Juvenile psammomatoid ossifying fibroma of the orbit and paranasal sinuses. A case report

Cranial Juvenile Psammomatoid Ossifying Fibroma: A Rare Entity

Juvenile ossifying fibroma (JOF) is an unusual fibro-osseous lesion primarily occurring in children and young adolescents. Anatomically, this lesion could predominantly arise from the bilateral orbits, paranasal sinuses, maxilla, or mandible. Although it is a benign lesion of osseous origin, it is an aggressive variant of ossifying fibroma of the jaw. Due to the aggressive nature of this lesion and its high tendency for recurrence, early radiological detection and prompt surgical treatment are required. The histologic diagnosis of this entity is purely based on hematoxylin and eosin (H&E), but immunohistochemistry and molecular diagnostic studies can also be performed in challenging cases. A thorough histopathological examination of this lesion is recommended because it can easily be mistaken for another benign fibrosis lesion arising at the same anatomical location. Here, we report the case of a juvenile psammomatoid ossifying fibroma (JPOF) occurring in a 12-year-old boy. The tumor is arising at an extracranial location behind the left anterior cranial fossa.

Psammomatoid Juvenile Ossifying Fibroma of the Maxilla Misdiagnosed as Fibrous Dysplasia: A Clinicopathologic Case Report

Juvenile ossifying fibroma (JOF) is a variant of the ossifying fibroma and includes two histopathological subtypes: trabecular and psammomatoid. Psammomatoid JOF (PJOF) in craniofacial structures should be distinguished from other fibro-osseous lesions, such as fibrous dysplasia (FD), considering the difference in the treatment protocols. Here, we present a rare case of PJOF that was initially misdiagnosed as a case of FD and emphasize the importance of considering JOF in the differential diagnosis of patients with craniofacial fibro-osseous lesions. A 4-year-old boy demonstrated progressive enlargement of the zygomaticomaxillary area on his left side for the last 6 months. The patient was diagnosed as a case of FD based on the clinical features and radiographic findings, and was operated considering the rapid progression. To achieve facial symmetry, contouring of the zygomatic bone and arch was performed. However, the patient demonstrated rapid enlargement at the 3-month postoperative follow-up. The decision was made to surgically remove the tumor due to visual field impairment. Intraoperatively, a rubbery mass, which was separated from the surrounding cortical bone, was identified and excised. The lesion was confirmed as PJOF by histopathological examination. The possibility of PJOF should not be ruled out in the differential diagnosis of patients with fibrous-osseous lesions. In the event of suspected PJOF, accurate diagnosis should be made through definitive biopsy.

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

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.

Juvenile psammomatoid ossifying fibroma with fluid–fluid levels: an unusual presentation

Background

Juvenile ossifying fibroma is an uncommon benign fibro-osseous tumor commonly involving the craniofacial skeleton of young patients with locally aggressive behavior and a high recurrence rate. Depending on the site of involvement it can present clinically as nasal obstruction, facial swelling, or proptosis.

Case presentation

Here we present a case of juvenile ossifying fibroma with an aneurysmal bone cyst component in the left nasal cavity in a 15-year-old boy who presented with gradually progressing left-sided nasal obstruction. Imaging findings were consistent with juvenile ossifying fibroma. Endoscopic resection of the tumor was done, and histopathological examination revealed it to be a psammomatoid variant of juvenile ossifying fibroma. Here we discuss its imaging findings, differential diagnosis, treatment options, and histopathological features.

Conclusion

Despite being a slow-growing benign tumor, early diagnosis and treatment are necessary due to its locally aggressive nature and invasion of adjacent structures. Complete surgical resection is the mainstay of treatment because of the high recurrence rate.

