It was first described as relatively uncommon, solitary, nonneoplastic gingival growth by eversol and robin. It is difficult to differentiate the calcified tissue within the lesion between bone and cementum. Both the trabecular and the psammomatoid juvenile cemento ossifying fibromas cofs are specific entities among the cofs being distinguished because of. More chandramani, thakkar krushna, mukesh asrani2011 cemento ossifying fibroma indian journal of dental research222 5. The hybrid name of central cemento ossifying fibroma is used because there is a spectrum of fibro osseous lesion, that arises from the periodontal ligament, varying from those only with cementum to those with only deposition of bone.
Ossifying fibroma of is a benign, nonodontogenic tumor of the jaw, a type of fibroosseous lesion. This article reports a case of ossifying fibroma of the mandible. Central cemento ossifying fibroma is a fibroosseous lesion causing slow expansion of the involved bone and is usually manifested after attaining significant growth. Ossifying fibromas form a part of the spectrum of fibroosseous lesions of the jaws. Cementoossifying fibroma of the mandible request pdf. However, in most cases both features are present, warranting the generic term cemento ossifying fibromas 1. Ossifying fibroma is an uncommon benign osteogenic neoplasm, and it is derived from the multipotential mesenchymal cells of the periodontal ligament. Peripheral ossifying fibroma a clinical and histological. Juvenile ossifying fibroma of the mandible journal of oral. Cemento ossifying fibroma was initially classified by the world health organization who as a fibroosseous neoplasm.
This condition should be differentiated from nonossifying fibroma and fibrous dysplasia of bone. They most often arise from the tooth bearing areas of these bones. Ossifying fibroma is commonly seen between third and fourth decade of life. Cementoossifying fibroma more c, thakkar k, asrani m. 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. 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. Lowgrade osteosarcoma arising from cementoossifying fibroma. Cof occurs more commonly in the females than males. The radiographic examination revealed radiolucency with scattered. Intraoral ossifying fibromas have been described in the literature since the late 1940s. The juvenile ossifying fibroma jof is a rare benign tumor 1, and it.
Nonossifying fibromas nofs are the most common benign bone tumor in children. Occasionally, they are identified in children, in which case they are a more aggressive variant and are known as juvenile aggressive cemento ossifying fibromas discussed separately 3,5. Cementoossifying fibroma cof are rare, benign neoplasms that usually arise from the mandible or maxilla. Cemento ossifying fibroma cof is a nonneoplastic but locally destructive tumor of unknown etiology consisting of fibrous tissue and varying amounts of mineralized material. We report a case of cementoossifying fibroma that presented as a large extraosseous mass in the masticator and parapharyngeal space.
Peripheral cemento ossifying fibroma is a gingival lesion of reactive nature and unknown etiology. Cementoossifying fibroma of the mandible case report. Ossifying fibromas are benign bone lesions that should be differentiated from non ossifying fibromas and fibrous dysplasia. Central cemento ossifying fibroma behaves like, a benign bone neoplasm. Cdc73 gene mutations in sporadic ossifying fibroma of the jaws. Osteofibrous dysplasia is considered as a separate pathological entity in view of its different presentation and treatment, although histopathologically similar to ossifying fibroma. A 72yearold patient was referred for a subclinical lesion of the mandible.
The orthopantomogram showed a wellcircumscribed radiolucent osteolytic image, 1 cm in. Psammomatoid juvenile cementoossifying fibroma of the. Today, however, the term cemento ossifying fibroma is widely used because both osseous and cemental tissues are seen commonly in a single lesion. Oct 01, 2015 juvenile ossifying fibroma jof is rare, benign tumor of the craniofacial skull and face bones. Juvenile ossifying fibroma journal of pathology and translational. Majority of the lesions are found in the posterior region of the mandible. Cemento ossifying fibroma cof is a distinct form of a benign fibroosseous tumor, affecting predominantly the craniofacial region. Two cases of multiple ossifying fibromas in the jaws. Fibrous dysplasia is first diagnosed in infancy and. Fibroosseous lesion other than fibrous dysplasia seems to arise from the periodontal membrane.
The tumor caused displacement of first right premolar with disappearing of its lamina dura. Central lesion of bone with variable fibrous proliferation of round, polyhedral or spindly cells and calcifications. Cemento ossifying fibroma of the jaw dental jounal424 3. It is considered a fibroosseous neoplasm because it is characterized by an overgrowth of bone.
