A giant peripheral ossifying fibroma of the mandible: A rare case report

INTRODUCTION

Peripheral ossifying fibroma (POF) is an unusual localized, reactive benign gingival growth. POF is usually small in size, it's measure <2 cm in diameter, but rarely reaches important sizes. The aim of this work was to present a rare case report of a giant peripheral ossifying fibroma of the mandible measuring >2 cm in diameter, misdiagnosed as peripheral myxoma.

CASE PRESENTATION

We present the case of a 42-year-old woman with a large peripheral ossifying fibroma in the oral cavity measuring 6 × 4 cm in diameter. The patient presented with an asymptomatic, slowly growing gingival mass in the left anterior and posterior region of the mandible. It gradually increased in size for more than two years. The patient had a mild mental deficit; however, we performed biopsy surgery, which revealed a peripheral myxoma, and then treated the tumor by excision under local anesthesia. The final histopathological examination revealed a peripheral ossifying fibroma.

CLINICAL DISCUSSION

This case report shows that POF can grow and reach unusual dimensions that may contribute to occlusal problems. The diagnosis of POF is based on clinical and radiographic features. The histopathological examination of the biopsy specimen can misdiagnose the lesion; therefore, the final diagnosis is based on the histopathological examination of the complete excised lesion.

CONCLUSION

POF is usually small, but can reach a larger size. The histopathological examination of the entire lesion is of paramount importance to make a final diagnosis.

Brown tumor of the jaw as a rare manifestation of hyperparathyroidism: Two case reports and literature review

INTRODUCTION AND IMPORTANCE

Brown tumor is a giant cell focal lesion of bone associated with hyperparathyroidism, even primary or secondary. Differential diagnosis of these lesions from others giant cell lesions of the jaw bone is mandatory for the correct treatment of the patient.

CASE PRESENTATION

We present here two cases of brown tumor affecting the jaws by describing their clinical aspects and radiographic features, diagnostic criteria and treatment of this disease.

CLINICAL DISCUSSION

Brown tumor is one of the lesions that develop in patients with hyperparathyroidism or renal failure. Skeletal bones including maxillo-facial ones can be the site of this lesion, also radiographic and histopathological exams of the jaw lesion are not sufficient to determine the diagnosis, which requires laboratory tests and radiographic examination.

CONCLUSION

Dental surgeon should be aware of oral manifestations associated with systemic diseases, hence the importance of careful physical examination and thorough investigation for the diagnosis and treatment success. This article aims to illustrate the management strategy to aid clinicians in suspected cases of brown tumor.

[Gamma-angiography during exercise in chronic aortic insufficiency. Development of ventricular function and regurgitation]

Twenty-three patients with chronic aortic incompetence (17 men and 6 women) aged 27 to 71 years (average 51 years) underwent sequential gamma-angiography at rest and during the different levels of exercise and recovery phase to investigate the evolution of ventricular function and regurgitant fraction and so, guide therapy. The radionuclide indices of left ventricular function (end diastolic and end systolic indexed volumes, global ejection fraction, regional wall motion) and the regurgitant fractions were calculated and compared with clinical, echocardiographic, angiographic and haemodynamic data. The changes observed on effort during gamma-angiography allowed identification of 3 groups of patients: Group I: compensated aortic incompetence with a normal left ventricular ejection fraction (0.69 +/- 0.1), a moderate regurgitant fraction (40 per cent +/- 20 per cent) and, during exercise, a stable left ventricular end diastolic volume index (less than 5 per cent variation), an end systolic volume index which decreased (average-13 per cent), an ejection fraction which increases (by more than 0.05 in 62.5 per cent of cases) and with good global and regional wall motion. Group II: intermediate cases with a left ventricular ejection fraction of 0.62 +/- 0.09 and a regurgitant fraction of 60 +/- 16 per cent. Individual variations were observed with this group which either resembled those of Group I or those of Group III.(ABSTRACT TRUNCATED AT 250 WORDS)

Symbolic reasoning about myocardial scintigrams in PROLOG

PROLOG (PROgramming in LOGic) is the declarative programming language at the heart of the Japanese fifth-generation computer project. It is proposed that PROLOG is a suitable tool for symbolic image processing, once standard preprocessing has been done. In the present application, the problem of prediction of coronary anatomy from myocardial scintigrams is addressed. Uncertainty is dealt with by a combination of fuzzy-set theoretic and probabilistic reasoning. Heuristic classification rules are based on clinical experience and on a set of 247 myocardial scintigrams with their corresponding coronary angiograms.

Discriminant analysis of thallium-201 myocardial scintigrams

In a group of 207 patients undergoing coronary angiography, myocardial scintigrams have been performed at rest (n = 95), after exercise testing (n = 50) or after dipyridamole vasodilation (n = 62). Pictures recorded in anterior and 45 degrees left anterior oblique projections have been analysed according to a model which divides each projection into 5 territories. Thallium uptake has been visually assessed using a three grade scale: 0 = normal uptake, + = sightly abnormal uptake, ++ = evident hypoactivity. With reference to angiography, sensitivity and specificity for prediction of coronary artery disease have been calculated in a classical way using three different criteria of positivity of increasing severity, and by a computerized method based on discriminant analysis. In the first case, sensitivity and specificity were highly dependent one on the other and, as could be expected, varied in opposite directions, a high sensitivity (89 to 100%) being only achieved by accepting a lack of specificity (33 to 57%). Discriminant analysis, on the contrary, provided for each type of protocol: rest, stress, dipyridamole and redistribution, a single optimized combination of sensitivity (74 to 87%) and specificity (92 to 100%). The corresponding point, when located on the receiver operating characteristics (ROC) diagram, demonstrated a clear improvement in diagnostic accuracy. The same method has been applied for discrimination, not only between normals and abnormals, but also between normals and patients with and without myocardial infarction (correct diagnosis in 50 to 68% of cases), and between normals and patients with single-, double- or triple-vessel disease (correct diagnosis in 17 to 65% of cases) with a high specificity (correct classification of normals in 86 to 100% of cases).