Displasia Cemento Ósea Florida: Reporte de un caso

La Displasia Cemento Ósea Florida corresponde a un tipo de lesión fibro ósea caracterizada por presentar un hueso trabecular con apariencia de tejido conectivo fibroso con áreas similares al cemento radicular. Afecta principalmente a mandíbula, a mujeres y a personas de etnia africana entre la cuarta a la quinta década. Posee crecimiento limitado, presentación de forma simétrica, bilateral y capacidad de afectar de uno a más cuadrantes. Tiene tres etapas de desarrollo, que se presentan con aspecto radiográfico diferente. En la primera etapa se aprecia un área radiolúcida, en la segunda etapa se visualizan radiopacidades circunscritas al área radiolúcida; y en la tercera etapa se observa una clara radiopacidad alrededor de la lesión. Para su correcto diagnóstico se necesita una cuidadosa correlación de los hallazgos clínicos, imagenológicos, de laboratorio e histopatológicos. Se presenta el caso de una paciente de género femenino de 70 años diagnosticada con Displasia Cemento Ósea Florida.

Florid Cemento-Osseous Dysplasia is a type of fibro-osseous lesion characterized by a trabecular bone with the appearance of fibrous connective tissue with areas similar to root cement. It mainly affects the jaw, women and people of African ethnicity between the fourth and fifth decades. It has limited growth, a symmetrical, bilateral presentation and the ability to affect one or more quadrants. It has three stages of development, with different radiographic appearance. The first stage shows a radiolucent area, the second stage shows radiopacities circumscribed to the radiolucent area; and in the third stage a clear radiopacity is observed around the lesion. For its correct diagnosis, a careful correlation of clinical, imaging, laboratory and histopathological findings is needed. The case of a 70-year-old female patient diagnosed with Florid Cemento-Osseous Dysplasia is presented.

Lesión Fibro-ósea de Mandíbula: Un Hallazgo Radiográfico / Fibro-osseous Lesion of the Mandible: A Radiographic Finding

Las lesiones fibro-óseas son consideradas benignas y componen un grupo de patologías de desórdenes que se caracterizan por el reemplazo de un hueso normal por un tejido compuesto de fibras colágenas, fibroblastos y tejido mineralizado. Presentamos un hallazgo radiográfico obtenido de un paciente de sexo masculino de 41 años de edad que asiste a un centro de radiología para realizarse una radiografía panorámica, el examen revela un interesante hallazgo radiográfico en la hemi mandíbula izquierda, donde se observa una lesión fibro-ósea con expansión ósea a nivel de reborde marginal y cortical basal mandibular, desplazamiento de canal mandibular, desplazamiento dentario, compromiso de cortical alveolar y rizálisis en diferentes niveles en los dientes adyacentes a la lesión. De acuerdo a los antecedentes anteriores se establece una hipótesis diagnóstica de Fibroma Osificante de larga data debido a su radiopacidad. La Organización Mundial de la Salud lo clasifica como una neoplasia ósea benigna con afección al esqueleto craneofacial, de mayor incidencia en mandíbula, se presenta generalmente entre la 3º y 4º década de vida. Concluimos que las lesiones fibro-óseas pueden ser detectadas como un hallazgo radiográfico, esto es relevante para un tratamiento precoz, sin embargo, el diagnóstico debe realizarse complementando los antecedentes clínicos e histopatológicos de la lesión, poniendo especial atención en el diagnóstico diferencial.

Fibro-osseous lesions are considered benign and make up a group of disorder pathologies that are characterized by the replacement of normal bone by tissue composed of collagen fibers, fibroblasts, and mineralized tissue. We present a radiographic finding obtained from a 41-year-old male patient who attended a radiology center for a panoramic radiograph. The examination revealed an interesting radiographic finding in the left hemi-mandible, where a fibro-osseous lesion was observed. with bone expansion at the level of the marginal ridge and basal mandibular cortex, displacement of the mandibular canal, dental displacement, compromise of the alveolar cortex and rizalysis at different levels in the teeth adjacent to the lesion. According to the previous antecedents, a long-standing diagnostic hypothesis of Ossifying Fibroma is established due to its radiopacity. The World Health Organization classifies it as a benign bone neoplasm affecting the craniofacial skeleton, with the highest incidence in the jaw, generally presenting between the 3rd and 4th decade of life. We conclude that fibro-osseous lesions can be detected as a radiographic finding, this is relevant for early treatment, however the diagnosis must be made by complementing the clinical and histopathological history of the lesion, paying special attention to the differential diagnosis.

