Tumores fibroóseos de cavidades paranasales: experiencia en el Hospital Clínico de la Universidad de Chile y revisión de la literatura / Fibro-osseous tumors of paranasal cavities: experience in the Hospital Clínico de la Universidad de Chile and review of the literature

Los tumores de cavidades paranasales presentan una baja frecuencia. Dentro de éstos, entre los benignos destacan las lesiones fibroóseas que se caracterizan por el reemplazo de hueso normal por estroma celular fibroso. Dentro de estas lesiones se describen osteoma, displasia fibrosa y fibroma osificante. Se revisan 3 casos de pacientes del Hospital Clínico de la Universidad de Chile y se presenta una revisión bibliográfica en cuanto a las lesiones fibroóseas, su clínica, diagnóstico, imagenología y tratamiento.

The tumors of paranasal cavities present a low frequency. Among the benign tumors are fibro-osseous lesions characterized by the replacement of normal bone by fibrous cell stroma. Osteoma, fibrous dysplasia, and ossifying fibroma are described within these lesions. Three cases of patients from the Hospital Clínico de la Universidad de Chile are reviewed and a bibliographic review is presented regarding the fibro-osseous lesions, their clinical features, diagnosis, imaging and treatment.

Psammomatoid variant of juvenile ossifying fibroma

Juvenile ossifying fibroma (JOF) is a rare benign tumor of the craniofacial bones differing from other fibro-osseous lesions in terms of early age of onset, aggressive clinical behavior, and high recurrence rate. Histopathologically, it is divided into two as trabecular JOF (TrJOF) and psammomatoid JOF (PsJOF). In PsJOF, psammoma-like spherical ossicles constitute pathognomonic histopathological images, whereas TrJOF has trabeculae of fibrillary osteoid and woven bone. Despite the histopathologic separation, both lesions have similar clinical behavior, thus the treatment procedure is also the same. Complete surgical resection is preferred for the treatment. We report a rare case of PsJOF involving the maxillary sinus and resultant facial symmetry in a 13-year-old female child.

Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report / 대한악안면성형재건외과학회지

BACKGROUND: Fibrous dysplasia (FD) is a benign bone lesion characterized by the progressive replacement of normal bone with fibro-osseous connective tissue. The maxilla is the most commonly affected area of facial bone, resulting in facial asymmetry and functional disorders. Surgery is an effective management option and involves removing the diseased bone via an intraoral approach: conservative bone shaving or radical excision and reconstruction. CASE PRESENTATION: This case report describes a monostotic fibrous dysplasia in which the patient’s right midface had a prominent appearance. The asymmetric maxillary area was surgically recontoured via the midfacial degloving approach under general anesthesia. Follow-up photography and radiographic imaging after surgery showed the structures were in a stable state without recurrence of the FD lesion. Furthermore, there were no visible scars or functional disability, and the patient reported no postoperative discomfort. CONCLUSIONS: In conclusion, the midfacial degloving approach for treatment of maxillary fibrous dysplasia is a reliable and successful treatment option. Without visible scars and virtually free of postoperative functional disability, this approach offers good exposure of the middle third of the face for treatment of maxillary fibrous dysplasia with excellent cosmetic outcomes.

Demystifying the Mystified - An Ambiguous Presentation of Cemento-ossifying Fibroma in Maxilla.

Cemento-ossifying fibroma is a slow growing benign tumor of mesenchymal origin. It is typically found in craniofacial bones, frequently involving the mandible and it tends to occur in third and fourth decade of life with predilection for women. Occurrence of this lesion in maxilla is a rare entity. We report one such case of cemento-ossifying fibroma of size 5x4 cm on upper left maxilla in 38 year old female patient which is an unusual presentation.

A Rare Intradural Extramedullary Calcifying Pseudoneoplasm of the Spine Presenting with Radiculopathy.

