Ossifying Fibroma Research Articles

Challenges in managing ossifying fibroma of the maxilla: A case report

Ossifying fibroma (OF) is a rare benign bone tumor that tends to grow aggressively, particularly in craniofacial bones such as the upper and lower jaw. The diagnosis of OF is often challenging, due to its rare nature and ability to invade adjacent anatomical structures. We present a case of OF in a 35-year-old woman with recurrent complaints of a lump on the right side of the face. Imaging evaluation showed widespread lesions in the right maxilla. Multidisciplinary discussion was required to determine the best approach in the management of this case, focusing on complete excision of the tumor while preserving function and aesthetics. In the context of recurrent or extensive disease, reconstructive techniques using local or distant flaps can be important to restore postoperative structure and function. Close postoperative surveillance is required to monitor for recurrence and facilitate timely intervention. With a multidisciplinary approach and appropriate management strategies, challenging OF cases can be effectively managed, although more research is needed to improve understanding and outcomes in this condition.

Assessment of MDM2 Gene Locus Amplification by Fluorescence In-Situ Hybridization in Juvenile Ossifying Fibroma.

With IRB approval, a search of the institutional files of the archives of the Oral Pathology and Surgical Pathology biopsy services at the University of Florida Health was performed. The cases were re-evaluated by an oral pathology resident, an oral and maxillofacial pathologist, and a bone and soft tissue pathologist. Cases with consensus in diagnosis were selected (n = 9) for MDM2 testing. Testing by FISH for MDM2 gene locus amplification was applied to all retrieved cases. The examined cases were all negative for MDM2 gene locus amplification via FISH testing. In our small series, JOF did not demonstrate MDM2 gene locus abnormality, a characteristic of LGIOS. This finding suggests that JOF has a distinct underlying pathogenesis. If confirmed in a larger series, these findings may be useful in distinguishing these two entities in cases with overlapping features or when minimal biopsy material is available.

Osteofibrous dysplasia of the 8th rib: a case report

Osteofibrous dysplasia of the 8th rib: a case report

Peripheral Ossifying Fibroma in a 5-year-old Female Patient: A Rare Case Report

Abstract Peripheral ossifying fibroma (POF) represents a rare entity among the frequently encountered solitary gingival growths. It is a reactive benign lesion of connective tissue whose pathogenesis is idiopathic, but authors believe that inflammatory hyperplasia originating in the superficial periodontal ligament can cause POF occurrence. Indistinguishable clinical features of soft-tissue lesions make the diagnosis strenuous for clinicians. However, we can achieve a definitive diagnosis with the help of histological findings. The favorable therapy of POF is surgical excision of the lesion along with the underlying periosteum after eliminating all possible local contributing factors to reduce its recurrence. This article presents a case of POF in a 5-year-old Indian girl who reported painless swelling in the area of mandibular anterior and also discusses its clinical presentation, radiographic findings, histological features, diagnosis, and satisfactory clinical management.

A Rare Case of Massive Juvenile Ossifying Fibroma Requiring Total Maxillectomy and Craniofacial Reconstruction

A Rare Case of Massive Juvenile Ossifying Fibroma Requiring Total Maxillectomy and Craniofacial Reconstruction

A genetic mouse model mimicking MET related human osteofibrous dysplasia is characterized by delays in fracture repair and defective osteogenesis.

Osteofibrous dysplasia (OFD) is a rare, benign, fibro-osseous lesion that occurs most commonly in the tibia of children. Tibial involvement leads to bowing and predisposes to the development of a fracture which exhibit significantly delayed healing processes, leading to prolonged morbidity. We previously identified gain-of-function mutations in the MET gene as a cause for OFD. In our present study, we test the hypothesis that gain-of-function MET mutations impair bone repair due to reduced osteoblast differentiation. A heterozygous Met exon 15 skipping (MetΔ15-HET) mouse was created to imitate the human OFD mutation. The mutation results in aberrant and dysregulation of MET-related signaling determined by RNA-seq in the murine osteoblasts extracted from the wide-type and genetic mice. Although no gross skeletal defects were identified in the mice, fracture repair was delayed in MetΔ15-HET mice, with decreased bone formation observed 2-week postfracture. Our data are consistent with a novel role for MET-mediated signaling regulating osteogenesis.