Florid Osseous Dysplasia in Edentulous Maxilla and Mandible: A Rare Case Report

Introduction: Florid osseous dysplasia (FOD) has been described as a reactive fibro-osseous lesion affecting the jaw bones especially the tooth bearing areas. Usually, this lesion is asymptomatic unless accidentally detected during radiographic examination for any other purpose. Although the etiology is unclear, several theories suggests that its origin was related to reactive or dysplastic changes within the periodontal ligament. Case Presentation: Presenting a case of Florid Osseous Dysplasia within the edentulous maxilla and mandible of 65-year-old female patient. Patient reported with a diffuse swelling in the edentulous maxillary and mandibular posterior regions intraorally. Radiographically, multiple radiopaque lesions were noted bilaterally in the posterior mandible and also in the right posterior side of the maxilla. On microscopic examination, the lesion was composed of spicules of bony trabeculae with osteocytes in lacunae and intervening fibro-fatty connective tissue with plump fibroblasts. Management and prognosis: After the incisional biopsy, surgical recontouring was done along with further regular follow up and observation. Conclusion: Diagnosis of the jaw lesions is based on clinical findings, radiographic features, and histological picture, whereas FOD can be diagnosed based on its clinical and radiographical features. Even though the surgical approach may lead to many complications like osteomyelitis, infection, fracture etc., a biopsy may be done to confirm the diagnosis.

Fibroma ossificante trabecular juvenil: um relato de caso / Juvenile ossifying fibroma: a case report

Objetivo: o fibroma ossificante trabecular juvenil (FOJT) é uma lesão fibro-óssea incomum, benigna, porém de comportamento agressivo. Ocorre, frequentemente, em crianças e adolescentes, com maior acometimento em maxila e mandíbula. O presente relato aborda os aspectos clínicos, imaginológicos, histopatológicos, imuno-histoquímicos e o tratamento de um caso de FOTJ. Além de discutir suas similaridades com o osteossarcoma de baixo grau e as alternativas para o seu diagnóstico. Relato de caso: paciente do sexo masculino, com 12 anos de idade, apresentando aumento de volume em mandíbula no lado esquerdo, perda de função mastigatória e de fala, com tempo de evolução de seis meses. Radiograficamente, a lesão apresentava aspecto unilocular, com limites definidos e de padrão misto. O tratamento consistiu em cirurgia de enucleação total da lesão, seguida de curetagem sob anestesia geral. A histopatologia e a ausência de marcação para MDM2 e CDK4 na imuno-histoquímica confirmaram o diagnóstico de FOTJ e excluíram o de osteossarcoma de baixo grau. No controle pós-operatório de 20 dias, o paciente relatou melhora da parestesia, da função mastigatória e da fala e ausência de dor. Não se observou recidiva no acompanhamento de 1 ano após a cirurgia. Considerações finais: a similaridade dos aspectos clínico, imaginológico e microscópico entre FOJT e osteossarcoma de baixo grau pressupõe o estudo imuno-histoquímico com os arcadores MDM2 e CDK4, minimizando equívocos no diagnóstico e orientando de forma mais eficiente o plano de tratamento adotado.(AU)

Objective: juvenile Trabecular Ossifying Fibromas (JTOF) are uncommon benign fibro-osseous lesions with a local aggressive behavior. They frequently occur in children and adolescents involving the jaw bones. This report addresses the clinical, imaging, histopathological, and immunohistochemical aspects and the treatment of a case of JTOF. In addition, it discusses similarities between JTOF and low-grade osteosarcomas and alternatives for their diagnosis. Case report: male patient, 12 years old, with a tumor in his left mandible, loss of masticatory function and speech, with a 6-month time course. Radiographically, the lesion had an unilocular aspect, with defined borders and a mixed image pattern. Treatment consisted surgical enucleation, followed by bone curettage, under general anesthesia. Histopathology presented fibrous stroma interspaced with bone trabeculae without signs of cellular malignancy. MDM2 and CDK4 markers in immunohistochemistry, confirmed the diagnosis of JTOF and excluded low-grade osteosarcoma. At the 20-day postoperative follow-up, the patient reported improvement in paresthesia, masticatory function and speech, and the absence of pain. Evaluation 1 year after surgery showed no signs of local recurrence. Final considerations: the similarity of clinical, imaging, and microscopic aspects between JTOF and low-grade osteosarcoma prompts an immunohistochemical study including MDM2 and CDK4 markers in order to improve final diagnosis and guide the treatment plan more efficiently.(AU)

Florid Cemento-osseous Dysplasia.

