Psammomatoid type juvenile ossifying fibroma of mandible

Cranial Juvenile Psammomatoid Ossifying Fibroma: A Rare Entity

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

S, Mohideen K, Balasubramaniam M, Ghosh S, Dhungel S. Juvenile psammomatoid ossifying fibroma of the maxilla and mandible: A systematic review of published case reports

OBJECTIVE

The aim of this study is to evaluate recent evidence-based data that summarize the clinicopathological findings and treatment along with follow-up measures taken in terms of published cases of Juvenile psammomatoid ossifying fibroma (JPOF) of the maxilla and mandible by a systematic review. MATERIALS AND METHODS: The databases searched were PubMed, MEDLINE, Scopus, Google scholar, and Cross references. Only those case reports of JPOFs published in the English language from 2000 to 2022 were considered. All cases included confirmed JPOF lesions histopathologically. The SR-included details like clinical and radiographic data, follow-up details such as recurrence, and the presence of any adverse outcome.

RESULTS

The database search produced 595 articles from 2000 to 2022, among which 22 case reports were included in the systematic review. The mean age of JPOF occurrence in patients was 18 ± 16 years. A male predilection was noted among patients younger than 14 years of age, whereas a female predilection was noted in patients older than 14 years of age. Frequent involvement of the mandible (56%) compared to the maxilla (44%) was reported. The posterior mandible was the most commonly affected site involving numerous adjacent structures. The expansile nature of the JPOF displayed 57% buccolingual expansion, 50% downward displacement or erosion of the lower border of the mandible and 81% of  involvement of the maxillary antrum/pterygoid plate/orbital floor. Among the 20 cases reported, the treatment provided included surgical excision in 45% of the patients, jaw resection in 35% of the patients, and enucleation and curettage in 18% of the patients. Follow-up details were provided in 80% of the reports that showed recurrence.

CONCLUSIONS

The diagnosis of JPOF requires correlation of the clinical and radiographic features with key histopathological features. Although long-term follow-up of the case reports has been reported, the data lack information about the long-term outcomes of JPOF.

Psammomatous calcifications in thyroid oncocytic (Hürthle cell) follicular tumors

Concentric calcifications, also known as psammoma bodies, are a relatively frequent finding in certain types of tumors, particularly papillary thyroid carcinoma (PTC). In the thyroid, they have been assigned a significant role in the diagnosis of PTC and in distinguishing between these tumors and other types of thyroid neoplasms. Concentric calcifications have also less commonly been noted in other processes in the thyroid, such as in tumors characterized by cells containing abundant oxyphilic cytoplasm (i.e., Hürthle cells). We have studied 12 patients with oncocytic thyroid follicular tumors that contained scattered psammomatous calcifications that led to difficulties in diagnosis. The patients were 9 women and 3 men, aged 34 to 63 years. 10 cases corresponded to benign, non-invasive oncocytic tumors and 2 cases were minimally invasive follicular carcinomas of oncocytic (so called Hürthle cell) type. The psammomatous calcifications were randomly scattered throughout the lesions and were present as a focal, incidental finding in 8 cases and were diffuse in 4 cases. They were composed of concentrically laminated deposits of dense basophilic material closely resembling psammoma bodies, often associated with more homogeneous deposits of lightly eosinophilic material without concentric lamination that were interpreted as precipitated thyroglobulin. Seven patients with clinical follow-up, including one with minimally invasive carcinoma, were alive and well between 5 and 12 years after diagnosis. Concentric laminated calcifications may be encountered in oncocytic (Hürthle cell) follicular tumors and should not be interpreted as indicative of PTC in the context of oncocytic neoplasms of the thyroid.

Aggressive juvenile ossifying fibroma of the ethmoid sinus with orbital and intracranial extension: A case report

BACKGROUND

Juvenile ossifying fibroma is a rare benign destructive lesion of nose and paranasal sinuses. It occurs in the craniofacial bones of children below 15 years of age. It is usually discovered in the mandible and maxilla and rarely in the paranasal sinuses.