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.

CT-based radiomics analysis of different machine learning models for differentiating gnathic fibrous dysplasia and ossifying fibroma.

In this study, our aim was to develop and validate the effectiveness of diverse radiomic models for distinguishing between gnathic fibrous dysplasia (FD) and ossifying fibroma (OF) before surgery. We enrolled 220 patients with confirmed FD or OF. We extracted radiomic features from nonenhanced CT images. Following dimensionality reduction and feature selection, we constructed radiomic models using logistic regression, support vector machine, random forest, light gradient boosting machine, and eXtreme gradient boosting. We then identified the best radiomic model using receiver operating characteristic (ROC) curve analysis. After combining radiomics features with clinical features, we developed a comprehensive model. ROC curve and decision curve analysis (DCA) demonstrated the models' robustness and clinical value. We extracted 1834 radiomic features from CT images, reduced them to eight valuable features, and achieved high predictive efficiency, with area under curves (AUC) exceeding 0.95 for all the models. Ultimately, our combined model, which integrates radiomic and clinical data, displayed superior discriminatory ability (AUC: training cohort 0.970; test cohort 0.967). DCA highlighted its optimal clinical efficacy. Our combined model effectively differentiates between FD and OF, offering a noninvasive and efficient approach to clinical decision-making.

Peripheral Ossifying Fibroma: A Case Report Highlighting Clinical Features and Management Strategies

Peripheral ossifying fibroma (POF) is a common and non-neoplastic gingival growth thought to arise from the periodontal ligament. Clinically, it presents as a firm, smooth or slightly pebbled, pink to red, and occasionally ulcerated mass. The lesion occurs frequently in the maxillary anterior region of young adults, with the most common age of occurrence in the second and third decades. POF comprises about 9.6 % of all gingival lesions, with a strong female predilection (73%). We present a 17-year-old male with a painless gingival swelling between the maxillary central incisors who underwent excisional biopsy of the lesion under local anesthesia. Following excisional biopsy, a diagnosis of POF was confirmed by histopathological examination. A comprehensive review of the literature was also conducted to analyze the clinical and pathological characteristics of POF.

Detection of MDM2 gene amplification by fluorescence in situ hybridization and its diagnostic value in low-grade osteosarcoma

Objective: To investigate the diagnostic value of detecting MDM2 gene amplification by fluorescence in situ hybridization (FISH) in low-grade osteosarcoma (LGOS). Methods: Thirty cases of parosteal osteosarcoma (POS) and 14 cases of low-grade central osteosarcoma (LGCOS) from April 2009 to August 2022 at Beijing Jishuitan Hospital, Capital Medical University were analyzed for the presence of MDM2 gene amplification by FISH. Fifty-eight additional cases were used as negative controls (including 28 cases of fibrous dysplasia, 5 cases of giant cell tumor, 4 cases of conventional osteosarcoma, 2 cases each of periosteal osteosarcoma, reparative changes after fracture, pleomorphic undifferentiated sarcoma, low grade myofibroblastic sarcoma, fibrous dysplasia with malignant transformation, one case each of leiomyosarcoma, sclerosing epithelioid fibrosarcoma, malignant peripheral nerve sheath tumor, desmoplastic fibroma of bone, solitary fibrous tumor, aneurysmal bone cyst, clear cell chondrosarcoma, osteofibrous dysplasia, and 3 cases of unclassified spindle cell tumor). Results: Among the 30 patients with POS, 15 were male and 15 were female, ranging in age from 10 to 59 years (mean 35 years, median 30.5 years). Among the 14 patients with LGCOS, four were male and 10 were female, ranging in age from 15 to 56 years (mean 37 years, median 36 years). All except one case were successfully detected by FISH. MDM2 gene amplification was detected in 27 cases of POS (27/29,91.3%) and 8 cases of LGCOS (8/14). All the negative controls were negative for MDM2 gene amplification. The positive rate of MDM2 gene amplification was significantly different between the case group and the control group (P<0.05). The sensitivity and specificity of MDM2 gene amplification in diagnosing POS and LGCOS were 91.3% and 100.0%; and 57.1% and 100.0%, respectively. The sensitivity and specificity of MDM2 gene amplification in diagnosing LGOS (including POS and LGCOS) were 81.3% and 100.0%, respectively. In cases where MDM2 gene was amplified, the MDM2 amplified signal was clustered. Nine cases showed increased CEP12 signal different from polyploidy which was displayed as small and weak signal points or cloud flocculent and cluster signals. Conclusions: Detection of MDM2 gene amplification by FISH is a highly sensitive and specific marker for LGOS. The interpretation criteria for FISH detection of MDM2 amplification are currently not unified. The signal characteristics need more attention when interpreting.

