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Multiple cemento-ossifying fibroma
Int. J. Oral Maxillofac. Surg. 1987: 16:368-371 (Key words:
lesions, fibro-osseous; fibroma ossifying; fibroma, cementifying)
Multiple cemento-ossifying fibroma YASUNORI TAKEDA AND YUKIO FUJIOKA Department of Oral Pathology and Oral Surgery, School of Dentistry, lwate Medical University, Morioka, Japan
ABSTRACT- - This report concerns a case of multiple cemento-ossifying fibroma involving the maxilla and mandible of a 55-year-old Japanese male. The clinical, radiographic and histopathological findings are presented and discussed. (Accepted for publication 30 July 1986)
The ossifying and cementifying fibromas o f the jaws are well circumscribed, generally slow-growing, benign lesions which enlarge in an expansile manner. On occasion, they may reach a large size and may result in considerable deformity. The histological pattern of these lesions varies with the stages. Almost all cases of ossifying and cementifying fibromas reported previously occur as a solitary lesion. Multiple occurrence of such lesion is rare ~. This paper reports a case o f multiple cemento-ossifying fibroma involving the maxilla and mandible of a 55-year-old male. The term "cementoossifying fibroma" is used to describe the f b r o u s lesion containing calcifications with strong similarity between bone and cemen, tum 2,3, though W H O 4 and some authors 5 regard the cementifying fibroma as an odontogenic tumor and consider ossifying fibroma separately as non-odontogenic neoplasm.
Case report A 55-year-old Japanese male was referred to the dental hospital of the Iwate Medical University in December 1983 for examination of a swelling of the left maxillary region. Spontaneous pain appeared in November 1983. As a 13-year-old, in August 1941, he had been hospitalized for surgical treatment of a left mandibular lesion at an-
Fig. 1. Panoramic radiograph showing 2 lesions in the maxilla and 1 lesion in the mandible (arrows).
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369
Fig. 2. Microphotographs of biopsy material. Each lesion consists of densely packed fibroblastic cells and collagen fibers with irregular arrangement (A, B). Eosinophilic calcified masses with irregular shape (A, C) and basophilic ones with oval shape (B) are scattered in the lesion. Calcified masses of intermediate type of both are seen in part (D). H&E stain.
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other university hospital, but detailed diagnosis and pathological findings at that time could not be obtained. Clinical examination showed a diffuse swelling of the left side of the maxilla. The overlying mucosa was normal in colour. In addition, a slight swelling of the right side of the maxilla was found. The maxillary molars and bicuspids of both sides had been extracted previously. The mandible was edentulous. On palpation, the maxillary lesions were of bone-like hardness and could be well demarcated from the adjacent soft tissues. Radiographically, the maxillary lesions were well circumscribed and showed radiolucent areas intermingled with radiopaque areas (Fig. 1). At this time, radiopaque masses were found in the right side of the mandibular molar region (Fig. 1). The general physical data and X-ray examination of the long bones revealed no abnormalities. Biopsies were taken from the periphery of each lesion and submitted for histopathological examination. In each lesion, the histopathological diagnosis of "cemento-ossifying fibroma" was made (Fig. 2). The patient refused surgical treatment because of complete relief of pain by symptomatic therapy.
Discussion The term "fibro-osseous lesions" has recently gained considerable acceptance as a general designation for a group o f p a t h o logical disturbances characterized by replacement o f the n o r m a l bone architecture by a tissue c o m p o s e d o f collagen fibers and fibroblasts containing various amounts o f calcified tissues which m a y be b o n y or cementum-like in appearance. T h a t group includes fibrous dysplasia, cementomas, ossifying fibroma, osteoid osteoma, osteoblastoma, etc. O f these, polyostotic fibrous dysplasia and gigantiform cementoma (florid cemento-osseous dysplasia 6) occur simultaneously in multiple sites in the jaws. In addition, m o s t cases o f periapical cemental dysplasia present as multiple lesions. The present case lacks the most characteristic clinical, r a d i o g r a p h i c and histopathological
features o f fibrous dysplasia, gigantiform c e m e n t o m a or periapical cemental d y s p l a sia. The calcified masses strongly resembled bone a n d cementum. In general, a m o r p h ous, basophilic and r o u n d e d calcified masses are considered to be cementum, and fibrous lesions containing such calcified masses are often diagnosed as cementifying fibroma. However, it is difficult to explain the m o r p h o l o g i c a l difference between such cementum-like masses and identical calcified masses seen in some o f the fibro-osseous lesions o f the skull a n d in other bones 6. On the other hand, fibrous lesions in which the calcified masses consist o f bone are usually diagnosed as ossifying fibroma, b u t some o f these cases m a y contain an admixture o f b o n y tissue and cementum-like substance 6. A l t h o u g h these lesions continue to be diagnosed on the basis o f the d o m i n a n t calcified part, there is no conclusive evidence as to whether the calcified masses seen in the present case are cementum or b o n y tissue. In consideration o f the abovem e n t i o n e d reasons, the present case is diagnosed as cemento-ossifying fibroma.