Aims: Calcifying pseudoneoplasms of the neuroaxis (CPN) are rare, poorly understood lesions of the central nervous system that pose a diagnostic challenge because they mimic the more common calcified lesions of the neuroaxis. We highlight the relevant clinical presentation as well as radiological and histopathological features unique to intraspinal CPNs. Presentation of Case: We present the case of a 44-year-old Hispanic male with lumbar radiculopathy, radiological features of an indolent, intradural extramedullary mass, and a histopathological evaluation consistent with CPN. The patient underwent successful surgical resection and remained neurologically intact at long-term follow-up. Discussion: Epidural CPNs have been described in the literature. However, intradural CPNs are exceedingly rare lesions, and as a result, are not routinely included in the differential diagnosis of calcified, intraspinal lesions. Although there are currently no consensus guidelines for the diagnosis and management of intraspinal CPNs, understanding the clinical presentation and radiological features of these lesions is crucial for spine surgeons and neurosurgeons because surgical resection may offer a cure. Conclusion: Calcifying pseudoneoplasms may present as intradural abnormalities that mimic more prevalent lesions such as meningiomas. Surgical resection should be considered as first-line treatment because it is associated with low morbidity and may be potentially curative.

Cemento Ossifying Fibroma of the Maxilla - A Case Report.

Cemento ossifying fibroma is a uncommon benign fibro osseous lesion commonly occurs in the young adults in the age group of 20 to 40 yrs, most commonly in the females with an female to male ratio of 5:1.It usually occurs in the craniofacial bones and rarely in long bones, of the craniofacial bones, posterior mandible in the region of premolar molar area is commonly seen. The occurrence COF in the maxillary, ethmoid, frontal, and sphenoid sinuses are rarely reported in the literature. A rare case of COF affecting the maxilla in a young male patient is discussed.

Aggressive Juvenile Ossifying Fibroma –A Rare Case Report

Juvenile ossifying fibroma (JOF) accounts for the most controversial fibro-osseous lesion occupying a subset within the spectrum of ossifying fibroma. It is distinguished from the adult group of ossifying fibromas on the basis of the age of the patient, most common site of involvement, clinical behaviour and microscopic features. JOF appears at an early age with 79% of the patients being diagnosed before the age of 15. JOF is considered by many to be a unique lesion because of its reported tendency to occur in children and its more complex histological features.

Largo Fibroma Cemento-Ossificante em Mandíbula: Relato de Caso / Large Cement-ossifying Fibroma of Mandible: a Case Report

O Fibroma Cemento-Ossificante (FCO), apesar de lembrar em menor proporção uma displasia cementoóssea, é considerado um neoplasma verdadeiro, com potencial de crescimento, apresentando recidivas raramente encontradas. A lesão é relativamente rara, haja vista que muitos casos no passado hoje são reconhecidos como displasia cemento-óssea focal. Há uma maior prevalência de ocorrência na 3ª e na 4ª década de vida, com considerável predileção pelo gênero feminino, maior acometimento na mandíbula e unilocular. O intuito deste trabalho é relatar um caso de FCO em um paciente, 19 anos de idade, no qual, após radiografia de controle, foi constatada uma lesão com graus variados de radiopacidade. Ao exame clínico, apresentava discreta assimetria em região de corpo mandibular esquerdo. A avaliação tomográfica foi avaliada, e, posteriormente a biópsia excisional foi realizada. Observou-se, após 2 anos de pós-operatório, adequado reparo ósseo e cicatrização do tecido gengival com ausência de recidivas.

Cement-ossifying fibroma (COF), despite its similarity, on a smaller scale, to a cement-osseous dysplasia, is considered a true neoplasm with growth potential, relapses being of rare occurrence. The lesion is relatively rare, since many presumed cases in the past, are now recognized as focal cement-osseous dysplasia. Its highest prevalence is in the third and fourth decades of life, and it has a marked predilection for females, affecting, in particular, a single locus of the mandible. The purpose of this paper is to report a case of COF in a 19-year-old male patient, in whom the control radiograph revealed a lesion with varying degrees of radiopacity. The clinical examination showed a slight asymmetry in the region of the left mandibular body. Tomography was evaluated and an excisional biopsy subsequently performed. After two years of follow-up satisfactory bone repair and healing of the gum tissue were observed, with an absence of relapses.