Jaw Fibro-Osseous Lesions: Use of a Predictive Index in Grading Probable Malignant Changes and a Review of Cases.

Fibro-osseous lesions (FLs), may rarely exhibit malignant features likewise undergo malignant transformation. Awareness of these features can assist in screening for potentially malignant cases and identifying low-grade central osteogenic sarcoma (LGCOS) that may mimic FLs. The objective of this study was to determine the usability of an index in predicting malignant changes in jaw FLs. This was a retrospective study where hematoxylin and eosin (H&E) slides and archival records of fibrous dysplasia (FD) and ossifying fibroma (OF) cases were reviewed. The sections were assessed for permeation of marrow spaces, stromal growth pattern, cytologic atypia, mitotic activity, and pattern of bone growth, which are parameters for diagnosing LGCOS. The predictive histologic index of malignancy (PHIM) was determined by a sum of the scores and graded as 0=nil, 1=low, 2 & 3=moderate, and 4 & 5=high. Data were presented using descriptive analysis. Ninety-three cases of FLs met the inclusion criteria, consisting of 40(43%) cases of FD and 53(57%) cases of OF. The peak age of presentation for FD and OF was 2nd and 3rd decade. There was a female preponderance of 1:1.6. The maxilla was the most common site affected by FD, while the mandible was most commonly affected by OF. For FD cases, the PHIM was moderate in 10(25%) cases and low in 21(52.5%) cases. Similarly, for OF cases, 30(56.6%) cases had low grade PHIM while 10(17%) cases had moderate grade PHIM. The PHIM depicted low to moderate malignancy grade in some of the cases studied. Follow up studies would be necessary to assess the PHIM.

Adamantinoma: About 4 Cases

Adamantinoma is a rare primary malignant bone tumor of the tibia in young adults. Histologically, it comprises malignant epithelial cells within a fibrous or osteofibrous stroma. Adamantinoma poses a problem of differential diagnosis with osteofibrous dysplasia and osteofibrodysplasia. the evolution of this low-grade sarcoma is slow. Treatment is surgical, involving resection of the tumour and reconstruction of the bone. Metastases may occur in the lungs, lymph nodes or bones. We report 4 cases of adamantinoma.

Correction of anterior bowing complicating tibial osteofibrous dysplasia in preadolescents by osteotomy and telescopic nailing without lesional resection: a preliminary study of four-case reports.

Osteofibrous dysplasia (OFD) occurs most frequently in the tibia and may result in deformity and pathological fracture. Surgical treatment such as curettage or segment excision has been performed but remains controversial due to high complication rates and surgical burden. This study introduces a new method to manage OFD with anterior bowing of the tibia using minimally invasive tibial osteotomy and telescopic rod (TR) osteosynthesis without extensive lesion resection. A retrospective study of 4 children with OFD and tibia bowing deformity treated with minimally invasive tibial wedge osteotomy and TR fixation between January 2015 and November 2020 was performed. Results including bone healing, complications, function based on MSTS score, and recurrance of deformity were assessed. The median follow-up was 29 months. Radiographs showed the median time for union was 3 months. There were no instances of refracture or recurrence of deformity. The mean post-operative MSTS score was significantly higher than preoperative score. This method avoids large bone defects and reconstructive procedures. It is an effective and minimally invasive approach for managing anterior bowing deformity secondary to OFD while improving function and quality of life. Level IV; Case Series; Treatment Study.

Endoscopic endonasal transsphenoidal surgery for unusual sellar lesions: eight cases and review of the literature.

