Abbreviated case report

Abbreviated case report Cementifying

fibroma

of the mandible

N. J. Burzynslci, D.D.S., MS., C. Rosenberg, D.M.D., R. Cder, and T. H. Martin, D.M.D., Lmi&lle, Ky. HEALTH

SCIENCE

CENTER,

UNIVERSITY

D.M.D.,

OF LOUISVILLE

A case of cementifying fibroma of the mandible in a 56-year-old man is presented. The uniqueness of this case lies in the time factor, which exemplifies the localized growing destructive capabilities shown by this tumor on rare occasions.

C

ementoid lesions have been studied at length and need no further elaboration.l-lo The purpose of the present report is to present a case of an infrequent response of the cementifying fibroma. CASE REPORT A 56-year-old Negro man was seen with a provisional clinical diagnosis of actinomycosis and a probable benign tumor on the left side of the mandible (Fig. 1). Approximately 8 years earlier, a radiographic diagnosis of fibrous dysplasia of the mandible had been made. The cortex appeared intact, and there was no apparent invasion of the soft tissue. The patient stated that he had had a swelling in the left jaw since the age of 15, when he was struck with a baseball in the affected area. Intraoral examination revealed an expanding lesion of the mandible with a prominent, firm lingual ridge. The patient had a normal complement of teeth in the affected area. Extraoral examination showed a large swollen area at the angle of the left mandible and a fistula which drained purulent material. Scar tissue was also noted in the area, suggesting healed drainage sites. The mass was firm and nontender. The completed physical examination was negative. Radiographs demonstrated a large radiopaque lesion causing extensive bone destruction and replacement of bone with tumor (Fig. 2). The left mandibular first and second molars were involved in the mass. There was also a draining tract in the middle of the mass beneath the left submandibular area. Chest and long-bone surveys were negative. Radiographic impressions were (1) ameloblastic odontoma, (2) fibrous dysplasia from previous report, (3) actinomyeosis, and (4) sarcoma. The initial biopsy of the involved area was read as indicative of an ossifying fibroma. Grossly, the periphery of the tumor had a “gritty” consistency, with the center of the mass gray in appearance and hard in consistency. Histopathologic study revealed fibrous tissue

245

246

Burzynski

et al.

Fig. 1. (Xnic :a1 ap‘I learawe

Fig. 8. Radiograph

showing

Oral February,

of patient

radiopaque

with left

facial

lesion involving

asymmetry.

mandible.

Surg. 1971

Abbrevia,ted

Volume 31 Number 2

Fig. 9. Histopathologic connective tissue.

section

showing

numerous

droplets

case report

of cementum

with

247

surrounding

with ovoid cells suggestive of cementoblasts or osteoblasts. Single and fused spherules of basophilic droplets of mineralized tissue consistent with cementum were randomly scattered throughout the specimen (Fig. 3). The diagnosis rendered was consistent with cementifying fibroma. Because of the persistence of the drainage and chronic osteitis, the mandible was resected at a later date. The patient tolerated the surgical procedure well and had an unevent,ful recovery.

SUMMARY A case of cementifying fibroma of the mandible in a 56-year-old man is presented. The uniqueness of this case lies in the factor of time, which exemplified the localized growing destructive capabilities shown by this tumor on rare occasions. The clinical history, growth, and appearance of the lesion are compatible with those of three previously reported case~=~.~~ $3lo The authors express their appreciation to Condiet Moore, M.D., Professor of Surgery and the Department of Pathology for their assistance. Also, the authors are (Oncology), grateful to Dr. W. Shafer of Indiana University and Dr. R. Vickers of the University of Minnesota for their professional consultations. REFERENCES

1. Gorlin, R. J., Chaudhry, A. P., and Pindborg, J. J.: Odontogenic Tumors; Classification, Histooathologv and Clinical Behavior in Man and Domestic Animals, Cancer 14: 73-101. 19lx-

-”

2. Stafne, E. C.: Cementoma: A Study of 35 Cases, Dent. Survey 9: 27-31,1933. 3. Zegarelli, E. V., and Ziskin, D. E.: Cementomas: A Report of 50 Cases, Amer. J. Orthodont. Oral Surp. 29: 289-292. 1943. H.’ C.: The Histogenesis of the Cementoma, Amer. J. 4. Bernier, J., and l’hompson, Orthodont. Oral Surg. 32: 543-555, 1946. 5. Scannell, J. M., Jr.: Cementoma, ORAL SURG. 2: 1169-1180, 1949. 6. Fontain, J.: Periapical Fibro-osteoma or Cementoma, J. Canad. Dent. Ass. 21: 10-20, 1955. 7. Chaudhry, A. P., Spink, J. H., and Gorlin, R. J.: Periapical Fibrous Dysplasia (Cementoma), J. Oral Surg. 16: 483-488, 1958. 8. Hamner, J. E., Scofield, H. II., and Cornyn, J.: Benign Fibro-osseous Jaw Lesions of Periodontal Membrane Origin, Cancer 22: 861-878, 1968.

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Oral Surg. February, 1971

9. Hamner, J. E,, Lightbody, P. M., Katcham, A. S., and Swerdlow, H.: Cemento-ossifying Fibroma of the Maxilla, ORAL SURG.26: 579-587, 1968. 10. Patti, W. M., Mason, J. H., and Kosmala, R. L.: Fibrocementoma of the Maxilla, Arch. Otolaryng. 84: 332-336, 1966. Reprint

requests to :

N. J. Burzynski, D.D.S., M.S. Medical-Dental Research Bldg. University of Louisville 511 South Floyd St. Louisville, Ky. 40202