Fibroma osificante periférico / Peripheral ossifying fibroma

RESUMEN Con relativa frecuencia, en la mucosa bucal se observan agrandamientos gingivales como el fibroma osificante periférico, que es una lesión reactiva inflamatoria del tejido blando. Clínicamente se trata de una tumefacción deformante, de crecimiento lento, sin una causa clara, aunque su formación está asociada a traumatismos o irritaciones crónicas a nivel gingival. Usualmente su aparición es a nivel de la papila interdental en la zona anterior del maxilar, aunque se puede observar en otras regiones de la cavidad bucal. El tratamiento es quirúrgico y consiste en la enucleación total de la lesión, retirando además los factores irritativos. En las radiografías, la imagen frecuentemente observada, aparece como un área radiolúcida, unilocular, bien definida y delimitada por un halo radiopaco (esclerótico); ocasionalmente puede presentarse como una imagen radiopaca.

ABSTRACT In the buccal mucosa are observed, with relative frequency, gingival enlargements such as the peripheral ossifying fibroma, which is considered a reactive inflammatory soft tissue lesion. It is clinically characterized by a slow-growing, disfiguring swelling with no clear cause, although its formation is associated with trauma or chronic irritation at the gingival level. Its appearance is usually at the level of the interdental papilla in the anterior region of the maxilla, although it can be seen in other regions of the oral cavity. The treatment is surgical consisting of the total enucleation of the lesion and removing the irritating factors. On radiographs, the frequently observed image appears as a well-defined, unilocular, radiolucent area delimited by a radiopaque halo (sclerotic); it can be occasionally presented as a radiopaque image.

Psammomatoid juvenile ossifying fibroma of frontal sinus - surgical and reconstructive approach

ABSTRACT Psammomatoid juvenile ossifying fibroma (PJOF) is a benign fibro-osseous lesion that mainly affects the paranasal sinuses and periorbital bones. It may cause significant esthetic and functional impairment. Herein, we describe the diagnosis and surgical approach of an extensive PJOF arising in the frontal sinus of a young male. After complete lesion removal and histopathological confirmation, the bone defect was repaired with a customized polymethylmethacrylate implant. PJOF may present aggressive clinical behavior. The excision of extensive PJOF in the orbitofrontal area can result in significant esthetic defects. Polymethacrylate implants restore functionally and esthetically the involved area.

O Cripto-1 é um potencial biomarcador para o diagnóstico diferencial dos tumores ósseos benignos e malignos dos maxilares / Cripto-1 is a potential biomarker for the differential diagnosis of benign and malignant jaw bone tumors

O termo lesão fibro-óssea dos maxilares (LFOM) é uma designação inespecífica para um grupo de distúrbios caracterizados, morfologicamente, pela substituição do tecido ósseo por uma matriz de tecido conjuntivo fibrosa, a qual exibe neoformação de tecido ósseo com diferentes graus de mineralização. O diagnóstico preciso das LFOM não é fácil e só pode ser realizado após uma análise minuciosa dos aspectos clínicos, radiológicos e histológicos. No entanto, deve-se admitir que alguns casos desafiam a exatidão na emissão do diagnóstico. Considerando a diversidade do comportamento biológico das lesões e as pesquisas sobre a identificação de potenciais marcadores moleculares, o objetivo deste trabalho foi realizar uma análise imunohistoquímica do cripto-1 (CR-1) e da ß-catenina em uma série de casos diagnosticados microscopicamente como displasia fibrosa (DF) (n=30), fibroma ossificante central (FOC) (n=28) e osteossarcoma (OS) (n=5) armazenados nos arquivos do Serviço de Anatomia Patológica Oral de uma população brasileira. As expressões imuno-histoquímicas foram analisadas através de escore imunorreativo. Os dados obtidos foram inseridos em um arquivo do software Microsoft Excel® e, posteriormente, analisados no software Statistical Package for Social Science. Para todos os testes estatísticos utilizados, o nível de significância foi estabelecido em 5% (p<0,05). O CR-1 exibiu predominância de um padrão fortemente positivo para os casos de FOC e OS, e do padrão moderado para os casos de DF (p<0,001). A ß-catenina exibiu predominância do padrão negativo para os casos de FOC e DF, e do padrão fortemente positivo para os casos de OS (p=0,001). O teste de correlação de Spearman revelou correlação positiva entre os escores imunorreativos de CR-1 e ß-catenina. Os resultados desta pesquisa sugerem a participação do CR-1 na patogênese do FOC e OS, assim como o uso dessa proteína como potencial biomarcador molecular para o diagnóstico diferencial de LFOM (AU).

