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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 30  |  Issue : 3  |  Page : 315-317

Central ossifying fibroma in old female: A case report and review of literature


1 Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Cairo University, Cairo, Egypt
2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hodeida University, Hodeida, Yemen

Date of Submission06-Jul-2018
Date of Acceptance10-Sep-2018
Date of Web Publication18-Oct-2018

Correspondence Address:
Dr. Hanaa Hezam Algadi
Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Cairo University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_116_18

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   Abstract 


Central ossifying fibroma is a benign, non-odontogenic tumor of the jaw, a type of fibro-osseous lesion characterized by slow growth and proliferation of fibrous cellular tissue, bone, cement, or a combination. This lesion tends to occur in the second to fourth decades of life, with predilection for women and for the mandibular premolar and molar areas. The following article reports a case of a 49-year-old female patient, who presented with large ossifying fibroma in the mandible and brief literature review of these uncommon lesions is also conducted.

Keywords: Cone beam computed tomography, fibro-osseous lesions, ossifying fibroma


How to cite this article:
Algadi HH, Alqasi WM, Jamali OM. Central ossifying fibroma in old female: A case report and review of literature. J Indian Acad Oral Med Radiol 2018;30:315-7

How to cite this URL:
Algadi HH, Alqasi WM, Jamali OM. Central ossifying fibroma in old female: A case report and review of literature. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2019 Mar 19];30:315-7. Available from: http://www.jiaomr.in/text.asp?2018/30/3/315/243648




   Introduction Top


Central ossifying fibroma (COF) is a benign fibro-osseous lesion that demonstrates a well-demarcated proliferation of cellular fibrous tissue with osseous products that include bone and cementum-like material.[1] This lesion tends to occur in the second to fourth decades of life, commonly found in females than in males, and has a predilection for mandible than maxilla.[2],[3],[4]

COF clinically presented as a painless slowly growing jawbone mass. Radiological COF demonstrates either completely radiolucent or a mixture of radiolucent and radiopaque appearance (according to the presence of cementum or bone).[2],[5] Most COF can be treated by conservative surgical enucleation, curettage, or excision with good prognosis.[4],[6]

The aim was to report on a case of COF in old female, with a brief discussion on its literature.


   Case Report Top


A 49-year-old female patient came to the outpatient department of the Faculty of Dentistry-Cairo University with complaining of an asymptomatic swelling in the vestibular region of the anterior mandible gradually increasing in size since 8 months. The past medical, dental histories, and family history were not contributory. On intraoral examination, the swelling was bony hard in consistency, obliteration of labial vestibule in anterior mandibular region was also noted, and the overlying mucosa was normal without any ulceration or discoloration. The vitality of teeth within affected area was normal. In addition, no lymphadenopathy was found on the extraoral examination.

Laboratory investigation including complete hemogram, serum calcium, serum phosphorus, serum alkaline phosphatase, and creatinine were suggestive of no abnormalities.

Cone beam computed tomography (CBCT) revealed a mixed radiopaque and radiolucent lesion with irregular expansion of buccal and lingual cortical plates, a well-circumscribed border, and a diameter of approximately 8 cm extended from the right lower canine to the left first molar region and superiorly from middle third of the root of 31 and 32 to inferiorly up to the superior band of inferior border of mandible [Figure 1]a and [Figure 1]b. These findings led to a radiographic diagnosis of COF.
Figure 1: Cone beam computed tomography scans: (a) Axial slice (b) Sagittal slice: Shows well-defined mixed radiopaque-radiolucent lesion in mandible

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Patient posted for surgery and the excision of lesion done and sent for histopathological examination. Grossly, we received soft and hard tissue mass measuring of 6 cm diameter. Representative area were sectioned and processed for microscopic examination.

Microscopy

Histopathological examination of H and E stained sections confirmed the diagnosis by revealed irregular osteoid rimmed by osteoblasts in a highly cellular fibroblastic stroma with small calcifications [Figure 2].
Figure 2: Histopathologic appearance of a central ossifying fibroma shows irregular osteoid rimmed by osteoblasts in a highly cellular fibroblastic stroma with small calcifications (H and E, ×100)

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   Discussion Top


The etiology and pathogenesis of ossifying fibroma are yet not clear, but odontogenic, developmental, and traumatic origins have been suggested and thought to be of periodontal ligament origin because of their capacity to produce cementum and osteoid material.[7]

Clinically, the COF presents as a painless, slowly growing mass in the jaw and because of the slow growth, the cortical plates of the bone and the overlying mucosa or skin are invariably intact, the first clinical manifestation being a swelling of the buccal cortical layer, which may produces a marked extraoral facial asymmetry.[2],[8] Small lesions are often discovered incidentally. In our case, the swelling was painless and caused noticeable facial swelling which similar clinical features to those of previously reported cases.[8]

COF is more common in females.[3],[6],[9] They occur predominantly between second to fourth decades of life.[3],[6],[10] The premolar and molar regions of the mandible are the most common sites[3],[6] Their growth is relatively slow.[6] Mobility and root resorption and root divergence can be found.[3],[5],[6] However, according to other authors, divergences and resorption of the roots are uncommon findings.[11],[12] In our case, we found similar features with the patient being a female presenting with a painless swelling in the mandible. Although swelling was present, there was no root resorption or divergence.

