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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 775-776

Ossifying fibroma and its differential diagnosis


1 Head of Oculoplasty Department, MN Eye Hospital, Chennai, Tamil Nadu, India
2 Academic Director, MN Eye Hospital Chennai, Tamil Nadu, India
3 ENT Consultant, SMF Chennai, Tamil Nadu, India
4 Arunai Medical College and Hospital, Vellore, Tamil Nadu, India

Date of Submission15-Feb-2022
Date of Acceptance19-Apr-2022
Date of Web Publication16-Jul-2022

Correspondence Address:
Dr. Pratheeba D Nivean
MN Eye Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_462_22

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  Abstract 


Bony lesions of the sinuses can cause disfigurement or functional issues in orbit. Benign bony lesions of the para-nasal sinuses are collectively called as the fibro-osseous lesions. Osteoma, fibrous dysplasia, and ossifying fibroma (OF) are common among them. OF is a rare benign bony tumor occurring in the second to fourth decade. We present this case as juvenile OF is very rare and to discuss the differentials of the bony sinus pathologies.

Keywords: Bony sinus lesions, fibrous dysplasia, ossifying fibroma


How to cite this article:
Nivean PD, Nivean M, Duraisamy R, Mohammed Sayee T S. Ossifying fibroma and its differential diagnosis. Indian J Ophthalmol Case Rep 2022;2:775-6

How to cite this URL:
Nivean PD, Nivean M, Duraisamy R, Mohammed Sayee T S. Ossifying fibroma and its differential diagnosis. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 19];2:775-6. Available from: https://www.ijoreports.in/text.asp?2022/2/3/775/351194



Ossifying fibroma (OF) is a rare benign fibro-osseous neoplasm of the jaw in which there is replacement of the normal bone with fibrous tissues and calcified products such as the bone, cementum, or both.[1] It is a well-demarcated lesion that differentiates it from fibrous dysplasia. It usually occurs in the second to fourth decade of life and has a strong female predilection. It is believed to derive from the multi-potential mesenchymal cells of the peri-odontal ligament which are able to form cementum, bone, and fibrous tissues.[2] There are two types: 1. OF when the bone predominates in a lesion and 2. Cementifying fibroma when curved/linear trabeculae or spheroids (psammoma-like calcifications) predominate.[3]

We present a juvenile OF which is a rare entity.


  Case Report Top


A 7-year-old boy came to us with mild prominence and upward deviation of his left eye for 4 months [Figure 1]a. There were no complaints of defective vision. On examination, his vision in both the eyes were 6/6 n6. His extra-ocular motility was slightly restricted inferiorly in his left eye. Hertel's examination showed a 2 mm difference in proptosis in the left eye. The pupil was round reacting to light, and anterior segment examination was normal in both the eyes. His fundus exam was also within normal limits. Magnetic resonance imaging (MRI) revealed an expansile circumscribed mass with a thick bony shell (reactive bony change). A computed tomography (CT) scan revealed a well-encapsulated homogeneous lesion with mild osteolytic activity inside and an osteoblastic rim around [Figure 1]b1 and [Figure 1]b2. Excision biopsy was performed through the trans-nasal endoscopic route by an ear, nose, and throat surgeon. Histopathology shows spindle-shaped fibroblast cells around the trabeculae. The fibroblast transforms to the rim of the osteoblast [Figure 2]. These features were suggestive of OF. The immediate post-operative period was uneventful. However, the patient was lost to follow up after that.
Figure 1: (a) External photograph of the boy with upward and mild forward displacement of the left eye. (b1) MRI picture of the expansile well-demarcated OF. (b2) CT picture of the lesion with osteolytic activity surrounded by the osteoblastic rim

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Figure 2: Histopathology picture of the patient with osteoids in the center surrounded by fibrous stroma

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  Discussion Top


OF is a slowly growing tumor commonly involving the maxilla and mandible which is usually asymptomatic. Massive bone expansion of the lingual and cortical buccal plates is a common sign. They may displace the roots of adjacent teeth and also cause root resorption. Sharp transition at the bony margin distinguishes this lesion from other bony lesions.[4]

