvious deformities, persistent pain, functional problems, or pathological fractures usually requires surgical intervention. This report highlights that computed tomography-based 3D printing preoperative planning can facilitate precise intraoperative positioning of the osteotomy plane and prosthesis stem design for complex bone deformities.

BackgroundThe management of osteofibrous dysplasia (OFD) is controversial, with limited reports on combining non-radical resection with internal fixation. This study evaluates optimal treatments for patients with OFD aged < 15 years, with attention to the limitations of the small sample size.Materials and methodsThis retrospective analysis included 28 patients (30 extremity) with severe pain, pathological fractures, angular deformities, or extensive cortical bone involvement. On the basis of the surgical approach, patients were divided into four groups: group 1, curettage, allograft, and plate fixation for six patients (six extremity); group 2, elastic stable intramedullary nailing fixation for six patients (six extremity); group 3, Fassier–Duval telescopic system fixation for eight patients (nine extremity); and group 4, interlocking intramedullary nail for eight patients (nine extremity).ResultsAll patients achieved bony union and pain alleviation with no recurrence of deformities. The refracture rate during the follow-up was zero cases (0%; group 1) versus one (16.7%; group 2) versus zero (0%; group 3) versus zero cases (0% group 4) (p > 0.05). Instances of internal fixation loosening were zero cases (0%; group 1) versus zero (0%; group 2) versus five (55.6%; group 3) versus zero cases (0%; group 4) (p < 0.05). The musculoskeletal tumor society (MSTS) scores of the four groups were 27.5 (group 1) versus 27.7 (group 2) versus 26.3 (group 3) versus 28.7 (group 4) (p < 0.05).ConclusionsSelecting different treatment strategies for patients of various ages and locations with OFD is vital. Surgical intervention for patients with persistent pain, pathological fractures, extensive cortical bone involvement, or significant tibial deformities can significantly improve their quality of life. The encouraging MSTS scores also support this conclusion. However, given the study’s single-center design and small sample size, further research with larger, multicenter studies is necessary.Level of evidence: Level IV.

Objective: Tissue Reactive hyperplastic lesions (TRHL) are reactions to local injury of the oral mucous membrane. The cause varies from mechanical injury to hormonal imbalance. Since they closely resemble each other in clinical as well as histological picture thus confusing the examiner all the more. Materials and Method: The four commonly found reactive lesions are Focal fibrous hyperplasia (FFH), Pyogenic granuloma (PG), Peripheral ossifying fibroma (POF), Peripheral giant cell granuloma (PGCG). The present study reviewed 238 cases, over a period of 10 years focussed on these four lesions. The clinical and histopathological records were assessed and documented. Any incomplete record was discarded. The records were categorised based on prevalence of jaw distribution, age, size and gender. Statistical analysis was done using chi square test and corelation was assessed using Pearsons’s chi square ratio. Results: The fibrous hyperplastic lesion was most prevalent lesion followed by Pyogenic granuloma, Peripheral ossifying fibroma and least was Peripheral giant cell granuloma. The most common site is buccal mucosa and gingiva. The age group which is most susceptible is from 3rd decade to 5th decade. Conclusion: The lesions are difficult to identify and recurrence rate often leaves the patient and operator troubled. Hence thorough knowledge and understanding of cause and manifestation in particular is warranted for proper diagnosis and treatment.