Ossifying fibroma of the maxilla: A case report with literature review

Ossifying fibroma is a benign fibro-osseous lesion arising from the periodontal ligament cells. The lesion may progressively enlarge with the mass affecting the mandible or maxilla, resulting in facial deformities and tooth displacement despite its benign nature. Here, we presented a case of an 18-year-old female with ossifying fibroma in the maxilla extending to the maxillary sinus, infraorbital area, and skull base, resulting in considerable facial asymmetry. Since the primary treatment of ossifying fibroma is surgical resection, it is essential to determine the areas where the lesion has expanded, where a 3-dimensional computed tomography scan could play a critical role in providing such information. A complete surgical excision and histopathologic examination in treating this patient are crucial, made possible by a meticulous preoperative radio imaging technique.

Fibrocartilaginous mesenchymoma of pelvis-a potential diagnostic pitfall

Fibrocartilaginous mesenchymoma (FM) is a rare bone tumor mimicking other fibrocartilaginous lesions on imaging and histologically. Hence, it is difficult to diagnose this entity especially on small biopsies. In this article, we report a case of FM mimicking desmoplastic fibroma on biopsy. A 36-year-old male presented with pain in the left hip. Imaging showed a large expansile lytic lesion involving the acetabulum and pubis. The differential diagnosis was suggestive of giant cell tumor, aneurysmal bone cyst, intraosseous desmoplastic fibroma, and chondrosarcoma. Biopsy revealed a low-grade spindle cell lesion with no evidence of osteoid or chondroid matrix. The lack of cartilaginous nodules in the biopsy prompted a preoperative diagnosis of desmoplastic fibroma. The excised mass showed bland spindle cell proliferation, benign cartilage nodules, and epiphyseal plate-like enchondral ossification suggestive of fibrocartilaginous mesenchymoma. Negative immunostaining for SATB2, CDK4, and MDM2 ruled out low-grade central osteosarcoma. Though GNAS mutations were not performed in this case, rimming of the bony trabeculae at the periphery of the epiphyseal growth plate-like cartilaginous nodule ruled out fibrous dysplasia. The absence of cartilaginous component misleads the diagnosis preoperatively in small biopsies.

Cystic degeneration in cemento-ossifying fibroma: Diagnosis challenge and conservative management - Case report

Introduction and importance

Cemento ossifying fibroma (COF) is an encapsulated lesion that is often found in the mandible of middle-aged females. Cystic degeneration may be associated to several osseous lesion. This particular presentation is not well documented in the jaws.

Case presentation

Patient presented was referred to oral surgery department for abnormal radiolucency in the right mandible on panoramic X-ray. The patient did not have any specific medical history and reported painful areas in right mandibular region. During diagnosis assessment, ameloblastoma was first considered due to the presence of cystic lesion clusters. But the mixed image in previous X-ray pointed to a fibro-osseous with a change in pathogenesis pathway. Diagnosis buildup was based on previous radiographs, incisional biopsy was proposed to identify the histopathological feature of the lesion before proceeding to further investigation (CBCT) or treatments (decompression or enucleation). COF of the jaws associated to non-specific cystic changes was the histopathological diagnosis. Delay in treatment showed an unexpected outcome with good clinical and bone healing.

Clinical discussion and conclusion

This case shows the importance of previous radiographs, when available, in diagnosis buildup. The fibro-osseous lesion with cystic change may show a good biological response with conservative management. A clinical and radiological surveillance after a conservative treatment may be a better option in treatment of these lesions.

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Non-epithelial lined cysts occasionally occur along with various bone lesions. These cysts vary from aneurysmal bone cyst (ABC), simple bone cyst (SBC) and non-specific cystic degeneration.

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Evaluation of previous X-rays may be of a great importance in objectifying modification of pathogenesis pathway in osseous lesions.

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Minimal surgical intervention with monitoring may be a great treatment choice in management of non-epithelial lined cysts associated to cemento-ossifying fibroma.

Spheno-orbital juvenile psammomatoid ossifying fibroma: a case report and literature review

Ossifying fibroma (OF) is an uncommon benign fibro-osseous lesion. Based on its clinical, morphological, and radiological features, OF is further divided into cemento-ossifying fibroma (COF), juvenile psammomatoid ossifying fibroma (JPOF), and juvenile trabecular ossifying fibroma (JTOF). JPOF rarely involves the cranial base, with limited reports published on spheno-orbital JPOF. In this paper, we report a case of JPOF of the greater wing of the sphenoid bone and lateral orbital wall in an 11-year-old child and show a surgical video. Although rare, JPOF should be considered in the differential diagnosis of fibro-osseous lesions of the spheno-orbital region.

