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Central ossifying fibroma is a benign slow-growing 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. Clinically, it is a large asymptomatic tumor of aggressive appearance, with possible tooth displacement. Occasionally treated by curettage enucleation, this conservative surgical excision is showing a recurrence rate extremely low. The objective of this study was to report a case of a 44-year-old woman, presenting a very large ossifying fibroma in the mandible, which was successfully treated with curettage, and to conduct a brief literature review of this lesion, focusing on the histology, clinical behavior, and management of these uncommon lesions.

WOS: 000276073200030 PubMed: 20216457 Osteomas of the jaws are rare osteogenic lesions considered to be true neoplasms, characterized by the proliferation of compact and/or cancellous bone. It can be central, peripheral, or of an extraskeletal type. The central osteoma arises from the endosteum, the peripheral osteoma from the periosteum, and the extraskeletal soft tissue osteoma usually develops within a muscle. However, in a previous work we have suggested that at least some peripheral osteomas may be reactive rather than neoplasms, probably associated with trauma. Some reported cases did have a clear history of trauma; however, this was not the case in the majority of cases. Whereas peripheral osteomas are fairly easy to diagnose, central osteomas pose a more challenging diagnostic problem and need to be differentiated from other similar lesions of the jaws, such as central ossifying fibroma, condensing osteitis, idiopathic osteosclerosis, osteoblastoma, cementoblastoma, and complex odontoma. With such a low number of case of central osteoma reported, the objectives of the present report are to describe a case of the central osteoma associated with partially root resorption of the mandibular first molar. Our case report participates to literature as a 11th case.

Background: Oral Pathologists often come across fibro-osseous lesions involving the jaws with intersecting clinico-pathologic features which makes their diagnosis challenging. Due to the difference in their pathogenesis, the treatment varies and so does the prognosis which makes differentiation essential. Objectives: This study intended to evaluate the stromal components of fibrous dysplasias, central and juvenile ossifying fibromas affecting the jaw bones using histochemical stains and to determine the histological parameters important for their differentiation. Methods: Three sections each of forty-seven formalin-fixed decalcified paraffin-embedded tissues were stained with three special stains (Modified Tetrachrome, Modified Attwood’s and Potassium-monopersulfate aldehyde fuschin stain) and analysed for morphology and structure of calcifications, osteoblastic rimming, cellularity and vascularity of the stroma, collagen pattern and oxytalan fibers. Results: Despite the overlap in the histopathological features, few parameters were more pertinent to one lesion than the others. Fibrous dysplasia cases had characteristic thin curvilinear calcifications which were discontinuous whereas central and juvenile ossifying fibromas had broader calcifications which were interconnected. The structure of calcifications was mostly woven in fibrous dysplasia but few longstanding cases did show lamellar bone. The cellularity and vascularity was considerably higher in ossifying fibromas than fibrous dysplasia. Oxytalan fibers were more evident in cases of ossifying fibromas. Conclusion: Histopathological analysis alone may not suffice for the diagnosis of fibro-osseous lesions due to the apparent similarity, thus stressing on the importance of radiologic and genetic analysis in the diagnosis of fibro-osseous lesions.

Central ossifying fibroma is a benign neoplasm, having slow growing nature. Some rare lesions show very aggressive nature, multifocal appearance and reach up to a very massive size. So, these kinds of cases require special attention for their treatment. A unique case of central ossifying fibroma with aggressive nature, multifocal appearance is reported. This case shows growth both in maxilla and mandible with maxillary lesion massive in size involving maxillary sinus. There have not been any such cases reported so far in the literature showing bimaxillary growth of ossifying fibroma.