Fibro-osseous lesions of maxilar (FOLM) is a non-specific designation for a group of disorders characterized, morphologically, by replacement of bone tissue by a matrix of fibrous connective tissue, showing neoformation of bone tissue with varying degrees of mineralization. Precise diagnosis of FOLM is not easy, and requires careful analyisis of clinical, radiological and histological aspects. Even so, some cases still challenge accuracy in diagnosis. Considering the diversity of biological behaviour of the lesions and the research regarding identification of potential molecular markers, this study aims to perform immunohistochemical analysis of crypto-1 and ß-catenin in a series of cases diagnosed microscopically as fibrous dysplasia (FD) (n=30), central ossifying fibroma (COF) (n=28) and osteossarcoma (OS) (n=5), stored in archives of Oral Pathological Anatomy Service of a Brazilian population. Immunohistochemical expressions were analysed by imunorreactive score. All data obtained was inserted into a file of Microsoft Excel® software (Microsoft Corporation, USA) and then transferred to a database of SPSS® for Windows software (Statistical Package for Social Sciences; IBM, USA), version 20.0. For all statistical tests used, the significance level established was p ≤ 0.05. CR-1 showed a predominant pattern of strong positive in COF and OS cases, and a moderate positive in FD cases (p<0,001). ß-catenin showed a predominant negative pattern for COF and FD cases, and a predominant strong positive pattern for OS cases (p=0,001). Spearman correlation tests showed positive correlation of the imunoreative scores of CR-1 and ß-catenin. Those results suggests CR-1 could be involved in the pathogenesis of COF and OS, and this protein could be used as a potential molecular biomarker for diferential diagnosis of FOLM (AU).

Comparison of radiological and clinicopathological features of craniofacial fibro-osseous lesions / 中华病理学杂志

To investigate the clinicopathological and radiological features of benign fibro-osseous lesion (BFOL). Sixty-five cases of craniofacial BFOL, eight cases of peripheral ossifying fibroma (POF) and one case of low-grade central osteosarcoma diagnosed at Sichuan Provincial People's Hospital between January 2010 and March 2019 were collected. The clinicopathologic features, hematoxylin-eosin and immunohistochemical (IHC) staining and radiographic features were analyzed. MDM2 gene amplification was detected by FISH in difficult borderline cases. This cohort of BFOLs included 50 cases of fibrous dysplasia (FD), 12 cases of ossifying fibroma (OF), and three cases of juvenile psammomatoid ossifying fibroma (JPOF). The average ages of patients with FD,OF and JPOF were 31.7, 39.2 and 26.0 years respectively. The male to female ratio was 1.0∶1.8.The average age of POF was 47.0 years, with male to female ratio of 1∶7. Patient of low-grade central osteosarcoma was a 48-year-old man. Twenty-seven cases of FD were located in the jaw, and 23 cases were in other craniofacial bones. Nine cases of OF were located in the jaw, and three cases were in the nasal cavity. Two cases of JPOF were in the nasal sinus, and one was in the jaw. All POF were located in the gingiva, and low-grade central osteosarcoma was located in the mandible. The imaging features of FD were luffa-like or ground-glass like signal shadows with poorly defined borders with expansion. OF had clear borders or sclerosing margins. Both JOF and low-grade central osteosarcoma were expansile intraosseously and with focally invasive nodular masses with ground-glass like signal shadows; and POF showed soft tissue mass with bone formation. Histological features of BFOLs showed mixed fibrous and irregular osteoid lesions. FD had no clear relationship with the host bone and no osteoblasts surrounded the bone trabeculae. Osteoblasts rimming was found in OF, and the boundaries of the host bone were clear. JPOF and low-grade central osteosarcoma infiltrated the host bone focally, and the latter showed mild cellular atypia. MDM2 amplification was detected in low-grade central osteosarcoma. BFOLs are a group of fibro-osseous lesions with similar morphology in the head and neck and face, but their clinical features and prognosis are different; and their imaging and histological characteristics are also slightly different. Attentions should be given to the combination of clinical, imaging and pathologic features of BFOLs, especially the differential diagnosis between BFOLs and low-grade central osteosarcoma. Molecular detection could be used to assist the diagnosis in difficult cases.