Ossifying Fibroma of Non-odontogenic Origin: A Fibro-osseous Lesion in the Craniofacial Skeleton to be (Re-)considered

In the cranio-facial skeleton, a heterogeneous group of well characterized fibro-osseous lesions can be distinguished. Whereas fibrous dysplasia can affect any skeletal bone, ossifying fibroma and cemento-osseous dysplasia exclusively develop in the cranio-facial region, with most subtypes restricted to the tooth bearing areas of the jaws. Herein we present a series of 20 fibro-osseous lesions that developed mostly in the frontal bone and in the mandible, presenting as expansile intramedullary tumors with a unique histologic appearance and an indolent clinical course. We provide evidence that these tumors are distinct from the categories included in the WHO classification and are therefore currently unclassifiable. The definition of cemento-ossifying fibroma as an odontogenic neoplasm developing only in close proximity to teeth should be re-considered and incorporate also extragnathic lesions as shown here.

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.

An unusual case of polyostotic fibrous dysplasia-A case report

Fibrous dysplasia (FD) is a fibro-osseous lesion where normal bone and marrow is replaced with fibrous tissue, resulting in formation of bone that is weak and prone to expansion. It is classified according to the number of affected bones, and its association to endocrine alterations, that is, monostotic (80-85%), polyostotic forms (20-30%), and Albright's disease. Involvement of two or more bones is termed as polyostotic FD, a relatively uncommon condition. Here we report a rare case of polyostotic FD involving facial bones, orbital bones, sphenoid bone, and spine in a 21-year-old male patient.

A clinicopathologic analysis of 135 cases of cemento-osseous dysplasia: To operate or not to operate?

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.

Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report

Background

Fibrous dysplasia (FD) is a benign bone lesion characterized by the progressive replacement of normal bone with fibro-osseous connective tissue. The maxilla is the most commonly affected area of facial bone, resulting in facial asymmetry and functional disorders. Surgery is an effective management option and involves removing the diseased bone via an intraoral approach: conservative bone shaving or radical excision and reconstruction.

Case presentation

This case report describes a monostotic fibrous dysplasia in which the patient’s right midface had a prominent appearance. The asymmetric maxillary area was surgically recontoured via the midfacial degloving approach under general anesthesia. Follow-up photography and radiographic imaging after surgery showed the structures were in a stable state without recurrence of the FD lesion. Furthermore, there were no visible scars or functional disability, and the patient reported no postoperative discomfort.

Conclusions

In conclusion, the midfacial degloving approach for treatment of maxillary fibrous dysplasia is a reliable and successful treatment option. Without visible scars and virtually free of postoperative functional disability, this approach offers good exposure of the middle third of the face for treatment of maxillary fibrous dysplasia with excellent cosmetic outcomes.

Recurrent juvenile psammomatoid ossifying fibroma with secondary aneurysmal bone cyst of the maxilla: a case report and review of literature

Juvenile ossifying fibroma is a benign fibro-osseous lesion commonly affecting the extra-gnathic craniofacial skeleton of the young individuals. The psammomatoid and trabecular variants are its two histopathological subtypes having distinctive clinico-pathological characteristics. Secondary aneurysmal bone cysts are frequently reported to arise in the pre-existing fibro-osseous lesions but rarely reported in the psammmomatoid variant of the juvenile ossifying fibroma. Such hybrid lesions, especially massive in size, tend to exhibit a greater aggressive growth potential and higher recurrence rate and mandate complete surgical removal of the lesion along with a long-term follow-up. The objective of this case report was to present a rare incident of recurrent psammomatoid ossifying fibroma associated with a secondary aneurysmal bone cyst in the maxillary jaw bone of a young patient and review the similar published reports in the English literature.

Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications

Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.

Florid Osseous Dysplasia-Report of Two Cases and Review of Literature

Florid osseous dysplasia is a rare benign fibro-osseous multiquadrant dysplastic lesion confined to the alveolar process of jaws, generally asymptomatic and usually detected incidentally during radiologic examination and requires no treatment unless symptomatic or cosmetically concerning. In this article, we present two rare cases of florid osseous dysplasia in Indian women with their clinical, radiographic and histologic findings and a brief review of literature. The first case was asymptomatic and the lesion was detected during routine radiographic examination and required no treatment whereas, the second case presented with features of osteomyelitis. Based on the clinical findings, the case was diagnosed as chronic suppurative osteomyelitis, but, after radiologic examination, diagnosis of florid osseous dysplasia with secondary osteomyelitis was made. Besides diagnostic challenge, management of the lesion is difficult due to poor vascularity. In our case, antibiotic prophylaxis along with surgical debridement and sequestrectomy was done with regular recall visits.

Large radiopaque lesion in the posterior mandible: A challenging case

Radiopaque lesions of the jawbones are frequently encountered in dental radiographs. A variety of conditions such as chronic inflammation, soft tissue calcifications, fibrosseous lesions, odontogenic tumors, and bone neoplasms can manifest as radiopaque lesions on the jawbones. These radiopaque lesions are often difficult to distinguish from each other, hence making the formulation of differential diagnosis challenging. A thorough patient's history and clinical examination supplemented by appropriate investigations will enable the clinician in narrowing down the differential diagnosis and to identify the condition accurately. Presented here is a case of the large radiopaque lesion on posterior mandible surrounded by lytic areas in a 20-year-old male patient.

