Misdiagnosed long-standing unilateral nasal obstruction: ossifying fibroma of the inferior turbinate

A man in his 20s presented with complaints of unilateral nasal obstruction for the past 6 years that progressively worsened leading to irrational use of over-the-counter nasal decongestants. With the worsening of symptoms, a non-contrast CT was done. It showed a dense expansile sclerotic lesion of the right inferior turbinate, which was excised endoscopically. Cemento-ossifying fibromas of the inferior turbinate are rare and require assessment and surgical excision to relieve the symptom of nasal obstruction. It derives its name from the variable proportions of fibrous and mineralised tissue present in it and exclusively develops in the craniofacial region. It can be surgically managed by an endoscopic, an endonasal non-endoscopic (with a speculum) or an open approach (lateral rhinotomy, sublabial approach or mid-facial degloving). Here, we present how such a case was detected and managed surgically by the endoscopic approach, which is a minimally invasive option with shorter hospital stay and early recovery.

When molecular outsmarts morphology: Malignant ossifying fibromyxoid tumors masquerading as osteosarcomas, including a novel CREBZF::PHF1 fusion

We present two cases of malignant ossifying fibromyxoid tumor (OFMT) which eluded diagnosis due to compelling clinicopathologic mimicry, compounded by similarly elusive underlying molecular drivers. The first is of a clavicle mass in a 69 year-old female, which histologically showed an infiltrative nested and trabeculated proliferation of monomorphic cells giving rise to scattered spicules of immature woven bone. Excepting SATB2 positivity, the lesion showed an inconclusive immunoprofile which along with negative PHF1 FISH led to an initial diagnosis of high-grade osteosarcoma. Next generation sequencing (NGS) revealed a particularly rare CREBBP::BCORL1 fusion. The second illustrates the peculiar presentation of a dural-based mass in a 52 year-old female who presented with neurologic dyscrasias. Sections showed a sheeted monotonous proliferation of ovoid to spindle cells, but in contrast to Case #1, the tumor contained an exuberance of reticular osteoid and woven bone deposition mimicking malignant osteogenic differentiation. NGS showed a novel CREBZF::PHF1 fusion. Both tumors recurred locally less than 1 year post-operatively. As such we reiterate that careful morphologic examination is axiomatic to any diagnosis in our discipline, but this paradigm must shift to recognize that molecular diagnostics can provide closure where traditional tools have notable limitations.

Tumor-induced Osteomalacia in a Boy with Maxillary Ossifying Fibroma

Tumor-induced osteomalacia (TIO) is a rare, paraneoplastic disorder of hypophosphatemia associated with elevated tumor-produced fibroblast growth factor 23 (FGF23). Maxillofacial tumors are rarely involved in TIO, especially maxillary TIO in children. We present a 14-year-old boy with osteomalacia and high serum levels of FGF23, a hormone associated with decreased phosphate resorption, due to a maxillary tumor. The patient was treated with oral phosphorus and calcitriol, and surgical removal of the tumor was performed. After 21 months follow-up, he was pain free and had returned to full activity. We review the reported pediatric cases of TIO in the maxillofacial and oral region and discuss the management of these patients considering the published evidence.

Extraosseous cemento-ossifying fibroma beneath the left buccal mucosa: a case report

Cemento-ossifying fibroma (COF) is a benign mesenchymal odontogenic tumor that commonly occurs in the tooth-bearing areas of the maxilla and mandible. This study reports a COF case located under the left buccal mucosa. The classification and differential diagnosis of this COF case were discussed based on the diagnosis and treatment of this case and previous literature.

Similar appearance of different multifocal carpal bone destructing disease entities in 3 patients: A case report

RATIONALE

Several diseases feature tumors, or tumor-mimicking lesions, that further invade the bone and surrounding joints of the wrist region. Here, we describe 3 rare cases of multiple destructed carpal bones and adjacent joints in different disease entities confirmed via pathologic diagnosis.

PATIENT CONCERNS

All 3 cases were examined between January 2016 and December 2019. Three patients presented with similar clinical manifestations and radiographic features, with multiple osteolytic lesions in the carpal bones and metacarpal bone base.