Comparison of radiological and clinicopathological features of craniofacial fibro-osseous lesions / 中华病理学杂志

Objective@#To investigate the clinicopathological and radiological features of benign fibro-osseous lesion (BFOL).@*Methods@#Sixty-five cases of craniofacial BFOL, eight cases of peripheral ossifying fibroma (POF) and one case of low-grade central osteosarcoma diagnosed at Sichuan Provincial People′s Hospital between January 2010 and March 2019 were collected. The clinicopathologic features, hematoxylin-eosin and immunohistochemical (IHC) staining and radiographic features were analyzed. MDM2 gene amplification was detected by FISH in difficult borderline cases.@*Results@#This cohort of BFOLs included 50 cases of fibrous dysplasia (FD), 12 cases of ossifying fibroma (OF), and three cases of juvenile psammomatoid ossifying fibroma (JPOF). The average ages of patients with FD,OF and JPOF were 31.7, 39.2 and 26.0 years respectively. The male to female ratio was 1.0∶1.8.The average age of POF was 47.0 years, with male to female ratio of 1∶7. Patient of low-grade central osteosarcoma was a 48-year-old man. Twenty-seven cases of FD were located in the jaw, and 23 cases were in other craniofacial bones. Nine cases of OF were located in the jaw, and three cases were in the nasal cavity. Two cases of JPOF were in the nasal sinus, and one was in the jaw. All POF were located in the gingiva, and low-grade central osteosarcoma was located in the mandible. The imaging features of FD were luffa-like or ground-glass like signal shadows with poorly defined borders with expansion. OF had clear borders or sclerosing margins. Both JOF and low-grade central osteosarcoma were expansile intraosseously and with focally invasive nodular masses with ground-glass like signal shadows; and POF showed soft tissue mass with bone formation. Histological features of BFOLs showed mixed fibrous and irregular osteoid lesions. FD had no clear relationship with the host bone and no osteoblasts surrounded the bone trabeculae. Osteoblasts rimming was found in OF, and the boundaries of the host bone were clear. JPOF and low-grade central osteosarcoma infiltrated the host bone focally, and the latter showed mild cellular atypia. MDM2 amplification was detected in low-grade central osteosarcoma.@*Conclusions@#BFOLs are a group of fibro-osseous lesions with similar morphology in the head and neck and face, but their clinical features and prognosis are different; and their imaging and histological characteristics are also slightly different. Attentions should be given to the combination of clinical, imaging and pathologic features of BFOLs, especially the differential diagnosis between BFOLs and low-grade central osteosarcoma. Molecular detection could be used to assist the diagnosis in difficult cases.

Peripheral ossifying fibroma on the mandible: report of atypical presentation case / Fibroma ossificante periférico na mandíbula: relato de caso atípico

ABSTRACT Peripheral ossifying fibroma (POF) is a benign lesion, nodular, firm on palpation; the base is sessile or pedunculated; similar in color to the mucosa and epithelium; it may be preserved or ulcerated. It is prevalent in female and exclusively affects the gingiva. It is usually associated with irritating factors such as caries, dental plaque, among others. The objective of the present study is to report the case of a 27-years-old female patient, presenting a lesion in the mandible, complaining of an increased volume. Surgical excision was the treatment of choice. The patient is 24 months postoperatively with no signs of relapse.

RESUMEN El fibroma osificante periférico es una lesión benigna, nodular, firme a la palpación, de base sésil o pediculada, de color similar a la mucosa y al epitelio; puede estar intacto o ulcerado. Se observa más en mujeres y acomete solamente la encía. La lesión se asocia a factores irritantes, como caries, cálculo dental, entre otros. El objetivo del presente estudio es reportar el caso de una paciente de 27 años de edad, que ha presentado lesión en la mandíbula, quejando-se de aumento de volumen. La escisión quirúrgica ha sido el tratamiento de elección. La paciente encuentra se con 24 meses de postoperatorio, sin señales de recidva.

RESUMO O fibroma ossificante periférico (FOP) é uma lesão benigna, nodular, firme à palpação, de base séssil ou pediculada, com coloração semelhante à mucosa e ao epitélio; pode estar íntegro ou ulcerado. Prevalece no gênero feminino e acomete exclusivamente a gengiva. Associa-se a fatores irritantes, como cárie, cálculo dentário, entre outros. O objetivo do presente estudo é relatar o caso de uma paciente de 27 anos de idade, que apresentou lesão em mandíbula, queixando-se de aumento de volume. A excisão cirúrgica foi o tratamento de escolha. A paciente encontra-se com 24 meses de pós-operatório, sem sinais de recidiva.

