Two cases of multiple ossifying fibromas in the jaws ncbi. Active ossifying fibroma must be separated from fibrous dysplasia, cementoblastoma, and meningioma. The following case report illustrates complete removal of an ossifying fibroma limited to the frontal bone which was thought preoperatively to be a mucocele of the frontal sinus. Fibrous dysplasia has margins which blend with the surrounding bone. Two cases of multiple ossifying fibromas in the jaws.
Intraoral ossifying fibromas have been described in the literature since the late 1940s. Non ossifying fibroma, fibrous cortical defect, fibroxanthoma, jaffecampanacci syndrome, cortical desmoids tumor, soap bubble, ground glass, eccentric. Peripheral ossifying fibroma a clinical and histological. Computed tomography ct detected a fibroosseous lesion that proved to be an ossifying fibroma figure. This is a growth that appears inside the mouth as a small lump on the gum. A nof is a result from failure of the bone to properly close at its outer shell. Ossifying fibromas are benign bone lesions that should be differentiated from non ossifying fibromas and fibrous dysplasia. Fibroosseous lesions refer to a collection of nonneoplastic intraosseous lesions that replace normal bone and consist of a cellular fibrous connective tissue within which nonfunctional osseous structures form. Nonossifying fibroma it is estimated that 30% to 40% of people under the age of 20 have an nof, although few will have any symptoms. Osteofibrous dysplasia is considered as a separate pathological entity in view of its different presentation and treatment, although histopathologically similar to ossifying fibroma. Ossifying fibroma of the frontal bone jama otolaryngology. Many names have been given to similar lesions, such as epulis,1 peripheral fibroma with calcification,1 peripheral ossifying fibroma,2,3 calcifying fibroblastic granuloma,4 peripheral cementifying fibroma, peripheral fibroma with cementogenesis5. Trabecular type of juvenile ossifying fibroma a rare. Radiologically, ossifying fibroma is a welldemarcated lesion and does not merge with the surrounding bone.
It is highly aggressive and has a high tendency to recur. The cemento ossifying fibroma cof is a mesodermal, nonodontogenic tumour of ectopic multipotential periodontal membrane blast cells. Ossifying fibroma of is classified as, and behaves like, a benign bone neoplasm. A nonossifying fibroma is a common benign bone tumor in children and adolescents. On comparing the two lesions, if was found that the ox. It is important to get complete excision as early in the disease process as possible. Nonossifying fibromas nofs are the most common benign bone tumor in children. Two cases of multiple ossifying fibromas in the jaws tingting wang1, ran zhang2, lin wang1, yan chen2, qing dong1 and tiejun li2,3,4 abstract background.
This type of separation must be made with the aid of imaging studies, and should not be done by histology examination only. Case report open access two cases of multiple ossifying. Histopathologic differential diagnoses thorakkal shamim department of dentistry, government taluk head quarters hospital, nilambur, india peripheral ossifying fibroma is a benign neoplasm that. Surgery is an option for those that weaken the bone. The trabecular juvenile ossifying fibroma who type is a rare fibroosseous begnin injury with biologic aggressive behavior, and unknown etiology. A schedule of followup care should be determined by your childs physician. An ossifying fibroma can be one of two different types of tumor, or growth. Peripheral ossifying fibroma pof is a reactive gingival overgrowth which is relatively uncommon in nature. Nonossifying fibroma is a benign intracortical, multilocular and well circumscribed lesion that affects young patients. Cementoossifying fibroma is a benign neoplasm characterized by replacement of. The clinicopathologic characteristics of multiple ossifying fibroma of are unclear due to the conditions rarity, making diagnosis challenging. Gnas mutational analysis in differentiating fibrous.
Nonossifying fibroma usually no cortical ballooning or cortical erosion2 fibrous dysplasia usually at a central location without internal septations. Ossifying fibroma of is considered as a part of complex entity of tumors in the fibroosseous group of lesions which is essentially identical to lesions that have been designated as cementifying fibroma and cementoossifying fibroma cof. Occurs in most cases in patients aged below 15 years, and the maxilla is the most involved bone. It has been reported from birth to old age, but peaks in the teenage years.
