|Year : 2008 | Volume
| Issue : 2 | Page : 54-56
Peripheral ossifying fibroma
Vaishali Keluskar, Raghavendra Byakodi, Nishit Shah
Department of Oral Medicine and Radiology, KLES's Institute of Dental Sciences, Nehrunagar, Belgaum- 590 010, India
Dept. of Oral Medicine and Radiology, K.L.E.S's Institute of Dental Sciences, Nehrunagar, Belgaum- 590010
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Here we report an unusual case of peripheral ossifying fibroma in a 57-year-old woman, who reported to the KLES Institute of Dental Sciences, Belgaum. Clinically, the lesion appeared as a nodular swelling on the gingiva. Though the possibility exists that the lesion is reactive, it appears to be true neoplastic growth and a purely soft tissue process arising from the gingiva. Thus, we proposed the term peripheral ossifying fibroma for this distinct lesion.
Keywords: Fibroma, ossifying fibroma, peripheral ossifying fibroma
|How to cite this article:|
Keluskar V, Byakodi R, Shah N. Peripheral ossifying fibroma. J Indian Acad Oral Med Radiol 2008;20:54-6
| Introduction|| |
There are two types of ossifying fibroma, the central type and the peripheral type. The central type arises from the endosteum or the periodontal ligament adjacent to the root apex and causes expansion of medullary cavity. The peripheral type occurs solely on the soft tissues covering the tooth bearing areas of the jaws. The main etiological factor for ossifying fibroma is local irritants like trauma or tobacco chewing etc. 
The peripheral ossifying fibroma occurs exclusively on the gingiva. The pathogenesis of this lesion is uncertain because of the clinical and histopathological similarities. There is considerable confusion over the nomenclature. Various other names suggested are calcifying fibroid epulis and osseous epulis. 
Peripheral ossifying fibroma appears as a nodular mass, either pedunculated or sessile. The color ranges from red to pink and the surface is frequently but not always ulcerated. It is more commonly seen in 1 st and 2 nd decade of life and has a female preponderance. There is a slight predilection for the maxillary arch and in the incisor cuspid region. 
| Case Report|| |
A 57-year-old female patient reported to the out patient department of KLES's Institute of Dental Sciences, Belgaum with a chief complaint of a painless mass on the gingiva that had grown to its present size over a period of 2 months [Figure 1]. There was no history of trauma and no history of ulceration.
Clinical examination of the oral cavity revealed a nodular mass on the gingiva in relation to the right canine and premolars [Figure 2] and [Figure 3]. The mass was dome shaped and overlying mucosa was normal in appearance. It appeared to be freely movable from the underlying bone.
On palpation the inspectory findings were confirmed. The mass was sessile and not fixed to the underlying bone. Radiographic examination (Intraoral periapical, Occlusal and Orthopantomograph) revealed a mixed radiolucent and radioopaque lesion [Figure 4],[Figure 5],[Figure 6] with a rim of peripheral radiolucency. Routine haemogram was done. A provisional diagnosis of peripheral ossifying fibroma was given.
The patient was then subjected to excisional biopsy under local anaesthesia and the excised uncapsulated tumor mass [Figure 7] was sent for histopathological examination.
The specimen consisted of a nodular mass of soft tissue measuring about 2 cm x 1.5 cm in size containing calcified tissues. Radiograph of the resected specimen revealed a dense radioopacity [Figure 8] within the lesion.
Histopathological examination revealed a well encapsulated tumor of cellular fibrous tissue covered by atrophic epithelium i.e., stratified squamous epithelium, the fibrous component was cellular with fibroblasts arranged in whorled pattern under low power [Figure 5]. High power revealed ulcerated epithelium with haematoxyphillic masses, which proves the presence of cementum like material [Figure 6]. The collagen fibers were delicate and febrile in nature although some forms of collagen bundles were noted.
Thus, the final diagnosis of peripheral ossifying fibroma was confirmed.
| Discussion|| |
Gingiva is often the site of localized growths that are considered to be reactive rather than neoplastic in nature. 
The fibrous lesions of the gingiva with or without calcifications have been documented in literature under a variety of terms like fibrous epulis, fibroepithelial polyp, calcifying fibroblastic granuloma, peripheral fibroma with or without calcification, peripheral odontogenic fibroma with cementogenesis, peripheral ossifying fibroma and ossifying fibrous epulis. , Most of these lesions are reactive chronic inflammatory hyperplasias with minor trauma and chronic irritation being the etiological factors. All these lesions have a similar clinical appearance that is a sessile or pedunculated nodule located on the interdental papilla. ,
It was first described in 1844. Bhasker et al. termed this as peripheral fibroma with calcification.  Arnott later described two lesions microscopically and gave the diagnosis of ossifying fibroma.
The term peripheral ossifying fibroma was coined by Eversol and Robin.  It is a localized growth on the gingiva with a pedunculated or a sessile base. This reactive proliferative lesion is so named because it presents clinically as a solid, firmly attached gingival mass. It is slow growing and asymptomatic.  This is not true in our case as the lesion was fast growing and attained a size of 2 cm x 1.5 cm within a span of 2 months. Studies have revealed that the size of these lesions varied from .1-1 cm in diameter and very few lesions were larger than 2 cm in diameter. This is most common in adolescents and young adults.
In the present case, it is reported in older age group and there are only 0.5% cases reported in older age group.  There is predilection for anterior maxilla as seen in our case. , The surface is frequently but not always ulcerated. Ulceration was not noted in the present case. According to Mulcahy and Dahl and Cundff there is a high prevalence of ulceration i.e., 62% and 65% and low prevalence of 22.5% to 36%. , Among the patients with ulcerated lesions the male: female ratio was equal in the 2 nd decade and in all other decades females predominated. 
Radiographic appearance of peripheral ossifying fibroma shows radioopaque flecks or patches. It frequently causes separation of the adjacent teeth and occasionally resorption of the adjacent teeth.  The present case revealed a mixed radioopaque and radiolucent lesion with a rim of radiolucent periphery. Treatment for these lesions is complete surgical excision as was done in the present case. Proper excision and aggressive curettage of the adjacent tissues is required for prevention of recurrence. , Recurrence rate is approximately 16%.  As it can be misdiagnosed as pyogenic granuloma, peripheral giant cell granuloma or odontogenic tumors, histopathological examination is essential for accurate diagnosis. 
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]