CASE PRESENTATION

We present a case of a 15-year-old girl with extensive right ethmoid sinus juvenile ossifying fibroma with intracranial and orbital involvement that was managed endoscopically at our center followed by lateral rhinotomy and frontal craniotomy with reconstruction due to the aggressive nature and recurrence of the disease. Patient was followed up post operatively for 3 years and was found free of symptoms ever since.

CONCLUSION

In this case report we present our experience in managing this aggressive recurrent disease of juvenile ossifying fibroma which requires multiple endoscopic and open surgical procedures. Such pathology needs a close and long follow up due to the aggressive nature of this disease.

Microvessel density and cell proliferation in juvenile ossifying fibroma: A comparative study with central ossifying fibroma

Considered as an aggressive counterpart of central ossifying fibroma (OF), juvenile ossifying fibroma (JOF) is a benign fibro-osseous neoplasm characterized by an unpredictable destructive behavior, elevated morbidity, mutilating treatment and high potential for local recurrences. The aim of this study is to compare the analysis for cell proliferation and vascular markers between JOF and OF. Cell proliferation index was measured by Ki-67 and Mcm-2 expression and microvessel density (MVD) was obtained by the immunoexpression of CD34/CD105. We observed a reduced expression of vascular markers, where MVD for CD34 was significantly higher in JOF than in OF (p = 0.009), but no statistical difference was found for CD105. JOF and OF showed low expression for Ki-67 and Mcm-2 and no difference was noted between both, suggesting that other mechanisms such as anti-apoptotic and/or pro-autophagic pathways or even increased expression of matrix metalloproteinases may be responsible for the aggressiveness of JOF.

Juvenile Ossifying Fibroma in the Mandible

Juvenile ossifying fibroma is a rare benign fibroosseous tumor which involves maxilla more than mandible. It usually occurs in children below 15 years of age. This article reports a case occurring in the mandible with the surgical treatment followed by us.

Psammomatoid Juvenile Ossifying Fibroma: Report of Three Cases with a Review of Literature

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.

Osteoid producing primary lesion at morphologic and biologic interface

Fibroosseous gnathic lesions comprise a wide spectrum of diseases. Many of the entities have overlapping features. A pediatric case is encountered with a complex clinicopathologic profile. Although radiographically the lesion appears benign but on histopathological examination it possesses features of osteoid producing aggressive neoplasm. This paper highlights the unusual histologic features existing within the spectrum of fibroosseous lesions and discusses relevant clinicopathologic correlations.

Juvenile psammomatoid ossifying fibroma with aneurysmal bone cyst in the posterior mandible

Aneurysmal bone cysts (ABCs) are a rare benign lesion seen as locally destructive, rapidly expansile, and mostly affecting the long bones and vertebrae. The association of ABCs with juvenile psammomatoid ossifying fibroma (PsJOF) is predominantly seen in the extragnathic region, and it is extremely rare with only a few cases reported so far in the mandible. Here, we report one such case of a hybrid lesion in a seven-year-old boy, who presented with a solitary swelling of the left mandible showing partial obliteration of buccal vestibular sulcus, which shows juvenile psammomatoid ossifying fibroma as a pre-exsiting lesion, transforming into an ABC. Such hybrid lesions are usually misdiagnosed and have been sparsely reported in the dental literature.

Juvenile ossifying fibroma diagnosed on fine needle aspiration cytology: a diagnostic challenge

Preoperative diagnosis of jaw lesions is not always possible on the basis of clinico-radiological findings alone and needs to be confirmed before attempting any surgical intervention. Fibro-osseous lesions of the jaw comprise a spectrum of diseases which include cement-osseous dysplasia, fibrous dysplasia, and ossifying fibroma. The cytomorphological distinction between these individual entities is difficult. We present a case of maxillary fibro-osseous lesion in an adolescent girl diagnosed and categorized as juvenile ossifying fibroma preoperatively on cytology and confirmed on histopathology. Although aspirates are usually paucicellular in fibro-osseous lesions, certain cytological features if present in cellular cytosmears can offer further categorization and a definitive diagnosis may be possible in light of clinico-radiological correlation.