DIAGNOSES

The 3 cases were diagnosed as diffuse type tenosynovial giant cell tumor, calcifying aponeurotic fibroma, and rheumatoid arthritis.

INTERVENTIONS

Separate, experienced radiologist and pathologist took part in the interpretation and compartmentalization of radiographs and pathological findings, respectively. Even magnetic resonance imaging could not achieve a diagnosis; surgical excision was therefore required, with subsequent pathological assessment for treatment and final diagnosis.

OUTCOMES

functional outcomes also differed among patients, poorest in rheumatoid arthritis patient.

LESSONS

We report 3 rare disease entities, presenting with multifocal osteolytic lesions in the wrist. They all presented with similar clinical manifestations, and the final diagnoses were made via pathological evaluation. Compared with tenosynovial giant cell tumor and calcifying aponeurotic fibroma, rheumatoid arthritis had the poorest outcome.

Peripheral ossifying fibroma: A case report

Peripheral ossifying fibroma (POF) is a reactive lesion that originates in the gingiva. Morphological similarity to other epulides and similar nomenclature to neoplastic tumors give rise to obvious problems both at the stage of diagnosis and treatment of POF. Although POF is one of the less common gingival lesions, it accounts for up to 2% of all oral lesions, which means that most general dentists will encounter POF in their practice. This paper aims to present the case of a 56-year-old woman diagnosed with POF. In the described case, POF most likely resulted from chronic periodontal irritation due to the presence of prosthetic crowns. The applied treatment in the form of total excision of POF, removal of irritants and gingivoplasty brought the expected therapeutic effect, i.e. no recurrence in the period of the hitherto follow-up. Terminological difficulties, the basics of differentiating typical gingival tumors, therapeutic options with suggested management of POF, and recurrence rate with the follow-up scheme were discussed. Despite the reactive nature of POF, this lesion recurs up to 20% and can transform to giant POF. For this reason, POF should not be underestimated, and proper diagnosis, treatment, and follow-up are critical to the success of therapy.

Central ossifying fibroma of mandible

Ossifying fibroma (OF) is a rare, benign, fibro-osseous lesion of the jawbone characterised by replacement of the normal bone with fibrous tissue. The fibrous tissue shows varying amount of calcified structures resembling bone and/or cementum. The central variant of OF is rare, and shows predilection for mandible among the jawbone. Although it is classified as fibro-osseous lesion, it clinically behaves as a benign tumour and can grow to large size, causing bony swelling and facial asymmetry. This paper reports a case of large central OF of mandible in a 40-year-old male patient. The lesion was treated by segmental resection of mandible. Reconstruction of the surgical defect was done using avascular fibula bone graft. Role of three-dimensional printing of jaw and its benefits in surgical planning and reconstruction are also highlighted.

Osseous mass in a maxillary sinus of an adult male from the 16th-17th-century Spain: Differential diagnosis

OBJECTIVE

To undertake a differential diagnosis of a large mass found in the left maxillary sinus of a cranium dated to the 16th-17th-century, and to expand knowledge of the diagnosis of osseous tissue formation in osteoarchaeological studies.

MATERIAL

A cranium recovered from the cemetery of San Salvador de Palat de Rey church, León (Spain).

METHODS

Macroscopic analysis, CT scanning.

RESULTS

Macroscopic analysis indicated that the individual was probably a male over 30 years old with an ossified mass in the left maxillary sinus, measuring 24 × 19 × 24 mm, occupying approximately 27 % of the maxillary antrum. Computed tomography revealed a well-demarcated radiolucent unilocular mass with some radiopaque areas, with no communication with the alveoli of the premolars or molars. No erosive lesions or signs of inflammation were found.

CONCLUSIONS

Neither the macroscopic, nor the radiological characteristics are compatible with inflammatory or malignant pathology, favoring a diagnosis of ossifying fibroma.

