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Salge-Arrieta FJ, Vior-Fernández C, Lee P, Reguero-Callejas ME, Pian-Arias HG, Martínez-San Millán JS, Carrasco-Moro R. Giant fronto-spheno-orbitary juvenile psammomatoid ossifying fibroma: Case report and literature review. Childs Nerv Syst 2024; 40:939-945. [PMID: 38038744 DOI: 10.1007/s00381-023-06206-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
Juvenile psammomatoid ossifying fibroma (JPOF) is an osteofibrous neoplasm that originates in the craniofacial skeleton typically during the first three decades of life. JPOFs usually involve the orbit, paranasal sinuses or the jaws. Extensive involvement of the anterior cranial base with compromised visual function is a rare phenomenon. In such clinical context, a definite diagnosis can only be made on the basis of histopathological findings, given the absence of pathognomonic radiological features. Despite being considered a benign entity, JPOFs present a locally aggressive behavior. Therefore, these neoplasms must be included in the differential diagnosis in every patient harboring a skull base osteofibrous lesion, and, once diagnosed, gross total surgical removal should be attempted. In this study, we present our experience in the diagnosis and treatment of a patient diagnosed with a giant JPOF involving the cranial base.
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Affiliation(s)
| | | | - Paul Lee
- Arkansas Neuroscience Institute, Sherwood, AR, USA
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2
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Tidke P, Gupta N, Patil D, Ghadage M, Sinha A, Dalave P, Makkad RS. Periapical Cemento-Osseous Dysplasia: A Journey from Diagnostic Dilemma to Accurate Diagnosis with Use of 3D Imaging. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S951-S954. [PMID: 38595463 PMCID: PMC11000969 DOI: 10.4103/jpbs.jpbs_465_23] [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] [Received: 08/02/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Abstract
Cemento-osseous dysplasia is a subgroup of fibro-osseous dysplasia commonly invading the tooth-bearing regions of the mandible quite often. These bony pathologies are asymptomatic and are seen on radiographs as an incidental finding. Accurate diagnosis of periapical cemento-osseous dysplasia is very crucial as it will help in the proper management of the patient as the incorrect diagnosis can lead to the unnecessary endodontic treatment of the concerned teeth as it may be misdiagnosed as a periapical pathology. We describe a case of periapical cemento-osseous dysplasia in which a 52-year-old woman had been experiencing discomfort in the right mental area of her mandible for the previous 6 months and had finally sought help at the outpatient department. This case study aims to highlight the significance of making an accurate diagnosis of cemento-osseous dysplasias in the tooth-bearing area.
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Affiliation(s)
- Priyanka Tidke
- Department of Oral Medicine and Radiology, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Neha Gupta
- Department of Oral Pathology, Microbiology and Forensic Odontology, Dental Institute, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Dipooja Patil
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Mahesh Ghadage
- Department of Prosthodontics and Crown and Bridge, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Anamika Sinha
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Pranita Dalave
- Department of Periodontology and Implantology, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Ramanpal S. Makkad
- Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
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Ebrahimi F, Ebrahimi F, An J. Surgical Management of Infection Secondary to Cemento-osseous Dysplasia. J Craniofac Surg 2023; 34:e614-e617. [PMID: 37552103 DOI: 10.1097/scs.0000000000009556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 08/09/2023] Open
Abstract
Cemento-osseous dysplasia (COD) of the jaws generally has no clinical manifestations when asymptomatic, thus requiring no treatment. However, secondary infection in COD requires surgical intervention. This study was focused on the evaluation of the surgical treatment of COD patients with secondary infections. The clinical data of COD patients with secondary infections, treated at the Peking University, Hospital of Stomatology between March 2021 and June 2022, were retrospectively reviewed. The data included age, sex, lesion characteristics, number of surgeries, and surgical outcomes. Seven COD patients with secondary infections underwent curettage, and the wounds were repaired using local soft tissue flaps, such as the buccal fat pad. Four of the patients had primary wound healing, while 3 presented with wound dehiscence. Healing occurred in 2 of these 3 patients after ~1 month of dressings. The remaining patient showed no improvement after 9 weeks, and underwent a second surgery, which led to primary wound healing. In conclusion, secondary infection in COD is an indication for surgical intervention, which may arrest the disease progression.
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Affiliation(s)
- Farin Ebrahimi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology South Avenue Zhongguancun, Haidian District, Beijing, PR China
| | - Faraz Ebrahimi
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing China
| | - Jingang An
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology South Avenue Zhongguancun, Haidian District, Beijing, PR China
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Tahir M, Ahmed Z, Elkadi O. Cranial Juvenile Psammomatoid Ossifying Fibroma: A Rare Entity. Cureus 2023; 15:e42122. [PMID: 37602120 PMCID: PMC10438793 DOI: 10.7759/cureus.42122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
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.
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Affiliation(s)
- Muhammad Tahir
- Pathology and Laboratory Medicine, University of South Alabama Health University Hospital, Mobile, USA
| | - Zan Ahmed
- Pathology and Laboratory Medicine, University of South Alabama Health University Hospital, Mobile, USA
| | - Osama Elkadi
- Pathology and Laboratory Medicine, University of South Alabama Health University Hospital, Mobile, USA
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Obermeier KT, Hartung JT, Hildebrandt T, Dewenter I, Smolka W, Hesse E, Fegg F, Otto S, Malenova Y, Abdullah A. Fibrous Dysplasia of the Jaw: Advances in Imaging and Treatment. J Clin Med 2023; 12:4100. [PMID: 37373793 DOI: 10.3390/jcm12124100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
A total of 7% of all benign bone lesions are diagnosed as fibrous dysplasia (FD). The symptoms of FD of the jaw range from asymptomatic to dental anomalies, pain and facial asymmetry. Due to its resemblance to other fibro-osseous bone lesions, misdiagnosis often occurs and can lead to inadequate treatment. Particularly in the jaw, this lesion does not become quiescent during puberty, making fundamental knowledge about the diagnosis and treatment of FD crucial. Mutational analysis and nonsurgical approaches offer new diagnostic and therapeutic options. In this review, we examine the advances and the difficulties of the diagnosis and the various treatment modalities of FD of the jaw in order to capture the current scientific knowledge on this bone disease.
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Affiliation(s)
- Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Jens Tobias Hartung
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Tim Hildebrandt
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Ina Dewenter
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Eric Hesse
- Institute of Musculoskeletal Medicine, University Hospital, LMU Munich, Fraunhoferstraße 20, 82152 Munich, Germany
- Musculoskeletal University Center Munich, University Hospital, LMU Munich, Fraunhoferstraße 20, 82152 Munich, Germany
| | - Florian Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Anusha Abdullah
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
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Decolibus K, Shahrabi-Farahani S, Brar A, Rasner SD, Aguirre SE, Owosho AA. Cemento-Osseous Dysplasia of the Jaw: Demographic and Clinical Analysis of 191 New Cases. Dent J (Basel) 2023; 11:dj11050138. [PMID: 37232789 DOI: 10.3390/dj11050138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
Cemento-osseous dysplasia (COD) is a form of benign fibro-osseous lesion of the jaw. We sought to evaluate the demographic and clinical presentations of COD by collecting and analyzing the demographic, clinical, radiographic, and pathologic data of COD diagnosed in our institution from 2017 to 2022. Over this six-year period, the records of 191 patients with COD were reviewed. Most patients were African American and female. Eighty-five patients were diagnosed with florid COD (FLCOD), 63 with periapical COD (PCOD), and 43 with focal COD (FCOD). Twenty-eight (14.7%) patients presented symptoms. The most common symptom was pain. All the symptomatic cases of COD that were histopathologically diagnosed were osteomyelitis in the setting of COD. Symptomatic patients were older (mean of 61.3 years) than the asymptomatic patients (mean of 51.2 years). Due to the radiographic appearance of a radiolucency or a mixture of radiolucency and radiopacity, forty-five asymptomatic patients were biopsied. Most of the asymptomatic patients biopsied were patients with FCOD (n = 19, 54.3%), followed by PCOD (n = 16, 25.8%), and FLCOD (n = 10, 15.2%). FLCOD is the most common form of COD to present with symptoms. Due to the significant overlap in clinical and radiographic presentation with other entities, FCOD and PCOD remain a diagnostic challenge to dentists. In conclusion, we analyzed the demographic and clinical features of 191 new cases of COD, which reaffirms that cemento-osseous dysplasia is a condition that primarily affects middle-aged females of African descent and occurs more frequently in the mandible.