Endoscopic salvage treatment for optic neuropathy caused by sinonasal fibro-osseous lesions / 中华耳鼻咽喉头颈外科杂志

Objective@#To summarize the surgical techniques, benefits and limitations of transnasal endoscopic resection and optic nerve decompression for patients with optic neuropathy caused by fibro-osseous lesions.@*Methods@#Eight patients with optic neuropathy caused by fibro-osseous lesions who accepted endoscopic surgery of either resection of the lesion or decompression of optic nerve in Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University from 2007 to 2016 were retrospectively reviewed and followed until April, 2017. Analyses were performed on the pathology type, disease extent and disease duration, especially on the visual acuity and visual field changes before and after surgery.@*Results@#Eight patients (5 male and 3 female) were included in this study, with a median age of 12 years old (8-19 years old). The median disease duration was 12 months (1-72 months). The visual acuity (VA) of five patients (40 cm/FC, 0.2, 0.1, 0.2, 10 cm/FC, respectively) improved after surgery (0.1, 0.3, 1.2, 0.1, 0.6, respectively), and one patient had no change of VA after the surgery. Two patients (0.02, hand movement, before surgery) became deprived of light perception (VA=0) immediately after surgery. One patient complicated with intra orbital hemorrhage because of anterior artery injury. No complications of cerebral spinal fluid leak, intra-ocular muscle injury, intra-cranial hemorrhage or brain tissue injury occurred.@*Conclusion@#For the treatment of optic neuropathy caused by fibro-osseous lesions, transnasal endoscopic surgery might have a good outcome.

The role of Osterix protein in the pathogenesis of peripheral ossifying fibroma

Abstract Peripheral ossifying fibroma (POF) is a reactive lesion of oral tissues, associated with local factors such as trauma or presence of dental biofilm. POF treatment consists of curettage of the lesion combined with root scaling of adjacent teeth and/or removal of other sources of irritants. This study aimed to analyze the clinical and pathological features of POF and to investigate the immunoexpression of Osterix and STRO-1 proteins. Data such as age, gender, and size were obtained from 30 cases of POF. Microscopic features were assessed by conventional light microscopy using hematoxylin-eosin staining and immunohistochemical markers, and by polarized light microscopy using Picrosirius red staining. The age range was 11-70 years and 70% of the patients were female. Moreover, the size of POF varied from 0.2 to 5.0 cm; in 43.33% of the cases, the mineralized content consisted exclusively of bony trabeculae. The immunohistochemical analysis showed nuclear staining for Osterix in 63% and for STRO-1 in 20% of the cases. Mature collagen fibers were observed in mineralized tissue in 76.67% of the cases. The clinical and microscopic features observed were in agreement with those described in the literature. Osterix was overexpressed, while STRO-1 was poorly expressed. Osterix was expressed particularly in cells entrapped in and around mineralized tissue, indicating the presence of a stimulus that triggers the differentiation of these cells into osteoblasts or cementoblasts, i.e., cells that produce mineralized tissue. Based on our results, Osterix may play a role in the pathogenesis of POF.

Fibroma osificante trabecular juvenil: presentación de tres casos / Juvenile trabecular ossyfying fibroma: presentation of three cases

Fundamento: el fibroma osificante trabecular juvenil es una lesión bien definida clínica e histológicamente, recientemente separada de otras lesiones fibro-óseas. Su comportamiento biológico está definido, pero a la vez es impredecible. Objetivo: describir tres casos de fibroma osificante trabecular juvenil, observados en el maxilar superior, se incluyen protocolos de diagnóstico y terapia. Casos clínicos: se presentan tres casos agresivos de fibroma osificante trabecular juvenil donde se describe su apariencia clínica, radiográfica y tomográfica. Igualmente, se presenta su histopatología, diagnóstico y plan de tratamiento. Conclusiones: el fibroma osificante trabecular juvenil es un tumor benigno muy raro que se presenta en personas muy jóvenes: es importante realizar un diagnóstico adecuado con el fin de diferenciar el fibroma osificante trabecular juvenil de otras lesiones fibrosas que permitan realizar una terapia adecuada precozmente.