The lesion was excised and histopathologic evaluation revealed a malignant osteoid producing lesion with areas of neoplastic chondroblastic activity. Lowgrade central osteosarcoma of the mandible clinically. Gnas mutational analysis in differentiating fibrous dysplasia. There are less than 30 reported cases, and a genetic profile has not yet been determined. Pofs comprises of, one or more mineralized tissues, including bone, cementum like material or dystrophic calcification, within a matrix of cellular fibroblastic tissue 2. It is aggressive, locally destructive, and has a high. Ossifying fibroma is an uncommon benign osteogenic neoplasm, and it is derived from the multipotential mesenchymal cells of the periodontal ligament.
Pdf central ossifying fibromas are benign fibro osseous neoplasms affecting the jaws and the craniofacial skeleton. The incidence of sporadic multiple ossifying fibroma was 2. They are noncancerous and do not spread to other areas of the body. Juvenile psammomatoid ossifying fibroma of the paranasal. Two cases of multiple ossifying fibromas in the jaws pdf. Surgical management of ossifying fibroma in maxilla. Children and adolescents are the most common group of age affected. However, certain authors have stated that peripheral ossifying fibroma is a variant of central ossifying fibroma and, therefore, a neoplastic process. The peak incidence of osteofibrous dysplasia occurs in the first decade of life and the lesions typically demonstrate more sclerosis2. The lesion had the histologic features of nonossifying fibroma metaphyseal fibrous defect. Pdf two cases of multiple ossifying fibromas in the jaws. The central type of ossifying fibroma arises from the endosteum or the periodontal ligament.
Ossifying fibroma of bone definition of ossifying fibroma. Today, however, the term cementoossifying fibroma is widely used because both osseous and cemental tissues are seen commonly in a single lesion. The spherules of cementumlike material often demonstrate peripheral brush borders that blend into the adjacent. Hyperparathyroidism jaw tumor syndrome head neck pathol 2014. Usually, of appears as a single, painless and slowgrowing lesion, mostly found in the posterior region of the mandible, specifically in the premolars and molars area 2, 3. Central ossifying fibroma of maxilla scholars middle east publishers.
An ossifying fibroma seldom originates in the frontal bone but more often involves the mandible or maxilla. Largely unknown for sporadic ossifying fibroma can rarely show syndromic inherited association. It has been distinguished from a larger group of ossifying fibromas on the basis of age of the patients, site of involvement and clinical behaviour. In this report, we present a case of sinonasal ossifying fibroma with fluidfluid levels and posterior extension toward the torus tubarius on mr images.
Sinonasal ossifying fibroma with fluidfluid levels on mr. Ossifying fibroma of is a benign, nonodontogenic tumor of the jaw, a type of. It is often considered to be a type of fibroosseous lesion. The lesion is considered part of an ossifying fibroma, but that. It was first described as relatively uncommon, solitary, nonneoplastic gingival growth by eversol and robin. Ossifying fibroma of is a benign and nonodontogenic. Trabecular type of juvenile ossifying fibroma a rare case. Ossifying fibromas are benign asymptomatic neoplasms of the maxillae that generally have slow growth and present proliferation of fibrous cell tissue, with a varying quantity of bone products that include bone, cement or a combination of these. He also suggested that the name peripheral ossifying fibroma should be retained for this lesion. Asymptomatic presentation of aggressive ossifying fibroma. Nonossifying fibroma is one of the skeletal dont touch lesions. Fibrous dysplasia and ossifying fibroma of the jaws are fibroosseous lesions with different clinical course and treatment strategies.
Aarthinisha sree balaji dental college and hospital, bharath university, chennai, india abstract. The to tal 18 sporadic multiform of cases were character ized as followed. Most of these fibromas heal spontaneously by the time the skeleton ceases to grow. Juvenile psammomatoid ossifying fibroma of the orbit and. They tend to persist or increase in size as the child grows but decrease in size or close once growth ends.