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Affiliation(s)
- Katherine Decolibus
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Shokoufeh Shahrabi-Farahani
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Anmol Brar
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Shane D Rasner
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Sarah E Aguirre
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Adepitan A Owosho
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
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Fukuchi M, Igarashi H, Suzuki S, Konno Y, Takano H, Fukuda M. Fibrous dysplasia of the zygomatic bone and mandibular coronoid process: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Kim JH, Kang J, Kim SI, Kim BJ. Psammomatoid Juvenile Ossifying Fibroma of the Maxilla Misdiagnosed as Fibrous Dysplasia: A Clinicopathologic Case Report. Arch Plast Surg 2023; 50:49-53. [PMID: 36755645 PMCID: PMC9902082 DOI: 10.1055/s-0042-1758468] [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: 02/19/2022] [Accepted: 08/17/2022] [Indexed: 02/09/2023] Open
Abstract
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.
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Affiliation(s)
- Jong-Ho Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Jiwon Kang
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Seong-ik Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Republic of Korea,Address for correspondence Byung Jun Kim, MD, PhD Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine103 Daehak-ro, Jongno-gu, Seoul 110-744Republic of Korea
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A two-generation hyperparathyroidism-jaw tumor (HPT-JT) syndrome family: clinical presentations, pathological characteristics and genetic analysis: a case report. Diagn Pathol 2022; 17:71. [PMID: 36153594 PMCID: PMC9508707 DOI: 10.1186/s13000-022-01248-x] [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: 02/13/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hyperparathyroidism-Jaw Tumor (HPT-JT) is caused by inactivating germline mutations of CDC73. This hereditary disease can present with a range of symptoms. Jaw ossifying fibroma (OF) is one of the most important clinical presentations, affecting 30% of HPT-JT patients. However, OF is easily confused with other fibro-osseous lesions (FOLs) of the jaw. The correct diagnosis of HPT-JT is a real challenge and must be confirmed by genetic testing. Case presentation A female proband and her father suffered from multiple and recurrent FOLs in the jaw. Considering well demarcated margin and heterogeneous calcified substance lying in a variable density of fibrous stroma, we reached the diagnosis of jaw OF through radiologic and microscopic analyses. Additionally, the proband presented with chronic anemia resulting from menorrhagia, as well as renal mixed epithelial and stromal tumor (MEST). Two patients both presented with no evidence of Hyperparathyroidism (HPT). A germline start codon mutation (c.1A > G) of CDC73 was identified in them. Copy number loss at the CDC73 gene locus was verified in the jaw tumor sample of the proband. Conclusion Regardless of whether HPT manifestations are present, patients with heritable jaw OF may be at risk for HPT-JT. Genetic testing should be adopted to confirm the diagnosis. Early recognition of HPT-JT helps to better develop tailored treatment plans and surveillance programs.
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Pediatric Benign Fibro-Osseous Lesions of the Nose and Paranasal Sinuses: A Tertiary Hospital Experience. Int J Otolaryngol 2022; 2022:1608015. [PMID: 36060197 PMCID: PMC9436620 DOI: 10.1155/2022/1608015] [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: 02/18/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Pediatric benign fibro-osseous lesions of the nose and paranasal sinuses are considered rare neoplastic entities. These fibro-osseous lesions are difficult to accomplish owing to the multifaceted anatomy of the skull base in addition to the closeness to neurovascular configurations. Objective The study aimed to study different clinical presentations, radiological manifestations, surgical management, and consequences of different benign fibro-osseous lesions in the pediatric age groups. Methods and Settings. This is a case series study of a single-center experience. Results Four different cases were presented and discussed (osteoma, fibrous dysplasia, and ossifying fibroma. Conclusion We reported four different cases of osteoma, ossifying fibroma, and fibrous dysplasia. All of these cases were managed endoscopically with no postoperative complications. Endoscopic management is considered highly effective with reduced morbidity. Preoperative radiographic studies are highly essential for diagnosis and operative planning.
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Pick E, Schäfer T, Al-Haj Husain A, Rupp NJ, Hingsammer L, Valdec S. Clinical, Radiological, and Pathological Diagnosis of Fibro-Osseous Lesions of the Oral and Maxillofacial Region: A Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12020238. [PMID: 35204329 PMCID: PMC8870765 DOI: 10.3390/diagnostics12020238] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/30/2021] [Accepted: 01/17/2022] [Indexed: 12/27/2022] Open
Abstract
Background: Fibro-osseous lesions (FOL) of the jaw represent a rare, benign group of lesions that share similar clinical, radiological, and histopathological features and are characterized by progressive, variable replacement of healthy bone tissue by fibrous connective tissue. Methods: This retrospective study aimed to evaluate the incidence of fibro-osseous lesions and to reassess the efficacy of case-specific treatment management from a clinical, radiological, and histopathological perspective based on 14 years of data. Results: Forty-four patients with a radiological and/or histopathological diagnosis of benign FOLs were identified and re-evaluated. Cemento-osseous dysplasia was the most common group of FOLs present in our patient cohort (45%), followed by ossifying fibroma (39%) and fibrous dysplasia (16%). The diagnostic imaging technique of choice was CBCT (68%), followed by PAN (18%), with most patients (95 %) additionally undergoing biopsy. The mean age of the patients at the time of diagnosis was 40.54 ± 13.7 years, with most lesions being located in the mandible (86%), with females being predominantly affected (73%). Conclusion: An interdisciplinary approach that analyzes all case-specific factors, including demographic data, medical history, intraoperative findings, and, most importantly, histopathological and radiological features, is essential for an accurate diagnosis and key to avoiding inappropriate treatment.
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Affiliation(s)
- Ellen Pick
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (E.P.); (T.S.); (A.A.-H.H.)
| | - Tobias Schäfer
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (E.P.); (T.S.); (A.A.-H.H.)
| | - Adib Al-Haj Husain
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (E.P.); (T.S.); (A.A.-H.H.)
| | - Niels J. Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Lukas Hingsammer
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (E.P.); (T.S.); (A.A.-H.H.)
- Department of Stomatology, Division of Periodontology, Dental School, University of São Paulo, Butantã 2227, SP, Brazil
- Correspondence: ; Tel.: +41-44-634-32-90
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Nwoga M, Okwuosa C, Adisa A. Ossifying fibroma of the jaws: Review of 57 cases in Enugu and of global literature. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Gumru B, Akkitap MP, Deveci S, Idman E. A retrospective cone beam computed tomography analysis of cemento-osseous dysplasia. J Dent Sci 2021; 16:1154-1161. [PMID: 34484583 PMCID: PMC8403794 DOI: 10.1016/j.jds.2021.03.009] [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: 03/08/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background/purpose Radiological examination is indispensable in the diagnosis and follow-up of cemento-osseous dysplasia (COD). The aim of this retrospective study was to describe a series of COD cases, identify the frequencies of COD subtypes, and investigate the demographic and radiological characteristics in relation to subtypes. Materials and methods Cone beam computed tomography (CBCT) images/reports of patients with a diagnosis of COD were included in the study. The data collected included information on the age, sex, subtype of COD, location of COD, and region involved. Information regarding the internal density, effects on surrounding structures, and presence of concomitant lesions was also collected. The data obtained were evaluated statistically. Results The study group included CBCT images of 142 patients (130 females (91.5%) and 12 males (8.5%)) with a mean age of 46.97 ± 10.57 years. The mandible was involved in almost all cases (99.3%). The most common subtype was florid COD (51.4%) and lesions with hyperdense internal density (81.7%) were more commonly observed. Cortical thinning (78.2%) was a prominent feature. The frequency of root resorption in periapical COD cases (57.1%) was observed to be significantly higher (p < 0.05). All hypercementosis cases were associated with florid subtype (p < 0.05). In a minority of cases (6.3%), the lesions were associated with bone cysts and osteomyelitis. Conclusion CBCT images clearly demonstrated the effect of COD lesions on surrounding structures. CBCT is an appropriate imaging modality for the diagnosis and follow-up of COD which is the most common fibro-osseous lesion in clinical practice.
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Affiliation(s)
- Birsay Gumru
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Melda Pelin Akkitap
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Sevilay Deveci
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Ender Idman
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Qureshi MB, Tariq MU, Abdul-Ghafar J, Raza M, Din NU. Concomitant bilateral mandibular cemento-ossifying fibroma and cementoblastoma: case report of an extremely rare occurrence. BMC Oral Health 2021; 21:437. [PMID: 34493273 PMCID: PMC8425131 DOI: 10.1186/s12903-021-01794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cemento-ossifying fibroma (COF) and cementoblastoma (CB) are rare benign odontogenic tumors with a predilection for the mandible. Cemento-ossifying fibroma is a fibro-osseous lesion that originates in the tooth bearing areas of jaw and shows cementum-like tissue in a fibrotic stroma. Cementoblastoma is classically related to roots of teeth with the presence of calcified cementum-like material. To date, only a single case of concomitant unilateral COF and CB has been reported in the literature. CASE PRESENTATION We present an unusual case of a 37-year-old female who presented with two discrete bilateral swellings in the right and left mandible for 10 years. The larger tumor involved the left posterior mandible with extension anteriorly to the left and right anterior mandibles, and the smaller tumor was present in right posterior mandible. Radiology revealed two distinct lesions involving both sides of mandible. Histopathological examination showed characteristic features of cemento-ossifying fibroma in sections of the larger tumor and cementoblastoma in sections of smaller tumor. CONCLUSION This case shows the very unique bilateral co-existence of COF and CB, the second case reported in literature to date.