OF occurs in the second to fourth decade, but there are reports of juvenile OF.[5] Juvenile OF has aggressive presentation. The etiology behind OF has been hypothesized as a developmental anomaly or trauma.[6]

MacDonald–Jankowski described three stages based on radiographic appearance as radiolucent (osteolytic image), then radiopaque (as the stroma mineralizes, thus transforming into a mixed lesion), and sclerotic lesion.[7]

Eden presented a study of five cases primarily from the pathological point of view and concluded that OF represents an immature form of the benign “fibro-osseous” tumors of the membranous bone. OF of the bone is essentially a monostotic process. The process is always monolocular and monostotic, having a thin bony capsule, which particularly grows in the maxilla and mandible, and possessing the property of destroying nearby bones without displacing them significantly.

The main differential diagnosis is fibrous dysplasia. Although histopathology plays an important role in differentiating both the entities, the well-demarcated nature and monostotic features are pathognomonic of OF.[1] Fibrous dysplasia contains only the woven bone, without evidence of osteoblastic rimming of the bone. The presence of bones with more mature lamellae is characteristic of OF. Histologically OF has an island of osteoids rimmed by osteoblast-forming lamellar bones and the cellular fibrous stroma with parallel and whorl arrangement of collagen and fibroblasts.[8]

Treatment depends on the size of the tumor, the presence or absence of symptoms, and the individual age and health. Surgical curettage and complete excision remain the treatments of choice. Recurrence rates have been reported; however, malignant transformation has not been reported. The other differentials and their characteristic features are listed in the [Table 1].[9]
Table 1: Differential diagnosis of bony lesions of sinus and its radiological finding

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  Conclusion Top


To conclude, the common bony lesions of the sinuses are osteomas, fibrous dysplasia, and OF. Osteomas have a peculiar pedunculated and more homogeneous bony growth with less destruction to surrounding tissues. Fibrous dysplasia affects children, although deforming it is not destructive. It has a characteristic ground glass density on CT. OF is more destructive and aggressive. It appears as a well-circumscribed lesion with an eggshell-thin wall and a hypo-dense center, and it should be completely excised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khan SA, Sharma NK, Raj V, Sethi T. Ossifying fibroma of maxilla in a male child: Report of a case and review of the literature. Natl J Maxillofac Surg 2011;2:73-9.  Back to cited text no. 1
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2.
Eversole LR, Leider AS, Nelson K. Ossifying fibroma: A clinicopathologic study of sixty-four cases. Oral Surg Oral Med Oral Pathol 1985;60:505-11.  Back to cited text no. 2
    
3.
Kramer IR, Pindborg JJ, Shear M. Histological Typing of Odontogenic Tumours. 2nd ed. Berlin: Springer; 1992.  Back to cited text no. 3
    
4.
Walter JM Jr, Terry BC, Small EW, Matteson SR, Howell RM. Aggressive ossifying fibroma of the maxilla: Review of the literature and report of case. J Oral Surg 1979;37:276-86.  Back to cited text no. 4
    
5.
Hakeem AH, Hakeem IH. Juvenile ossifying fibroma of paranasal sinuses-do we need to be radical in surgery? J Craniofac Surg 2013;24:e257-8.  Back to cited text no. 5
    
6.
Villemure JG, Meagher-Villemure K. Giant ossifying fibroma of the skull. Case report. J Neurosurg 1983;58:602-6.  Back to cited text no. 6
    
7.
MacDonald-Jankowski DS. Cemento-ossifying fibromas in the jaws of Hong Kong Chinese. Dentomaxillofac Radiol 1998;27:298-304.  Back to cited text no. 7
    
8.
Eller R, Sillers M. Common fibro-osseous lesions of the paranasal sinuses. Otolaryngol Clin North Am 2006;39:585-600.  Back to cited text no. 8
    
9.
Chang CC, Hung HY, Chang JY, Yu CH, Wang YP, Liu BY, et al. Central ossifying fibroma: A clinicopathologic study of 28 cases. J Formos Med Assoc 2008;107:288-94.  Back to cited text no. 9
    


    Figures

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    Tables

  [Table 1]



 

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