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Manlove AE, Quintana EN, Cuellar LM, Linnebur AM. Benign Intraoral Soft Tissue Lesions in Children. Oral Maxillofac Surg Clin North Am 2024; 36:265-282. [PMID: 38395668 DOI: 10.1016/j.coms.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Benign intraoral soft tissue pathology in pediatric patients includes developmental, traumatic, inflammatory, and infectious lesions. Common pathology includes gingival cysts, mucoceles, fibromas, and parulis. Less common lesions include peripheral ossifying fibromas, congenital epulis of the newborn, and congenital mandibular duct atresia. Most of these lesions present at painless masses but can have significant effects on children and their caregivers. Although these lesions are generally harmless, evaluation and treatment is necessary for appropriate management and health of the child.
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Affiliation(s)
- Ashley E Manlove
- Carle Illinois College of Medicine, Carle Cleft and Craniofacial Team, Carle Foundation Hospital, Urbana, IL, USA.
| | - Erik N Quintana
- Division of Oral and Maxillofacial Surgery, Carle Foundation Hospital, Urbana, IL, USA
| | - Leticia M Cuellar
- Division of Oral and Maxillofacial Surgery, Carle Foundation Hospital, Urbana, IL, USA
| | - Alexis M Linnebur
- Arnold Palmer Hospital for Children - Orlando Health, 207 W. Gore Street, 3Road Floor, Suite.302, Orlando, FL 32806, USA
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2
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Takagi R, Mori K, Koike T, Tsuyuguchi S, Kanai K, Watanabe Y, Okano M, Noguchi Y, Tanaka A, Kurihara K, Sato K, Ishizaki K, Hayashi Y, Imanishi Y. A giant peripheral ossifying fibroma of the maxilla with extreme difficulty in clinical differentiation from malignancy: a case report and review of the literature. J Med Case Rep 2024; 18:220. [PMID: 38702820 PMCID: PMC11069167 DOI: 10.1186/s13256-024-04529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Peripheral ossifying fibroma is a nonneoplastic inflammatory hyperplasia that originates in the periodontal ligament or periosteum in response to chronic mechanical irritation. Peripheral ossifying fibroma develops more commonly in young females as a solitary, slow-growing, exophytic nodular mass of the gingiva, no more than 2 cm in diameter. While various synonyms have been used to refer to peripheral ossifying fibroma, very similar names have also been applied to neoplastic diseases that are pathologically distinct from peripheral ossifying fibroma, causing considerable nomenclatural confusion. Herein, we report our experience with an unusual giant peripheral ossifying fibroma with a differential diagnostic challenge in distinguishing it from a malignancy. CASE PRESENTATION A 68-year-old Japanese male was referred to our department with a suspected gingival malignancy presenting with an elastic hard, pedunculated, exophytic mass 60 mm in diameter in the right maxillary gingiva. In addition to computed tomography showing extensive bone destruction in the right maxillary alveolus, positron emission tomography with computed tomography revealed fluorodeoxyglucose hyperaccumulation in the gingival lesion. Although these clinical findings were highly suggestive of malignancy, repeated preoperative biopsies showed no evidence of malignancy. Since even intraoperative frozen histological examination revealed no malignancy, surgical resection was performed in the form of partial maxillectomy for benign disease, followed by thorough curettage of the surrounding granulation tissue and alveolar bone. Histologically, the excised mass consisted primarily of a fibrous component with sparse proliferation of atypical fibroblast-like cells, partly comprising ossification, leading to a final diagnosis of peripheral ossifying fibroma. No relapse was observed at the 10-month follow-up. CONCLUSIONS The clinical presentation of giant peripheral ossifying fibromas can make the differential diagnosis from malignancy difficult. Proper diagnosis relies on recognition of the characteristic histopathology and identification of the underlying chronic mechanical stimuli, while successful treatment mandates complete excision of the lesion and optimization of oral hygiene. Complicated terminological issues associated with peripheral ossifying fibroma require appropriate interpretation and sufficient awareness of the disease names to avoid diagnostic confusion and provide optimal management.
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Affiliation(s)
- Ryo Takagi
- Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Kosei Mori
- Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Takashi Koike
- Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Sayumi Tsuyuguchi
- Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Kengo Kanai
- Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Yoshihiro Watanabe
- Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Mitsuhiro Okano
- Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Yoshihiro Noguchi
- Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Aya Tanaka
- Department of Oral Rehabilitation and Maxillofacial Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Kinue Kurihara
- Department of Oral Rehabilitation and Maxillofacial Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Kazumichi Sato
- Department of Oral Rehabilitation and Maxillofacial Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Ken Ishizaki
- Department of Oral Rehabilitation and Maxillofacial Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Yuichiro Hayashi
- Department of Pathology, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Yorihisa Imanishi
- Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan.