Cementoossifying fibroma more c, thakkar k, asrani m. Diagnostic pathology two cases of multiple ossifying fibromas in the jaws tingting wang 1 ran zhang 0 lin wang 1 yan chen 0 qing dong 1 tiejun li 0 2 3 0 department of oral pathology, peking university school and hospital of stomatology, 22 south zhongguancun avenue, haidian district, beijing 81, pr china 1 department of oral medicine, hebei united university, school and hospital of. This lesion occurs more often in females in the third and fourth decades of life. Cementoossifying fibroma of the jaw journal unair universitas. Juvenile psammomatoid ossifying fibroma jpof is an uncommon benign boneforming neoplasm in the craniofacial skeleton of juvenile patients and defined as a variant of ossifying fibroma of. Menzel first described the lesion ossifying fibroma in 1872 5, but its terminology was given by montgomery in 1927. More chandramani, thakkar krushna, mukesh asrani2011 cemento ossifying fibroma indian journal of dental research222 5. However, it is controversial whether it represents a true neoplasm or rather a developmental disorder of growing bone. The aim of this study was to assess and present the radiological morphology of the nonossifying fibroma nof, to describe the life span according to the ritschlstages in an effort to determine critical stages with regard to pathological fractures and discuss the need for a followup. It is rare in children in relation to primary dentition milk teeth and incidence declines after the age of 30 years. Ossifying fibroma definition of ossifying fibroma by.
Ossifying fibroma of is the most frequent of the three fibroosseous lesions of the jaws. Non ossifying fibroma risks, symptoms and leading causes. Non ossifying fibroma is one of the skeletal dont touch lesions. Cemento ossifying fibroma of the jaw dental jounal424 3.
Usually, of appears as a single, painless and slowgrowing lesion, mostly found in the posterior region of the mandible, specifically in the premolars and molars area. Diagnosis of jof is dependent on clinical, radiologic and pathologic correlation jof, of, fibrous dysplasia fd and osseous dysplasia may show significant histologic overlap particularly on small biopsies, however, clinical surgical management of these entities is markedly different. The term ossifying fibroma includes lesions with similar histological compositions and different forms of clinical behavior. Ossifying fibromas form a part of the spectrum of fibroosseous lesions of the jaws. In some cases it may be what is called a peripheral ossifying fibroma. Nonossifying fibroma musculoskeletal medicine for medical. Ossifying fibromas are benign bone lesions that should be differentiated from nonossifying fibromas and fibrous dysplasia. Cemento ossifying fibroma is a benign fibroosseous maxillary tumor belonging to the same category as fibrous dysplasia and cement ossifying dysplasia. First description of ossifying fibroma was given by menzel in 1872 while the term was given by montgomery in 1927.
Peracetic acidaldehyde fuschinmodified hami stain collagen appears green. This paper presents the case of a 40yearold female patient presented with minimal clinical symptoms, diagnosed to be suffering from aggressive form of ossifying fibroma of maxilla involving the maxillary sinus and. A dermatofibroma is a common overgrowth of the fibrous tissue situated in the dermis also known as. Mar 15, 20 fibrous dysplasia and ossifying fibroma of the jaws are fibroosseous lesions with different clinical course and treatment strategies. The aim of the present study was to determine the clinical and radiologic features of of at a tertiary hospital in south africa, assess its management.
The description of ossifying fibroma in the jaws british journal of. Multiple nonossifying fibromas as a cause of pathological. If large involving more than 50% of the diameter of the parent bone then prophylactic curettage and bone grafting may be prudent to avoid a pathological fracture 1. Pdf ossifying fibroma of is classified as, and behaves like, a benign bone neoplasm. They are rare, benign, nonaggressive tumors that are commonly seen in head and neck region. Two cases of multiple ossifying fibromas in the jaws diagnostic. Peripheral ossifying fibroma pof is usually a fibroma of the gingival which shows areas of calcification or ossification. Cementoossifying fibroma is a benign fibroosseous maxillary tumor belonging to the same category as fibrous dysplasia and cementossifying dysplasia. Peripheral ossifying fibroma, also known as ossifying fibrous epulis, is a gingival nodule which is composed of a cellular fibroblastic connective tissue stroma which is associated with the formation of randomly dispersed foci of mineralised products, which consists of bone, cementumlike tissue, or a dystrophic calcification. Helder rodrigues of department of pathology of chuc for his assistance. The case presented is an injury with corresponding to the characteristics described in the literature. The ossifying fibroma of is a benign neoplasm that affects the jaws. It is distinguished from the adult variant of ossifying fibroma on the basis of age, site, cilinical behaviour and. The cytomorphologic features were characteristic of lowgrade central osteosarcoma lgco.
