Journal of Advanced Clinical and Research Insights

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Central ossifying fibroma-A unique case report
  JCRI
CASE REPORT
Central ossifying fibroma-A unique case report
Rashmi G. S. Phulari1, Kinjal Rajyaguru2, Dharmesh Vasavada2, Rajendrasinh Rathod2
1Department of Oral Pathology and Microbiology, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat India
2Department of Oral Pathology, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
Correspondence: Dr. Kinjal Rajyaguru, Department of Oral Pathology, Manubhai Patel Dental College and Hospital, Vishwajyoti Ashram, Nr Vidyakunj School, Munjmahuda, Vadodara - 390 011, Gujarat, India.E-mail: kinjalrajyaguru20@gmail.com
Received 11 December 2017;
Accepted 18 January 2017
doi: 10.15713/ins.jcri.196
 
ABSTRACT
Ossifying fibroma is an osseous neoplasm occurring mainly in younger individuals with a predisposition for mandible and females are mainly affected. The tumor is not symptomatic until the expansion produces an observable swelling and little impairment. Depending on the stage of development it presents an exceedingly variable roentgenographic appearance. This neoplasm is comprised mainly of greater amount of intertwining collagen fibers, rarely organized in discrete bundles, intermixed with large amount of proliferating fibroblasts. The tumor should be removed conservatively.
Keywords:Fibro-osseous,maxilla,ossifying fibroma
How to cite this article: Phulari RGS, Rajyaguru K, VasavadaD, Rathod R. Central ossifying fibroma-A unique case report.J Adv Clin Res Insights 2018;5:9-11.
 
 

Introduction

Central ossifying fibroma (Central OF) is a benign osseous tumor made up of remarkably cellular and fibrous tissue with wavering amount of calcified tissue, which appears such as bone, cementum, or both.[1] It is thought that Central OF is derived from periodontal membrane.[2] Patients of the third and fourth decade are mostly affected, and it usually shows a female domination.[3] Mandible is greatly affected than maxilla, and very few case reports are there in the literature. Mandibular posterior area is the common site to get involved. Small lesions rarely cause any symptoms and only detected on radiographic examination whereas larger tumors present painless swelling of the involved bone; causing obvious facial asymmetry.[4] Central OF is treated by conservative surgical excision through the use of curettage, enucleation, or excision and has a good prognosis.[5]

Case Report

A 16-year-old female patient reported to the Outpatient Department of Manubhai Patel Dental College and Hospital and Oral Research Institute. The patient had complaint of swelling on the right side of the upper vestibule, which progressively increased in size within 6 months. The patient had no other medical history. On examination, on the right side of the maxillary vestibule, an intraoral swelling was present extending from maxillary lateral incisor to first premolar antero-posteriorly.

 
It was 7.0 cm × 5.0 cm in size and ovoid in shape. The teeth associated with the lesion were free of any carious lesion and periodontal problems. No facial asymmetry was present. On inspection of the lesion, the overlying skin was normal. The swelling was firm and non-tender on palpation [Figure 1] Regional lymph nodes on the right side were nonpalpable and non-tender. Hematological investigations were within the normal limits.

Intraoral Periapical Radiograph showed diffuse radiolucency in relation to maxillary canine and premolars. Occlusal radiograph showed radiolucency involving apical regions of maxillary right central incisor to canine region [Figure 2a and b]. Orthopantogram showed diffuse radiolucency involving distal surface of root of maxillary right lateral incisor to mesial surface of the root of second premolar [Figure 3]. A wide excision of lesion was done under local anesthesia with vasoconstrictor. Excised specimen was received for histopathological examination. On gross examination, the specimen was not encapsulated and was received in the form of bits. The consistency was firm and the surface was rough. The cutsurface was smooth and homogenous [Figure 4a and b].

Histopathologically, the lesion showed dense connective tissue stroma, which contained areas of immature bone formation and cementum-like tissue. The stroma was highly cellular with numerous plump fibroblasts in the background of haphazardly arranged collagen fibers. Thus, the diagnosis of COF was given [Figures 5 and 6].

