Odontogenic fibroma with calcification. Report of a case with a review of the literature

Central Odontogenic Fibroma: characteristics and management

Introduction: Central Odontogenic Fibroma (COF) is a rare benign odontogenic tumour of the jaws. Until its recent change in classification by the WHO in 2017, this entity has gone without an agreed upon definition for many years. For this reason, COF would remain largely unknown to practitioners. Corpus: The pedagogical objectives of this article are, through a systematic review of the literature using the PRISMA methodology, to list the epidemiological, aetiological, clinical, radiological, histological, therapeutic and prognostic characteristics of COF. All the data collected made it possible to establish a COF management summary for practitioners in order to optimize it. Conclusion: Based on the 135 cases listed, it appears that surgical enucleation is the treatment of choice for COF. The recurrence rate is low and malignant transformation has never been reported. However, regular clinical and radiological follow-up of patients over several years seems to be a justified precaution.

Central odontogenic fibroma: an international multicentric study of 62 cases

OBJECTIVE

The aim of this study was to report the clinicopathologic features of 62 cases of central odontogenic fibroma (COdF).

STUDY DESIGN

Clinical and radiographic data were collected from the records of 13 oral pathology laboratories. All cases were microscopically reviewed, considering the current World Health Organization classification of tumors and were classified according to histopathologic features.

RESULTS

There were 43 females and 19 males (average age 33.9 years; range 8-63 years). Clinically, COdF lesions appeared as asymptomatic swellings, occurring similarly in the maxilla (n = 33) and the mandible (n = 29); 9 cases exhibited palatal depression. Imaging revealed well-defined, interradicular unilocular (n = 27), and multilocular (n = 12) radiolucencies, with displacement of contiguous teeth (55%) and root resorption (46.4%). Microscopically, classic features of epithelial-rich (n = 33), amyloid (n = 10), associated giant cell lesion (n = 7), ossifying (n = 6), epithelial-poor (n = 3), and granular cell (n = 3) variants were seen. Langerhans cells were highlighted by CD1a staining in 17 cases. Most patients underwent conservative surgical treatments, with 1 patient experiencing recurrence.

CONCLUSIONS

To the best of our knowledge, this study represents the largest clinicopathologic study of COdF. Most cases appeared as locally aggressive lesions located in tooth-bearing areas in middle-aged women. Inactive-appearing odontogenic epithelium is usually observed within a fibrous/fibromyxoid stroma, occasionally exhibiting amyloid deposits, multinucleated giant cells, or granular cells.

Central odontogenic fibroma with osteoid formation showing atypical radiographic appearance

We recently encountered an interesting tumour, containing both a diffuse sclerotic border and calcified bodies, which was eventually diagnosed as a central odontogenic fibroma. The patient was a 40-year-old man with a painless radiolucent area in the crown area of the unerupted left lower third molar shown by panoramic radiography. Clinically, the lesion was thought to represent an odontogenic tumour involving a calcified body, i.e. calcifying cystic odontogenic tumour, calcifying epithelial odontogenic tumour or ossifying fibroma. Diagnosis by radiographic findings was extremely difficult.

Case report of intra-osseous fibroma: a study on odontogenic and desmoplastic fibromas with a review of the literature

Intra-osseous fibromas of the jaw are classified by origin. Intra-osseous odontogenic fibromas have odontogenic epithelia, while desmoplastic fibromas do not. However, it is often difficult to determine the odontogenic origin for central fibromas. Three subjects with a diagnosis of intra-osseous fibroma were examined. Case 1 was a 35-year-old man found to have a panoramic radiograph from the right premolar to the mandibular ramus in the mandible that exhibited multilocular radiolucency. Within the radiolucency, small-radioopaque bodies were observed. Case 2 was a 13-year-old female, in whom a panoramic radiograph from the left premolar to the molar in the mandible showed multilocular radiolucency. Case 3 was a 51-year-old female who exhibited a heart-shaped radiolucency in the panoramic radiograph of the left first molar area in the mandible. We also reviewed the literature for previously reported cases of intra-osseous odontogenic and desmoplastic fibroma. In 64 cases of intra-osseous odontogenic fibroma and 68 cases of desmoplastic fibroma we extracted data on age, sex, location, and radiographic findings. Based on the analysis of the reported literature cases, re-evaluation of the patients in our study revealed that case 1 could be classified as desmoplastic fibroma, while cases 2 and 3 were intra-osseous odontogenic fibromas.