Florid osseous dysplasia: report of two cases and a review of the literature / Displasia ósea florida: reporte de dos casos y revisión de la literatura

Florid osseous dysplasia (FOD) is a benign condition of the jaws in which the normal architecture of bone is replaced by a fibrous tissue containing a variable amount of bone and cementum-like tissue. This lesion is most commonly seen in middle aged black women. FOD appears as dense, lobulated masses, often symmetrically located in the mandible, rarely in the maxilla. The lesion is usually asymptomatic and benign. However, a secondary infection may occur and its treatment can be difficult and complicated. This paper reports the case of two patients. The first one is a white woman aged 65 and the second one is a black woman aged 70, both diagnosed with FOD, revealed by secondary infections. The diagnosis was based on clinical and radiographic findings, as biopsy is contraindicated. Radiological and clinical features of FOD and its management will be also discussed on the basis of recent literature.

La displasia ósea florida (DOF) es una patología benigna del maxilar y mandíbula en la que se sustituye la arquitectura normal del hueso por un tejido fibroso que contiene una cantidad variable de tejido óseo y cementoide. Esta lesión es más frecuente en mujeres negras de edad media. La DOF aparece como una masa densa, lobulada, a menudo situada simétricamente en la mandíbula, rara vez en el maxilar. La lesión suele ser asintomática y benigna. Sin embargo, una infección secundaria puede ocurrir y su tratamiento puede ser difícil y complicarse. Este artículo reporta el caso de dos pacientes. La primera es una mujer blanca de 65 años y la segunda es una mujer negra de 70 años, ambas diagnosticadas con DOF, revelada por infecciones secundarias. El diagnóstico se basó en los hallazgos clínicos y radiológicos, ya que la biopsia está contraindicada. Las características clínicas y radiológicas de la DOF y su manejo son discutidos en base a la literatura reciente.

Cemento-ossifying fibroma.

Cemento-ossifying fibromas (COFs) are benign lesions affecting the jaws and other craniofacial bones. They commonly affect adult females between the third and fourth decade of life, predominantly occurring in the premolar/molar region of the mandible. Most of the lesions typically show slow and often expansile growth, centrally within the jaw and characteristically behave in a benign form, but occasionally they may present as an aggressive gigantiform lesion. Radiographically, they appear as well-defined unilocular or multilocular intraosseous masses. The lesion is invariably encapsulated and of mixed radiolucent densities. The tumor may grow quite extensively; thus, the term "aggressive" is sometimes applied. Surgical resection is the treatment of choice. They are insensitive to radiotherapy and recurrences are uncommon. Clinical, radiographic and histopathologic features of COF and other fibro-osseous lesions are overlapping and may cause confusion in classification, diagnosis and treatment.

Tratamento cirúrgico de fibroma cemento-ossificante: relato de caso clínico / Surgical treatment of cemento-ossifying fibroma: case report

As lesões fibro-ósseas constituem um grupo de patologias caracterizadas pela substituição de tecido ósseo normal por tecido fibroso benigno contendo quantidades variadas de material mineralizado. A displasia fibrosa óssea, o fibroma ossificante, o fibroma cemento-ossificante e a displasia cemento-óssea são as mais frequentes. Na literatura, a classificação e a terminologia das lesões fibro-ósseas apresentam-se ainda confusas e controversas, pois essas patologias exibem, freqüentemente, características clínicas e morfológicas muito semelhantes. O fibroma cemento-ossificante é uma neoplasia benigna que faz parte do grupo das lesões fibro-ósseas. Caracteriza-se por crescimento bem delimitado e eventualmente encapsulado, apresentando quantidades variáveis de tecido mineralizado semelhante ao osso e cemento. São lesões incomuns, que tendem a ocorrer durante a 3ª e 4ª décadas de vida, com uma predileção pelo gênero feminino. Acomete preferencialmente a mandíbula. Este trabalho tem por objetivo descrever e discutir um caso clínico-cirúrgico de fibroma cemento ossificante.