Background: juvenile trabecular ossyfying fibroma is a well-defined lesion from the clinical and histological points of view. It has been recently separated from other fibro-osseous lesions. Its biological behavior is defined but unpredictable. Objective: to describe three cases of juvenile trabecular ossyfying fibroma observed in the upper jaw. Diagnosis protocols and therapy are included. Clinical cases: three severe cases of juvenile trabecular ossyfying fibroma are presented. The clinical, radiographic and tomographic appereances are described. The histopathology, diagnosis and treatment are also presented. Conclusions: juvenile trabecular ossyfying fibroma is a very uncommon benign tumor that appears in young people. It is important to make an adequate diagnosis with the objective of differentiating juvenile trabecular ossyfying fibroma from other fibrose lesions; this allows early applying an adequate therapy.

Fibroma cemento-ossificante: relato de caso / Cemento-ossifying fibroma: case report

O fibroma cemento ossificante é uma patologia benigna, de crescimento lento e expansivo. O presente trabalho tem como objetivo descrever um caso clínico, cujos aspectos eram sugestivos de granuloma piogênico e lesão central de celulas gigantes e, principalmente, a displasia óssea fibrosa e o fibroma cemento ossificante. A lesão foi biopsiada, evidenciando à microscopia óptica uma presença de tecido fibroso e presença de calcificações ovoides basofílicas, indicando o diagnóstico final de fibroma cemento-ossificante. Para o diagnóstico, os autores consideram essencial a associação dos aspectos clínicos, radiográficos e histopatológicos

Cemento ossifying fibroma is a benign pathology with slow and expansive growing. The present study aims to describe a clinical case, whose initial aspects were suggestive of pyogenic granuloma, central giant cell lesion and especially bone fibrous dysplasia and cemento-ossifying fibroma. The lesion was biopsied revealing light microscopy presence fibrous tissue and calcification ovoid basophilic, indicating the final diagnosis of cemento ossifying fibroma. For diagnosis, the authors consider essential an association of clinical, radiographic and histopathologic findings

Fibroma Ossificante Periférico: Relato de Caso / Peripheral Ossifying Fibroma: Case Report

O Fibroma Ossificante Periférico é uma lesão proliferativa reacional, não neoplásica, de crescimento lento, que pode produzir recidiva após exérese. Sua etiologia é incerta, mas está associado a fatores irritantes locais, e é encontrado, na maioria das vezes, na região anterior de maxila. Clinicamente, caracteriza-se por um aumento volumétrico assintomático, que pode determinar, com o tempo, assimetria facial. O objetivo deste trabalho é descrever um caso de Fibroma Ossificante Periférico em paciente de 40 anos, sexo feminino, com lesão exofitica em maxila, atípico por suas grandes dimensões e com história de 3 recidivas, levando à assimetria facial. Foi submetida à cirurgia de remoção da lesão juntamente com os prováveis fatores irritantes, sendo o diagnóstico anatomopatológico de Fibroma Ossificante Periférico. Conclui-se que é de fundamental importância a remoção completa da lesão para minimizar a tendência à recidiva, incluindo o periósteo subjacente e o ligamento periodontal, além dos prováveis fatores causais.

The Peripheral ossifying fibroma is a reactive proliferative lesion, non neoplastic, slow growth, which can produce recurrence after removal. It´s etiology is uncertain, but is associated with local irritants, and is found mostly in the anterior maxilla. Clinically it is characterized by an asymptomatic increase in volume, which may, over time, facial asymmetry. The aim of this paper is to describe a case of peripheral ossifying fibroma in a patient 40, female, exophytic lesion in the jaw, unusual for its large dimensions and with a history of three recurrences, leading to facial asymmetry. She underwent surgery to remove the lesion along with the likely irritants, and the pathological diagnosis of peripheral ossifying fibroma. We conclude that it is fundamentally important for complete removal of the lesion to reduce the tendency to relapse, including the periosteum and the periodontal ligament, in addition to possible causes.

