Trabecular Variant Research Articles

Juvenile ossifying fibroma of maxilla: Concurrent presentation of psammomatoid and trabecular variant.

Juvenile Ossifying Fibroma (JOF) is a type of ossifying fibroma which occurs in younger individuals and manifests as trabecular and psammomatoid variants. The nature and behaviour of these variants vary, and they exhibit characteristic histopathological appearance. The solitary presentation of these subtypes is reported in numbers, but co-occurrence of both these entities is very few. Here, we present a case of JOF with the co-occurrence of both trabecular and psammomatoid variants in relation to an incompletely healed extraction socket.

Salivary Gland Neoplasms With a Unique Trabecular Histology and MAML2 Translocation : A Trabecular Variant of a Mucoepidermoid Carcinoma.

Mucoepidermoid carcinomas (MECs) are the most common salivary gland malignancy and have a diverse histology. Many histologic variants of MEC have now been confirmed with characteristic molecular alterations involving CRTC1::MAML2 or CRTC1::MAML3 translocations. We here report a series of 7 trabecular variants of MEC which showed a predominant trabecular or nested pattern with either focal glandular differentiation or clear cell change and keloid-like fibrosis in the background. In addition, these tumors were either negative or showed only focal positivity for p63. Such features are not characteristic of known disease entities and resulted in an initial misdiagnosis of adenocarcinoma, not otherwise specified, or low-grade to intermediate-grade MEC with uncertainty. The patients' ages in our cohort ranged from 26 to 55 years with a female predominance (5/7). The tumors were located in the parotid gland (n=3), base of tongue (n=2), hard palate (n=1), and parapharyngeal space (n=1), with a median size of 1.5cm. All 7 cases showed an MAML2 split pattern on fluorescence in situ hybridization analysis, and both RNA and whole-genome sequencing presented CRTC1::MAML2 translocation. All 7 cases showed a solid-predominant histology, and 3 cases displayed extracapsular extension. There were no other signs of high-grade histology and no recurrences or deaths occurred over a follow-up period of up to 79 months. We thus propose a unique trabecular variant of MEC that has atypical histologic and immunohistochemical features.

Juvenile trabecular ossifying fibroma: Immunohistochemical expression of MDM2, CDK4 and p53 compared to conventional ossifying fibroma.

BackgroundJuvenile ossifying fibroma (JOF) is an uncommon benign fibro-osseous lesion of the craniofacial skeleton; compared to conventional ossifying fibroma (OF), JOF is characterized by local aggressiveness and propensity for recurrence. The biologic basis for this different biologic behavior between JOF and OF remains elusive. The aim of this study was to evaluate the immunohistochemical expression of MDM2, CDK4 and p53, molecules associated with bone oncogenesis, in the trabecular variant of JOF. Material and MethodsThe study material consisted of five cases of trabecular JOF, affecting three male and two female patients with a mean age of 11.8 years. Three cases arose in the maxilla and two in the mandible. All cases were initially treated by enucleation; two cases recurred necessitating more aggressive treatment. Immunohistochemical study of MDM2, CDK4 and p53 was performed in all cases, as well as in five control cases of conventional OF. ResultsCDK4 positivity was noted in all JOF cases; the staining pattern was diffuse and strong in 4 cases and focal and weak in one case. In contrast, 4 out of 5 cases of OF were weakly and focally CDK4 positive, the remaining one being negative. Immunostaining for MDM2 was observed in 3 JOF cases; all OF were MDM2 negative. All cases of OF and JOF were negative for p53, except for one focally positive JOF case. ConclusionsCDK4 and MDM2 expression in the trabecular variant of JOF is higher compared to conventional OF. In contrast, p53 expression is almost universally negative in JOF and OF. Despite some overlapping features, differential expression patterns of proteins involved in bone oncogenesis can elucidate the pathogenesis and may facilitate accurate diagnosis and prediction of behavior of bone tumors in the craniofacial region. Key words:Juvenile ossifying fibroma, trabecular variant, conventional ossifying fibroma, MDM2, CDK4, p53.