Computed tomography and CBCT help in differentiating this lesion from other fibro-osseous lesions. The lesions may be either unilocular or multilocular.[2],[4],[13] In most cases, the lesions are radiolucent with radiopaque foci, depending on the quantity of tissue calcification, which gives rise to varying degrees of radiopacity.[2],[11] The imaging features in the present case were similar to those of most reported cases, showing a circumscribed radiolucent lesion with well-defined margins and intralesional calcification.[8],[14],[15]

Histopathological COFs show a pattern with small irregular osteoid trabeculae that are typically rimmed by osteoblasts, proliferation of irregularly shaped calcifications within a hypercellular fibrous connective tissue stroma. The calcifications are extremely variable in appearance and represent various stages of bone and cementum deposition.[7],[16] Additional biochemical studies such as ultrastructural studies and polarized studies have been utilized for differentiating between cementum-like material and bone in these lesions with no definite results.[16]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hamner JE 3rd, Scofield HH, Cornyn J. Benign fibro-osseous jaw lesions of periodontal membrane origin. An analysis of 249 cases. Cancer 1968;22:861-78.  Back to cited text no. 1
    
2.
Liu Y, Wang H, You M, Yang Z, Miao J, Shimizutani K, et al. Ossifying fibromas of the jaw bone: 20 cases. Dentomaxillofac Radiol 2010;39:57-63.  Back to cited text no. 2
    
3.
Eversole LR, Leider AS, Nelson K. Ossifying fibroma: A clinicopathologic study of sixty-four cases. Oral Surg Oral Med Oral Pathol 1985;60:505-11.  Back to cited text no. 3
    
4.
Tchane IB, Adjibabi W, Biaou O, Alamou S, Balle M, Alao N, et al. Cemento-ossifing fibroma: Two cases. Rev Stomatol Chir Maxillofac 2005;106:30-2.  Back to cited text no. 4
    
5.
Eversole LR, Merrell PW, Strub D. Radiographic characteristics of central ossifying fibroma. Oral Surg Oral Med Oral Pathol 1985;59:522-7.  Back to cited text no. 5
    
6.
Sciubba JJ, Younai F. Ossifying fibroma of the mandible and maxilla: Review of 18 cases. J Oral Pathol Med 1989;18:315-21.  Back to cited text no. 6
    
7.
Carvalho B, Pontes M, Garcia H, Linhares P, Vaz R. Ossifying Fibromas of the Craniofacial Skeleton, Histopathology Enrique Poblet, IntechOpen. Available from: https://www.intechopen.com/books/histopathology-reviews-and-recent-advances/ossifying-fibromas-of-the-craniofacial-skeleton. [Last accessed on 2018 Jun 25].  Back to cited text no. 7
    
8.
Chang CC, Hung HY, Chang JY, Yu CH, Wang YP, Liu BY, et al. Central ossifying fibroma: A clinicopathologic study of 28 cases. J Formos Med Assoc 2008;107:288-94.  Back to cited text no. 8
    
9.
Martín-Granizo R, Sanchez-Cuellar A, Falahat F. Cemento-ossifying fibroma of the upper gingivae. Otolaryngol Head Neck Surg 2000;122:775.  Back to cited text no. 9
    
10.
Zachariades N, Vairaktaris E, Papanicolaou S, Triantafyllou D, Papavassiliou D, Mezitis M, et al. Ossifying fibroma of the jaws. Review of the literature and report of 16 cases. Int J Oral Surg 1984;13:1-6.  Back to cited text no. 10
    
11.
Gurol M, Uckan S, Guler N, Yatmaz PI. Surgical and reconstructive treatment of a large ossifying fibroma of the mandible in a retrognathic patient. J Oral Maxillofac Surg 2001;59:1097-100.  Back to cited text no. 11
    
12.
da Silveira DT, Cardoso FO, E Silva BJ, E Alves Cardoso CA, Manzi FR. Ossifying fibroma: Report on a clinical case, with the imaging and histopathological diagnosis made and treatment administered. Rev Bras Ortop 2016;51:100-4.  Back to cited text no. 12
    
13.
Fujimoto Y, Katoh M, Miyata M, Kawai T, Saito K, Morita M, et al. Cystic cemento-ossifying fibroma of the ethmoidal cells (a case report). J Laryngol Otol 1987;101:946-52.  Back to cited text no. 13
    
14.
Ribeiro AC, Carlos R, Díaz KP, Gouvêa AF, Vargas PA. Bilateral central ossifying fibroma affecting the mandible: Report of an uncommon case and critical review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:e21-6.  Back to cited text no. 14
    
15.
Dominguete MH, Dominguette AA, Matos BH, Dominguete PR, León JE, Oliveira LR, et al. Extensive presentation of central ossifying fibroma treated with conservative surgical excision. Case Rep Dent 2014;2014:204258.  Back to cited text no. 15
    
16.
Ojo MA, Omoregie OF, Altini M, Coleman H. A clinico-pathologic review of 56 cases of ossifying fibroma of the jaws with emphasis on the histomorphologic variations. Niger J Clin Pract 2014;17:619-23.  Back to cited text no. 16
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  [Figure 1], [Figure 2]



 

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