Florid cemento-osseous dysplasia is a condition of the bone which is rare and usually affects jaw bones. It is classified as sclerosing osteitis, multiple exostoses, diffuse chronic osteomyelitis, and gigantiform cementoma. The age group varies from 19 to 76 years and mostly presents in the fourth and fifth decade. Most commonly affects middle-aged women. It is identified on radiographic examination and manifested as diffuse irregularly shaped radiopacities in the alveolar processes. It usually presents as a bilaterally symmetrical lesion. This lesion is benign and requires treatment only if symptomatic or for cosmetic reasons. We report a case of an uncomplicated florid cemento-osseous dysplasia in a 35-year-old woman the diagnosis of our case was made radiographically.

Central Ossifying Fibroma of the Maxilla (Matured Type): Report of a Rare Case.

Central ossifying fi broma is a bony tumor, which is believed to be derived from the cells of the periodontal ligament. Central ossifying fi broma behaves like, a benign bone neoplasm. Th is bone tumor consists of highly cellular, fi brous tissue that contains varying amounts of calcifi ed tissue resembling bone, cementum, or both. Central ossifying fi bromas of the mandible are common; however, they are rare in the maxillary region however they are common in the mandible, have got a female predeliction and is usually seen in the age between 35 and 40 years of age. In this report, we have described a 35-year-old female with minimal clinical symptoms diagnosed as central ossifying fi broma in the anterior maxillary region.

Psammomatoid Type Juvenile Ossifying Fibroma of Mandible: A Rare Entity.

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous neoplasm that arises within the craniofacial bones. Two distinct histopathological variants have been described; trabecular JOF and psammomatoid JOF (PsJOF). The later occurs predominantly in craniofacial skeleton and rarely in jaws and more so in mandible (50% of the times than that in maxilla). Here we report a rare case of PsJOF in mandible body ramus region with its unique radiographic characteristics to help the diagnostician approach the diagnosis very closely for this rare entity. The tumor has been present since 1 year with unilocular radiographic appearance; having homogeneous ground-glass appearance with higher imaging, without any focal radio-opacity and inferior alveolar canal was displaced but still intact. Thus these lesions can expand to large sizes even without maturing to its radiopaque stages and without destruction of adjacent vital structures although displacing them.

Immunolocalization of bmp2/4, tgfβ-1 and osteonectin in fibro-osseous lesions of the jaws / Imunolocalização de bmp2/4, tgfß-1 e osteonectina em lesões-fibro-óssea benignas

Objetivo: as lesões fibro-ósseas benignas (LFOB) correspondem a um grupo diverso de patologias caracterizadas pela substituição do tecido ósseo por tecido conjuntivo e matriz extracelular mineralizada. Pouco se conhece a respeito da etiologia desse grupo de lesões. Propomo-nos a analisar por meio da técnica imunohistoquímica a expressão de 3 moléculas (osteonectina, TGFβ-1 e BMP 2/4) envolvidas no metabolismo ósseo. Métodos: Trinta e dois casos diagnosticados como osso normal (ON,8), displasia fibrosa (DF,8), displasia cemento-óssea (DCO,8) e fibroma cemento-ossificante (FCO,8) foram selecionados. Resultados: A osteonectina e a BMP2/4 foram positivas em todos os casos. O TGFβ-1 revelou positividade em 1 caso de DCO e FCO. Conclusão: Os achados imunohistoquímicos sugerem que as LFOB tem processos diferentes de produção de tecido ósseo.

Background: Benign fibro-osseous lesions (BFOL) comprise a diverse group of pathologies characterized by the replacement of normal bone by fibrous tissue and a mineralized product. Little is known about the biology of this group of lesions. We have analyzed the immunohistochemical expression of three molecules involved in bone metabolism, namely osteonectin, TGF-b1, and BMP2/4. Methods: Thirty-two cases diagnosed as normal jaw bone (NJB, 8 cases), fibrous dysplasia (FD, 8 cases), cemento-osseous dysplasia (COD, 8 cases), and cemento-ossifying fibroma (COF, 8 cases) were selected. Results: Osteonectin and BMP2/4 antibodies were positive in all cases. TGFb-1 labeling was seen in one case of COD and COF. Conclusion: The immunohistochemistry findings suggest that BFOL have different processes of osseous tissue production.