Radiologic features of central odontogenic fibroma

The central odontogenic fibroma is a rare benign neoplasm that is considered to be derived from mesenchymal dental tissue. This study reviews and analyzes the radiologic features of 51 cases (5 new cases and 46 from the literature). Central odontogenic fibroma appears in both the mandible and maxilla (55% and 45%, respectively). In the maxilla it has a tendency to involve the anterior area, whereas in the mandible the molar and premolar areas are the most prevalent sites. The majority of central odontogenic fibromas are unilocular radiolucent lesions with well-defined borders, but they may also appear as multilocular lesions and in rare instances may exhibit a mixed radiolucent/radiopaque appearance with poorly defined or diffused borders. The great variability in radiologic appearance of the central odontogenic fibroma means that it should be considered in the differential diagnosis of all radiolucencies found in the jaws.

Peripheral odontogenic fibroma: a clinicopathologic study

The clinicopathologic features of 30 cases of peripheral odontogenic fibroma are reviewed. The age distribution is wide (11 to 76 years), and there is a slight predilection for males. The majority of the lesions (93%) occurred in blacks on the attached gingiva, and with equal frequency in the maxilla and mandible. Size varied between 1 and 3 cm in diameter. One case recurred after 14 months. Histologically, the lesions are nonencapsulated and poorly delineated. The amount of odontogenic epithelium varies considerably and consists usually of small islands or strands, although larger follicles are sometimes present. In one case the epithelial cells had a clear cytoplasm, whereas in another it was granular and eosinophilic. Origin from the surface oral mucosa can sometimes be seen. The connective tissue component is usually cellular, but collagenous, myxomatous, and mixed forms occur. Calcifications were present in 22 cases and consisted of tissue interpreted as either dentinoid, cementum, bone, or dystrophic calcific material.

Central odontogenic fibroma: clinicopathologic features of 19 cases and review of the literature

The odontogenic fibroma is a benign neoplasm infrequently reported in the literature (20 cases). Nineteen additional examples are reported. This lesion occurs most frequently in the maxilla anterior to the molars and displays a striking female predilection. On occasion, it may be associated with an unerupted mandibular third molar. Histomorphologically, it is not encapsulated. A spectrum of fibrous connective tissue stroma is present: from myxoid to densely hyalinized and from relatively acellular to cellular. Calcification may or may not be present. It is distinguished by the presence of sparse cords and islands of inactive odontogenic epithelium. Enucleation or surgical curettage is appropriate therapy and recurrence is low. As there appears to be no correlation of histologic pattern with clinical behavior, it seems unnecessary to try to separate the tumor into two variants.

Contiguous enlarged dental follicles with histologic features resembling the WHO type of odontogenic fibroma

Defective odontogenesis and/or retarded eruption of teeth can be associated with histologic features akin to odontogenic fibroma in the dental follicles. Unerupted mandibular premolar and molar teeth of a 24-year-old man were surgically exposed, yet the teeth failed to erupt. About a year and a half later, radiographs indicated further enlargement of the follicle of the premolar, and both teeth were subsequently surgically removed. Histologically, the follicles were composed of mature collagenous tissue among which epithelial islands and numerous clusters of calcified bodies were present. Indirect immunofluorescence showed positive staining for type I and type III collagen, which exhibited a sparse distribution, but not for the aminoterminal propeptide of type III procollagen. The hamartomatous nature of the lesions is discussed with emphasis on their histologic resemblance to the WHO type of odontogenic fibroma.