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Alfred Xavier S, Yazhini P K. Peripheral Ossifying Fibroma: A Case Report. Cureus 2024; 16:e59749. [PMID: 38841021 PMCID: PMC11152567 DOI: 10.7759/cureus.59749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Peripheral ossifying fibroma (POF) is a reactive overgrowth that most commonly occurs on the gingiva. It is a benign oral soft tissue tumour. It is most commonly found on the anterior maxilla and has a female predilection. Most commonly found to occur in the second decade of life. This type of lesion originates from the cells of the periodontal ligament. It is often associated with trauma or local irritants, such as subgingival plaque and calculus, dental appliances and poor-quality dental restorations. This entity requires a proper treatment protocol and a regular follow-up. It can cause significant discomfort and irritation in the oral health if left untreated. The recurrence rate of the lesion varies according to the authors. This case report describes a case of POF in an adult female patient which was treated using surgical excision resulting in an uneventful healing during the post-operative period.
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Affiliation(s)
- Soya Alfred Xavier
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Kandhal Yazhini P
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Parsegian K, Arce RM, Angelov N. Surgical Periodontal Management of Peripheral Ossifying Fibroma: A Series of Three Cases. Case Rep Dent 2024; 2024:3683561. [PMID: 38501031 PMCID: PMC10948227 DOI: 10.1155/2024/3683561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/07/2024] [Accepted: 02/24/2024] [Indexed: 03/20/2024] Open
Abstract
Peripheral ossifying fibroma (POF) is a benign swelling of the gingival connective tissue commonly associated with dental biofilm and biofilm-retentive dental appliances. In the present case report, we described three cases of POF with different clinical presentations and treatment approaches. The treatment consisted of the removal of supra- and subgingival calculus, followed by a flap surgery with excision of the entire lesion ensuring the inclusion of the periosteal bed. The first patient developed POF during her pregnancy that remained clinically noticeable postpartum. The second case represented a rare case of POF appearing on the palatal aspect of the anterior maxilla of an African American male. The third case represented POF that developed on the mandible, and contrary to the first two cases, it was excised using a diode laser and not a scalpel blade. All patients showed uneventful healing during follow-up appointments; however, poor patient compliance did not allow for evaluation of long-term healing responses and possible recurrence of the lesion. Within the limitations of this clinical report, it is evident that the periodontal surgical approach was effective in managing POF with stable short-term clinical outcomes.
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Affiliation(s)
- Karo Parsegian
- Division of Periodontics, Department of Diagnostic Sciences and Surgical Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Roger M. Arce
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas Health Science Center, Houston, TX, USA
| | - Nikola Angelov
- Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas Health Science Center, Houston, TX, USA
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Tompodung LM, Sensusiati AD. Ossifying fibroma of the maxilla: A case report with literature review. Radiol Case Rep 2024; 19:915-921. [PMID: 38188957 PMCID: PMC10767277 DOI: 10.1016/j.radcr.2023.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024] Open
Abstract
Ossifying fibroma is a benign fibro-osseous lesion arising from the periodontal ligament cells. The lesion may progressively enlarge with the mass affecting the mandible or maxilla, resulting in facial deformities and tooth displacement despite its benign nature. Here, we presented a case of an 18-year-old female with ossifying fibroma in the maxilla extending to the maxillary sinus, infraorbital area, and skull base, resulting in considerable facial asymmetry. Since the primary treatment of ossifying fibroma is surgical resection, it is essential to determine the areas where the lesion has expanded, where a 3-dimensional computed tomography scan could play a critical role in providing such information. A complete surgical excision and histopathologic examination in treating this patient are crucial, made possible by a meticulous preoperative radio imaging technique.
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Affiliation(s)
- Linda M. Tompodung
- Department of Radiology, Faculty of Medicine, Airlangga University/Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Anggraini Dwi Sensusiati
- Department of Radiology, Faculty of Medicine, Airlangga University/Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
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6
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Muylaert F, De Kock L, Creytens D, Verstraete K, Coopman R. High-grade osteosarcoma arising in DCIA flap reconstruction after a prior resection of maxillar cemento-ossifying fibroma: A case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101591. [PMID: 37558180 DOI: 10.1016/j.jormas.2023.101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
Cemento-ossifying fibroma is a rare benign odontogenic tumour of the tooth-bearing jaws. Its concomitant occurrence with osteosarcoma, a malignant maxillofacial bone tumour, has never been described before. We present an uncommon case of a 43-year-old woman in whom a cemento-ossifying fibroma in the right maxilla was treated by resection and reconstruction using a deep circumflex iliac artery flap. During surgical prosthetic rehabilitation one-year post-operative, an osteosarcoma extending from the contralateral maxilla was coincidentally discovered in the deep circumflex iliac artery flap. The aim of this case report is to raise awareness on the extremely rare but possible simultaneous and independent occurrence of a cemento-ossifying fibroma and an osteosarcoma.