SIGNIFICANCE

This case adds to the few reported cases in the osteoarchaeological literature, especially since there is limited relevant reference data to assist diagnosis. The CT scans and 3D reconstruction presented here facilitate differential diagnosis in future paleopathological studies.

LIMITATIONS

Destructive methods were not authorized.

SUGGESTIONS FOR FURTHER RESEARCH

In the future, micro-CT analysis, which was not performed in the current study, may add new and valuable information.

Rapidly growing Fibro-osseous pseudotumor of the digit: A case report

INTRODUCTION

Fibro-osseous pseudotumor of the digit is a rare benign lesion of subcutaneous tissue that typically arises in the parabone site of the proximal phalanx in young adult females. The lesion is histopathologically characterized by fibroblastic proliferation and osteoid formation. Good prognosis following complete surgical excision of the tumor has been reported, with a very low recurrence rate and no reports of malignant transformation. Despite its benign clinical behavior, the lesion can be mistaken for a malignant neoplasm, such as an extraskeletal or parosteal osteosarcoma, in case of rapid growth, thereby rendering the diagnosis challenging.

PATIENT CONCERNS

We report the case of a 30-year-old right-handed male who presented to our hospital with a rapidly growing mass on the dorsal aspect of the right little finger.

DIAGNOSIS

The patient was suspected to have soft tissue tumor of the little finger. The lesion could be considered a malignant tumor on the basis of clinical findings.

INTERVENTIONS

The patient underwent surgery for exploration and excision of the mass.

OUTCOMES

The excised mass was diagnosed to be fibro-osseous pseudotumor of the digit upon histological assessment. Postoperatively, the wound healed without complications. At postoperative 6 months, there were no signs or symptoms of recurrence, and the patient returned to his premorbid functional status.

CONCLUSION

Following the detection of a soft tissue mass with clinicopathological features of pseudomalignancy in the digit, clinicians should consider fibro-osseous pseudotumor of the digit as a possible diagnosis, thereby avoiding unnecessary aggressive surgery.

The use of 3D printing in shared decision making for a juvenile aggressive ossifying fibroma in a pediatric patient

Juvenile aggressive ossifying fibromas (JAOF) are rare, typically benign pediatric tumors that are locally aggressive and have high recurrence rates. A 7-year old male presented with a palatal mass and a 3D printed model was created and used as a visual aide to highlight the importance of management in terms of functional, cosmetic, and disease-free outcomes with the family. The patient ultimately underwent successful enucleation with final pathology consistent with JAOF. To our knowledge, this is the first description of the use of 3D printing to help in the shared decision-making process for the treatment of this aggressive tumor.

Can non-collagenous proteins be employed for the differential diagnosis among fibrous dysplasia, cemento-osseous dysplasia and cemento-ossifying fibroma?

Differential diagnosis among fibrous dysplasias, cemento-ossifying fibromas and cemento-osseous dysplasias is difficult, since there is considerable overlap of histologic features, but also extremely important, since they differ greatly in etiology, clinical behaviour, prognosis and terapeuthic approach. There is no data about the use of immunohistochemistry, a viable and accessible technique, for this purpose. The objective of this study was to investigate, comparatively, the immunohistochemical expression of major non-collagenous proteins (osteonectin [ON], osteopontin [OP], bone sialoprotein [BSP] and osteocalcin [OC]) of mineralized tissue extracellular matrix in 22 cases of fibrous dysplasias, 16 of cemento-ossifying fibromas and 16 of cemento-osseous dysplasias. ON maintained the same expression profile in all cases; the staining for OP was negative in fusiform cells producing cementoid globules and weak, as well as heterogeneous, in high mineralized matrixes; there was negativity for BSP in cementoid globules and in the fusiform cells that produce them, differently from the strong positive expression found in the majority of bone trabeculae and their peripheral cuboidal osteoblasts; and finally, the immuno-reactivity for OC was weak, except in cuboidal osteoblasts and osteocytes. We can conclude that the nature of mineralized structure and the cellular phenotype are much more responsible for variability in immunohistochemical profile than the type of lesion (fibrous dysplasias, cemento-ossifying fibromas and cemento-osseous dysplasias) which makes difficult, at least for a while, the use of these proteins with diagnosis purpose.