Fibro-osseous lesion is a generic designation for a clinically diverse group of bone disorders in which the lesional tissue consists of large volumes of fibrous connective tissue, principally collagens type I and III, as well as an osseous component in the form of woven or lamellar bone or cementum with varying degrees of mineralization. These lesions exhibit nearly identical histomorphologic features, yet demonstrate widely ranging clinical behavior. The site-dependent morphology applies especially to fibro-osseous lesions, as some occur exclusively at a particular anatomic location (i.e., osteofibrous dysplasia and central ossifying fibroma). A specific diagnosis is crucial because the management differs substantially from no treatment to complete excision. It should be noted as well that entities undergo name changes over time, especially among fibro-osseous lesions. Thus, ossifying fibroma is a synonym for osteofibrous dysplasia in long bones, whereas ossifying fibroma of maxillofacial bones is commonly referred to as central ossifying fibroma. Other synonyms (or perhaps variants) of this entity include cementifying fibroma, cemento-ossifying fibroma, juvenile (active/aggressive) ossifying fibroma, and psammomatoid ossifying fibroma.

Swelling may lead to various known and unknown diseases one among can be fibro osseous lesion. Central ossifying fibroma (COF) is classified as and behaves like a benign bone neoplasm. However, it is considered to be a type of fibro osseous lesion. The OF affecting the jaws exhibits a variable behaviour ranging from slow growth to occasionally aggressive local destruction; some cases recur after surgery. Most OFs grow slowly, and once completely excised do not recur, but a minority, particularly in children, exhibit rapid growth and a tendency to recur; they are generally called ‘'juvenile ossifying fibroma' ’We present an unusual case of a central ossifying fibroma in an unusual age.

Aneurysmal bone cysts (ABCs) are benign osteolytic lesions that occur rarely in the jaws. The aim of this study was to investigate the clinical, radiographical and pathological features of ABCs of the jaws. A retrospective analysis of the content of a 39-year database, including nine cases of ABCs of the jaws diagnosed from the archives of the Oral Pathology Service. Nine patients (3 males and 6 females), ranging in age from 5 to 33 years were included. Seven (7/9) lesions were located in the mandible and two (2/9) in the maxilla. A painful swelling was the most common clinical finding (n = 4, 4/9). Radiologically, the lesions frequently presented as multilocular (5/9), well defined (4/9), bone expansion and perforation (2/9). Pathological analysis revealed that two cases were associated with central ossifying fibroma and one case with central giant cell lesion. Histomorphology showed a predominance of the solid type (5/9) and of sinusoidal pseudocystic spaces (4/9). Giant cells, osteoid material, calcified material, blood vessels and hemosiderin deposits were observed in 6/9, 7/9, 8/9, 9/9 and 7/9, respectively. The patients with ABCs presented clinical and radiographical features, which often posed a diagnostic dilemma. Knowledge about the most common characteristics of ABCs may contribute to the establishment of a more accurate diagnosis.

espanolEl fibroma osificante central (fibroma cementificante / fibroma cemento osificante) es un tumor benigno oseo bien delimitado, se localiza principalmente en los maxilares aunque se puede presentar en los huesos orbital, frontal, paranasal y temporal. Se caracteriza por presentar un crecimiento y una tumefaccion deformante de evolucion lenta con una incidencia mayor en la mandibula. El tratamiento consiste en la extirpacion quirurgica de la lesion. En este articulo se presenta un caso de fibroma osificante central localizado en la region posterior derecha del maxilar superior, de gran dimension, que acomete a una paciente de sexo femenino de 46 anos de edad, revelando datos clinicos, aspectos diagnosticos, imagenologicos, histopatologicos asi como su tratamiento. EnglishCentral ossifying fibroma (cementing fibroma / cemento ossifying fibroma) is a bone benign tumor almost exclusively from maxillary region but can be in the orbital bones, frontal, paranasal and temporal. Progressive growth and disfiguring swelling of slow evolution are characteristics with more prevalence in the mandible. The treatment choice is a surgical excision of the lesion. This article presents a case of central ossifying fibroma located in the region of the right posterior maxilla of large dimension of a female patient of 46 years of age, describing clinical, diagnostic, imaging, and histopathological aspects as well as the treatment employed.