Ocurrence enzootic hematuria in buffaloes in Brazil: epidemiological, clinical, and pathological aspects

ABSTRACT: It is reported the occurrence of enzootic hematuria (EH) in buffaloes in Brazil after performing an epidemiological survey and clinicopathological analises. To date, EH caused by ingestion of Pteridium esculentum subsp. arachnoideum, a radiomimetic plant popularly known as “bracken fern”, has not been described in this species in Brazil. Bovine EH is responsible for high economic losses in Brazil’s Southeast Region not only because of the deaths it causes, but also owing to its negative effect on productivity. In São José do Barreiro County, São Paulo, some farmers in areas with a high incidence of bovine EH have been replacing cattle with buffaloes, based on the premise that the latter would be more resistant to poisoning by ingestion of Pteridium spp. However, even though initial observations indicated that buffaloes are indeed less sensitive than cattle to the toxic principle of Pteridium spp., cases of hematuria in this species have been reported. According to preliminary date, EH only occurs in buffaloes over six years of age. Macroscopic examination revealed a thickened urinary vesicle mucosa, along with multiple foci of ulcerated, exophytic, verrucous, and pedunculated lesions. In one of the buffaloes studied, the bladder wall was ruptured and exhibited marked secondary inflammation. Histologically, neoplastic and non-neoplastic changes similar to those described in cattle poisoned by Pteridium spp. were observed. The neoplasms found included papilloma, carcinoma in situ, urothelial carcinoma (low and high grade), inverted, microcystic, and trabecular variants, urothelial carcinoma with divergent differentiation (squamous and glandular), squamous cell carcinoma, lymphangioma, hemangioma, and hemangiosarcoma. There was also coexistence of epithelial and mesenchymal neoplasms. Bovine papillomavirus particles were not detected by polymerase chain reaction in the bladder samples analyzed.

Juvenile Ossifying Fibroma: Multiportal Endoscopic Trans-Nasal and Orbital Surgical Approaches, Histopathological and Radiological Findings

Abstract: Ossifying fibroma of the nasal cavity and paranasal sinus is a benign tumor histologically, however clinically may show invasive characteristics. It has malignancy rate of 0.4–0.5%. Here, we presented a 2 rare cases of Ossifying fibroma in two female children with Juvenile ossifying fibroma of the paranasal sinuses with orbital involvement and reviewed the literature of this rare tumour. Both cases subjected to complete ENT and ophthalmological examination and investigated by CT study of the paranasal sinuses, orbit and brain using specific protocol. Both underwent excision of the lesions as much as accessible and applicable to avoid complications and morbidity through combined trans-nasal endoscopic and orbital approaches with repair of the orbital wall with titanium as in first case and high-density porous polyethylene sheets as in the second case. We did report some minor post-operative complications. Post-operative follow up included complete ENT and ophthalmological examination and Follow up CT. A histopathological feature of the first case is consistent with diagnosis of trabecular variant of ossifying fibroma, while the second case is consistent with the diagnosis of psammomatoid variant of ossifying fibroma. Radilogically there were partially defined expansile heterogeneous fibro-osseous mass with ground glass appearance occupying the right maxillary, ethmoidal sinuses, and the right nasal cavity and invading the orbit. Conclusion: The diagnosis of JOF is made by correlation of clinical, radiological, histopathological findings. A combined Trans- Nasal endoscopic and orbital approach is effective for adequate excision. Key Words: ossifying fibroma; juvenile aggressive ossifying fibroma; fibro-osseous lesion.

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.