Cementifying Fibroma of the Sphenoid Wing in a Child: A Case Report

"Cementifying fibroma" is a benign tumor of the fibroblastic tissue containing masses of cementum-like calcified tissue, usually occurring between the third and fourth decades. Cementifying-ossifying fibromas are rare non-odontogenic, fibro-osseous tumors of the periodontal ligament that arise from the mesodermal germ layer3. We report a 12-year-old male child, who presented with a swelling in the left temporal region near the angle of the left eye. These non-neoplastic, locally destructive tumors present as an osseous lesion involving the mandible, maxilla, zygoma, paranasal sinuses, orbit, and rarely the petromastoid regions. The preoperative diagnosis was not clear even with CT and MRI, and, hence, all fibro-osseous lesions were considered as differential diagnosis. The lesion was surgically resected completely, and the histology confirmed it as a cementifying fibroma. According to the WHO classification, this is a variant of cementifying fibromas, which represent a subgroup of cementomas, that is, fibro-osseous lesions containing cementum. Histologically, these are fibrous tissues with calcified structures resembling bone and cementum. Cranioplasty was done simultaneously, with successful clinical results.

Simultaneous presentation of juvenile ossifying fibroma in the maxilla and mandible: a case report

INTRODUCTION

Juvenile ossifying fibroma (JOF) is a controversial and uncommon lesion that has been distinguished from the larger group of ossifying fibromas because of distinct clinical features and some morphological peculiarities. Furthermore, JOF shows an aggressive biological behavior that has led researchers to consider it a benign neoplasm, resulting in its differential diagnosis with important benign and malignant bone neoplasms.

PRESENTATION OF CASE

This study describes a case of synchronous presentation of JOF in the mandible and maxilla of a young patient. In addition, the literature was reviewed to identify clinical-pathologic features and possible factors that could help establish the correct diagnosis. A 26-year-old male patient presented simultaneously a lesion affecting the body, angle and ramus of the left mandible and another lesion in the left maxilla. Both lesions were well delimited and radiolucent, being unilocular in the maxilla and multilocular in the mandible. The mandibular lesion was partially resected and the maxillary lesion was submitted to curettage. The diagnosis was JOF.

DICUSSION

A delay in seeking medical care and a late diagnosis can have serious consequences for the postoperative functional and esthetic outcome. Much care should be taken during establishment of this diagnosis since an equivocal diagnosis can have serious consequences for the patient in terms of treatment.

CONCLUSION

After 1 year, the patient shows no signs or symptoms of recurrence of the lesions and was referred for reconstructive surgery of the mandible. An early and correct diagnosis is necessary to permit the best therapeutic management.

Orbit ossifying fibroma - Case report and literature review

Background:

Ossifying fibroma (OF) is benign bone lesions, most frequent in young children, more common in the maxillary sinus and mandible (75–89%), the pathogenesis of the tumor is not clear, there are many subtypes of OF. This paper aims to report an OF a case and literature review.

Case Description:

Male, 19 years old, with a progressive history proptosis since 2012, diagnosed as a right supraorbital lesion at an external service and assigned to conservative management. Then, he evolved with double vision, which worsened in February of 2018, associated with a moderate headache. On admission: proptosis and downward deviation of the right orbit was noticed on the physical exam and with exception of limited right upgaze, external ocular movements were maintained. Head computed tomography showed a multiloculate expansive osteolytic lesion at the right orbital roof. On magnetic resonance imaging, the lesion had an inner content with septations, T1-weighted imaging heterogeneous signal, T2-weighted imaging high signal intensity, and peripheral contrast enhancement. The patient underwent a right frontal craniotomy with a gross total resection and the postoperative follow-up was uneventful. Menzel reported the first case in 1782. The clinical findings depend on localization. There are five subtypes. In general, the lesions have a radiological appearance with hyperdense boundary and cause deformity and destruction in bones with high recurrence risk. Radical resection is curative.

Conclusion:

As a result, the correlation of clinical, radiologic, and pathologic data is significant while going for a specific diagnosis in cases of craniofacial fibrous lesions. Total excision is the best treatment, but it can recur.

Juvenile Psammomatoid Ossifying Fibroma of the Orbital Roof: A Rare Cause of Proptosis among Children

INTRODUCTION

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare bone tumor characterized by a predilection for the sinonasal region and a tendency to affect younger patients, with a potential for aggressive growth and high recurrence (30-56%). JPOF warrants complete surgical resection to avoid recurrence.