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Affiliation(s)
- Madiha Bilal Qureshi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Muhammad Usman Tariq
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Muhammad Raza
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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15
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Günhan Ö, Kahraman D, Yalçın ÜK. The possible pathogenesis of cemento-osseous dysplasia: A case series and discussion. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rodríguez-Cuentas GK. [Clinical and imaging characteristics of familial gigantiform cementoma. A review of the literature]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e073. [PMID: 38464860 PMCID: PMC10919829 DOI: 10.21142/2523-2754-0903-2021-073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/15/2021] [Indexed: 03/12/2024] Open
Abstract
Familial gigantiform cementoma (FGC) is a rare benign fibro-cementum lesion, which follows an autosomal dominant inheritance pattern and presents during childhood. It is limited to the bones of the face, with a predilection for the jaw, is fast growing and painless and expands considerably over time. It is considered among the seven disorders that affect the physiognomy of the craniofacial skeleton. Radiographically, FGC occurs in three stages of maturation similar to bone dysplasia, being radiolucent, mixed and radiopaque and is described as a mixed lobular well delimited mass, which can occur in both maxillae, causing expansion of the buccal and palatal / lingual bone cortices. displacement and retention of teeth. The aim of this study was to perform a review of the literature to identify the clinical, radiographic and histopathological characteristics of FGC in the jaws and describe the imaging tools that are useful for the diagnosis and follow-up of this lesion.
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Affiliation(s)
- Grizel Karem Rodríguez-Cuentas
- Facultad de Odontología, Universidad de Aquino Bolivia. Oruro, Bolivia. Universidad de Aquino Bolivia Facultad de Odontología Universidad de Aquino Bolivia Oruro Bolivia
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Copy number alteration profiling facilitates differential diagnosis between ossifying fibroma and fibrous dysplasia of the jaws. Int J Oral Sci 2021; 13:21. [PMID: 34188021 PMCID: PMC8242074 DOI: 10.1038/s41368-021-00127-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
Ossifying fibroma (OF) and fibrous dysplasia (FD) are two fibro-osseous lesions with overlapping clinicopathological features, making diagnosis challenging. In this study, we applied a whole-genome shallow sequencing approach to facilitate differential diagnosis via precise profiling of copy number alterations (CNAs) using minute amounts of DNA extracted from morphologically correlated microdissected tissue samples. Freshly frozen tissue specimens from OF (n = 29) and FD (n = 28) patients were obtained for analysis. Lesion fibrous tissues and surrounding normal tissues were obtained by laser capture microdissection (LCM), with ~30–50 cells (5 000–10 000 µm2) per sample. We found that the rate of recurrent CNAs in OF cases was much higher (44.8%, 13 of 29) than that in FD cases (3.6%, 1 of 28). Sixty-nine percent (9 of 13) of the CNA-containing OF cases involved segmental amplifications and deletions on Chrs 7 and 12. We also identified eight CNA-associated genes (HILPDA, CALD1, C1GALT1, MICALL2, PHF14, AIMP2, MDM2, and CDK4) with amplified expression, which was consistent with the copy number changes. We further confirmed a jaw lesion with a previous uncertain diagnosis due to its ambiguous morphological features and the absence of GNAS mutation as OF based on the typical Chr 12 amplification pattern in its CNA profile. Moreover, analysis of a set of longitudinal samples collected from an individual with a cellular lesion in suspicion of OF at the first surgery, recurrence and the latest malignant transformation revealed identical CNA patterns at the three time points, suggesting that copy number profiling can be used as an important tool to identify borderline lesions or lesions with malignant potential. Overall, CNA profiling of fibro-osseous lesions can greatly improve differential diagnosis between OF and FD and help predict disease progression.
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Ossifying Fibromas of the Head and Neck Region: A Clinicopathological Study of 45 Cases. Head Neck Pathol 2021; 16:248-256. [PMID: 34184157 PMCID: PMC9018917 DOI: 10.1007/s12105-021-01350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
Ossifying fibromas of the head and neck region are classified as cemento-ossifying fibroma (COF) (odontogenic origin), and two types of juvenile ossifying fibromas: juvenile trabecular ossifying fibroma (JTOF), and juvenile psammomatous ossifying fibroma (JPOF). The potential for recurrence in JTOF and JPOF and the discovery of newer molecular signatures necessitates accurate histological classification. Over 12 years (2005-2017), a total of 45 patients with 51 tumours were retrieved and reviewed for clinic-pathological features from the archives of a tertiary care oncology centre. Of 45 cases, COF, JTOF and JPOF comprised 13 (28.9%), 11 (24.4%) and 18 (40%) cases respectively. Three cases were unclassifiable. M: F ratio was 1:3.3, 1.1:1, 2:1 for COF, JTOF and JPOF respectively with an age range of 6-66 years (mean: 24.6, median; 18.1 years). The most common site for COF was mandible, for JTOF was maxilla, and for JPOF was ethmoid sinus. One case of mixed JTOF and JPOF histology was seen. Aneurysmal bone cyst-like areas were seen in 26.6% of cases, most commonly in JPOF. Follow up was available in 23 cases, and ranged from 4 to 207 months. Three cases of JPOF had a recurrence and one patient with JTOF had residual disease after surgery. One case of COF demonstrated increased parathyroid hormone levels. COF, JTOF, and JPOF are clinically, radiologically and histologically distinct entities. Surgical resection is the mainstay of treatment. JPOF has a higher incidence of recurrence as compared to JTOF and COF and hence needs a more aggressive follow-up.
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Kamalakaran A, Ramakrishnan B, Thirunavukkarasu R. Juvenile psammomatoid ossifying fibroma of Orbit-A rare case report and review of literature. J Clin Exp Dent 2021; 13:e614-e619. [PMID: 34188769 PMCID: PMC8223155 DOI: 10.4317/jced.57897] [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: 09/26/2020] [Accepted: 12/20/2020] [Indexed: 11/23/2022] Open
Abstract
Fibro osseous lesions of the craniofacial skeleton are a benign condition in which the normal architecture of the bone is replaced by fibrous connective tissue with varying degrees of mineralization. JOF forms a special entity among the fibro osseous lesions because of its age of occurrence and its aggressive nature thereby mimicking a malignancy. The Juvenile Ossifying Fibromas were further subdivided into Psammomatoid and Trabecular variant based on their histopathological characteristics. They tend to differ in their mineralized portion with the trabecular variant showing woven bone while the psammamotoid shows lamellated and spherical ossicles in various shapes in a myxoid stroma intermingled with bone cyst like areas. The reported cases of JPSOF are few, hence histopathological examination is a valuable tool in the diagnosis of this rare lesion and JOF should always be considered in the differential diagnosis of the lesions of the craniofacial skeleton. Early diagnosis and a complete surgical excision with adequate margins and a long term follow up is mandatory for a good prognosis of this highly recurrent and aggressive lesion.The diagnosis of JOF requires a careful correlation of clinical, radiological and histopathological features. The purpose of this paper is to report a case of JPOF of the orbit to stress the need for consideration of JOF in the differential diagnosis of the aggressive lesions of the Cranio facial skeleton. Key words:Juvenile psammomatoid ossifying fibroma, orbit, ossifying fibroma.
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Affiliation(s)
- Arunkumar Kamalakaran
- Associate Professor, Department of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai
| | - Bharathi Ramakrishnan
- Professor, Department of Oral and Maxilofacial Pathology, Tamilnadu Government Dental College and Hospital, Chennai
| | - Rohini Thirunavukkarasu
- Senior Assistant professor, Department Of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai
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Kumar S, Dorairaju P, Abirami V, Jeddy N. Cemento-Ossifying Fibroma of Upper Lip in a Female Child. Cureus 2021; 13:e14692. [PMID: 34055536 PMCID: PMC8153964 DOI: 10.7759/cureus.14692] [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] [Indexed: 11/27/2022] Open
Abstract
Cemento-ossifying fibroma (COF) is a benign tumor classified under fibro-osseous lesions characterized by the proliferation of fibrous tissue associated with the presence of osteoid or cementicle-like masses. COF of bony origin is highly neoplastic in nature compared to their soft tissue counterparts which are relatively rare. The authors here present a case report of COF arising from the left upper lip in a 10-year-old female patient. The lesion was initially asymptomatic, slow-growing in nature, and later turned painful over a period of eight months. A medical CT was taken to elicit a calcified mass seen at the left subcutaneous plane of the upper lip. The lesion was surgically treated by complete excision under local anaesthesia and sutured. Follow-up was done for a period of one year to assess for recurrence which was not evident in this case. This case report, being a peculiar case of COF arising from the soft tissue of the upper lip, describes the clinical presentation, diagnostic imaging, histopathological evidence, and brief surgical management of the lesion.
