Differential distribution of glycosaminoglycans in human cementifying fibroma and fibro-osseous lesions

Cementifying Fibroma of the Sphenoid Wing in a Child: A Case Report

"Cementifying fibroma" is a benign tumor of the fibroblastic tissue containing masses of cementum-like calcified tissue, usually occurring between the third and fourth decades. Cementifying-ossifying fibromas are rare non-odontogenic, fibro-osseous tumors of the periodontal ligament that arise from the mesodermal germ layer3. We report a 12-year-old male child, who presented with a swelling in the left temporal region near the angle of the left eye. These non-neoplastic, locally destructive tumors present as an osseous lesion involving the mandible, maxilla, zygoma, paranasal sinuses, orbit, and rarely the petromastoid regions. The preoperative diagnosis was not clear even with CT and MRI, and, hence, all fibro-osseous lesions were considered as differential diagnosis. The lesion was surgically resected completely, and the histology confirmed it as a cementifying fibroma. According to the WHO classification, this is a variant of cementifying fibromas, which represent a subgroup of cementomas, that is, fibro-osseous lesions containing cementum. Histologically, these are fibrous tissues with calcified structures resembling bone and cementum. Cranioplasty was done simultaneously, with successful clinical results.

A rare presentation of cemento-ossifying fibroma in the maxilla: A case report

The basis of the problem: Cemento-ossifying fibroma is a benign fibro-osseous lesion of the jaw. It presents as a slow growing swelling which progressively enlarges if not surgically intervened. Cemento-ossifying fibroma revolves around the use of different terminologies and diagnostic criteria in proposing a strategic treatment plan. Method: The current article describes a rare occurrence of cement-ossifying fibroma affecting maxilla in a 44 year old female patient. Clinically, the lesion was painless and slow growing in nature. Computed tomography revealed a hypodense area in the right posterior maxilla measuring 19.07mm X 27.11mm. The lesion was surgically resected under general anesthesia and it was histopathologically confirmed to be cemento-ossifying fibroma. Results: Total enucleation/ resection of the osseous lesion must be timely ensured to prevent recurrence and also to achieve good prognosis which was done in the described case report. No recurrence was reported in the present case which had a follow up for 24 months. Conclusion: Although numerous controversies exist in the use of terminologies, a multi centric approach mandates to correlate clinically, radiographically and histologically to determine the treatment perspective.

Cemento-Ossifying Fibroma in Maxillofacial Region: A Series of 16 Cases

Introduction

Cemento-ossifying fibroma is considered as a benign osseous tumour, closely related to other lesions such as fibrous dysplasia and cementifying periapical dysplasia. These lesions occur in the second to the fourth decade of life. It is a bony tumour of maxilla and mandible of possibly odontogenic origin with aggressive behaviour and high tendency for recurrence. Radiologically, the lesion appearances varied ranging from radiolucent cyst-like appearance to mixed and/or radiopaque areas.

Aims and objectives

The article attempts to highlight the importance of clinical, imaging aspects and histopathology in diagnosis of cemento-ossifying fibroma along with management and long-term follow-up.

Materials and methods

This retrospective study was done on histologically diagnosed 16 fibro-osseous lesions. These patients were treated under general anaesthesia at our institute. The demographic data, radiographic features, and histopathologic findings were analysed and compared. The treatment and follow-up data were also recorded.

Results

Cemento-ossifying fibroma showed higher predilection for female than for male patients and with an equal number of cases reported in maxilla and mandible with no signs of recurrence in long-term follow-up of 15 years.

Conclusion

Complete surgical excision of cemento-ossifying fibroma comes out to be only effective treatment that gave satisfactory results and can be considered as a definitive treatment modality.

Cemento-ossifying fibroma of the mandible. A clinicopathological report

Cemento-ossifying fibromas are rare fibro-osseous benign neoplasms that affect the jaws. They are included in the group of mesodermal odontogenic tumors and commonly present as a progressively growing lesion that might attain enormous size with resultant deformity, if left untreated. A confusion prevails on the terminology, which can only be confirmed by histopathologic evaluation. A case of cemento-ossifying fibroma involving the right mandible is described in a 30 year-old female patient. The clinical, radiographic, histologic features are presented and the various differential diagnosis are discussed.