Skull Base Juvenile Psammomatoid Ossifying Fibroma: Clinical Characteristics, Treatment, and Prognosis

OBJECTIVE

The diagnosis and management for juvenile psammomatoid ossifying fibroma (JPOF) of the skull base are challenging, and clinical data are limited.

METHODS

A retrospective review of JPOF was performed, and the clinical characteristics, treatment strategy, and prognosis were analyzed.

RESULTS

There were 23 patients pathologically confirmed with JPOF, most with JPOF located in the skull base area (19/23, 82.6%). Of those tumors, 43.5% presented with dura matter breakthrough. Most of the chief complaints were headache (n = 8, 34.8%) and visual impairment (n = 5, 21.7%). Most of the tumors were solid tumors with spherical appearance, frequently accompanied by cysts of various size (n = 14, 60.9%). Craniotomy, mostly via the frontal approach, was the most common approach in the present series, comprising 73.6% (17/23) of all cases. The endoscopic endonasal approach was performed in 6 cases (26.1%). In total, 62.5% of patients (15/23) underwent gross total resection, 8.7% of patients (2/23) underwent subtotal resection, and 26.1% of patients (6/23) underwent partial resection. After a mean follow up of 66.1 ± 36.1 months (range, 3-124), 3 patients (13.6%) suffered from tumor recurrence with a mean recurrence time of 13 months.

CONCLUSIONS

The present series of skull base JPOFs showed that radical surgery combined with skull base reconstruction contributed to overall good prognosis. Further studies are needed to evaluate the long-term outcomes and to characterize its pathologic characteristics.

Calcifying aponeurotic fibroma: a core biopsy-based diagnosis

Calcifying aponeurotic fibroma (CAF) is a very rare tumor of the extremities, which can be difficult to diagnose due to its wide cyto-architectural pattern. We herein report the clinicopathologic features of a case of CAF localized on the dorsal face of the foot in a 5-year-old male child, diagnosed by needle core biopsy. Differential diagnostic problems are discussed. The present case emphasizes that the diagnosis of CAF can be confidentially rendered on core needle biopsy if the main morphological components of this tumor are concurrently present; however, before making the diagnosis of CAF, the clinical and radiological context should be considered.

Juvenile Ossifying Fibroma of Maxilla

Ossifying fibroma (OF) is a rare, benign, non-odontogenic tumor of the jaw which comes under the group of fibro-osseous lesions. Ossifying fibromas of the mandible are more common than in the maxillary region. Juvenile ossifying fibroma has been distinguished from conventional ossifying fibroma on the basis of patient's age, site predilection, and clinical behavior. The lesion should be differentiated from other fibro-osseous lesions as its management varies from surgical enucleation to complete resection. Present report describes the case of juvenile ossifying fibroma of anterior maxillary region in a 7 year old male patient, with a detailed description of clinical, radiographic, histopathologic features, and its surgical management.

Ossifying Fibroma of the Skull: Clinical and Therapeutic Study

Aims and Backround

Ossifying fibroma is a tumor with benign course that rarely affects the cranial bones.

Methods

The authors report 5 cases of ossifying fibroma of the skull and analyze the clinical course and treatment of this lesione.

Results

3 patients were females and 2 males. The mean clinical history was 3.2 years. 4 patients underwent total removal and 1 partial. At mean follow-up of 19 years, all patients who underwent total removal showed improvement of neurological deficit, whereas the patient who underwent partial removal had clinical regrowth.

Conclusion

The authors conclude that total removal of fibroma should be extended to normal bone and in cases in which total removal is not possible the residue should be checked for regrowth by serial MRI.

Cemento-ossifying fibroma of the mandible. A clinicopathological report

Cemento-ossifying fibromas are rare fibro-osseous benign neoplasms that affect the jaws. They are included in the group of mesodermal odontogenic tumors and commonly present as a progressively growing lesion that might attain enormous size with resultant deformity, if left untreated. A confusion prevails on the terminology, which can only be confirmed by histopathologic evaluation. A case of cemento-ossifying fibroma involving the right mandible is described in a 30 year-old female patient. The clinical, radiographic, histologic features are presented and the various differential diagnosis are discussed.