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Affiliation(s)
- Satish Kumar
- Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital, Chennai, IND
| | - Pavithra Dorairaju
- Oral and Maxillofacial Pathology, Dr. M.G.R. Educational and Research Institute, Chennai, IND
| | - V Abirami
- Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital, Chennai, IND
| | - Nadeem Jeddy
- Oral and Maxillofacial Pathology, Thai Moogambigai Dental College and Hospital, Chennai, IND
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Soluk-Tekkesin M, Sinanoglu A, Selvi F, Cakir Karabas H, Aksakalli N. The importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws: Study of 276 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:364-371. [PMID: 33878496 DOI: 10.1016/j.jormas.2021.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Benign fibro-osseous lesions (BFOLs) are heterogeneous intraosseous disease processes sharing overlapping histopathologic features and demonstrate a wide range of biological behavior. The aim of this study is to highlight the importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws. MATERIALS AND METHODS This is a cross-sectional retrospective study evaluating the three main groups of BFOLs: Cemento-osseous dysplasia, ossifying fibromas, and fibrous dysplasia. Previously diagnosed BFOL cases were searched for thoroughly from the archives of Istanbul University, Institute of Oncology, Department of Tumor Pathology in between 2005 and 2015. Clinical and radiological data of these cases were identified and recorded. The histopathologic features were reevaluated from the H&E-stained slides. RESULTS A total of 276 BFOL cases were identified and reevaluated for the study. The most common BFOL type was cemento-osseous dysplasia (n = 135), followed by cemento-ossifying fibroma (n = 77), fibrous dysplasia (n = 53) and juvenile ossifying fibroma (n = 11). The female/male ratio was 3.4:1 with a strong predilection for the 4th decade (n = 102). The mandible (n = 209) was the predominantly affected jaw. Prominent osteoblastic rimming around the bony lesion was commonly observed for cemento-ossifying fibroma (n = 60/77), followed by cemento-osseous dysplasia (n = 23/135). Predominant ossification patterns showed some differences among the groups. The most common radiological feature was the mixed radiolucent/radiopaque internal structure. CONCLUSION Our results document various clinical, radiological and histopathologic findings of BFOLs. Even some histopathologic differences are observed, clinical and radiographic correlation is mandatory prior to the definitive histopathologic diagnosis of BFOLs for the prevention of possible misdiagnoses or inappropriate treatments.
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Affiliation(s)
- Merva Soluk-Tekkesin
- Istanbul University, Institute of Oncology, Department of Tumour Pathology, Istanbul, Turkey.
| | - Alper Sinanoglu
- Kocaeli University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Kocaeli, Turkey
| | - Firat Selvi
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| | - Hulya Cakir Karabas
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Istanbul, Turkey
| | - Nihan Aksakalli
- Istanbul University, Institute of Oncology, Department of Tumour Pathology, Istanbul, Turkey
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Classification and nomenclature of fibro-osseous lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:385-389. [DOI: 10.1016/j.oooo.2020.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
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Urs AB, Augustine J, Gupta S. Cemento-osseous dysplasia: Clinicopathological spectrum of 10 cases analyzed in a tertiary dental institute. J Oral Maxillofac Pathol 2021; 24:576. [PMID: 33967503 PMCID: PMC8083436 DOI: 10.4103/jomfp.jomfp_139_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/03/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Cemento-osseous dysplasia (COD) is a distinct entity, which is confined to the tooth-bearing areas of the jaws or edentulous alveolar processes. Aims: This study analyzes the demographic, clinical, radiographic and histopathological features of COD. Materials and Methods: Archival data from 2013 to 2017 present in the Department of Oral Pathology were retrieved. Clinicopathological and radiological features of all the cases which had been previously diagnosed as COD were analyzed in detail. Results: In the present study, 10 cases of COD were analyzed (1 periapical, 6 florid and 3 focal). Equal sex predilection was observed. The mean age in females and males was 42.6 years (22–64 years) and 28.6 years (17–36 years), respectively. Bony expansion was seen frequently, but pain was not a common feature. Mandible was affected almost twice as frequently as maxilla and posterior region was affected more than anterior region. Most cases showed mixed radiopaque and radiolucent lesion (5/10) and peripheral radiolucent rim (9/10) on radiographic examination. Histopathological features included the presence of curvilinear trabeculae (4/10), sheets of compact bone (3/10) or both (3/10). Foci of mineralization in form of ossicles or cementicles were noted in 5 out of 10 cases. Conclusion: COD is a nonneoplastic process usually confined to the tooth-bearing areas of the jaws or edentulous alveolar processes. Depending on the location and extent, it can be either focal/periapical/florid variant. Histopathological features of COD can overlap with other fibro-osseous lesions. Hence, the correlation of clinical, radiological and histopathological features is of paramount importance in the accurate diagnosis of COD.
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Affiliation(s)
- Aadithya B Urs
- Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Jeyaseelan Augustine
- Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sunita Gupta
- Department of Oral Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Nottle BF, Tatarniuk DM, Caldwell FJ, Bell CD, Caston SS, Merkatoris PT, Gillen AM, Katzman SA. Fibro-Osseous Lesions Of The Craniofacial Complex In Horses: 30 Cases (2001-2019). Vet Surg 2021; 50:383-392. [PMID: 33399249 DOI: 10.1111/vsu.13559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/20/2020] [Accepted: 11/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the presentation, diagnosis, treatment, and outcome for horses with fibro-osseous lesions of the craniofacial complex. STUDY DESIGN Retrospective multicenter case series. ANIMALS Thirty horses evaluated for fibro-osseous lesions of the skull from January 1, 2001 through December 31, 2019 in four centers. METHODS Medical records were reviewed for signalment, clinical presentation, histological and diagnostic imaging findings, treatment instituted, and outcome. Long-term outcome information was obtained by owner questionnaire or the medical record. RESULTS Diagnoses included ossifying fibroma in 20 of 30 horses, osteoma in eight of 30 horses, and fibrous dysplasia in two of 30 horses. Twelve of 30 lesions were diagnosed in horses <1 year old, and 20 of 30 lesions originated from the rostral mandible. The most common treatment was rostral mandibulectomy. Recurrence was not reported after complete excision. Incomplete excision was confirmed in eight horses (four ossifying fibromas, three osteomas, and one fibrous dysplasia), and follow-up information was available for seven horses. Recurrence occurred in one horse, while six horses had long-term resolution of clinical signs. Prognosis for survival and return to use was excellent in 23 horses with long-term follow-up. CONCLUSION Fibro-osseous lesions were uncommon in this multicenter study; they were most commonly diagnosed in young animals and most frequently affected the rostral mandible. Long-term survival was excellent. CLINICAL SIGNIFICANCE The definitive diagnosis of fibro-osseous lesions of the craniofacial complex in horses is made from results of histopathology and cannot be determined on the basis of clinical presentation alone. Surgical excision is indicated, and prognosis can be favorable even when complete surgical margins are not obtained.
