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Case Report Peripheral Cemento-Ossifying Fibroma: Case Series Literature Review

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Case Report Peripheral Cemento-Ossifying Fibroma: Case Series Literature Review Hindawi Publishing Corporation Case Reports in Dentistry Volume 2013, Article ID 930870, 5 pages http://dx.doi.org/10.1155/2013/930870 Case Report Peripheral Cemento-Ossifying Fibroma: Case Series Literature Review Kiran Kumar Ganji,1 ArunKumar Bhimashankar Chakki,2 Sharanbasappa Chandrashekar Nagaral,3 and Esha Verma4 1 Department of Periodontics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed University), Nagpur, India 2 Department of Oral and Maxillofacial Pathology, Guru Gobind Singh College of Dental Sciences, Devi Ahilya University, Burhanpur, Indore, India 3 Department of Prosthodontics, Al-badar Dental College and Hospital, Near PDA Engineering College, Rajiv Gandhi University of Health Sciences, Gulbarga, Bangalore, India 4 Department of Periodontics, College of Dental Sciences & Hospital, Devi Ahilya University, Rau, Indore, India Correspondence should be addressed to Kiran Kumar Ganji; [email protected] Received 3 September 2012; Accepted 4 November 2012 Academic Editors: A. Kasaj, Y. S. Khader, and M. Machado Copyright © 2013 Kiran Kumar Ganji et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. e concept of �broosseous lesions of bone has evolved over the last several decades and now includes two major entities: �brous dysplasia and ossifying �broma. Peripheral cemento-ossifying �broma is a relatively rare tumour classi�ed between �broosseous lesions. It predominantly affects adolescents and young adults, with peak prevalence between 10 and 19 yrs. e cemento-ossifying �broma 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. e cemento-ossifying �broma is odontogenic in origin, whereas ossifying �broma is of bony origin. Lesions histologically similar to peripheral ossifying �broma have been given various names in existing literature. erefore, we present and discuss in this paper a series of cases of peripheral cemento-ossifying �broma emphasizing the differential diagnosis. 1. Introduction [5]. e pathogenesis of this tumor is uncertain. Due to their clinical and histopathological similarities, some PCOFs are Benign �broosseous lesions of the jaws present problems believed to develop �brous maturation and subsequent cal- in diagnosis and classi�cation. e 1992 WHO classi�ca- ci�cation. PCOF is frequently associated with irritant agents tion groups under a single designation (cemento-ossifying such as calculus, bacterial plaque, orthodontic appliances, ill �broma) two histologic types (cementifying �broma and adapted crowns, and irregular restorations. e mineralized ossifying �broma) that may be clinically and radiograph- product probably originates from periosteal cells or from the ically undistinguishable [1]. Cemento-ossifying �broma is a relative rare lesion considered as an osteogenic tumor periodontal ligament [6]. PCOF affects both genders, but (nonodontogenic) with variable expressiveness. It is de�ned a higher predilection for females has been reported in the as a well-demarcated and occasionally encapsulated lesion literature [4]. With respect to race, there is a predominance in consisting of �brous tissue containing variable amounts of Whites (71 ) compared to Blacks (36 )[7]. It may occur at mineralized material resembling bone (ossifying �broma), any range, but exhibits a peak incidence between the second cementum (cementifying �broma), or both [2, 3]. [8] and third% decades [7]. However, Neville% et al. [9] say that Peripheral cemento-ossifying �broma (PCOF) accounts it predominantly affects adolescents and young adults, with a for 3.1 of all oral tumors [4] and for 9.6 of gingival lesions peak prevalence between 10 and 19 years. % % 2 Case Reports in Dentistry (a) (b) F 1: (a) Clinical view of lesion. (b) Postoperative view. (a) (b) F 2 Clinically, PCOF manifests as a pediculate or sessile and revealed indentations made by the occluding mandibular nodular mass, which usually originates in the interdental premolar. e surface of the occlusal plane was pinkish red in papilla. Its color is similar to that of the mucosa unless the color (Figure 1). lesion is ulcerated. Most tumors measure less than 2 cm in diameter, although lesions larger than 10 cm are occasionally Case 2. A healthy 25- year-old male reported to College observed. About 60 of the tumors occur in the maxilla and of Dental Sciences & Hospital, Rau, Indore, India, with morethan50 of all cases affect the region of the incisors a lump in his back teeth. According to the patient, the and canines. A potential% of tooth migration PCOF has been reddish purple lump has