A Case Series of Fibro-Osseous Lesions of the Jaws

The aim of this case series was to reveal the difficulties in diagnosing fibro-osseous lesions with radiological and histopathological examinations and quantify the potential risk of infection to fibro-osseous legions. To analyze the concordance between radiological and histopathological diagnoses, this retrospective case series included patients who were clinically diagnosed with fibro-osseous lesions via radiological findings and excluded the patients who did not undergo histopathological examinations. This study also included the patients in whom histopathological results confirmed fibro-osseous legions when preoperative radiological diagnosis did not include fibro-osseous legions. Eleven patients (three men, eight women; median age 24.5 years, range 15-57 years) were enrolled. Although radiological diagnoses of fibrous dysplasia (FD) corresponded with histopathological diagnoses in seven patients, mismatches between radiological findings and histopathological results were found in three patients. In one patient, suspected diagnosis with radiological examinations was malignant lymphoma or FD. In two patients, the histopathological differentiation between FD and ossifying fibroma (OF) was difficult. One patient had lesion recurrence which was suspected to be OF with surgical findings and postoperative course after the initial surgery. In three patients, infections of FD were found. Preoperative diagnosis of OF with radiographic feature of unilocular radiolucency is difficult. In cases in which histopathological differentiation between FD and OF is difficult, operative findings should be used because OF is often found to be well-encapsulated and easily enucleated. Bone in FD showing mixed radiolucent-radiopaque may be vulnerable to infection.

Bone-Related Lesions of the Jaws

The jaws combine several unique properties that mainly result from their distinct embryonic development and their role in providing anchorage for the teeth and their supporting structures. As a consequence, several bone-related lesions almost exclusively develop in the jaws (eg, osseous dysplasias, ossifying fibromas), have distinct clinical features (eg, osteosarcoma), or hardly ever occur at this location (eg, osteochondroma, enchondroma). The specific characteristics of these tumors and tumorlike lesions are outlined in this article.

Peripheral Cemento-Ossifying Fibroma

Peripheral cemento-ossifying fibroma (PCOF), a relatively uncommon lesion, reactive in nature is seen as an overgrowth of the gingival tissues often leading to periodontal problems. It is a benign tumor with slow-growing potential commonly affecting the anterior maxilla whose pathogenesis till date is uncertain. It is usually challenging to diagnose peripheral cemento-ossifying fibroma based on clinical observation and examination, hence histopathological examination is mandatory to arrive at an accurate diagnosis. Recurrence of the lesion is common unless and until it is completely excised. We present the report of two cases of peripheral cemento-ossifying fibroma of our department, complaining of a mass in the gingiva of posterior maxilla and mandible.

Ossifying Fibroma in a Miniature Rex Rabbit (Oryctolagus cuniculus)

In humans and animals, ossifying fibroma is a benign neoplasm that most frequently affects the mandible, often resulting in cosmetic deformities and malocclusion. It is considered rare in animals and most frequently affects young horses. A surgical biopsy of a solitary mass located beneath the gingiva in the right maxillary region, which had overgrown teeth and expanded the adjacent hard palate from a 6-year-old miniature Rex rabbit was submitted for light microscopic examination. The submitted incisional biopsy specimen was pale pink, firm, and nodular. Histopathologically, the neoplasm was composed of fibroblastic cells separated by abundant collagen. The neoplastic cells were interwoven with osteoblasts surrounding islands of mineralized, bony matrix containing few, widely spaced, often empty, lacunae. Minimal inflammation was present. Based on the histopathologic features, the tumor was diagnosed as an ossifying fibroma. To our knowledge, this is the first report of an ossifying fibroma in a rabbit.