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Affiliation(s)
- Bridget F Nottle
- William R. Pricthard Veterinary Medical Teaching Hospital, University of California, Davis, California, USA
| | - Dane M Tatarniuk
- Department of Veterinary Clinical Sciences, Lloyd Veterinary Medical Center, Iowa State University, Ames, Iowa, USA
| | - Fred J Caldwell
- Department of Clinical Sciences, JT Vaughan Large Animal Teaching Hospital, Auburn University, Auburn, Alabama, USA
| | - Chris D Bell
- Elders Equine Veterinary Services, Winnipeg, Manitoba, Canada
| | - Stephanie S Caston
- Department of Veterinary Clinical Sciences, Lloyd Veterinary Medical Center, Iowa State University, Ames, Iowa, USA
| | - Paul T Merkatoris
- Department of Veterinary Clinical Sciences, Lloyd Veterinary Medical Center, Iowa State University, Ames, Iowa, USA
| | - Alex M Gillen
- Philip Leverhulme Equine Hospital, University of Liverpool, Neston, Cheshire, United Kingdom
| | - Scott A Katzman
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
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Porto DE, Diniz JA, Barbirato DDS, Silva TDS, Andrade RRAD, Andrade ESDS. Agreement Between Clinical-Radiographic and Histopathological Diagnoses in Maxillofacial Fibro-Osseous Lesions. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mashhadiabbas F, Sadeghi HM, Torabi Z, Moslemi H, Shafiei S, Toghchi S. Juvenile trabecular ossifying fibroma of the maxilla: Case report of a diagnostic dilemma. Dent Res J (Isfahan) 2021. [DOI: 10.4103/1735-3327.332096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Junaid M, Bukhari SS, Ismail M, Kulsoom A. Transcranial resection of a juvenile psammomatoid ossifying fibroma of the orbit: A case report with 2-year follow-up. Surg Neurol Int 2020; 11:293. [PMID: 33093970 PMCID: PMC7568113 DOI: 10.25259/sni_205_2020] [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: 04/22/2020] [Accepted: 08/24/2020] [Indexed: 11/04/2022] Open
Abstract
Background:
Juvenile psammomatoid ossifying fibromas (JPOFs) are benign, locally invasive lesion of the craniofacial skeleton that may undergo rapid growth resulting in damage to cranial and facial structures. They usually occur before the age of 15 years and should be carefully treated as their diagnosis may be confused with other lesions such as psammomatous meningioma.
Case Description:
A 14-year-old male presented to the clinic with a history of progressive left proptosis. Imaging studies revealed a well-circumscribed lesion involving the left orbital roof and showing internal areas of calcification and sclerosis. He underwent a transcranial resection of the lesion and follow-up imaging revealed no evidence of recurrence.
Conclusion:
JPOFs are locally invasive lesions that require careful diagnosis and meticulous excision to prevent recurrence.
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Affiliation(s)
- Muhammad Junaid
- Department of Neurosurgery, Bahria University Medical and Dental College, Karachi, Sindh, Pakistan
| | - Syed Sarmad Bukhari
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Majid Ismail
- Department of Neurosurgery, Bahria University Medical and Dental College, Karachi, Sindh, Pakistan
| | - Anisa Kulsoom
- Department of Radiology, Fauji Foundation Hospital, Rawalpindi, Punjab, Pakistan
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Macedo DDV, Ferreira G, Vieira EH, Monnazzi MS. Ossifying fibroma in the maxilla and orbital floor: report of an uncommon case. J Korean Assoc Oral Maxillofac Surg 2020; 46:204-207. [PMID: 32606282 PMCID: PMC7338631 DOI: 10.5125/jkaoms.2020.46.3.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 12/04/2022] Open
Abstract
Benign fibro-osseous lesions occur when normal bone is replaced by cellular fibrous connective tissue and mineralized structures. One rare type of these lesions is the ossifying fibroma (OF). The aim of this study is to report an unusual case of OF in a 57-year-old female. Physical examination showed facial asymmetry without any tenderness, fluctuation, ocular pain, or ophthalmoplegia. Imaging exams revealed a solid mass involving the left maxilla and orbital floor. Surgical resection was performed without any complications or sequelae, and the histopathological results confirmed OF. Although recurrence is rare in this condition, the patient remains under follow-up.
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Affiliation(s)
- Diogo de Vasconcelos Macedo
- Department of Diagnosis and Maxillofacial Surgery, São Paulo State University (UNESP) Dental School, Araraquara, Brazil
| | - Gabriely Ferreira
- Department of Diagnosis and Maxillofacial Surgery, São Paulo State University (UNESP) Dental School, Araraquara, Brazil
| | - Eduardo Hochuli Vieira
- Department of Diagnosis and Maxillofacial Surgery, São Paulo State University (UNESP) Dental School, Araraquara, Brazil
| | - Marcelo Silva Monnazzi
- Department of Diagnosis and Maxillofacial Surgery, São Paulo State University (UNESP) Dental School, Araraquara, Brazil
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A clinicopathologic analysis of 135 cases of cemento-osseous dysplasia: To operate or not to operate? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:278-282. [PMID: 32565263 DOI: 10.1016/j.jormas.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this retrospective study was to investigate the characteristics of cemento-osseous dysplasia (COD) lesions for devising a clinical algorithm to help management decisions, specifically discussing the need for a possible surgical intervention versus solely follow-up. MATERIALS AND METHODS One hundred thirty-five subjects were thus identified having previously diagnosed and treated for COD from the archives of the pathology in between 2005-2015. These were then re-evaluated. Demographic features, radiographic and histopathologic findings were assessed. RESULTS The most frequent variant was the focal type (n=83), and the mandible (n=131) was predominantly affected jaw bone. Female predilection was evident for all subtypes. Almost half of the lesions (n=72) presented with mixed radiolucent and radiopaque appearances in radiography at the time of the biopsy. Cementicles/psammoma body-like calcifications and trabecular pattern were the most common hard tissue appearances. CONCLUSION COD lesions are non-neoplastic fibro-osseous lesions which can exhibit similar histopathologic and radiologic features with other bone lesions. Ideally, these lesions should be clinically identified and followed-up. Considering the possible complications, a thorough knowledge of these lesions and their differentials is essential in order to avoid unnecessary surgical interventions.
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Sofokleous V, Chrysouli K, Kyrodimos E, Giotakis E. Massive juvenile ossifying fibroma arising from the middle turbinate. BMJ Case Rep 2020; 13:13/4/e234432. [PMID: 32295801 DOI: 10.1136/bcr-2020-234432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 19-year-old man presented with a long-standing history of nasal obstruction, which gradually became worse over the past 2 years. Nasal endoscopy revealed a sizeable rounded mass covered by a normal-looking mucosa. Imaging studies showed a mass arising from the left middle turbinate that extended throughout the expanse of the anterior skull base. The tumour was resected via an endoscopic endonasal approach. Histopathological examination revealed a psammomatoid juvenile ossifying fibroma. The patient remains free of recurrence after almost 3 years of follow-up. Only four cases of ossifying fibroma with middle turbinate localisation have been reported in the literature so far, with our case representing the fifth and most extensive case. Clinical, radiological and histological findings should all be considered for establishing the correct diagnosis. An endoscopic approach represents an excellent therapeutic option. Long-term clinical and radiological surveillance is required due to the risk of recurrence.
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Affiliation(s)
- Valentinos Sofokleous
- 1st Department of Otorhinolaryngology - Head & Neck Surgery, University of Athens Medical School, Athens, Greece .,Department of Pediatric Otorhinolaryngology, Athens Children's Hospital "P. & A. Kyriakou", Athens, Greece
| | - Konstantina Chrysouli
- 1st Department of Otorhinolaryngology - Head & Neck Surgery, University of Athens Medical School, Athens, Greece
| | - Efthymios Kyrodimos
- 1st Department of Otorhinolaryngology - Head & Neck Surgery, University of Athens Medical School, Athens, Greece
| | - Evangelos Giotakis
- 1st Department of Otorhinolaryngology - Head & Neck Surgery, University of Athens Medical School, Athens, Greece
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Salvi AS, Patankar S, Desai K, Wankhedkar D. Focal cemento-osseous dysplasia: A case report with a review of literature. J Oral Maxillofac Pathol 2020; 24:S15-S18. [PMID: 32189897 PMCID: PMC7069140 DOI: 10.4103/jomfp.jomfp_349_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/16/2020] [Indexed: 01/20/2023] Open
Abstract
Cemento-osseous dysplasia (COD) is the most prevalent lesion and presents as an asymptomatic, mixed radiolucent/radiopaque lesion in the tooth-bearing region of the jawbones. Histological features of COD include a cellular connective tissue stroma interspersed by the islands of woven or lamellar bone and cementum-like calcifications. Radiographically, the early COD lesions appear radiolucent, whereas in the mature lesions, radiopacities are observed surrounded by a thin rim of radiolucency. Early lesions tend to get misdiagnosed as their radiographic appearance mimics periapical cyst or granuloma. In the mixed radiolucent-radiopaque stage, the lesion could be confused with chronic sclerosing osteomyelitis, cemento-ossifying fibroma, odontoma and osteoblastoma. A correct diagnosis is of utmost importance as most of the CODs are self-limiting and nonneoplastic and do not require surgical intervention. However, periodic follow-up is recommended because occasional cases of focal COD are known to progress into florid COD. Here, we present the case of focal COD in a 27-year-old male patient.