Central ossifying fibroma is a rare fibro-osseous neoplasm in young children. It is highly aggressive and has a strong tendency to recur. We describe an 11-year-old girl with juvenile central ossifying fibromas of the mandible that caused obstruction of tooth eruption of the lower left second premolar. Oral examination revealed the presence of the primary lower left second molar and a small bony hard swelling over the left side of the mandibular body. After a computed tomographic scan, an incisional biopsy was performed, and the lesion proved to be a juvenile ossifying fibroma. Although this tumor often recurs early, and many authors suggest radical en bloc resection, we performed a more conservative procedure to avoid damage to the mandibular nerve. There has been no evidence of recurrence 1 year later.

Objective To investigate the prevalence of clinical, radiographic, and histopathologic characteristics of combined central giant cell granuloma (CGCG) and central ossifying fibroma (COF). Study design Retrospective clinical and histomorphometric analysis of all cases diagnosed as CGCG or COF between 1994 and 2002. Results A total of 51 cases were included in the study: CGCG (n = 23), COF (n = 25), and combined COF-CGCG (n = 3). All 3 lesions presented expansile, well-defined unilocular radiolucencies, with radiopacities (66%), root resorption (66%) and tooth displacement (33%). Microscopically, areas of classical CGCG and COF were separated by a transition zone of nonvascularized densely packed spindle cells. Surgical procedure resulted in recurrence within 1 year in 1 of 2 patients, calcitonin nasal spray treatment resulted in growth arrest in 1 case. Conclusions Because of the small number of the combined cases, the biologic behavior of the lesions is uncertain. The CGCG component may drive the clinical behavior toward a more aggressive behavior than classical COF; therefore, close follow-up is recommended.

Central ossifying fibroma is a rare, benign fibro-osseous lesion that arises from the periodontal ligament. Periapical cemento-osseous dysplasia is another variant of fibro-osseous lesion which occurs in the anterior region of the mandible of females. Odontoma is a benign odontogenic tumor that contains enamel, dentine cement and pulp tissue. A 46-year-old woman was referred to the Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, with two nonpainful swellings on both sides of the mandible, which had been slowly growing over a period of one year. Our differential diagnosis was florid cemento-osseous dysplasia, focal cemento-osseous dysplasia for the right side, complex odontoma for the left side and periapical cement-osseous dysplasia for the anterior side. The historical feature revealed ossifying fibroma, complex odontoma and periapical cemento-osseous dysplasia. The occurrence of these three lesions in the same jaw has been rarely reported in the literature. The relationship between the occurrence of these three lesions is not obvious it could be coincidental. It seems that more case reports are needed to establish the relationship between them.

Two cases of central ossifying fibroma of the jaw are reported—one in the maxilla and the other in the mandible. Both occurred in young men, aged 16 and 17, respectively, when first seen by us. Contrary to the usual description of these tumors, neither of the lesions was encapsulated. Although not strictly malignant in character, the central ossifying fibroma is an aggressive lesion which grows persistently and distorts or destroys structures with which it comes in contact.

Sixty-four instances of histologically documented ossifying and/or cementifying fibromas were evaluated. Adequate radiographs were available in 43 of the cases. Most of these benign fibro-osseous neoplasms occurred in women, with a predilection for the third and fourth decades. Six distinct radiographic patterns could be identified: (1) radiolucent, superimposed over teeth or residing in edentulous regions (28%); (2) radiolucent with opaque foci, lying in edentulous areas or superimposed over teeth (42%); (3) radiolucent, interposed between contiguous teeth (5%); (4) radiolucent with opaque foci, interposed between contiguous teeth (9%); (5) multilocular expansile (7%); and (6) aggressively expansile with opacification (9%). All lesions exhibited well-defined margins. Root resorption was a feature in 11% of the sample, and root divergence occurred in 17% of the cases.

Central ossifying fibromas are well-documented, benign lesions usually found on the mandible and posterior maxilla. These lesions are differentiated from other fibro-osseous proliferations by specific clinical, radiographic, and histopathological criteria. An unusual case involving the anterior maxilla is described, including a review of the diagnostic features of the lesion as well as a discussion of its relationship to other fibro-osseous lesions.