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Affiliation(s)
- Frances Muylaert
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Lisa De Kock
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Koenraad Verstraete
- Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium; Head of Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Renaat Coopman
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
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7
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El ayachi H, Assimi S, Sabaoui Z, Cherkaoui A. Ossifying fibroma from surgical excision to periodontal management: case report. Ann Med Surg (Lond) 2024; 86:463-466. [PMID: 38222715 PMCID: PMC10783395 DOI: 10.1097/ms9.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/10/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance Peripheral ossifying fibroma is one of the commonly occurring reactive benign lesions that occurs in the gingiva, predominantly in females, especially in the anterior maxillary region of young women and in pediatric patients. It causes unsatisfactory esthetics, difficulty in maintaining good oral hygiene and difficulty in mastication.The importance of this clinical case is to emphasize the interest of early management of the residual defect after the removal of the gum growth. Case presentation A 39-year-old female patient was referred to the clinical department of periodontology, with the chief complaint of bleeding gingiva, unsatisfactory esthetics and gum growth on the interproximal area in relation to left maxillary canine and premolar region, with the size ~2 cm×1.5 cm. Clinical discussion This article describes an atypical case of peripheral ossifying fibroma with the clinical, histopathologic, and radiographic features in the posterior maxilla in an adult female patient. Treatment consisted of complete surgical excision, gingival curettage, and management of keratinezed gingiva by utilizing laterally displaced flap. Clinical healing was satisfactory at 2 weeks, and excellent coverage of residual mucogingival defect with no evidence of recurrence was achieved 3 weeks postoperatively. The patient was satisfied with case resolution with a follow-up of 1 year. Conclusion Although surgical excision is the treatment of choice, sometimes it may induce residual soft tissue defect, which may further precipitate functional and esthetic discrepancies if not managed.
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Affiliation(s)
- Houda El ayachi
- Department of Periodontology, Faculty of Dental Medicine, Mohammed V University in Rabat, Morocco
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8
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Darling M, Li K, Burnside K, Smith N, Jackson-Boeters L, Hamilton D. Immunohistochemical Characterization of Gingival Fibromas. Head Neck Pathol 2023; 17:355-363. [PMID: 36472794 PMCID: PMC10293518 DOI: 10.1007/s12105-022-01493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Gingival fibromas (GFs) are fibrous lesions of the gingiva that are not well defined in the literature. They are histologically similar to peripheral ossifying fibromas (POFs), both being characterized as cellular proliferations of dense fibrous tissue, with POFs differing in that they demonstrate foci of calcification. This study aims to expand upon the immunohistochemical characterization of GFs, and to confirm their osteoblastic phenotype. METHODS Formalin fixed, paraffin embedded GFs, POFs and fibroepithelial polyps (FEPs) of the gingiva were examined. Immunohistochemical staining was performed for special AT-rich sequence binding protein 2 (SATB2), runt-related transcription factor 2 (RUNX2), osteocalcin and alpha-smooth muscle actin (αSMA). Sections were evaluated by light microscopy and the immunohistochemical staining patterns were assigned immunoreactive scores (IRS) based on percentage of stained cells and intensity of staining. RESULTS GFs, POFs, and FEPs of the gingiva expressed osteoblastic markers SATB2, RUNX2 and osteocalcin. GFs and POFs expressed αSMA while FEPs of the gingiva did not. GFs and POFs had similar staining patterns of SATB2, RUNX2 and αSMA. DISCUSSION These findings demonstrate that GFs and POFs exhibit a similar immunohistochemical profile, and supports a theory that GFs are osteoblastic lesions possibly related to POFs.
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Affiliation(s)
- Mark Darling
- University of Western Ontario, London, ON, Canada.