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Affiliation(s)
- Anuprita S Salvi
- Department of Oral and Maxillofacial Pathology, YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Sangeeta Patankar
- Department of Oral and Maxillofacial Pathology, YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Khushal Desai
- Department of Oral and Maxillofacial Surgery, YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Divyesh Wankhedkar
- Department of Oral and Maxillofacial Pathology, YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
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Animasahun BA, Kayode-Awe G, Kusimo OY. Juvenile ossifying fibroma in a Nigerian boy: a rare case report. AME Case Rep 2019; 3:20. [PMID: 31380504 DOI: 10.21037/acr.2019.05.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/15/2019] [Indexed: 11/06/2022]
Abstract
Cases of jaw masses abound in our environment which is a tropical one, with Burkitt lymphoma being the commonest aetiology. However rarer causes like juvenile aggressive ossifying fibroma should also be considered. It is a locally aggressive tumor with high recurrent potentials occurring in children and adolescent. Here we present the clinical features, physical findings and challenges in diagnosing and management of a 7-year-old boy who presented to the Paediatric unit of our institute with a right jaw mass.
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Affiliation(s)
- Barakat Adeola Animasahun
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Gbenga Kayode-Awe
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Mukherjee B, Devi U, Agarkar S. Recurrent benign ossifying fibroma of the orbit - clinical, radiological profile and management options in a child. Orbit 2019; 38:252-255. [PMID: 30089218 DOI: 10.1080/01676830.2018.1505919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/22/2018] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Bipasha Mukherjee
- a Department of Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - Uma Devi
- a Department of Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - Sumita Agarkar
- b Department of Pediatric Ophthalmology & Strabismus , Sankara Nethralaya, Medical Research Foundation , Chennai , India
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Davidova LA, Bhattacharyya I, Islam MN, Cohen DM, Fitzpatrick SG. An Analysis of Clinical and Histopathologic Features of Fibrous Dysplasia of the Jaws: A Series of 40 Cases and Review of Literature. Head Neck Pathol 2019; 14:353-361. [PMID: 31079311 PMCID: PMC7235148 DOI: 10.1007/s12105-019-01039-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
Fibrous dysplasia (FD) is a rare condition commonly involving the jaws. While FD has a typical clinical and histological presentation, considerable variation exists. Moreover, overlap of features with other disorders is possible. This study serves to characterize the features of a large case series of FD of the jaws. With IRB approval, the University of Florida Oral Pathology Biopsy Service archive was retrospectively searched from 1994 to 2015 for cases of FD. Epidemiological data, location, duration, clinical and radiographic appearance, clinical impression and exact microscopic diagnosis were recorded. The average age was 37.3 years (range 7-87 years) with majority of cases in females (67.5%). The most common ethnicity was Caucasian. Maxillary location was predominant (59%), followed by mandible (38%) and multiple locations (3%). Expansion was reported in 78% of cases. Radiographically, most cases exhibited ground glass opacity, however some presented with a mottled or mixed radiopaque/radiolucent appearance. Histologically, a wide variation in terms of stromal cellularity, presence of osteoblastic rimming, and presence of calcified material mimicking cemento-osseous dysplasia was observed. Clinicians and pathologists should be cognizant of the significant variability in clinical, histopathologic, and radiographic presentation of FD, which may pose a diagnostic challenge.
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Affiliation(s)
- L. A. Davidova
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
| | - I. Bhattacharyya
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
| | - M. N. Islam
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
| | - D. M. Cohen
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
| | - S. G. Fitzpatrick
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
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Infected Cemento-Osseous Dysplasia: Analysis of 66 Cases and Literature Review. Head Neck Pathol 2019; 14:173-182. [PMID: 31011984 PMCID: PMC7021850 DOI: 10.1007/s12105-019-01037-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
The aim of this study was to describe a series with 66 cases of infected cemento-osseous dysplasia (COD) and to discuss the demographic distribution, clinicoradiographic features and treatment of this condition. A study looking back on the diagnoses made at a single Brazilian centre within a 28-year timeframe was performed. A literature review with searches across five databases was also conducted to identify reports on osteomyelitis/infected COD. Descriptive and statistical analyses were performed. The case series study showed a female/male ratio of 21:1. Affected individuals' mean age was 57.4 years. Mandible was the most affected site (95.5%) and florid subtype was the most frequent infected COD (62.1%). Tooth extraction was the main factor associated with the development of infection associated within a COD lesion. The literature review retrieved 30 studies reporting 46 cases of this condition. Asian women in their 40 s and 50 s were more affected. Surgery for removal/curettage of necrotic bone was acknowledged as an appropriate approach to the treatment of this infection. The clinicodemographic data of the study were similar to data collected across the literature. Clinicians, maxillofacial surgeons and oral rehabilitation providers should be alert to the diagnosis of COD, since infection is a frequent complication whose management is challenging.
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Abstract
Benign fibro-osseous lesions (BFOLs) are a particularly challenging set of diagnoses for the pathologist. This diverse collection of diseases includes fibrous dysplasia, ossifying fibroma and cemento-osseous dysplasia. While all three conditions have similar microscopic presentations, their treatment and prognosis differ, demanding an accurate and definitive diagnosis. A practical and systematic approach considering the patient's history, demographics, intraoperative presentation, and gross appearance with an emphasis on radiology and histology will be discussed.
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Ta NH, Addison A, Beigi B, Philpott C. Unilateral visual loss resulting from orbital encroachment of an ethmoidal juvenile trabecular ossifying fibroma. Ann R Coll Surg Engl 2019; 101:e111-e114. [PMID: 30854866 DOI: 10.1308/rcsann.2019.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ossifying fibromas are mainly found in the mandible and maxilla. Reports of them arising in the ethmoid sinuses and orbits are rare. We present a case of an otherwise healthy 20-year-old man with gradual onset of right visual disturbance signified by right relative afferent pupillary defect due to a large unilateral ossifying fibroma arising from the ethmoid sinus compressing the medial half of the right orbit. We emphasise the multidisciplinary combined endoscopic endonasal and external approach to ensure a successful debulking of the fibroma.
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Affiliation(s)
- N H Ta
- Norwich Medical School, University of East Anglia , Norwich , UK
| | - A Addison
- Ear, Nose and Throat Department, James Paget University Hospital , Great Yamouth , UK
| | - B Beigi
- Ophthalmology Department, Norfolk and Norwich University Hospitals NHS Foundation , Norwich , UK
| | - C Philpott
- Norwich Medical School, University of East Anglia , Norwich , UK
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Le Donne M, Abattu O, Pernier C, Durieux E, Bodard AG. Impacted canine and ossifying fibroma: case report and literature review. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2019018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: An impacted tooth is a permanent tooth that has a completely developed root but which has failed to erupt. Many etiologies can lead to impaction, including a mechanical obstacle, such as benign tumor. Observation: An 11-year-old girl was referred for the avulsion of the left mandibular permanent canine, which was impacted. A radiolucent lesion with ground glass opacity was found on the eruption pathway of the tooth. Anterior radiographs showed the lesion that seemed to be the cause of the impacted canine. Anatomopathological examination revealed the lesion to be a juvenile trabecular ossifying fibroma. Comments: Ossifying fibromas are rare jaw tumors. They can be of various types: ossifying fibroma, psammomatoid, or trabecular juvenile ossifying fibroma. This is the first case that clearly shows the association between ossifying fibroma and tooth impaction. A literature review of ossifying fibromas and the management of fibro-osseous benign lesions of the jaws was performed. Conclusion: Although benign, juvenile trabecular ossifying fibroma can be locally aggressive and has a high rate of recurrence. It is very important to establish a precise diagnosis of a fibro-osseous benign lesion of the jaws to plan optimal management.
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Pereira TDSF, Gomes CC, Brennan PA, Fonseca FP, Gomez RS. Fibrous dysplasia of the jaws: Integrating molecular pathogenesis with clinical, radiological, and histopathological features. J Oral Pathol Med 2018; 48:3-9. [PMID: 30376190 DOI: 10.1111/jop.12797] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fibrous dysplasia is a non-neoplastic developmental process that affects the craniofacial bones, characterized by painless enlargement as a result of bone substitution by abnormal fibrous tissue. Postzygotic somatic activating mutations in the GNAS1 gene cause fibrous dysplasia and have been extensively investigated, as well as being helpful in the differential diagnosis of the disease. Fibrous dysplasia may involve one (monostotic) or multiple bones (polyostotic), sporadically or in association with McCune-Albright syndrome, Jeffe-Lichenstein syndrome, or Mazabreud syndrome. This review summarizes the current knowledge on fibrous dysplasia, emphasizing the value of integrating the understanding of its molecular pathogenesis with the clinical, radiological, and histopathological features. In addition, we address important aspects related to the differential diagnosis and patient management.