JUVENILE OSSIFYING FIBROMA: A RARE CASE REPORT EMPHASIZING CLINICAL, RADIOGRAPHIC, AND HISTOPATHOLOGIC ASPECTS

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous lesion, which most often arises in children, adolescents, and young adults; however, a broad age range has been reported for the psammomatoid and trabecular variants. A 29-year-old male patient presented with a 5-year history of painless swelling in the mandible. Intraoral examination revealed a mass of approximately 3 cm in the molar region of the left mandible. Radiographic examination showed a well-circumscribed radiolucent lesion containing radiopaque areas. An incisional biopsy was performed, and histopathologic evaluation revealed a lesion characterized by deposition of trabecular immature bone within fibrous connective tissue, associated with proliferation of large mesenchymal cells presenting with varied morphology, and multinucleated giant cells. The final diagnosis was JOF (trabecular variant) and the patient was referred to a surgical service for excision of the lesion. This case reinforces the importance of knowledge of clinicopathologic features for the correct diagnosis of JOF. Juvenile ossifying fibroma (JOF) is a rare fibro-osseous lesion, which most often arises in children, adolescents, and young adults; however, a broad age range has been reported for the psammomatoid and trabecular variants. A 29-year-old male patient presented with a 5-year history of painless swelling in the mandible. Intraoral examination revealed a mass of approximately 3 cm in the molar region of the left mandible. Radiographic examination showed a well-circumscribed radiolucent lesion containing radiopaque areas. An incisional biopsy was performed, and histopathologic evaluation revealed a lesion characterized by deposition of trabecular immature bone within fibrous connective tissue, associated with proliferation of large mesenchymal cells presenting with varied morphology, and multinucleated giant cells. The final diagnosis was JOF (trabecular variant) and the patient was referred to a surgical service for excision of the lesion. This case reinforces the importance of knowledge of clinicopathologic features for the correct diagnosis of JOF.

A case of juvenile ossifying fibroma with conglomeration of trabecular and psammomatoid variants in the maxilla of an 11-year-old boy

A case of juvenile ossifying fibroma with conglomeration of trabecular and psammomatoid variants in the maxilla of an 11-year-old boy

Recurrent juvenile psammomatoid ossifying fibroma with secondary aneurysmal bone cyst of the maxilla: a case report and review of literature.

Juvenile ossifying fibroma is a benign fibro-osseous lesion commonly affecting the extra-gnathic craniofacial skeleton of the young individuals. The psammomatoid and trabecular variants are its two histopathological subtypes having distinctive clinico-pathological characteristics. Secondary aneurysmal bone cysts are frequently reported to arise in the pre-existing fibro-osseous lesions but rarely reported in the psammmomatoid variant of the juvenile ossifying fibroma. Such hybrid lesions, especially massive in size, tend to exhibit a greater aggressive growth potential and higher recurrence rate and mandate complete surgical removal of the lesion along with a long-term follow-up. The objective of this case report was to present a rare incident of recurrent psammomatoid ossifying fibroma associated with a secondary aneurysmal bone cyst in the maxillary jaw bone of a young patient and review the similar published reports in the English literature.

Trabecular Variant of Juvenile Ossifying Fibroma (WHO Type) - A Rare Case Report and Review of the Literature

Trabecular Variant of Juvenile Ossifying Fibroma (WHO Type) - A Rare Case Report and Review of the Literature

Strong Expression of HBME-1 Associates with High-Risk Clinicopathological Factors of Papillary Thyroid Carcinoma

Thyroid cancer comprises a heterogeneous group of lesions with great diversity of biological behaviour. Markers which could help clinicians to identify high-risk patients for tailored optimization of clinical management are of crucial importance. HBME-1 protein level was analysed immunohistochemically using routinely prepared archival tissue sections of a broad range of papillary thyroid carcinoma (PTC) variants and in corresponding lymph node metastases (LNM). The results were evaluated in comparison with clinicopathological features of PTC. Positive immunoreaction was noticed in most classical (83/92; 90.2 %), follicular (60/71; 84.5 %) and trabecular (4/5; 80.0 %) variants of PTC. All cases of macrofollicular, Warthin-like and diffuse sclerosing PTC variants were HBME-1 positive (4/4, 3/3, 2/2; 100 % respectively). Tall cell and solid PTC variants showed diversity of staining (2/3; 66.67 % and 13/23; 56.52 % respectively), while PTCs with mixed histological pattern containing insular areas were mainly weakly positive (2/5; 40.0 %). A single case of clear cell PTC variant showed no reaction. Moreover, all matched metastatic PTC into lymph nodes (LNM) were HBME-1 positive (17/17; 100 %) and expressed HBME-1 in a similar pattern to the matched primary tumour. We also found a statistically significant association between high HBME-1 expression and the presence of lymph node metastasis, advanced pT status and pTNM stage (P < 0.05), but only a tendency for association with extrathyroidal invasion of the tumour (P = 0.058). Therefore, we recommend using immunoexpression of HBME-1 as useful mean to increase the likelihood of detecting most PTC variants and to predict some unfavourable clinical parameters in these patients.