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine, University of Western Ontario, 1151 Richmond St, N6A 5C1, London, ON, Canada.
| | - Kunning Li
- University of Western Ontario, London, ON, Canada
| | | | - Nicole Smith
- University of Western Ontario, London, ON, Canada
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Wang Y, Du J, Jiang Z, Meng J. Transformation of Cemento-Ossifying Fibroma into Osteosarcoma after Radiotherapy and Nine Endoscopic Surgeries. EAR, NOSE & THROAT JOURNAL 2023; 102:24-27. [PMID: 35575211 DOI: 10.1177/01455613221101944] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cemento-ossifying fibromas (COFs) are benign fibro-osseous tumors usually found in the mandible and maxilla that can show malignancy in rare situations. COFs usually grow slowly and asymptomatically until they produce local bulges, pain, headaches, and visual impairment, and have a Ki-67 index within 3%, even in aggressive and recurrent cases. Surgical resection can usually provide a satisfactory prognosis. However, no cases of COF transforming into osteosarcoma have been reported. We present a case of COF involving a 58-year-old woman whose initial symptom was hearing loss in the right ear accompanied by tinnitus. Enhanced magnetic resonance imaging revealed a 3.1 cm x 3.2 cm mass centered on the right pterygoid process of the sphenoid bone. Postoperative pathology revealed a COF with a high Ki-67 index (8%-10%). Over the next two years, the tumor relapsed repeatedly. The patient underwent nine endoscopic surgeries and radiotherapy. The sixth postoperative biopsy showed that the COF had transformed into an osteosarcoma. The patient subsequently experienced respiratory and cardiac arrests and was receiving treatment in the intensive care unit with a poor prognosis at the time of writing this manuscript. Thus, a high Ki-67 index may be a risk factor for malignant transformation for COFs.
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Affiliation(s)
- Yang Wang
- Department of Oto-Rhino-Laryngology, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Jintao Du
- Department of Oto-Rhino-Laryngology, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Zihan Jiang
- Department of Oto-Rhino-Laryngology, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Juan Meng
- Department of Oto-Rhino-Laryngology, West China Hospital, 34753Sichuan University, Chengdu, China
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Xu K, Zhu Y, Li Y, Huang J, Wan Q, Hao J, Ji Z, Liu Y, Tay FR, Jiao K, Niu L. Clinical and pathologic factors associated with the relapse of fibrous gingival hyperplasia. J Am Dent Assoc 2022; 153:1134-1144.e2. [DOI: 10.1016/j.adaj.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
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de Oliveira Freitas DC, Melo FG, de Melo Ocarino N, Abreu DM, Araújo FR, Serakides R. Three Cases of Mandibular Ossifying Fibroma in Cattle. J Comp Pathol 2022; 198:16-21. [DOI: 10.1016/j.jcpa.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/21/2022] [Accepted: 07/26/2022] [Indexed: 10/14/2022]
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Recurrent Gingival Lesions in a Pediatric Patient. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4382. [PMID: 35720203 PMCID: PMC9200379 DOI: 10.1097/gox.0000000000004382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022]
Abstract
We present the case of a 13-year-old girl who developed numerous gingival masses that recurred after two prior resections. Following the initial resection as a child, she reported that there was a period of resolution for several years before recurrence as a teenager. After the second resection, the masses recurred after 4 months. The lesions obscured the majority of her dentition and interfered with speech, eating, and oral hygiene. The patient underwent staged resection of the masses, and the wounds were allowed to heal by secondary intention. The histopathologic findings of the specimens were consistent with a diagnosis of peripheral ossifying fibroma, which is unusual as these are generally solitary lesions. We believe that this case brings attention to an underrecognized and atypical presentation of peripheral ossifying fibroma, and it should be considered in the differential diagnosis of multicentric gingival masses.
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Godinho GV, Silva CA, Noronha BR, Silva EJ, Volpato LE. Peripheral Ossifying Fibroma Evolved From Pyogenic Granuloma. Cureus 2022; 14:e20904. [PMID: 35145808 PMCID: PMC8807426 DOI: 10.7759/cureus.20904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/05/2022] Open
Abstract
The aim of the present article is to present the clinical case of a large peripheral ossifying fibroma that evolved from a previously diagnosed pyogenic granuloma in a 50-year-old woman. The patient was referred for treatment of a lesion over the buccal and palatal gingiva close to the left upper first molar. It was purplish-red in color, approximately 3 cm in diameter, having a smooth surface, a pedicled and bleeding base, with seven years of evolution, and diagnosed as pyogenic granuloma. After three years of evasion, the patient returned reporting an increase in the lesion and difficulty in eating. Clinically the nodule was lobular in appearance, pink in color and smooth, pediculated, firm in consistency, non-bleeding, about 5 cm in its greatest extension, extending to the maxillary tuberosity. The lesion was excised and referred for histopathological examination, which led to the diagnosis of peripheral ossifying fibroma. The patient was followed for approximately 18 months, prosthetically rehabilitated, with satisfactory healing and no clinical signs of recurrence. The possible evolution of a pyogenic granuloma to a peripheral ossifying fibroma was observed in this case, based on the histopathological changes that occurred, with the development of calcified material, fibrous maturation, and decreased vascular content of the initial lesion after three years.