References 1. BRADLBV, E. S. & LEAI~, D.: Ossifying fibroma involving the maxilla and mandible. Oral Surg. 1968: 26: 605-614. 2. DEH~mR, L. P.: Tumors of the mandible and maxilla in children (I). Clinicopathologic study of 46 histologically benign lesions. Cancer 1973: 31: 364--371. 3. HAMNr~, J. E., SCOFIELD,H. H. & CORNYN, J.: Benign fibro-osseous jaw lesions of periodontal membrane origin: an analysis of 249 cases. Cancer 1968: 22: 861-878. 4. PINDBORG, J. J. & KRAMER, I. R. H.: Histological typing of odontogenic tumours, jaw cysts and allied lesions. Geneva, WHO, 1971. 5. SHAFER,W. G., HINE, M. & LEVY, B. A.: A textbook of oral pathology, 4th edition. Philadelphia, W B Saunder, 1983.
MULTIPLE CEMENTO-OSSIFYING FIBROMA
6. WALDRON, C. A.: Fibro-osseous lesions of the jaws. J. Oral Maxillofac. Surg. 1985: 43: 249-262.
Address:
Yasunori Takeda Department of Oral Pathology School of Dentistry Iwate Medical University Uchimaru 19-1 Morioka Iwate 020 Japan
371
lesions, fibro-osseous; fibroma ossifying; fibroma, cementifying)
Multiple cemento-ossifying fibroma YASUNORI TAKEDA AND YUKIO FUJIOKA Department of Oral Pathology and Oral Surgery, School of Dentistry, lwate Medical University, Morioka, Japan
ABSTRACT- - This report concerns a case of multiple cemento-ossifying fibroma involving the maxilla and mandible of a 55-year-old Japanese male. The clinical, radiographic and histopathological findings are presented and discussed. (Accepted for publication 30 July 1986)
The ossifying and cementifying fibromas o f the jaws are well circumscribed, generally slow-growing, benign lesions which enlarge in an expansile manner. On occasion, they may reach a large size and may result in considerable deformity. The histological pattern of these lesions varies with the stages. Almost all cases of ossifying and cementifying fibromas reported previously occur as a solitary lesion. Multiple occurrence of such lesion is rare ~. This paper reports a case o f multiple cemento-ossifying fibroma involving the maxilla and mandible of a 55-year-old male. The term "cementoossifying fibroma" is used to describe the f b r o u s lesion containing calcifications with strong similarity between bone and cemen, tum 2,3, though W H O 4 and some authors 5 regard the cementifying fibroma as an odontogenic tumor and consider ossifying fibroma separately as non-odontogenic neoplasm.
Case report A 55-year-old Japanese male was referred to the dental hospital of the Iwate Medical University in December 1983 for examination of a swelling of the left maxillary region. Spontaneous pain appeared in November 1983. As a 13-year-old, in August 1941, he had been hospitalized for surgical treatment of a left mandibular lesion at an-
Fig. 1. Panoramic radiograph showing 2 lesions in the maxilla and 1 lesion in the mandible (arrows).
MULTIPLE CEMENTO-OSSIFYING FIBROMA
369
Fig. 2. Microphotographs of biopsy material. Each lesion consists of densely packed fibroblastic cells and collagen fibers with irregular arrangement (A, B). Eosinophilic calcified masses with irregular shape (A, C) and basophilic ones with oval shape (B) are scattered in the lesion. Calcified masses of intermediate type of both are seen in part (D). H&E stain.