Central odontogenic fibroma. A report of two controversial cases illustrating diagnostic dilemmas

Two unusual cases of central odontogenic fibroma are described and used to illustrate differential diagnostic problems in this controversial group of lesions. The first case had a cystic lesion noted on routine radiography in the left ramus of the mandible. This particular case was unusual histologically as it showed in addition to typical areas of odontogenic fibroma a small inflamed cyst lined by epithelium containing many hyaline bodies. The second case presented with anaesthesia of the right lower lip and an enlarged chin prominence. The lesion was diagnosed as an odontogenic fibroma but with a somewhat unusual histological appearance in that there were abundant areas of osseous metaplasia throughout the lesion.

Multiple dental follicles with odontogenic fibroma-like changes (WHO type)

A 15-year-old boy, in the case presented in this article, had 13 unerupted teeth, each associated with hyperplastic pericoronal tissue that showed histologic features suggestive of the WHO type of odontogenic fibroma. The etiology, clinical features, radiographic findings, and histopathology of the odontogenic fibroma are reviewed. It is suggested that the unusual pericoronal findings represent a hamartomatous change.

Central odontogenic fibroma

An example of a central odontogenic fibroma is presented. This is a rare, benign neoplasm which affected the molar region of the left side of the mandible of a 63-year-old female Caucasian. Histologically, it consisted of fibroblast-like cells lying in a rather myxomatous delicate collagenous stroma. Few islands of odontogenic epithelium were also found. At the ultrastructural level, the tumour cells contained large numbers of fine filaments with focal densities similar to those described in smooth muscle cells. They also showed a moderately developed r ER. These features are consistent with cells referred to as myofibroblasts.

Central odontogenic fibroma

The article presents a case of central odontogenic fibroma occurring in the maxilla. The literature is reviewed, in the belief that a discussion of the controversial issues surrounding this neoplasm, its treatment and follow-up information, is warranted, due to the small number of cases (13) of this tumor that have been recognised and reported up to the present.

Central odontogenic fibroma. A case report

A case of central odontogenic fibroma is reported. The clinical, radiological and pathological features are discussed. It is of particular interest because of its maxillary location and the severe external root resorption associated with the tumour.

Odontogenic fibroma of the complex (WHO) type: report of six cases

Six cases of the complex (World Health Organization) type of odontogenic fibroma are described. The relationships of these lesions to the simple type of odontogenic fibroma, desmoplastic fibroma, and to certain reactive lesions are discussed.

Recurrent central odontogenic fibroma

This article presents a case of a central odontogenic fibroma which recurred 9 years after it was enucleated. Very few cases of this tumor have been recognized and reported. The clinical and histopathologic criteria and the differential diagnosis of the lesion are stressed.

The central odontogenic fibroma. Clinical and morphologic studies

The clinical, pathologic, and ultrastructural features and pertinent case history of an 11-year-old boy with a rare benign odontogenic neoplasm, the central odontogenic fibroma, are presented. A review of the literature reveals seven other lesions with clinical and pathologic findings similar to those of this case. This study supports the concept that the central odontogenic fibroma is a distinct odontogenic neoplasm of bone which occurs most commonly in the mandible as a multilocular, radiolucent, and slowly growing expansile lesion with no tendency to recur after surgical enucleation. The ultrastructural findings indicate that the central odontogenic fibroma and the odontogenic myxoma share many common morphologic features and have an apparently similar histogenesis.

The peripheral odontogenic fibroma

An extensive review of the English-language literature has produced only five undoubted cases of peripheral odontogenic fibroma. This article reports ten new cases. The age and sex of the patients and the distribution by site and histology of the lesions are compared with those of other cases of bifrous tumors and neoplasms of odontogenic origin. It is postulated that this lesion may be more closely related to the fibrous euplis than was previously realized. Both lesions show hyperplasia of the basal layer of the covering ipithelium into double strands resembling odontogenic epithelium. It is suggested that this hyperplasia may be related to induction of the covering epithelium by primitive ectomesenchymal remnants within the gingivae. Proliveration of odontogenic rests within the peripheral odontogenic frbroma may be related to the same stimulus.