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Affiliation(s)
- Thaís Dos Santos Fontes Pereira
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Cavalieri Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Wu Z, Xing Y, Liu X, Chen W, Kong J, Wu R, Zhang L. Surgical correction of residual facial deformity following conservative excision of a giant maxillary ossifying fibroma: A case report. Medicine (Baltimore) 2018; 97:e13186. [PMID: 30461617 PMCID: PMC6393081 DOI: 10.1097/md.0000000000013186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Ossifying fibroma (OF) is a benign fibro-osseous lesion that can develop in the oral and maxillofacial region. OF is more common in females and has a marked predilection for the mandible, occurring rarely in the maxilla. Lesions grow slowly and are usually asymptomatic until growth produces an obvious swelling, pain, paresthesia, and facial deformity. With low rates of recurrence, treatment is usually curettage or resection. Very large lesions that invade other organs and that cannot be completely removed should be excised conservatively. PATIENT CONCERNS We present a case of a 46-year-old female with a very large fibro-osseous lesion arising from the maxilla who was more concerned about the facial appearance and requested conservative treatment for economic reasons. DIAGNOSES The pathological results based on conservative excision of the lesion confirmed the diagnosis of OF. INTERVENTIONS We chose conservative excision via the Weber-Ferguson approach and followed up every 6 months. Facial deformity correction was performed 2 years postoperatively and right lower eyelid ectropion correction 3 years after the primary excision. OUTCOMES The ectropion deformity in the right lower eyelid improved dramatically with a better facial appearance and no obvious swelling. LESSONS Treatment programs for OF should be individualized based on the size, growth rate, invasion, and interference with facial function and esthetics. If lesions grow slowly, we suppose that it is feasible to excise conservatively when reconstruction cannot be performed due to esthetic and functional problems. Also regular postoperative follow-up is necessary to detect recurrence, and to improve facial appearance as required.
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Affiliation(s)
- Zhuoxia Wu
- Department of Plastic and Reconstructive Surgery
| | - Yunlong Xing
- Department of Plastic and Reconstructive Surgery
| | - Xin Liu
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wanying Chen
- Department of Plastic and Reconstructive Surgery
| | - Jiao Kong
- Department of Plastic and Reconstructive Surgery
| | - Ronghui Wu
- Department of Plastic and Reconstructive Surgery
| | - Lianbo Zhang
- Department of Plastic and Reconstructive Surgery
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Seifi S, Foroghi R, Rayyani A, Kiani M, Mohammadi MR. Juvenile Trabecular Ossifying Fibroma-a Case Report. Indian J Surg Oncol 2018; 9:260-264. [PMID: 29887713 PMCID: PMC5984869 DOI: 10.1007/s13193-018-0759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022] Open
Abstract
Ossifying fibroma is a benign osteogenic mesenchymal tumor that is classified in the fibro-osseous lesions. Fibro-osseous lesions contain minerals, blood vessels, and giant cells that have the same radiographic and pathologic features but have different clinical behaviors, and were replaced with the normal bone. These lesions include fibrous dysplasia, cemento-osseous dysplasia, and ossifying fibroma. Juvenile ossifying fibroma is a type of uncommon and has invasive behavior, high incidence and occurs in young men, especially in maxilla, and is different from the type of adult in age, location, and clinical behavior and microscopic view. Pathologically, ossifying fibroma is divided into two types of trabecular and psammomatoid. The trabecular type is characterized by the presence of the osteoid trabeculae and the woven bone, and the type of psammomatoid by the presence of round, integrated, and small ossicles that are similar to the components of the psammoma. The purpose of this report is the clinical examination, radiography, pathology, and the treatment of a rare case of ossifying fibroma (trabecular) in mandible in a 7-year-old boy.
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Affiliation(s)
- Safoura Seifi
- 1Oral Health Research Center, Institute of Health, Babol University of Medical Sciences, Babol, Iran
| | - Ramin Foroghi
- 2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Babol University of Medical Sciences, Babol, Iran
| | - Arezo Rayyani
- Department of Oral and Maxillofacial Pathology, Bandarabbas University of Medical Sciences, Bandar Abbas, Iran
| | - Marjan Kiani
- 4Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Babol University of Medical sciences, Babol, Iran
| | - Mohamad Reza Mohammadi
- 5Department of Oral and Maxillofacial Surgery Specialized, Babol University of Medical Sciences, Babol, Iran
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Martini M, Klausing A, Heim N, Fischer HP, Sommer A, Reich RH. Fibrous dysplasia imitating malignancy. J Craniomaxillofac Surg 2018; 46:1313-1319. [PMID: 29859820 DOI: 10.1016/j.jcms.2018.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/06/2018] [Accepted: 05/07/2018] [Indexed: 11/19/2022] Open
Abstract
Fibrous dysplasia is a benign bone disease, presenting as monostotic or polyostotic lesions, or as part of a syndrome (McCune-Albright/Mazabraud). Its clinical course shows a variegated picture and the progression of its growth is unpredictable. In the workup of 39 fibrous dysplasia cases in the cranio-facial area, four cases presented fast growth tendencies, of which two patients with McCune-Albright syndrome showed malignant-like rapid growth. This local aggressive form is extremely rare, and the concept of this issue has not been clearly defined. With regard to the speed of growth a volumetric-time analysis in one of our cases demonstrated a 74 days tumor doubling rate with an exponential growth curve. According to the literature the aggressive form presented extra-cranially mainly at an adult age, whereas its appearance in our cranio-facial patient collective was much younger. Distinguishing nonmalignant and malignant aggressive forms is difficult and highly inconsistent in the literature. We therefore implemented a quantitative growth measure analysis to define aggressive forms based on progression and speed of growth and impartial of type of FD, localization or functional incapacity. Due to our study findings and literature review we state a prevalence of an aggressive form might be possibly about 5 %.
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Affiliation(s)
- Markus Martini
- Department of Maxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. R. H. Reich), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Anne Klausing
- Department of Maxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. R. H. Reich), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Nils Heim
- Department of Maxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. R. H. Reich), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Hans-Peter Fischer
- Department of Pathology, (Head: Prof. Dr. G. Kristiansen), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Alexandra Sommer
- Department of Radiology, (Head: Prof. Dr. H. H. Schild), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Rudolf Hermann Reich
- Department of Maxillofacial and Plastic Surgery, (Head: Prof. Dr. Dr. R. H. Reich), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
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Kato CDNADO, Nunes LFM, Chalub LLFH, Etges A, Silva TA, Mesquita RA. Retrospective Study of 383 Cases of Fibro-Osseous Lesions of the Jaws. J Oral Maxillofac Surg 2018; 76:2348-2359. [PMID: 29859157 DOI: 10.1016/j.joms.2018.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The aims of this study were to describe the clinical and radiologic features of 383 fibro-osseous lesions (FOLs) from an oral pathology reference service in Brazil and to compare the findings with previous studies. The hypothesis of the study was that the most common type of FOL would differ from other investigations. MATERIALS AND METHODS We conducted a descriptive and retrospective study with review of the records of the clinical and biopsy services (1990 to 2015). All records of the patients included showed a definitive diagnosis of FOL. The primary outcome variable was the type of FOL, and the predictor variables were gender, age, ethnicity, location, and clinical and radiologic characteristics. Descriptive analyses and χ2 tests were performed. The P value was set at .05. RESULTS From the 27,998 records available, 383 showed FOLs, with 187 (48.8%) being cemento-osseous dysplasias (CODs), 103 (26.9%) being fibrous dysplasias (FDs), and 93 (24.3%) being ossifying fibromas (OFs). The mean age of the patients was 38.5 ± 17.5 years. CODs presented a predilection for female gender (n = 314, 82.0%), African descent (n = 134, 71.6%), and the mandible (n = 248, 64.6%). The most common radiologic feature was a mixed radiolucent-radiopaque image (n = 149, 51.7%). FDs and OFs were commonly diagnosed during the first and second decades of life (P < .001), whereas CODs were more frequently diagnosed beyond the third decade (P < .001). Secondary osteomyelitis was more significantly observed in CODs (P < .001) than in FDs and OFs. Swelling was more frequently reported for FDs and OFs than for CODs (P < .001). CONCLUSIONS CODs were the most frequently observed FOLs in this Brazilian population. Female patients, patients of African descent, and patients with mandibular localization were most commonly affected by these conditions. The most common type of FOL differed from that in similar case reports or series from various geographic locations. It is believed that the data source (clinical and/or biopsy services) can directly influence the outcome.