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Rashmi G. S. Phulari, et al. Central ossifying fibroma

Central ossifying fibroma-A unique case report
Figure 1: Intraoral swelling of right maxilla

Central ossifying fibroma-A unique case report
Figure 2: (a) Intraoral periapical radiograph of the involved region.(b) Occlusal radiograph of the maxillary arch

Central ossifying fibroma-A unique case report
Figure 3: Orthopantomogram showing ill-defined radiolucencydistal to canine

Discussion

Recently, the World Health Organization in the classificationof odontogenic tumors has replaced the previous edition's"cemento-OF" (COF) with "OF." Brannon and Fowler initiatedto use the terminology of OF instead of COF, and it wascontinued by Reichart and Philipsen.[6,7] Fibro-osseous lesionsof head and neck are rare and occur because of the introductionof fibrous tissue in the normal bone replacing the osseoustissue, which, mineralize in different structures such as wovenbone, lamellar bone, or cementum, and comprise an extensivespectrum of specific entities with unique clinical appearance andhistopathological features.[8]

 
Central ossifying fibroma-A unique case report
Figure 4: (a) Grossing of the specimen showing multiple bitsof tissue. (b) Largest bit cut into slices showing smooth andhomogenous inner surface

Central ossifying fibroma-A unique case report
Figure 5: Histopathology of the lesion showing immature boneformation and cementum like tissue (H & E stain - ×40)

Central ossifying fibroma-A unique case report
Figure 6: Loose connective tissue stroma showing immature bone

Differential diagnosis of Central OF leans on theroentgenographic features of the lesion. COF with a completelyradiolucent lesion may be misinterpreted as an early stage ofcemento-osseous dysplasia, odontogenic cyst, periapical granuloma,traumatic bone cyst, ameloblastoma, or central giant cell granuloma.

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Rashmi G. S. Phulari, et al. Central ossifying fibroma

COF with mixed roentgenographic features may get misdiagnosedas a calcifying odontogenic cyst (Gorlin cyst) or an adenomatoidodontogenic tumor.[9] Moreover, COF with completely radioopaqueroentgenographic features may be misinterpreted as retained root,odontoma, idiopathic osteosclerosis, condensing osteitis, latestage of cemento-osseous dysplasia, or osteoblastoma. COF with agreater content may be misinterpreted as an osteogenic sarcoma.[9]Radiographically, early lesions may show radiolucency, but as theymature, they become a mixed radiolucent and radioopaque lesionand ultimately become radioopaque.

Histopathologically, the lesion is composed mainly of a greateramount of fine interlacing collagen fibers, rarely arranged in discretebundles. These fibers are intermixed with many active, proliferatingfibroblasts. Although mitotic figures may be present in less numbers,rarely any noticeable cellular pleomorphism is observed. The stromaindistinctively shows many small foci of irregular bony trabeculaewhich may carry some resemblance to the bizarre Chinese-characterpattern of the bony trabeculae in fibrous dysplasia of bone.[10]

Many authors advocate complete excision of the lesion atthe earliest.[11] Eversole et al. reported a recurrence rate of 28%following curettage.[12] Hence, the follow-up of the patients forlonger duration is advised.

References
  1. Liu Y, You M, Wang H, Yang Z, Miao J, Shimizutani K,et al. Ossifying fibromas of the jaw bone: A study of 20 cases.Dentomaxillofac Radiol 2010;39:57-63.
  2. Sarwar HG, Jindal MK, Ahmad SS. Cemento-ossifying fibroma-arare case. J Indian Soc Pedod Prev Dent 2008;26:128- 31.

 
  1. Eversole LR, Leider AS, Nelson K. Ossifying fibroma:A clinicopathologic study of sixty-four cases. Oral Surg OralMed Oral Pathol 1985;60:505-11.
  2. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral andMaxillofacial Pathology. 3rd ed. St. Louis: W. B. Saunders;2009.
  3. Kumar A, Gupta DS, Jurel SK, Khanna R, Yadav M. Extensiveossifying fibroma of jaw. Natl J Maxillofac Surg 2014;5:224-7.
  4. MacDonald-Jankowski DS. Ossifying fibroma: A systematicreview. Dentomaxillofac Radiol 2009;38:495-513.
  5. Reichart PA, Philipsen HP, Sciubba JJ. The new classificationof head and neck tumours (WHO)-any changes? Oral Oncol2006;42:757-8.
  6. Waldron CA. Fibro-osseous lesions of the jaws. J Oral MaxillofacSurg 1993;51:828-35.
  7. Chang CC, Hung HY, Chang JY, Yu CH, Wang YP, Liu BY,et al. Central ossifying fibroma: A clinicopathologic study of28 cases. J Formos Med Assoc 2008;107:288-94.
  8. Rajendran A, Sivapathasundharam B. Shafer's Textbook of OralPathology. 7th ed. New Delhi: Elsevier; 2012.
  9. Koury ME, Regezi JA, Perrott DH, Kaban LB. Atypical fibroosseouslesions: Diagnostic challenges and treatment concepts.Int J Oral Maxillofac Surg 1995;24:162-9.
  10. Eversole LR, Leider AS, Nelson K. Ossifying fibroma: aclinicopathologic study of sixty-four cases. Oral Surg Oral MedOral Pathol 1985;60:505-11.

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