Surgical management of ossifying fibroma in maxilla. Lesions histologically similar to peripheral ossifying fibroma have been given various names in existing literature. Cemento ossifying fibroma is an unusual benign nonodontogenic fibroosseous tumor that is limited to the jaws and facial bones. A weberfeguson incision was used to expose the lesion, which was excised. They are rare, benign, nonaggressive tumors that are commonly seen in head and neck region. She gave history of sudden onset, with lancinating type of pain which is severe in nature. Cemento ossifying fibroma is a benign growth, considered to originate from the periodontal ligament. Such a lesion can either interfere with normal tooth eruption or become a factor in plaque development, which usually results in caries formation in newly erupted teeth.
Here we present a case of 18year old female having slow growing painless swelling on left side of mandible over 2year period. A case report of cementoossifying fibroma springerlink. Eversole fibro osseous lesions are a diverse group of processes that are characterized by. 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. Florid cemento osseous dysplasia mixed fibrous dysplasia mixed cementoossifying fibroma 2nd stage paget disease mixed osteogenic sarcoma mixed chondrosarcoma mixed metastatic tumors mixed osteoradionecrosis mixed. Osteofibrous dysplasia is a rare, benign nonneoplastic condition with no known cause. The orthopantomogram showed a wellcircumscribed radiolucent osteolytic image, 1 cm in diameter, on the mandibular angle.
The cemento ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion regarding terminology and the criteria for its diagnosis. Juvenile ossifying fibroma genetic and rare diseases. It is derived from cells of the periodontal ligament and is usually classified as a reactive hyperplasia but sometimes as a benign neoplasm. Peripheral cemento ossifying fibroma a case report with. Sporadic multiple ofs must be distinguished from hyperparathyroidismjaw tumour syndrome hptjt related of and other fibroosseous lesions. Psammomatoid active ossifying fibroma cementifying or cemento ossifying fibroma is a variant that typically occurs in the sinonasal tract and may behave aggressively, with locally invasive and destructive capabilities. It therefore involves exclusively the maxillofacial bones. The cemento ossifying fibroma is odontogenic in origin where as ossifying fibroma of bony origin.
Extensive presentation of central ossifying fibroma. Cemento ossifying fibroma is a benign fibroosseous tumor. Cementoossifying fibroma of the mandible sciencedirect. Histopathological examination showed the presence of a benign bone lesion suggestive of ossifying fibroma. In most cases, no treatment is necessary because nofs typically go away on their own when a child is fully grown.
Head and neck ossifying fibroma of is a rare, benign, locally aggressive, fibroosseous tumor. Giant cementoossifying fibroma of the maxilla causing. Alamou s, balle m, alao n, cementoossifying fibroma two cases. Cemento ossifying fibroma is a rare benign tumor most often discovered incidentally. Cementoossifying fibroma radiology reference article. Despite the similarities in clinical, radiographic and. Cemento ossifying fibroma of mandible a case report. Psammomatoid ossifying fibroma pof is characterized histologically by numerous small round ossicles resembling psammoma bodies and is a locally invasive lesion of facial and cranial bones. They do not become cancerous and they do not spread metastasize. Cemento ossifying fibroma is a benign fibroosseous maxillary tumor belonging to the same category as fibrous dysplasia and cement ossifying dysplasia. The lesion was welldefined, and some areas of cystic degeneration were encountered.
It is most commonly seen between the third and fourth decades of life 26, and is more frequent in women than in. An aged mongrel dog was admitted for hemimandibulectomy as treatment for a mandibular mass that had been diagnosed as osteosarcoma. Peripheral ossifying fibroma is a reactive lesion and peripheral odontogenic fibroma is an extraosseous variant of central odontogenic fibroma. Pofs comprises of, one or more mineralized tissues, including bone, cementum like material or dystrophic calcification, within a matrix of cellular fibroblastic tissue 2.
The lesion, termed as cemento ossifying fibroma, has been regarded as an osteogenic neoplasm. Osseous dysplasia and fibrous dysplasia are reactive lesions while ossifying fibroma is a true neoplasm. Central cementoossifying fibroma is a fibroosseous lesion causing slow expansion of the involved bone and is usually manifested after attaining significant growth. Department of pathology, burdwan medical college, india. Ct scanning and mr imaging showed a large extraosseous mass with central conglomerated, wellmatured ossified nodules and fatty marrow. 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. These are slow growing, painless lesions which are seen more commonly in women between the third and fourth decades of life. Case report juvenile aggressive ossifying fibroma of the. Cemento ossifying fibroma cof is considered a benign osseous tumour, very closely.