been present for approximately reported [6]. Hence,% the purpose of this paper is to present a 6monthsandthelumpwasinterferingwithhisbiteand series of cases of PCOF lesions and emphasize the importance felt uncomfortable. Occasionally bleeding occurred when of discussion of the reasonable differential diagnosis with the he brushed his teeth. Clinical examination revealed erythe- patient. matous interdental papilla in relation to maxillary central incisors 11,12 visible from facial aspect with no evidence of lesion palatally. e lesion appeared exophytic and nodular 2. Case Description with irregular surface. It measured approximately 10 mm laterally and 8 mm in anterior-posterior direction and 6 mm Case 1. A 21-year-old male reported to College of Dental thick. It was slightly pedunculated with what appeared to be Sciences & Hospital, Rau, Indore, India, with his slow a broad-based attachment. e lesion was neither �uctuant growing, painless growth that had been present facial in nor did it blanch on pressure, but had a rubbery consistency. upper right premolar to molar region. Lesion started as a It was tender (Figure 2). small papule approximately 1 year earlier. According to the patient, there was no bleeding and pain except difficulty in Case 3. A 26-year-old male patient was referred by his general mastication. Examination revealed approximately cm dental practitioner for gingival swelling in relation 15 to 16 pedunculated nontender, �rm, pinkish red growth present on region. e past dental history revealed presence of swelling the buccal gingival in relation to maxillary right canine2 × 1.5 to 1st since last one and half year duration. On examination, the molar. e lesion extended up to the level of occlusal plane associated so tissue was slightly swollen but there was no Case Reports in Dentistry 3 (a) (b) (c) F 3: (a) Clinical view. (b) Clinical view. (c)View aer excision. (a) (b) (c) F 4: Clinical view. ulceration, on palpation the swelling was so rubbery in (3) sparse-to-profuse endothelial proliferation; consistency, but no tenderness. e lesion was well demar- (4) mineralized material consisting of mature, lamellar or cated and pedunculated measuring approximately cm woven osteoid, cementum like material, or dystrophic (Figure 3). calci�cations; 1.5 × 2 Case 4. A 31-year-old male reported to the College of Dental (5) acute or chronic in�ammatory cells in lesion (Figure Sciences & Hospital, Rau, Indore, India complaining of 5). inabilitytochewfoodsince6to8months.epatientwas apparently asymptomatic 18 months back when he developed 4. Discussion a small swelling in the mandibular anterior labial region in 31, 41 which gradually increased in size. On examination, �eripheral ossifying �broma is thought to be either reactive or a uniform rounded swelling was present in mandibular neoplastic in nature. Considerable confusion has prevailed in anterior region due to which the patient could not chew the the nomenclature of peripheral ossifying �broma with var- food. e size of the lesion was cm and the shape ious synonyms being used, such as peripheral cementifying was ovoid. e overlying mucosa was pinkish in color and �broma, ossifying �broepithelial polyp, peripheral �broma �rm in consistency. e texture was2.5 smooth.× 2 ere was no with osteogenesis, peripheral �broma with cementogenesis, compressibility or depressibility (Figure 4). peripheral �broma with calci�cation, calcifying or ossifying �broma epulis, and calcifying �broblastic granuloma �10]. 3. Diagnosis Ossifying �bromas elaborate bone, cementum and spheroidal calci�cations, which has given rise to various terms for these Di�erential diagnosis consisted of irritational �broma, pyo- benign �broosseous neoplasms. When bone predominates, genic granuloma, peripheral giant cell granuloma, peripheral “ossifying” is the appellation, while the term “cementi- cemento-ossifying �broma. fying” has been assigned when curvilinear trabeculae or A con�rmatory diagnosis of peripheral cemento- spheroidal calci�cations are encountered �11]. When bone ossifying �broma is made by histopathologic evaluation and cementum-like tissues are observed, the lesions have of biopsy specimens. e following features were observed been referred to as cemento-ossifying �broma �11]. Cementi- during microscopic examination: fying �bromas may be clinically and radiographically impos- sible to separate from ossifying �bromas �12]. An attempt (1) ulcerated strati�ed s�uamous surface epithelium; has been made by Endo et al. to distinguish cementifying (2) benign �brous connective tissue with varying num- �broma from ossifying �bromas and �brous dysplasias by bers of �broblasts; using immunohistochemical analysis for keratin sulfate and 4 Case Reports
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