Avaliação da desposição do íon cálcio em lesões fibro-ósseas benignas: estudo histoquímico / Evaluation of calcium íon deposition in benign fibro-osseous lesions: a histochemical study

As Lesões Fibro-Ósseas Benignas (LFOB) são alterações caracterizadas pela substituição de osso normal por tecido conjuntivo fibroso e quantidades variáveis de mineralização. São lesões que apresentam dificuldade no diagnóstico quando observados, apenas, os aspectos histopatológicos. Torna-se interessante o conhecimento e aplicação de métodos auxiliares de diagnóstico anátomo-patológicos na tentativa de facilitar o diagnóstico dessas lesões, quando na ausência de critérios clínicos e/ou radiográficos. A técnica histoquímica de Von Kossa consiste em um método auxiliar, indicado como específico para o íon cálcio, permitindo detectar as fases de mineralização dos tecidos em formação.O objetivo deste estudo é o de tentar diferenciar entre as LFOB a forma de deposição do íon cálcio com a finalidade de individualizá-las. Foram analisados 24 casos de LFOB, sendo 6 de Displasia Fibrosa (DF), 4 de Displasia Cemento-Óssea (DCO) e 14 de Fibroma Ossificante (FO). A DF foi negativa em 3 casos; nos demais casos, havia presença de osso imaturo em que se observou fraca positividade. Os casos de DCO mostraram-se negativos em 3 casos. Por fim, 13 casos de FO foram positivos. Observamos que a mineralização derivada do ectomesênquima odontogênico sempre se mostrou positiva. A coloração de Von Kossa pode ser, portanto, uma ferramenta útil na diferenciação das LFOB.

Benign fibro-osseous lesions (BFOL) are changes characterized by the replacement of normal bone by fibrous connective tissue and variable degrees of mineralization. They are difficult to diagnose when only the histopathological features are observed. Thus, in the absence of clinical and/or radiographic criteria, an auxiliary method of diagnosis may be useful. The Von Kossa histochemical technique is one such method, making it possible to detect the phases of mineralization of the tissues in formation. The purpose of this study was to identify the type of BFOL by observing the calcium ion deposition patterns. Twenty-four cases of BFOL (six of fibrous dysplasia, four of cemento-osseous dysplasia and 14 of ossifying fibroma) were analyzed. Three cases of fibrous dysplasia were positive in the immature bone structure. Three cases of cemento-osseous dysplasia were negative. Thirteen cases of ossifying fibroma were positive. It was observed that the mineralization resulting from odontogenic ectomesenchyme was always positive. The results suggest that von Kossa staining may be a useful tool in the differentiation of the BFOLs.

Fibroma ossificant: relato de 2 casos / Fibroma ossifying: report of 2 cases

O Fibroma Ossificante e o Fibroma Ossificante Juvenil são lesões fibro-ósseas benignas de origem mesenquimal. O primeiro acomete mais comumente a região de pré-molares e molares de mandíbula na terceira e quarta década de vida e com maior prevalência no sexo feminino. O segundo tem um comportamento clínico mais agressivo em jovens geralmente de até 15 anos e é mais comum em maxila. Ambas as lesões necessitam de remoção cirúrgica, e, sempre que possível, deve-se procurar uma reconstrução adicional devido aos problemas funcionais e estéticos. Este trabalho apresenta o tratamento cirúrgico de 2 relatos de caso, sendo um de Fibroma Ossificante, e o outro, da sua variante, o Fibroma Ossificante Juvenil. Através da enucleação associada à reconstrução com malha de titânio para o primeiro caso e do emprego de uma placa de reconstrução de titânio como uma boa alternativa para o tratamento da ressecção marginal do segundo caso.

Ossifying fibroma and juvenile ossifying fibroma are benign fibro-osseous lesions that originate in the mesenchyme. The former most commonly affects regions of the lower pre-molars and molars in patients in their thirties and forties and has a higher prevalence in females; the latter has a more aggressive clinical behavior in younger patients, usually up to the age of 15 years, and is more frequent in the mandible. Both injuries need surgical removal and, whenever possible, an additional reconstruction because of functional and esthetic problems. This paper presents the surgical treatment of 2 reports of case, one of ossifying fibroma, and the other of its variant, juvenile ossifying fibroma. Treatment by enucleation, following reconstruction with a titanium mesh, was used in the first case and the use of a titanium reconstruction plate of titanium was a good alternative for the treatment of marginal resection in the second case.