It is aggressive, locally destructive, and has a high. Cemento ossifying fibroma is a slowgrowing lesion most. Surgical enucleation with curettage of the lesion of the patient mentioned in this case report. It is almost unavoidable that diagnosis of fibrous dysplasia from cof will be complicated by the fact that some pathologic. Fibrous dysplasia, osseous dysplasia and ossifying fibroma compose the group of fibroosseous lesions. What is peripheral ossifying fibroma peripheral ossifying fibroma is a benign swelling of the gum, most commonly seen in teenagers and young adults. 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. Clinicopathological characteristics and prognosis of ossifying. Cementoossifying fibroma cof is a benign fibroosseous lesion which belongs to same category as fibrous dysplasia and cement ossifying dysplasia. When the bone predominated, ossifying fibroma was assigned. It is arises from periodontal membrane which contains multipotential cells that are capable of forming cementum, lamellar bone.
The cemento ossifying fibroma is odontogenic in origin, whereas ossifying fibroma is of bony origin. The fibrous dysplasia in which the normal bone structure is. Cementoossifying fibromas are benign tumors, and, although cases of an aggressive type have been reported, no cases of cementoossifying fibroma. Cementifying fibroma definition of cementifying fibroma by medical dictionary s. Cemento ossifying fibroma of mandible 2 introduction ossifying fibroma is a benign fibroosseous neoplasm uncommon lesion rarely seen in the jaws and craniofacial bones of head and neck region. Non ossifying fibroma description non ossifying fibroma is a cortically based benign lesion of bone wherein the normal bone has failed to form during skeletal growth and the area instead contains fibrous tissue. Cementoossifying fibroma radiology cytology histopathology. Terminology in the 2005 who histological classification of odontogeni. It comprises fibrous tissue containing a variable quantity of mineralized material resembling bone andor cement, whence the term cementoossifying.
The average diameter at the time of first radiological examination has been given as 1. Bilateral cemento ossifying fibroma of maxillary sinus. Cemento ossifying fibroma cof are rare, benign neoplasms that usually arise from the mandible or maxilla. Fibrous dysplasia and ossifying fibroma an advent in. When curvilinear trabeculae or spheroidal calcifications were encountered, the lesion was often referred to as cementifying fibroma. Sometimes, the classic clinical, radiologic or pathologic features of fibrous dysplasia or ossifying fibroma may not be evident, but overlapping features of both may be seen. 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. It is a bony tumour of the maxilla of possibly odontogenic origin with aggressive behavior and high tendency for recurrence. Jan 14, 20 the cemento ossifying fibroma is odontogenic in origin, whereas ossifying fibroma is of bony origin. Peripheral ossifying fibroma pof is a gingival nodule composed of a cellular fibroblastic connective tissue stroma associated with the formation of randomly dispersed foci of a mineralized product consisting of either bone woven and lamellar. Aggressive psammomatoid ossifying fibroma is still employed by some, but is to be discouraged.
The fibroosseous mass that surrounded the first molar tooth and replaced alveolar and cortical bone was reclassified as ossifying fibroma on the basis of anatomic location and histologic features. Ossifying fibroma in the jaws is a benign tumor and easily recurs in children, of which the treatment methods and prognosis. Cemento ossifying fibroma presenting as a mass of the parapharyngeal and masticator space. Ossifying fibroma an overview sciencedirect topics. Affected people generally experience a gradual or rapid, painless expansion of the affected bone or region. Cemento ossifying fibroma is a benign, non odontogenic tumour of the jaw, a subdivision of fibroosseous lesions. Occasionally treated by curettage enucleation, this conservative. In consequence, the fibroosseous lesions present different biological behavior 1, 2. Clinically, it is a large asymptomatic tumor of aggressive appearance, with possible tooth displacement. In early stage it appears as unilocular, welldefined radiolucency. Cemento ossifying fibroma is a rare benign neoplasm, affecting the jaws.