Carcinoid tumor arising in a mature cystic teratoma: A case report.

Mature cystic teratomas are common benign tumors of the ovary. The most common form of malignant transformation is squamous cell carcinoma, however, malignant transformation is rarely observed and cases are usually asymptomatic. Carcinoid tumors are rare tumors of the neuroendocrine system. A number of the carcinoids result in clinical syndromes due to the secretion of vasoactive substances produced by the tumor. A 75-year-old woman suffering from groin pain was admitted to the Faculty of Medicine at Bezmialem Vakıf University (Istanbul, Turkey). An adnexal mass was detected during the physical examination. Magnetic resonance imaging scans exhibited an 8×7-cm mass in the right ovary. Surgical excision of the mass was performed and histopathological examination revealed a mature cystic teratoma with three germ layers. An area consisting of nests and trabeculae was evident in the cyst wall. The pathological diagnosis was of an insular and trabecular variant of carcinoid tumor arising in a mature cystic teratoma. The patient did not present with carcinoid syndrome, and no recurrence was observed after 11 months of follow-up examinations.

Psammomatoid and trabecular juvenile ossifying fibroma: two distinct radiologic entities.

Evaluate and compare the radiologic features of psammomatoid versus trabecular variants of juvenile ossifying fibromas. Twelve of fifteen cases of juvenile ossifying fibroma of the craniofacial bones, retrieved from our pathology archives for the period between 2002 and 2013, had available preoperative computed tomography (CT) scans. The radiologic features of each case were analyzed and compared by two neuroradiologists and one oral and maxillofacial radiologist, each blinded to the histopathologic diagnosis. Juvenile psammomatoid ossifying fibroma (JPOF) exhibited a ground-glass pattern, as an outer mantle with central radiolucency, a single mural nodule, or a solid homogeneous mass. The trabecular variant presented as a radiolucent lesion with irregular, scattered calcifications. Both variants displayed a well-defined border. This study demonstrates that psammomatoid and trabecular juvenile ossifying fibromas exhibit unique radiologic features that allow for distinction between the two variants on CT studies.

A Novel Treatment of Aggressive Psammomatoid Juvenile Ossifying Fibroma: A Case Report

Introduction: Juvenile ossifying fibroma is a benign, bone-forming neoplasm with aggressive local growth that is distinguished from other fibro-osseous lesions primarily by its age of onset, clinical presentation and aggressive behavior. Although a benign entity, juvenile ossifying fibroma is known to be locally aggressive and has a high tendency to recur. Two distinctive microscopic patterns have been described: a trabecular variant and a psammomatoid variant. This latter variant is predominantly a craniofacial lesion and occurs rarely in the jaws. Treatment plans include a range of enucleation to total resection. Case Presentation: Reported here is a case of a huge psammomatoid juvenile ossifying fibroma of the maxilla in a 19-year-old man. Right maxillectomy was done while brain exposure in sphenoid and ethmoidal region was covered with fat and bone graft. After 1 year follow up, an endosseous dental implant was inserted in right lateral pterygoid plate. Conclusions: Six months later an obturator was made over that osseointegrated implant to reconstruct the anatomic defect, achieving functional rehabilitation and satisfactory facial appearance.

Juvenile ossifying fibroma of the mandibular ramus in a five-year-old boy

Juvenile ossifying fibromas (JOF) are benign central lesions occurring in children. Two variants of this entity have been recognized - trabecular and psammomatoid. These lesions are usually asymptomatic and present only as a growing swelling. We hereby report a case of a trabecular variant of a juvenile ossifying fibroma in a five-year-old boy.