Preoperative imaging for some unusual lesions in the sellar region can pose challenges in establishing a definitive diagnosis, impacting treatment strategies. This study is a retrospective analysis of eight cases involving unusual sellar region lesions, all treated with endoscopic endonasal transsphenoidal surgery (EETS). We present the clinical, endocrine, and radiological characteristics, along with the outcomes of these cases. Among the eight cases, the lesions were identified as follows: Solitary fibrous tumor (SFT) in one case, Lymphocytic hypophysitis (LYH) in one case, Cavernous sinus hemangiomas (CSH) in one case, Ossifying fibroma (OF) in two cases; Sphenoid sinus mucocele (SSM) in one case, Pituitary abscess (PA) in two cases. All patients underwent successful EETS, and their diagnoses were confirmed through pathological examination. Postoperatively, all patients had uneventful recoveries without occurrences of diabetes insipidus or visual impairment. Our study retrospectively analyzed eight unusual lesions of the sellar region. Some lesions exhibit specific imaging characteristics and clinical details that can aid in preoperative diagnosis and inform treatment strategies for these unusual sellar diseases.

LE FORT I OSTEOTOMY AS A SURGICAL APPROACH TO REMOVE A JUVENILE OSSIFYING FIBROMA IN THE MAXILLARY SINUS: PEDIATRIC CASE REPORT

Ossifying fibroma (OF) is a well-defined benign neoplasm formed by different fibrocellular tissue and mineralized material. The OF clinical presentation is commonly an asymptomatic slow-growing swelling, mainly affecting the posterior mandibular region. Radiographically, this condition is characterized as a well-defined lesion with radiopaque and radiolucent areas. Histopathology shows dense cellular fibrous stroma and characteristic spheroidal calcifications called psammoma bodies. Regarding pediatric patients, the Juvenile Ossifying Fibroma (JOF) is an uncommon benign fibro‑osseous lesion with fast growth that impacts the facial skeleton, as it has a high-frequency potential. It occurs in early life, and approximately 79% are diagnosed before the age of 15 years. It affects both genders equally, and the maxilla is more involved compared to the mandible, there are cases also discovered in the orbit and skull. Surgical intervention to remove the tumor is the treatment of choice. The article presents a case of a pediatric patient who had the diagnosis of Juvenile Ossifying Fibroma and was submitted to surgical removal. The Le-Fort I Osteotomy approach proved to be safe, as it allows direct access to the base of the skull, allows good visualization and tumor exposure, and also allows easy tumor manipulation and curettage, enabling the preservation of facial aesthetics.

Large-Scale assessment of ChatGPT's performance in benign and malignant bone tumors imaging report diagnosis and its potential for clinical applications

ObjectiveThis study was designed to delve into the complexities involved in diagnosing of benign and malignant bone tumors and to assess the potential of AI technologies like ChatGPT in improving diagnostic accuracy and efficiency. The study also explores the few-shot learning as a method to optimize ChatGPT's performance in specialized medical domains such as benign and malignant bone tumors diagnosis. MethodsA total of 1366 benign and malignant bone tumors-related imaging reports were collected and diagnosed by 25 experienced physicians. The gold standard of diagnosis was established by combining clinical, imaging and pathological principles.These reports were then input into the ChatGPT model which underwent a few-shot learning method to generate diagnostic results. The diagnostic results of the physicians and the AI model were compared to evaluate the performance of ChatGPT. An experiment was conducted to assess the influence of different radiologist's reporting styles on the model's diagnostic performance. Furthermore, in-depth analysis of misdiagnosed cases was carried out, categorizing diagnostic errors and exploring possible causes. ResultsThe diagnostic results generated by ChatGPT showed an accuracy of 0.73, sensitivity of 0.95, and specificity of 0.58. After few-shot learning, ChatGPT demonstrated significant improvement, achieving an accuracy of 0.87, sensitivity of 0.99, and specificity of 0.73, bringing it much closer to the level of physician diagnostics. In an experiment analyzing the influence of the radiologist's reporting style, the model demonstrated higher sensitivity when interpreting reports written by high-level radiologists. In 56 benign cases, ChatGPT misdiagnosed them as malignant. Among these, 35 benign lesions- fibrous dysplasia and osteofibrous dysplasia- were incorrectly identified as metastatic tumors or osteosarcomas; 8 cases of myositis ossificans were wrongly diagnosed as extraosseous osteosarcoma. 7 cases of giant cell tumor of bone at the end of long bone were misdiagnosed as osteosarcoma by intermediate doctors. Chondroblastoma was misdiagnosed as malignant tumor in 6 cases −2 osteosarcoma and 4 chondrosarcoma-In this study, 23 osteosarcoma cases were misdiagnosed by ChatGPT as osteomyelitis; Chondrosarcoma was misdiagnosed as fibrous dysplasia or aneurysmal bone cyst in 8 cases. Four cases of spinal chordoma were misdiagnosed as spinal tuberculosis. ConclusionOur findings highlight the potential of ChatGPT in the diagnosis of benign and malignant bone tumors, offering advantages like enhanced efficiency and a reduction in missed diagnoses. However, the necessity of collaborative interactions between physicians and ChatGPT in practical settings was underscored. With an examination into AI's capacity in benign and malignant bone tumors diagnosis, this study lays the groundwork for future AI advancements in medicine. Additionally, the benefits of few-shot learning in fine-tuning ChatGPT applications in specialized fields were also demonstrated.