Multicentric peripheral ossifying fibroma: A case report and review of the literature

A peripheral cement-ossifying fibroma is a benign fibro-osseous lesion of a reactive rather than a neoplastic nature, whose pathogenesis is uncertain. It predominantly affects adolescents and young adults, with the peak prevalence between 10 and 19 years, especially affecting females (two to four times more). Such lesions are commonly found on the maxillary bone. We hereby present and discuss a unique case of multicentric Peripheral Ossifying Fibroma (POF) affecting both the maxillary and the mandibular gingiva in an 11-year-old boy, with a disease duration of two months. This case is probably one of the first few cases discovered, which demonstrates that there may be a multicentric variant of the Peripheral Ossifying Fibroma. The purpose of this article is to present a case of POF and to briefly review the current literature on this condition.

Peripheral cemento-ossifying fibroma: case series literature review

The concept of fibroosseous lesions of bone has evolved over the last several decades and now includes two major entities: fibrous dysplasia and ossifying fibroma. Peripheral cemento-ossifying fibroma is a relatively rare tumour classified between fibroosseous lesions. It predominantly affects adolescents and young adults, with peak prevalence between 10 and 19 yrs. 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. The cemento-ossifying fibroma is odontogenic in origin, whereas ossifying fibroma is of bony origin. Lesions histologically similar to peripheral ossifying fibroma have been given various names in existing literature. Therefore, we present and discuss in this paper a series of cases of peripheral cemento-ossifying fibroma emphasizing the differential diagnosis.

Peripheral cemento-ossifying fibroma of maxilla

Peripheral cemento-ossifying fibroma is a reactive gingival overgrowth occurring frequently in anterior maxilla. It is a slow-growing benign tumor which may lead to pathologic migration and other periodontal problems, so it should be excised as soon as possible. The recurrence rate of peripheral cemento-ossifying fibroma is reported to be 8% to 20%, so a close postoperative follow-up is required. Herein, we are reporting a similar case of peripheral cemento-ossifying fibroma in the maxillary anterior region.

The cementum-dentin junction also contains glycosaminoglycans and collagen fibrils

The presence of glycosaminoglycans (GAGs) and their contribution to mechanical properties of the cementum-dentin junction (CDJ) were investigated using nanometer scale characterization techniques. Five to two millimeter thick transverse sections from the apical ends of human molars were ultrasectioned at room temperature under wet conditions using a diamond knife and an ultramicrotome. The structure of the CDJ under dry and wet conditions before and after digestion of GAGs and collagen fibrils was studied using an atomic force microscope (AFM). The mechanical properties of the untreated and enzyme treated CDJ under wet conditions were studied using an AFM-based nanoindenter. GAG digestion was performed for 1, 3, and 5 h at 37 degrees C using chondroitinase-ABC. Collagen fibril digestion was performed for 24 and 48 h at 37 degrees C using collagenase. As reported previously, AFM scans of dry untreated CDJ (control) revealed a valley, which transformed into a peak under wet conditions. The height differences relative to cementum and dentin of untreated and treated CDJ were determined by measuring the CDJ profile under dry and wet conditions. The depth of the valley of GAG and collagen-digested CDJ was greater than that of undigested CDJ under dry conditions. The height of the peak of GAG-digested CDJ was significantly higher than that of the undigested CDJ under wet conditions. The collagen-digested CDJ under wet conditions is assumed to form a valley because of the removal of collagen fibrils from the CDJ. However, the depth of the valley was lower compared to the depth under dry conditions. Wet AFM-based nanoindentation showed that the elastic modulus and hardness of control (3.3+/-1.2 and 0.08+/-0.03 GPa) were significantly higher (ANOVA & SNK, P < 0.05) than chondroitinase-ABC treated CDJ (0.9+/-0.4 and 0.02+/-0.004 GPa) and collagenase treated CDJ (1.5+/-0.6 and 0.04+/-0.01 GPa). No significant difference in mechanical properties between chondroitinase-ABC and collagenase treated CDJ was observed. Based on the results it was concluded that the 10-50 microm wide CDJ is a composite that includes, chondroitin-4-sulfate, chondroitin-6-sulfate, and possibly dermatan sulfate, and collagen fibrils. The association of GAGs with the collagen fibrils provides the observed controlled hydration and partially contributes toward the stiffness of the CDJ under wet conditions.