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Affiliation(s)
| | | | - Loliza Luiz Figueiredo Houri Chalub
- Professor, Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adriana Etges
- Professor, Departament Oral Pathology, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Tarcília Aparecida Silva
- Professor, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Professor, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Gresky J, Kalmykov A, Berezina N. Benign fibro-osseous lesion of the mandible in a Middle Bronze Age skeleton from Southern Russia. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2018; 20:90-97. [PMID: 29496222 DOI: 10.1016/j.ijpp.2017.09.001] [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: 05/12/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 06/08/2023]
Abstract
A discrete dysplastic lesion of the mandible found in a skeleton of a young adult male of the Middle Bronze Age in the Northern Caucasus/Russia is described. The periapical lesion of the right lower canine alveolus was examined by digital microscopy, plain radiology, and plain and polarizing microscopy. Its macroscopic, radiologic and microscopic characteristics are discussed in reference to different fibro-osseous lesions arising from the odontogenic apparatus and maxillofacial skeleton. Periapical osseous dysplasia was considered to be the most likely diagnosis.
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Affiliation(s)
- Julia Gresky
- Department of Natural Sciences, German Archaeological Institute, 14195 Berlin, Germany.
| | - Alexey Kalmykov
- SUE "Nasledie" Ministry of Culture of the Stavropol Region, 355006 Stavropol, Russia
| | - Natalia Berezina
- Research Institute and Museum of Anthropology, Moscow State University, 123001 Moscow, Russia
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Differentiating early stage florid osseous dysplasia from periapical endodontic lesions: a radiological-based diagnostic algorithm. BMC Oral Health 2017; 17:161. [PMID: 29284472 PMCID: PMC5745995 DOI: 10.1186/s12903-017-0455-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 12/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Osseous dysplasia (OD) is the most common fibro-osseous lesion of the jaw affecting the periapical region. Early stages of OD can resemble periapical radiolucencies, thus mimicking the radiological aspects of an endodontic pathology. Such radiolucent lesions affecting previously decayed or treated teeth are even more complex to interpret. Case presentation The aim of this paper is to report a case-series of representative clinical situations describing the radiological features and illustrating the diagnostic workup of patients with florid osseous dysplasia (FOD). Emphasis is given to the endodontic implications of such periapical bone disease and the complexity of accurate diagnosis in the context of endodontic retreatment. We then propose a practical radiological-based diagnostic algorithm to assist the clinician in the diagnostic of OD periapical lesions. Conclusion Periapical lesions may be confused with bone diseases such as osseous dysplasia, especially in the radiolucent initial stage. Knowledge of clinical features associated with a careful reading of cone beam CT images, such as fine opacities within the hypodense periapical lesion, may help determine the right diagnostic.
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Pereira TDSF, Brito JAR, Guimarães ALS, Gomes CC, de Lacerda JCT, de Castro WH, Coimbra RS, Diniz MG, Gomez RS. MicroRNA profiling reveals dysregulated microRNAs and their target gene regulatory networks in cemento-ossifying fibroma. J Oral Pathol Med 2017; 47:78-85. [PMID: 29032608 DOI: 10.1111/jop.12650] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cemento-ossifying fibroma (COF) is a benign fibro-osseous neoplasm of uncertain pathogenesis, and its treatment results in morbidity. MicroRNAs (miRNA) are small non-coding RNAs that regulate gene expression and may represent therapeutic targets. The purpose of the study was to generate a comprehensive miRNA profile of COF compared to normal bone. Additionally, the most relevant pathways and target genes of differentially expressed miRNA were investigated by in silico analysis. METHODS Nine COF and ten normal bone samples were included in the study. miRNA profiling was carried out by using TaqMan® OpenArray® Human microRNA panel containing 754 validated human miRNAs. We identified the most relevant miRNAs target genes through the leader gene approach, using STRING and Cytoscape software. Pathways enrichment analysis was performed using DIANA-miRPath. RESULTS Eleven miRNAs were downregulated (hsa-miR-95-3p, hsa-miR-141-3p, hsa-miR-205-5p, hsa-miR-223-3p, hsa-miR-31-5p, hsa-miR-944, hsa-miR-200b-3p, hsa-miR-135b-5p, hsa-miR-31-3p, hsa-miR-223-5p and hsa-miR-200c-3p), and five were upregulated (hsa-miR-181a-5p, hsa-miR-181c-5p, hsa-miR-149-5p, hsa-miR-138-5p and hsa-miR-199a-3p) in COF compared to normal bone. Eighteen common target genes were predicted, and the leader genes approach identified the following genes involved in human COF: EZH2, XIAP, MET and TGFBR1. According to the biology of bone and COF, the most relevant KEGG pathways revealed by enrichment analysis were proteoglycans in cancer, miRNAs in cancer, pathways in cancer, p53-, PI3K-Akt-, FoxO- and TGF-beta signalling pathways, which were previously found to be differentially regulated in bone neoplasms, odontogenic tumours and osteogenesis. CONCLUSION miRNA dysregulation occurs in COF, and EZH2, XIAP, MET and TGFBR1 are potential targets for functional analysis validation.
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Affiliation(s)
- Thaís Dos Santos Fontes Pereira
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - João Artur Ricieri Brito
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Carolina Cavaliéri Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Wagner Henriques de Castro
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Marina Gonçalves Diniz
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Abstract
Fibroosseous lesions in the jaws have similar histologic and radiographic features. Despite their similarity, management varies significantly. In this article, common fibroosseous lesions and key radiographic features are described. Many of the fibroosseous lesions are diagnosed radiographically, without performing histologic examinations. For some of the fibroosseous lesions, for example, periapical osseous dysplasia, histologic examination is contraindicated. Cherubism and fibrous dysplasia have specific radiographic findings; these conditions can be diagnosed radiographically. Accurate diagnosis conditions is essential; some conditions do not require any intervention, while others require surgical resection. Patient demographics, for example, age, gender, and race, play important roles in diagnosis.
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Affiliation(s)
- Mansur Ahmad
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
| | - Laurence Gaalaas
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA
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Strickler S, Hitchcock KE, Dziegielewski PT, Mendenhall WM. Radiotherapy for juvenile ossifying fibroma of the maxillary sinus: Case report and literature review. Head Neck 2017; 39:E81-E84. [PMID: 28467645 DOI: 10.1002/hed.24811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/08/2017] [Accepted: 03/14/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Juvenile ossifying fibroma (JOF) is a benign fibro-osseous lesion that can be locally aggressive. It is typically treated with surgical excision. A few cases using adjuvant radiotherapy have been reported in the literature. METHODS We report a case of JOF treated with surgical excision and adjuvant radiotherapy to minimize the risk of local recurrence. We also review the literature. RESULTS Our patient tolerated radiotherapy without complication and had not experienced a local recurrence at the time of writing this manuscript. CONCLUSIONS This is one of the first reports of adjuvant radiotherapy after surgical excision to improve local control in patients with JOF. Radiotherapy should be considered in patients for whom reexcision after a recurrence would result in unacceptable morbidity.
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Affiliation(s)
- Scott Strickler
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Kathryn E Hitchcock
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, Florida
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
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Abstract
Introduction: Juvenile ossifying fibromas are uncommon benign tumors. Their aggressiveness added to their high tendency to recur, provoke real diagnostic and therapeutic challenges for the dental practitioner and make a postoperative follow-up over the years indispensable. Case report: In this report, we present a case of a seven-year-old girl presented with a swelling in the face at the upper right maxillary region. After clinical, radiological, and histopathological examinations the diagnosis of trabecular juvenile ossifying fibroma was made. The lesion was surgically excised and followed up for two years with no evidence of recurrence.
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Affiliation(s)
- Samia Aboujaoude
- Department of Pediatric Dentistry, Faculty of Dentistry, Lebanese University, Beirut, Lebanon
| | - Georges Aoun
- Department of Oral Pathology and Diagnosis, Faculty of Dentistry, Lebanese University, Beirut, Lebanon
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50
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Rao S, Nandeesh BN, Arivazhagan A, Moiyadi AV, Yasha TC. Psammomatoid Juvenile Ossifying Fibroma: Report of Three Cases with a Review of Literature. J Pediatr Neurosci 2017; 12:363-366. [PMID: 29675079 PMCID: PMC5890560 DOI: 10.4103/jpn.jpn_78_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Psammomatoid juvenile ossifying fibroma (PJOF), a variant of juvenile ossifying fibroma (JOF), is a locally aggressive neoplasm of the children and young adults. This entity has predilection for the sinonasal region. It forms a differential diagnosis for many bone neoplasms. We report three cases of PJOF, in young patients whose biopsy showed the presence of psammomatoid bodies in a cellular fibrous stroma. The diagnosis of JOF indicates requirement of extensive surgery due to its locally aggressive nature.
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Affiliation(s)
- Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bevinahalli N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arimappamagan Arivazhagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Aliasgar V Moiyadi
- Department of Neurosurgery, ACTREC, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - T Chickabasaviah Yasha
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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