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14
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Karube T, Munakata K, Yamada Y, Yasui Y, Yajima S, Horie N, Kawana H, Mikami S, Nakagawa T, Asoda S. Giant peripheral ossifying fibroma with coincidental squamous cell carcinoma: a case report. J Med Case Rep 2021; 15:599. [PMID: 34922609 PMCID: PMC8684643 DOI: 10.1186/s13256-021-03187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral ossifying fibroma is an inflammatory or reactive hyperplasia of the gingiva that is usually small. It is formed by hard tissue in fibrous tissue, and the name “neoplastic lesion” has tended to be used frequently in Europe and America. Clinically, peripheral ossifying fibromas are painless, solitary, exophytic, sessile, or pedunculated and more frequently found in females than in males. To the best of our knowledge, there have been no reports of malignant cases. We herein report the case of giant peripheral ossifying fibroma with squamous cell carcinoma. Case presentation The patient was an 83-year-old Japanese woman who visited our hospital with a gingival massive mass. She was referred to us for an examination and treatment because it was difficult to perform tracheal intubation for surgery of sigmoid colon cancer at another hospital. The mass measured 83 × 58 × 35 mm, and it protruded to the extra-oral region from the right maxillary premolar alveolar region. Panoramic X-ray revealed the shadow of the mass in the right maxillary premolar region, which included some hard tissue. Computed tomography showed scattering calcified images in the mass. Magnetic resonance imaging was not performed because she had vertebral artery clips and screws in her forehead. Given the above findings, we performed a biopsy under local anesthesia. However, we were unable to diagnose absolutely whether the dysplastic squamous epithelia were pseudocarcinomatous hyperplasia of the gingiva or well-differentiated squamous cell carcinoma. Therefore, tumor resection was performed under general anesthesia. The histopathological diagnosis was peripheral ossifying fibroma with coincidental squamous cell carcinoma. There have been no signs of recurrence during follow-up as of 2 years after surgery. Conclusions The etiology of giant peripheral ossifying fibroma with squamous cell carcinoma is still not definite. Therefore, careful observation is necessary. It needs to be examined by accumulation of more cases in the future. We herein report the case of giant peripheral ossifying fibroma coincidental squamous cell carcinoma.
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Bawazir M, Islam MN, Cohen DM, Fitzpatrick S, Bhattacharyya I. Gingival Fibroma: An Emerging Distinct Gingival Lesion with Well-Defined Histopathology. Head Neck Pathol 2021; 15:917-922. [PMID: 33686583 PMCID: PMC8384971 DOI: 10.1007/s12105-021-01315-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
Gingival growths, barring a few are mostly reactive and seldom exhibit significant true neoplastic potential. The common etiology is local irritation from dental plaque/calculus, trauma as well as medication-related overgrowth. Such lesions are easily distinguishable and categorized into diagnoses such as pyogenic granuloma, peripheral ossifying fibroma, etc. We present a previously undescribed, but commonly encountered, reactive gingival growth with unique histologic features and suggest the diagnostic term "gingival fibroma." An IRB approved retrospective review of the University of Florida Oral Pathology Biopsy Service encompassing years 2010-2019, was performed to select cases. Demographics, clinical data, and microscopic diagnoses were recorded and analyzed. Four board-certified oral and maxillofacial pathologists agreed upon and established the diagnostic criteria. These are: a prominent fibromyxoid stroma, variable cellularity, a whorled or storiform pattern of arrangement of the cellular elements, lack of significant inflammation or vascularity, and complete absence of calcification, and/or odontogenic islands. A total of 60 cases met all criteria and were included in the study. Age range in years was 14-87 with the mean at 45.11 years. A striking female predilection (90%) was noted. Approximately 62% of cases were reported on the maxillary gingiva, followed by 38.3% in the mandibular gingiva. Majority, 66.7% were in the anterior incisor region followed by 11.7% in the canine/first premolar areas. All lesions were submitted as excisional biopsy, and 4 cases recurred within 2-3 years of excision. In all cases, lesional tissue appeared to extend to the surgical base of the specimen. We present 60 cases of a histologically unique entity occurring exclusively on the gingiva and introduce the diagnostic term "Gingival Fibroma" for these lesions. Further studies with adequate clinical follow-up may help understand the exact clinical behavior of these lesions.
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Affiliation(s)
- M. Bawazir
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA ,Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, Gainesville, USA
| | - M. N. Islam
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA
| | - D. M. Cohen
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA
| | - S. Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA
| | - I. Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA
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