The central matured ossified nodules were of low density on ct scans and high signal intensity on t1. Cementoossifying fibroma a rare case article pdf available in journal of indian society of pedodontics and preventive dentistry 263. Fibroosseous lesions represent a variety of bone proliferations each characterized by different morphologic patterns of osteoid production. Nonossifying fibroma musculoskeletal medicine for medical. They tend to persist or increase in size as the child grows but decrease in size or close once growth ends. This condition should be differentiated from nonossifying fibroma and fibrous dysplasia of. We report a case of very large ossifying fibroma of the maxilla in a 22yearold male. A 29yearold male patient was attended at a hospital, after he had suffered a car accident. Sep 22, 2010 the cemento ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion of terminology and criteria of diagnosis. The classification of cemento osseous lesions remains problematic, and there is divergence of opinion among pathologists 1 3. Microscopically, some times the lesion may be confused with fibrous. Central ossifying fibroma is a lesion in which diagnosis has proved intriguing and unclear for presenting clinical, radiographic, and even. Cementoossifying fibroma presenting as a mass of the. The lesions of the jaws usually arise in the tooth bearing regions 1.
The definitive diagnosis of these lesions requires integration of its clinical, radiological and histological features. Peripheral cemento ossifying fibroma shows parakeratinised epithelium and well cellularised connective tissue containing mineralized components ranging from bone to cementum. Cementoossifying fibroma of the jaw bmj case reports. Apr 27, 2014 just recently i emailed my friend and said funny well, not really how many psychologists, doctors, dieticians, support groups, hospitals, and even a hypnotist, i went to over the years that couldnt help me and all it took in the end was a simple site like this, and a supportive partner. Central ossifying fibroma is a benign slowgrowing tumor of mesenchymal origin and it tends to occur in the second and third decades of life, with predilection for women and for the mandibular premolar and molar areas.
Cemento ossifying fibroma is a benign osteogenic tumor with membranous ossification. It comprises fibrous tissue containing a variable quantity of mineralized material resembling bone andor cement, whence the term cemento ossifying. Ossifying fibroma of the maxilla and sinonasal tract lester dr. First description of ossifying fibroma was given by menzel in 1872 while the term was given by montgomery in 1927. Cementifying ossifying fibroma belonged to the osteogenic group of. Therefore, we present and discuss in this paper a series of cases of peripheral cemento ossifying fibroma emphasizing the. Fibroosseous lesions are characterized mainly by replacement of normal bony architecture with fibrous collagenous connective tissue that contains varying amounts of mineralized substances, which may be bony or cementum like in appearance. Campanacci described this condition in two leg bones, the tibia and fibula, and coined the term. Mar 28, 2014 the clinicopathologic characteristics of multiple ossifying fibroma of are unclear due to the conditions rarity, making diagnosis challenging.
The ossifying fibroma of is a benign neoplasm that affects the jaws. Cemento ossifying fibroma cof is a well demarcated and encapsulated neoplasm that contains fibrous tissue and varying amounts of calcified tissue resembling bone, cementum or both. The cementoossifying fibroma cof is a mesodermal, nonodontogenic tumour of ectopic multipotential periodontal membrane blast cells. Multiple of cases were identified from ossifying fibroma cases.
They are noncancerous and do not spread to other areas of the body. Orthopaedic institute for children nonossifying fibroma. Cementoossifying fibroma is a benign osteogenic tumor with membranous ossification. Introduction cemento ossifying fibroma is a benign fibroosseous maxillary tumor belonging to the same category as fibrous dysplasia and cement ossifying dysplasia 1. In the second who classification in 1992, benign fibroosseous lesions in the maxillo facial region were separated into two groups, osteogenic neoplasm and nonneoplastic bone lesions. The average diameter at the time of first radiological examination has been given as. Diagonosed by cytological and radiological correlation. The trend to reuse of in preference to cof would appear to have been started by brannon and fowler, 3 and continued by reichart and philipsen.
Asymptomatic presentation of aggressive ossifying fibroma. Here we present a case of 18 year old female having slow growing painless swelling on left side of mandible over 2year period. Peripheral ossifying fibroma pof is a reactive gingival overgrowth which is relatively uncommon in nature. It is usually located in the premolarmolar area in the mandible. Cementoossifying fibroma is a benign fibroosseous maxillary tumor. It is often encapsulated and predominantly located in the mandible, and presents as a slowgrowing lesion, but may cause deformity if left untreated. Because it shares many features with other lesions of the jaws, definitive diagnosis of the cemento ossifying fibroma is a challenge for the clinician and requires the integration of histopathological, radiological, and clinical examinations. The most recent edition of the classification of odontogenic tumours produced by the world health organization who 1 has replaced the second editions 2 cemento ossifying fibroma cof with ossifying fibroma of.
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