An update on peripheral ossifying fibroma: case report and literature review

The purpose of the present article was to present a clinical case of an 11-year-old girl with peripheral ossifying fibroma (POF). Additionally, after performing a literature review, we identified clinical information that occurs more frequently in association with POF, such evidence would help professionals in yielding a specific diagnosis and tailor a more specific therapeutic approach with the objective to decrease morbidities' associated with POF. This lesion represents the third most common lesion of all localized reactive hyperplastic lesions. Clinical aspects related to this pathology include the fact that it occurs most frequently in women between the first and second decades of life. It affects anterior maxillary region and interferes with normal functioning of this anatomical structure. After conducting the literature search, we found that it can also be presented in a considerable number of males with pain and hyperemia being the most common clinical manifestations. We found that often clinical cases are presented with incomplete information. It is important that in order to get to a consensus with respect to updates about information related to this lesion, new case series that include complete clinical information, radiographic analysis, and histopathology tests could be presented.

[Giant ossifying fibroma of nasal cavity and nasal sinuses: one case report]

A 39 years old male patient was admitted with the right of facial abnormalities and gradually protruding in right eye more than 30 years. CT shows high mixed density, clear boundary, and the right eye was crowded to the right. Giant tumor had completely been excised, and the result was fine. The outline figure and function of patients were obviously improved. The pathological examination after resection showed ossifying fibroma.

A pediatric viewpoint on peripheral ossifying fibroma: a case report

A peripheral ossifying fibroma (POF) is a type of reactive hyperplasia that is found exclusively on the gingiva. It is identified through histologic evidence of calcifications and ossifications that are seen in the context of a hypercellular fibroblastic stroma. This article presents the case of a POF in a 7-year-old girl, and examines the pediatric considerations for diagnosing and managing this lesion.

A peripheral giant cell granuloma with extensive osseous metaplasia or a hybrid peripheral giant cell granuloma-peripheral ossifying fibroma: a case report

INTRODUCTION

Peripheral giant cell granuloma and peripheral ossifying fibroma are clinicopathologically distinct gingival lesions. Both are included in clinical differential diagnoses of common benign and reactive gingival epulides in humans. It is often impossible to make a clinical distinction between the two entities, thereby making definitive diagnosis dependent on histopathologic features. While our search of the English literature revealed several reports of peripheral giant cell granuloma with 'bone formation', we were unable to identify any reports of hybrid peripheral ossifying fibroma-peripheral giant cell granulomas.

CASE PRESENTATION

We report a case of a 44-year-old Caucasian man presenting with a three-month history of swelling of his right posterior mandible, related to an area of previous dental implant restoration. A clinical examination revealed modest extraoral facial swelling of his right posterior mandible, while an intraoral examination showed a 45 × 25 × 15 mm sessile, lobular soft tissue mass of the right posterior mandibular gingiva. The mucosal covering of the lesion exhibited focal surface ulceration. A panoramic radiograph showed two implants at the vicinity of the lesion with no other significant findings. An excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed salient and distinctive features of peripheral giant cell granuloma and of peripheral ossifying fibroma, estimated at near equal proportions. This raises the possibility of a hybrid odontogenic lesion.

CONCLUSION

The presentation of this lesion, with areas of peripheral giant cell granuloma along with a distinct area of extensive osseous formation and stroma reminiscent of a peripheral ossifying fibroma, justifies consideration of this as a possible hybrid lesion. Although the biologic behavior of a combined lesion is not anticipated to deviate significantly from that of either of the single entities, this case resurrects an enduring debate as to whether peripheral giant cell granuloma and peripheral ossifying fibroma are simply parts of a disease spectrum, or whether some of these lesions represent true hybrid lesions. It is therefore recommended that more cases with histopathologic features similar to the lesion in our case be reported in the literature to further elucidate the histogenesis of these lesions.

