Can Differences in Vascularity Serve as a Diagnostic Aid in Fibro-Osseous Lesions of the Jaws?

PURPOSE: Different lesions in the fibro-osseous group share microscopic features; thus, establishing a definitive diagnosis based on microscopic features alone can be a challenge. There is a need for additional microscopic tools to aid in differentiating these lesions. This study compared parameters related to vascularity among 3 lesions in the fibro-osseous group: fibrous dysplasia (FD), central ossifying fibroma (COF), and cemento-osseous dysplasia (COD). MATERIALS AND METHODS: This study was a cross-sectional analysis of biopsied lesions retrieved from 3 medical centers over a 14-year period. The primary predictor variables were the vascularity parameters (number, perimeter, and area). The outcome variables were diagnoses of FD, COF, and COD. Diagnosis was based on clinical, microscopic, and radiologic correlations. From each histopathologic slide, 5 representative fields were captured with a computerized digital camera. The number of blood vessels was counted, and the surface area and vascular perimeter were measured by tracing the perimeter of each vessel. Data were statistically analyzed using analysis of variance with logarithmic transformation and a Tukey adjustment. RESULTS: Sixty-six cases were included in the study (26 in FD group, 26 in COF group, and 14 in COD group). The mean number of vessels showed only a tendency to be larger in the FD group compared with the COF and COD groups (5.4 ± 2.6, 3.7 ± 2.3, and 3.6 ± 1.7, respectively), but the results did not reach the threshold for significance. The mean vascular perimeter was 1,385.8 ± 859.2 pixels in the FD group and 742.6 ± 661.8 in COF group after logarithmic transformation (P = .012). The perimeter in the COD group was smaller (941.1 ± 502) compared with that in the FD group, but the difference did not reach the threshold for significance. The mean area was 25,061 ± 24,875.6 in the FD group and 11,773.8 ± 21,734.4 in the COF group after logarithmic transformation (P = .004). The perimeter in the COD group was smaller (13,011.1 ± 8,338.3) compared with the FD group, but the difference did not reach the threshold for significance. CONCLUSION: The vascular content of the FD group was markedly higher than of the COF group. These vascular changes can aid in differentiating these lesions microscopically.

Fibro-osseous lesion of the middle turbinate: ossifying fibroma or fibrous dysplasia?

Benign fibro-osseous tumours of the head and neck region seldom appear in the midface and nasal cavity. Correct differential diagnosis of fibro-osseous tumours is crucial for adequate therapy, as their clinical aggressiveness seems to differ. The rather uncommon case of a 14-year-old boy with a tumour of the middle turbinate is presented. The radiologic appearance of the tumour, on computed tomography and magnetic resonance imaging scans, was consistent with fibrous dysplasia. Angiography revealed extensive vascularisation of the tumour from both the internal and external carotid arteries. To avoid ipsilateral blindness following embolisation, a superselective embolisation of the supplying blood vessels was performed. The tumour was completely resected via an endoscopic approach. Histopathology revealed an ossifying fibroma. This case emphasises the importance of interpretation of the clinical, radiological and histological features before planning definitive treatment. Moreover, when fibro-osseous tumours are suspected, the possibility of extensive, complicated vascularisation must be considered. This case underwent radical resection, with no recurrence after four years' follow up.

Extensive neglected psammomatoid ossifying fibroma with craniofacial deformity.

The psammomatoid ossifying fibroma is a rare and aggressive lesion that usually arises from the sinonasal region. The lesion is well circumscribed with the pathognomonic feature of concentric or laminated spherical ossicles that appear similar to psammoma bodies. The authors report a case of an extensive and neglected psammomatoid ossifying fibroma in a 10-year-old West African girl. She had a 5-year history of a slowly growing tumor, which at presentation was 15 cm in diameter and had resulted in left craniofacial deformity as well as left visual impairment. Due to the large tumor, the surgical resection plan necessitated a cranio-facial neurosurgical approach in combination with autogenous bone grafts for cranofacial reconstruction, and allogenous demineralized bone grafts for donor site coverage. In addition, preoperative embolization was utilized to reduce tumor vascularity. However, this embolization resulted in reduction of pericranial flap vascularity, leading to flap ischemia, infection and subsequent removal of necrotic autogenous bone graft. Ultimately, the objectives of large tumor resection and acceptable aesthetic outcome were met after controlling an episode of postoperative infection.

Evaluation of an ossifying fibroma using three-dimensional computed tomography.

We describe the appearance of a mandibular ossifying fibroma in spiral computed tomography-based multiplanar (MPR) and three-dimensional (3D) reconstruction using computer graphics. The usefulness of the interactive reconstructed images, especially using a vascular protocol, for qualitative and quantitative analyses is demonstrated. This technique is an important adjunct to evaluation with conventional axial CT.