Huge ossifying fibroma maxilla

Maxillofacial fibro-osseous lesions comprise a group of face and jaw disorders characterized by the replacement of bone by a benign connective-tissue matrix with varying amount of mineralized substances. Fibro-osseous lesions of the maxilla are not an uncommon tumor. Majority of the lesions with fibrous and osseous components include ossifying fibroma, fibrous dysplasia, cemento-ossifying fibroma, and cementifying fibroma. We present a case of 15-year-old female with huge fibroosseous lesion which was treated with total maxillectomy via a Weber-Ferguson approach. Histopathology established that fibroosseous lesion as an ossifying fibroma.

Psammomatoid juvenile ossifying fibroma of mandible in a 6-year-old child

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous lesion of the jaw occurs at the early age of onset frequently under 15 years with a propensity to recur. It appears as a unilobulated/multilobulated lesion at an early stage followed by radiopaque appearance surrounded by radiolucent rimming at advanced stages. The psammomatous type of JOF (PsJOF) principally involves the bones of the orbit and paranasal sinuses. However in some cases, maxilla or rarely the mandible may be pretentious. Here, we report a challenging case of PsJOF in a 6-year-old child with a complaint of swelling imitating a cystic lesion in left back region of the lower jaw for 2 months. The authors propose that a careful examination and correlations of clinical, radiological, and histopathological features are essential to arrive at correct diagnosis and play a vital role in management of such patients.

Unusually large-sized peripheral ossifying fibroma

Fibrous growths in the gingiva with the histopathological presence of calcifications are a common occurrence in the oral cavity. These lesions can be neoplastic in nature with either odontogenic or non odontogenic origin or they can be reactive lesions. This is a case report of an unusual presentation of peripheral ossifying fibroma , unusual because of its abnormally large size with review of literature.

Psammomatoid juvenile ossifying fibroma of mandible in a 6-year-old child

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous lesion of the jaw occurs at the early age of onset frequently under 15 years with a propensity to recur. It appears as a unilobulated/multilobulated lesion at an early stage followed by radiopaque appearance surrounded by radiolucent rimming at advanced stages. The psammomatous type of JOF (PsJOF) principally involves the bones of the orbit and paranasal sinuses. However in some cases, maxilla or rarely the mandible may be pretentious. Here, we report a challenging case of PsJOF in a 6-year-old child with a complaint of swelling imitating a cystic lesion in left back region of the lower jaw for 2 months. The authors propose that a careful examination and correlations of clinical, radiological, and histopathological features are essential to arrive at correct diagnosis and play a vital role in management of such patients.

Psammomatoid variant of juvenile ossifying fibroma involving mandible: A rare case report

The term juvenile ossifying fibroma (JOF) is used in literature in naming two microscopically distinct fibro-osseous lesions of the craniofacial skeleton. One is characterized by small uniform spherical ossicles resembling psammoma bodies (psammomatoid JOF [PsJOF]). The other is distinguished by trabeculae of fibrillary osteoid and woven bone (trabecular JOF). Psammomatoid ossifying fibromas represent a unique subset of fibro-osseous lesions of the craniofacial region. PsJOF has been distinguished because of its location, clinical behavior, and age of occurrence. They have distinctive histomorphologic features and a tendency toward locally aggressive behavior, including invasion and destruction of adjacent anatomic structures. It is generally seen in the younger age group, and the most common site is paranasal sinuses, orbits, and frontoethmoidal complex. We report a case of JPOF involving mandible which is rarely been described in literature. An insight into the radiographic progression of this rare entity along with the clinical feature and surgical management is discussed.

Juvenile psammomatoid ossifying fibroma: An unusual case report

Ossifying fibromas are well-demarcated benign fibro-osseous tumors of craniofacial skeleton most often in the jaws. It has two types, conventional and juvenile ossifying fibroma (JOF). JOF is considered a separate entity from ossifying fibroma due to its locally aggressive behavior and tendency to occur at a young age. Two subtypes of JOF, i.e., juvenile psammomatoid ossifying fibroma (JPOF) and juvenile trabecular ossifying fibroma have been identified on the basis of histology 70% of the JPOF occur in the paranasal sinuses, 20% in the maxilla and only 10% in the mandible. Here, we report a case of JPOF in a 14-year-old girl causing an asymptomatic expansile swelling in the right mandibular posterior region, which is a rare site for this tumor.

Juvenile aggressive ossifying fibroma of the maxilla: a case report

Juvenile ossifying fibroma is an uncommon fibro osseous neoplasm at a younger age. It is a well-defined clinical and histological lesion. This lesion is locally invasive and spreads quickly. Early detection and complete surgical excision of this lesion is essential since it has high recurrence rate.