Ossifying Fibroma in a Patient With Oculocerebrocutaneous (Delleman) Syndrome

Delleman syndrome is a rare neurocutaneous disorder characterized by congenital anomalies affecting the eye, skin, and central nervous system. This disorder was first raised as a distinct syndromic entity by Delleman and Oorthuys in 1981 under the term "oculocerebrocutaneous syndrome" (OCCS). Since then, fewer than 40 cases have been reported. All cases have been sporadic, and no patient with an abnormal karyotype has been reported. Although the etiology is still unknown, several theories have been advanced. Most of the tissues affected by OCCS are neural crest derivatives, with a striking homogeneity of the tissues and regions involved. It is this recurring craniofacial pattern of OCCS that lends support to the hypothesis that the most probable pathogenesis is a neurocristopathy that interferes with craniofacial morphogenesis. Ossifying fibroma is a destructive, potentially deforming, benign tumor that can occur almost anywhere in the facial skeletion. Some cases of ossifying fibroma have occurred in patientswith underlying neurocutaneous syndromes such as neurofibromatosis, Sturge-Weber syndrome, and encephalocraniocutaneous lipomatosis (ECCL). We report a patient with OCCS who presented with an ossifying fibroma. This has not been reported previously and is noteworthy in that it might be part of a wider phenotypic spectrum of the less common manifestations associated with OCCS.

Diagnosis and management of focal reactive overgrowths of gingiva--a case series

Localized overgrowths of gingiva such as peripheral fibroma, peripheral ossifying/cementifying fibroma, pyogenic granuloma and peripheral giant cell granuloma belong to a common group of lesions designated as focal reactive overgrowths (FROG). These growths are reactive in nature. They occur in response to chronic, low grade irritation caused by plaque or any other irritant. Etiology, clinical features and treatment modes of these lesions are the same with slight variations. The present case series describes five different cases of FROG where the lesions were treated by surgical excision under local anesthesia followed by a three month re-evaluation where no recurrences were observed.

An unusual presentation of peripheral ossifying fibroma in an elderly man

Peripheral ossifying fibroma is a common solitary gingival overgrowth thought to arise from the gingival corium, periosteum or periodontal ligament. Ossifying fibroma has the propensity to occur in cranial bones, but the peripheral variety shows a close relationship with the periodontal ligament and adjacent alveolar bone. It is more commonly seen in women (predilection of 3:1) and usually at a young age. This report describes an unusual presentation in an elderly man and presents a systematic way of diagnosing and treating peripheral ossifying fibroma.

Psammomatoid juvenile ossifying fibroma: case study and a review

BACKGROUND

The group of fibro-osseous lesions from the maxillofacial region is very heterogeneous, but what they all have in common is the substitution of normal bone by fibroblasts with the consequent formation of collagen fibers, as well as substitution by different types of mineralized tissues which may be similar to bone or cement. Within this group of lesions, the juvenile ossifying fibroma is found, considered a rare and recurrent benign fibro-osseous neoplasia. The term juvenile ossifying fibroma has been used in the literature to describe two histopathological variations of conventional ossifying fibroma. These variations are trabecular juvenile ossifying fibroma and psammomatoid juvenile ossifying fibroma. Psammomatoid juvenile ossifying fibroma is an uncommon bone-forming neoplasm with aggressive local growth. Diagnostic of this lesion occurs after the correlation of clinical, imaging, and histopathological findings. Proposed treatments range from enucleation and curettage to resection of the tumor.

OBJECTIVES

The present article has as its objectives to report an uncommon case of a 4-year-old male patient treated by conservative approach and revise the literature on juvenile ossifying fibroma.

CONCLUSIONS

Psammomatoid juvenile ossifying fibroma, for its being very uncommon, warrants further investigation in order to establish the best treatment, principally in children, with a view to minimizing mutilating treatments. In the case examined, a conservative treatment was chosen, where the surgeon established curette and cryotherapy, and the reintegration of the child in his social environment, without relapse during the first year of therapy.

An unusual case of gingival enlargement: peripheral odontogenic fibroma

The peripheral odontogenic fibroma (POdF) is an uncommon gingival enlargement. It is a benign, unencapsulated exophytic gingival mass, which is composed of fibrous connective tissue associated with various amounts of calcifications and islands of odontogenic epithelium.The lesion is usually firm to palpation and non-tender, and it could be mistaken for other more common exophytic gingival lesions, such as peripheral ossifying fibroma, pyogenic granuloma, or peripheral giant cell granuloma. Therefore, a histopathologic examination is necessary for accurate diagnosis. This article presents a well-documented case of POdF and a review of the literature in regards to its diagnostic features, treatment modalities, and recurrence.