Role of collagen and immunostaining for TGF-β in the clinical and microscopic findings of pyogenic granuloma and peripheral ossifying fibroma.

Collagen is a component of Pyogenic Granuloma (PG) and Peripheral Ossifying Fibroma (POF) and performs different functions in these lesions. The objective of this study is to evaluate the role of collagen and immunostaining for Transforming Growth Factor beta (TGF-β) in the clinical and microscopic findings of PG and POF. PG (n=20) and POF (n=20) were selected for clinical evaluation (sex, age, localization, size and evolution time) and microscopic analysis (picrosirius red staining for collagen analysis and immunohistochemistry for TGF-β) performed in the superficial and deep areas of the two lesions. ANOVA/Bonferroni and t-test, Pearson correlation and χ2 were used to compare the sites and parameters analyzed (p<0.05, GraphPad Prism 5.0). The depth of PG presented the highest amount of collagen (p<0.001), and its surface showed the lowest amount of type 1 collagen (yellow-red strong birefringence). Type 1 collagen gradually increased in depth of PG, surface and depth of POF (p<0.001). The number of TGF-β+ cells was lower on the surface of PG compared with the depth of PG and the two areas of POF (p<0.001). Sex and localization did not affect these parameters, but the profile of collagen and immunostaining for TGF-β suffered from modifications by the time of evolution and the size of the lesion. Although PG and POF are reactive gingival lesions, the expression of TGF-β and its role in collagen showed different biological behaviors in these lesions, suggesting different biological origins for its components.

A Case of Osteofibrous Dysplasia at Birth: 2-Year Follow-Up

Osteofibrous dysplasia (OFD) is characterized by excessive resorption of long bone, especially tibia, with subsequent fibrous repair of the defect. OFD is an uncommon benign tumor of young children – neonatal presentation is restricted to single digits in literature. We describe a rare case of OFD in a newborn, which presented as unilateral painless lower limb deformity at birth. Radiological findings were suggestive and biopsy was diagnostic of OFD. Postbiopsy, the patient underwent expectant management given the generally slow progression of this condition, the possibility of postbiopsy regression, and the known risk of recurrence after surgical intervention. By 13 months, the lesion had undergone complete radiological resolution with spontaneous reduction of deformity. There has been no recurrence of disease at the same or another site till now (24 months age). There is no limb length discrepancy and motor milestones are appropriate for age; nevertheless, follow-up till puberty has been advised.

Diagnosis and Surgical Management of Juvenile Psammomatoid Ossifying Fibroma: A Case Report

Diagnosis and Surgical Management of Juvenile Psammomatoid Ossifying Fibroma: A Case Report

Surgical and Prosthetic Management of a Juvenile Ossifying Fibroma In a 5-Year-Old Child: A Clinical Report

Juvenile ossifying fibroma (JOF) is a rare and benign fibro-osseous lesion of the craniofacial skeleton commonly seen in children under 15 years of age. Despite being classified as benign, JOF lesions are aggressive in nature and reach large dimensions in a short period of time. Thus, their resections may cause large orofacial defects which have serious detrimental effects on the functional and nutritional requirements of pediatric patients being in the pe-riod of growth. Therefore, its early diagnosis and proper surgical and prost-hetic management are of vital importance for the survival of patients. However, no detailed reports in the literature describe the prosthetic mana-gement of large intraoral defects in pediatric patients under 10 years old.