CASE PRESENTATION

In this article, we report a young boy who presented with unilateral prop-tosis with an expansile bony tumor with ground glass appearance involving the left frontal bone and orbital roof on his images. Complete surgical resection was done, and histopathological examination revealed JPOF with abundant psammomatoid bodies.

DISCUSSION

This patient is a rare case of neurocranial JOPF and adds new features to the typical features already described for JPOF.

Recurrent benign ossifying fibroma of the orbit - clinical, radiological profile and management options in a child

Ossifying fibroma (OF) is a benign fibro-osseous neoplasm which may be mistaken for other similar lesions due to overlapping clinical and radiological features. We report a 5-year-old male child with recurrent benign OF of the orbit. The child had two episodes of recurrence in a span of 18 months. Computed tomography (CT) of orbit showed a large, lobulated expansile fibro-osseous lesion involving the greater wing of sphenoid and orbital roof without intracranial extension. An excisional biopsy was done though an orbital approach. Histopathology showed fibroblast rich stroma with bony trabeculae. Osteoblastic rimming without any mitotic activity was suggestive of juvenile OF. The child developed a recurrence 6 months following the initial excision, and surgical excision was done by a neurosurgeon using a bicoronal approach. The patient had another recurrence after 1 year requiring further surgery. At 2-year follow up there was no recurrence. Juvenile OF is the most aggressive variant that commonly occurs in children, the other benign fibro-osseous lesions being fibrous dysplasias (FDs), osseous dysplasias, and familial gigantiform cementomas.

A large psammomatoid ossifying fibroma with proptosis: A case report

The psammomatoid ossifying fibroma (POF) is a rare and benign fibro-osseous lesion predominantly affecting the paranasal sinuses and orbits of children and young adults. The diagnosis and management of the lesion remains challenging. The present study reported a rare case of a large POF in a 39-year-old male patient. The patient had a 30 year history of a slowly growing tumor and this had resulted in right craniofacial deformity, as well as right lateral displacement of the eye ball. Due to the large tumor size, surgical removal of the lesion was the predominant treatment. At 5 months after complete surgical resection, the patient was free from any symptoms. The radiological and histological findings, as well as the surgical management, were presented and the relevant literature was reviewed.

Juvenile ossifying fibroma of the jaw: a retrospective study of 15 cases

The management of patients with juvenile ossifying fibroma (JOF) remains controversial. To explore the correlations between different treatments and the patient prognosis, 15 cases of JOF of the jaw were reviewed. Five patients were male and 10 were female. Patient age at the time of disease onset ranged from 7 to 18 years (mean 10.9 years). Nine tumours were located in mandible and six in the maxilla. These cases typically manifested clinically as painless swelling of the jaw (9/15, 60%); 40% (6/15) of the cases were associated with pain, diplopia, stuffy nose, and/or rapid growth. Images of JOF can show a radiolucent, mixed, or ground glass-like appearance. Pathological examinations revealed 10 cases of juvenile trabecular ossifying fibroma (JTOF) and five cases of juvenile psammomatoid ossifying fibroma (JPOF). In terms of the treatment plan, six patients initially received radical surgery; nine patients underwent conservative treatment, among whom six (6/9, 66.7%) had one or more recurrence. At the end of the follow-up period, 12 patients had no evidence of tumour recurrence and three cases were alive with a tumour. In summary, surgeons should develop the surgical plan according to the extent of the lesion, relapse status, growth rate, and family choice, and these patients should be followed up closely.

Subacute cystic expansion of intracranial juvenile psammomatoid ossifying fibroma

Juvenile psammomatoid ossifying fibroma (JPOF) is a benign fibro-osseous lesion typically associated with the jaw, paranasal region, or orbit. However, JPOF may also originate from the skull base and locally invade the cranium. In published reports, intracranial JPOFs constitute only a small percentage of cases, and therefore it is not known whether more aggressive behavior typifies this distinct population of JPOFs compared with those in other locations. Nevertheless, JPOF histopathology is characterized by a number of active processes, including cystic transformation, that may precipitate violation of skull base boundaries. In the following article, the authors present a case of skull base JPOF that underwent cystic expansion in a young girl, produced a focal neurological deficit, and was resolved using a staged surgical approach.