370
TAKEDA AND FUJIOKA
other university hospital, but detailed diagnosis and pathological findings at that time could not be obtained. Clinical examination showed a diffuse swelling of the left side of the maxilla. The overlying mucosa was normal in colour. In addition, a slight swelling of the right side of the maxilla was found. The maxillary molars and bicuspids of both sides had been extracted previously. The mandible was edentulous. On palpation, the maxillary lesions were of bone-like hardness and could be well demarcated from the adjacent soft tissues. Radiographically, the maxillary lesions were well circumscribed and showed radiolucent areas intermingled with radiopaque areas (Fig. 1). At this time, radiopaque masses were found in the right side of the mandibular molar region (Fig. 1). The general physical data and X-ray examination of the long bones revealed no abnormalities. Biopsies were taken from the periphery of each lesion and submitted for histopathological examination. In each lesion, the histopathological diagnosis of "cemento-ossifying fibroma" was made (Fig. 2). The patient refused surgical treatment because of complete relief of pain by symptomatic therapy.
Discussion The term "fibro-osseous lesions" has recently gained considerable acceptance as a general designation for a group o f p a t h o logical disturbances characterized by replacement o f the n o r m a l bone architecture by a tissue c o m p o s e d o f collagen fibers and fibroblasts containing various amounts o f calcified tissues which m a y be b o n y or cementum-like in appearance. T h a t group includes fibrous dysplasia, cementomas, ossifying fibroma, osteoid osteoma, osteoblastoma, etc. O f these, polyostotic fibrous dysplasia and gigantiform cementoma (florid cemento-osseous dysplasia 6) occur simultaneously in multiple sites in the jaws. In addition, m o s t cases o f periapical cemental dysplasia present as multiple lesions. The present case lacks the most characteristic clinical, r a d i o g r a p h i c and histopathological
features o f fibrous dysplasia, gigantiform c e m e n t o m a or periapical cemental d y s p l a sia. The calcified masses strongly resembled bone a n d cementum. In general, a m o r p h ous, basophilic and r o u n d e d calcified masses are considered to be cementum, and fibrous lesions containing such calcified masses are often diagnosed as cementifying fibroma. However, it is difficult to explain the m o r p h o l o g i c a l difference between such cementum-like masses and identical calcified masses seen in some o f the fibro-osseous lesions o f the skull a n d in other bones 6. On the other hand, fibrous lesions in which the calcified masses consist o f bone are usually diagnosed as ossifying fibroma, b u t some o f these cases m a y contain an admixture o f b o n y tissue and cementum-like substance 6. A l t h o u g h these lesions continue to be diagnosed on the basis o f the d o m i n a n t calcified part, there is no conclusive evidence as to whether the calcified masses seen in the present case are cementum or b o n y tissue. In consideration o f the abovem e n t i o n e d reasons, the present case is diagnosed as cemento-ossifying fibroma.
References 1. BRADLBV, E. S. & LEAI~, D.: Ossifying fibroma involving the maxilla and mandible. Oral Surg. 1968: 26: 605-614. 2. DEH~mR, L. P.: Tumors of the mandible and maxilla in children (I). Clinicopathologic study of 46 histologically benign lesions. Cancer 1973: 31: 364--371. 3. HAMNr~, J. E., SCOFIELD,H. H. & CORNYN, J.: Benign fibro-osseous jaw lesions of periodontal membrane origin: an analysis of 249 cases. Cancer 1968: 22: 861-878. 4. PINDBORG, J. J. & KRAMER, I. R. H.: Histological typing of odontogenic tumours, jaw cysts and allied lesions. Geneva, WHO, 1971. 5. SHAFER,W. G., HINE, M. & LEVY, B. A.: A textbook of oral pathology, 4th edition. Philadelphia, W B Saunder, 1983.
MULTIPLE CEMENTO-OSSIFYING FIBROMA
6. WALDRON, C. A.: Fibro-osseous lesions of the jaws. J. Oral Maxillofac. Surg. 1985: 43: 249-262.
Address:
Yasunori Takeda Department of Oral Pathology School of Dentistry Iwate Medical University Uchimaru 19-1 Morioka Iwate 020 Japan
371