Fibroma ossificante periférico maxilar: relato de caso clínico / Peripheral ossifying fibroma of the maxilla: case report

O fibroma ossificante periférico é um tumor benigno de crescimento lento, que pode produzir recidiva após exérese. Possui origem fibro-óssea e é encontrado na maioria das vezes no osso maxilar. Clinicamente, caracteriza-se por um aumento volumétrico assintomático, que pode determinar, com o tempo, assimetria facial. Objetivo: Descrever um caso de fibroma ossificante de grandes dimensões em maxila. Relato do Caso: Paciente de 32 anos, sexo feminino, com um tumor de crescimento lento na maxila, atípico por suas grandes dimensões e aspecto clínico, levando à assimetria facial, dificuldade mastigatória, da fala e disfagia. Foi submetida à cirurgia de remoção da lesão juntamente com os prováveis fatores irritantes, sendo o diagnóstico histológico de fibroma ossificante periférico. Conclusão: É importante que se remova completamente a lesão para minimizar a tendência à recidiva, incluindo o periósteo subjacente e o ligamento periodontal, além dos prováveis fatores causais.

The peripheral ossifying fibroma is a slow growth benign tumor that may induce recurrence after removal. It is of fibro-osseous origin and it is commonly found on maxillary bone. It is of asymptomatic growth that may induce facial asymmetry. Objective: This article presents a clinical case of peripheral ossifying fibroma. Case Report: A-32-year-old female patient presented a slow growth tumor in the maxilla; atypical for its dimensions and appearance; leading to facial asymmetry, masticatory, deglution and dysphagia problems. She underwent surgery for lesion excision and likely irritating factors, and was diagnosed with Peripheral Ossifying Fibroma. Conclusion: It is important to completely remove the lesion to reduce the possible recurrences; the periosteum, the periodontal ligament and other factors should be included.

Juvenile Ossifying Fibroma: A Clinicopathologic Study of 8 Cases and Comparison with Craniofacial Fibro-osseous Lesions

BACKGROUND: Juvenile ossifying fibroma (JOF) is defined as a variant of the ossifying fibroma, and the latter includes juvenile trabecular ossifying fibroma (JTOF) and juvenile psammomatoid ossifying fibroma (JPOF). JOF can be distinguished from other craniofacial fibroosseous lesions by its tendency to recur and its clinical mimicry of malignant bone tumors, but some clinical and histological features of JOF overlap with the other fibro-osseous lesions as well. We aimed to identify the clinicopathologic definition of JOF. METHODS: Forty-two cases of fibro-osseous lesions were reviewed and they were classified into JOF, fibrous dysplasia (FD) and ossifying fibroma (OF). RESULTS: JTOF had long, slender and anastomosing trabeculae of osteoid in a fibrocellular stroma, and JPOF had small ossicles resembling psammoma bodies with a thick collagenous rim in the fibrous stroma, which are features that differ from those of FD and OF. Radiologically, JOF and OF showed a well-defined lesion but FD exhibited an ill-defined lesion. Clinically, the average age of the JOF patients was the youngest, followed by OF and FD. For JOF, three cases had rapid growth and two others showed recurrences. JOF mainly occurred in the paranasal sinuses, OF in the mandible and FD in any craniofacial bone. CONCLUSION: We demonstrated the distinct characteristics of JOF and these features may be helpful for the diagnosis and management of this malady.

A Case of Ossifying Fibroma of the Temporal Bones / 대한이비인후과학회지

We report, with a review of literature, an unusual case of ossifying fibroma of temporal bone. A 34-year-old female with history of left craniectomy for hemifacial spasm visited our department in 1998 because of an incidentally found temporal bone mass. Magnetic resonance imaging showed a well-circumscribed, lobulated 3x3x3 cm sized tumor mass which was localized in the temporal bone but did not invade the middle and inner ear with high signal intensity at T2 weighted image. The patient did not have the spasm until 2000, when she manifested intermittent right otalgia. A computed tomography scan showed the 3x3x3 cm sized right temporal bone tumor with bony erosion including tegmen mastoid and partial bony destruction. After retroauricular incision, tumor and granulation tissue were removed through simple mastoidectomy. The permanent pathologic report confirmed the diagnosis of ossifying fibroma. The patient returned in August of 2004 with recurrent right otalgia that had been there for 3 months. A computed tomography scan showed lobulated, multiseptated, osteolytic, low density tumor which located in the upper portion of mastoid pyramidal base. She underwent a simple mastoidectomy with removal of the recurred ossifying fibroma with destruction in tegmen mastoid. Ossifying fibroma are rare lesions of the temporal bone. Because tumors progress and can become clinically massive, early complete resection is advised whenever feasible to prevent clinically evident recurrences and potentially life-threatening complication.