Fibro-osseous lesions of bone are a group of diseases characterized by replacement of normal bone tissue with benign fibrous tissue containing different amounts of mineralized material. The most frequent are fibrous dysplasia, ossifying fibroma, cemento-ossifying fibroma, and osteofibrous dysplasia. In the literature, classification and terminology of these entities remain confusing and controversial, since these lesions show some clinical and morphologic similarities. Cemento-ossifying fibroma is a benign neoplasia that is a part of the group of the fibroosseous lesions. It is characterized by well delimited growth and occasionally encapsulated, presenting changeable amounts of mineralized tissue similar to the bone and cemento. They are uncommon lesions that tend to occur during the 3rd and 4th decades of life, mainly in females and preferentially appearing in the mandible. The aim of this work is to describe and discuss a clinical surgical case of cemento-ossifying fibroma.

Cementifying fibroma—A case report.

The etiology and pathogenesis of fibro-osseous lesions remain a subject of investigation. Various explanations are offeredcongenital anomaly of bone, developmental defect caused by faulty embryogenesis ; hamartoma, tumor of periodontal membrane origin, mesenchymal tumor arising in spongiosa and an abnormal repair of bone after injury. Fibro-osseous lesions of the jaws form a group of conditions, which are remarkable for their clinicopathological similarities. On occasions clinician may find himself in the position of being the arbiter in the face of equivocal histological evidence. Some pathologists use the same terminology for apparently quite dissimilar lesions, and seemingly others to render the same diagnosis use variable histologic criteria. By analyzing the clinical, radiographic, gross/surgical and histological features of all lesions coded as fibro-osseous lesions we should be able to separate a clinicopathologic entity. A case of cementifying fibroma is presented here along with discussion.

Intracranial Fibro-Osseous Lesion: A case report and literature review

Intracranial fibro-osseous lesion, also reported as calcifying pseudoneoplasm of the neural axis, is an uncommon lesion of the central nervous system. Since the discovery of this entity by Rhodes and Davis in 1978, there have been a total of 21 cases reported in the literature. We encountered one such case in a 28 year old male, who presented with left hemiparesis for 1 year. By the MR images, a 1.5 cm sized round mass was found at right parietal lobe near motor cortex. The mass lesion enhanced well, homogenously and revealed clear, slightly irregular margin. Excisional biopsy of the mass was performed. Microscopically the lesion was composed of calcified fibrous tissue with an amorphous gray-blue, coarsely fibrillar to chondromyxoid nodular areas. Sparse spindle cells, immunohistochemically negative for GFAP, vimentin and S-100, were scattered within the amorphous material. Palisading spindle or polygonal cells were present at the more cellular periphery of the lesion, which were vimentin positive but S-100 negative. There was no evidence of the pilocytic astrocytes, Rosenthal fibers, or GFAP positive hypertrophic astrocytes. Intracranial fibro-osseous lesions are apparently slow-growing with generally excellent prognosis after wide excision. The etiology remains unclear, but most investigators favor a reactive rather than neoplastic process.

Clinical and histopathological study of fibro-osseous lesions of the jaws

Seventy-two cases of benign fibro-osseous lesions of the jaws were reassessed, and a modified classification is proposed that may be helpful in their understanding and management. The anatomical distribution of these cases is described and compared to previously reported cases. The histogenesis of each particular lesion is also discussed. Correlative analysis of histopathologic and oral radiographic features is essential for definitive diagnosis.