When curvilinear trabeculae or spheroidal calcifications were encountered, the lesion was often referred to as cementifying fibroma. Prognosis for a nonossifying fibroma is generally good. Cemento ossifying fibroma is a benign, non odontogenic tumour of the jaw, a subdivision of. Retrospective analysis of ossifying fibroma of jaw bones over a. Peripheral ossifying fibroma is a fairly common lesion, representing % of all oral biopsies in most series. Aug 01, 2004 ossifying fibroma is a benign fibroosseous lesion that commonly involves the maxilla. Nofs are often discovered by chance when a patient requires xrays for another reason, such as a knee injury. Eversole fibro osseous lesions are a diverse group of processes that are characterized by. A juvenile active ossifying fibroma is a benign fibroosseous neoplasm composed of mixture of stroma and bone characterized by rapid and destructive growth.
Ossifying fibroma is a rare benign neoplasm that usually affects mandibular and maxillary bones. A nonossifying fibroma nof is one of the most common benign bone tumors found in 30 to 40% of children between 820 years of age. Juvenile ossifying fibroma jof is a rare controversial fibroosseous lesion affecting the craniofacial skeleton and occurring commonly in childrens and young adults. Skills and competencies a medical student should be able to recognize and describe the lesion radiographically as diagnosis on plain radiograph is the single essential skill needed to manage.
Histopathologic differential diagnoses thorakkal shamim department of dentistry, government taluk head quarters hospital, nilambur, india peripheral ossifying fibroma is a benign neoplasm that usually develops from gingiva, presenting as an. Ossifying fibroma of is considered as a part of complex entity of tumors in the fibroosseous group of lesions which is essentially identical to lesions that have been designated as cementifying fibroma and cemento ossifying fibroma cof. A definitive surgical protocol has not yet been published. Ossifying fibroma of is one of the most frequent of the 3 fibroosseous lesions of the jaws and has had an inconstant recurrence rate. These growths are most frequently seen in adolescents but they can occur at. Fibrous dysplasia and ossifying fibroma an advent in. Furthermore, it has not been clarified whether it is a subtype of type 1. Jaffecampanacci is a rare syndrome characterised by the association of cafeaulait spots, axillary freckles, multiple nonossifying fibromas of the long bones and jaw, as well as some features of type 1 neurofibromatosis. Due to its clinical and histopathological similarities, some pofs are believed to develop initially as a pyogenic granuloma that. Orthopaedic institute for children nonossifying fibroma. It is estimated that 30% to 40% of people under the age of 20 have an nof, although few will have any symptoms. This tumor has gone by several names in the past, but active ossifying fibroma is similar to juvenile active ossifying fibroma, except it does not develop in young patients. When the bone predominated, ossifying fibroma was assigned. It occurs mostly in patients between the age of 20 and 40 years.
It originates from the proliferation of fibrous tissue and histocytes. Cof is described by the world health organization who classification of odontogenic tumors to. Radiographically, the tumor presents as a well marginated radiolucent lesion, with a. We report a case of jpof involving the paranasal sinuses and orbit in a 15yearold boy that presented due to progressive proptosis and downward displacement of the left eye. Aug 10, 2011 juvenile psammomatoid ossifying fibroma jpof is an uncommon benign fibroosseous lesion predominantly arising in the paranasal sinuses and orbits of children and young adults. We describe a case of a young adult male with cementoossifying fibroma of paranasal sinus presenting acutely as. The most common location are the distal femoral and distal tibial methaphyses. Reports of a consecutive series of 87 patients with 103 nofs and a mean followup of 27 months were analysed.
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