Genetic basis of osteoporosis; looking for trabecular and cortical BMD variants

Genetic basis of osteoporosis; looking for trabecular and cortical BMD variants

Juvenile ossifying fibroma of jaws: a clinicopathological analysis of eight cases

Background Juvenile ossifying fibroma is defined as an aggressive variant of the ossifying fibroma and includes juvenile trabecular ossifying fibroma and juvenile psammomatoid ossifying fibroma. Materials and methods A retrospective review was made of all the biopsies performed at the Government Dental College, Trivandrum between 2001 and 2010. The reason for consultation was analysed, along with patient age, sex, clinical and radiological characteristics, tentative diagnosis, histological diagnosis, and treatment provided. Results and conclusion Among the eight cases reported as juvenile ossifying fibroma, there were five girls and three boys with a mean patient age of 14 years (range 9–20 years). The most frequent location was the mandible (six cases). Size of the lesions was 2 cm on average. Four patients presented with painful, hard tumour mass with a duration of several months. The remaining four cases were hard swellings without any symptoms. Four of the lesions were also completely radiolucent, three cases showed mixed radiolucent radio-opaque picture, and one was radio-opaque. Microscopically, four cases were trabecular variant, two were psammomatoid type, and rest of the two cases exhibited both patterns with a predominant trabecular pattern. Surgical resection was performed in all the eight cases. Follow-up was performed in six cases, of which two recurred after 3 years. Rest of the two patients did not report back to our institution.

A massive sinonasal psammomatoid variant of juvenile ossifying fibroma: Report of a rare entity

Juvenile ossifying fibroma (JOF) is an uncommon, benign, bone-forming neoplasm with an aggressive local growth that is distinguished from other fibro-osseous lesions primarily by its age of onset, clinical presentation and aggressive behaviour. JOF is considered as a variant of the ossifying fibroma (OF) and the former includes psammomatoid JOF (PsJOF) and Trabecular JOF (TrJOF). Both variants involve the craniofacial bones with the trabecular variant being more common in the jaws and the psammomatoid variant being more common in the craniofacial skeleton. PsJOF is an unique variant of JOF that has a predilection for the sinonasal tract and the orbit particularly centered on the periorbital, frontal, and ethmoid bones. We report a rare case of massive PsJOF involving the maxillary sinus in a 20-year-old female.

Trabecular Variant of Juvenile Aggressive Ossifying Fibroma of Anterior Mandible

Juvenile ossifying fibroma (JOF) is an expansile intra-osseous lesion of the jaw that emulate odontogenic lesions frequently seen in patients under 15 years of age. They are histologically characterized by the presence of fibrous stromal cells along with mineralized tissues. Clinically, these are characterized by early age of onset, histological patterns, high rate of recurrence and the aggressive local behavior. The differential diagnosis of JOF with other fibro-osseous lesions of the jaw should be made along with an essential microscopic examination and be largely based on the character of the calcified products of the tumor. The purpose of this article is to present a rare clinical case of the trabecular type of JOF and to describe its clinical, radiological and histological characteristics. The clinician should be aware of this type of lesion in order to be able to distinguish this it from other fibrous lesions if encountered in routine practice and for appropriate treatment to be carried out.

Maxillary cementifying fibroma: A case report with fine‐needle aspiration cytology highlighting the expanding role of e‐medicine in cytopathologist collaborations

Cementifying fibroma is an uncommon fibro-osseous lesion presenting in the oral cavity, which may present in children as an aggressive juvenile subtype of either psammomatoid or trabecular variant. Appropriate management, to achieve local control and prevent destructive expansion, requires early diagnosis, which fine-needle aspiration cytology (FNAC) can provide rapidly in a minimally invasive manner. The role of FNAC is even more powerful in situations where medical facilities are limited or where surgical biopsy is contraindicated. We report a case of a 6-year-old boy from Lagos, Nigeria, whose initial diagnosis of cementifying fibroma was made on photographed digital images in jpeg format of FNAC slides, which were then e-mailed as attachments to Sydney, Australia and to Scottsdale, USA. The tumor was subsequently confirmed as a juvenile trabecular variant of cementifying fibroma on histopathology on a surgical excision in London, United Kingdom. The ability to electronically send cytopathology images around the world for a definitive second opinion is a practical example of the power of e-medicine to achieve an accurate FNAC diagnosis.