Giant cemento-ossifying fibroma of the mandible: a rare case

The World Health Organization classifies cemento-ossifying fibroma (COF) as a fibro-osseous neoplasm included among the nonodontogenic tumors derived from the mesenchymal blast cells of the periodontal ligament, with a potential for forming fibrous tissue, cementum and bone, or a combination of such elements. These are slow-growing lesions, and are more frequent in women, between the third and fourth decades of life. Case reports of massive expansile COFs (measuring more than 10 cm) are rarely reported in the literature. This article aims to describe a case of giant cemento-ossifying fibroma with radiographic and 3D CT features in a 34 year old female patient, who came with the complaint of progressive swelling of the face which had started 6 years earlier.

[Clinical analysis of 23 patients with ossifying fibroma of paranasal sinuses]

OBJECTIVE

To investigate the clinical features and treatment options of ossifying fibroma of paranasal sinuses.

METHOD

A retrospective evaluation of twenty-three patients with ossifying fibroma of paranasal sinuses was presented. The choice of surgical operations on ossifying fibroma of paranasal sinuses was mainly decided by the location and area of ossifying fibroma. Radical operations were performed in twenty-one patients, ten of them through a lateral rhinotomy approach, eight through nasal endoscopic approach, four through Caldwell-Luc approach, one through coronal approach.

RESULT

Two patients were performed partial resection by nasal endoscopic surgery. Diagnoses of all cases were confirmed by pathology. All patients outcomes were successful, no serious complication from the surgical technique occurred. Twenty cases were followed-up for six months to nineteen years. Two patients recurred.

CONCLUSION

Earlier diagnosis, CT scan, proper surgery, and radical resection are the keys to the treatment of ossifying fibroma of paranasal sinuses.

Peripheral cementifying fibroma: a clinical diagnostic dilemma

The peripheral ossifying fibroma (POF) is a reactive gingival overgrowth occurring frequently in the anterior maxilla. It originates in the cells of the periodontal ligament and is more common in children and young adults. In the current article a case of gingival over growth, which was thought to be puberty-induced gingivitis was seen in the lower anterior maxillary gingiva. Histology of the excised tissue showed cellular, fibrous connective tissue stroma with calcified osseous calcifications indicative of POF. The definitive diagnosis is established only by histological examination, which revealed the presence of highly cellular connective tissue with focal calcifications. Surgery is the treatment of choice, though the recurrence rate can reach 20% in case of POF. After histological confirmation the recall and clinical evaluation protocol of POF varies due to its increased recurrence rate, which the general dentist should be aware of.

Extensive central ossifying fibroma of the maxilla: a case report

Central ossifying fibroma (COF) is a benign osteogenic neoplasm, with fibrous tissue and calcifications similar to bone, which has the clinical presentation of an asymptomatic bulging. It is more common in the mandibular premolar and molar region, in the third and fourth decades of life, and in women more frequently than men. Surgical removal is the treatment of choice and additional reconstruction is essential due to the functional and esthetic problems faced by the patient. This article describes the surgical treatment and subsequent reconstruction in a 22-year-old man with COF and an expansile lesion of the anterior maxilla. Enucleation of the lesion was performed and porous high-density polyethylene biomaterial was used for reconstruction.

Aneurysmal bone cyst-plus: a diagnostic enigma

Aneurysmal bone cyst, commonly reported in the second and third decades of life, is characterized by a rapid growth pattern with resultant bony expansion and facial asymmetry. Interestingly, these lesions can occur in association with other primary bone pathologies, where they are referred to as "hybrid lesions" or "ABC-Plus." Their rarity, especially in the head and neck region, may pose a diagnostic challenge to clinicians. Following is a discussion of one such enigmatic lesion that includes description of a unique case of ABC-Plus that affected the right mandible of a young male.