A Clinical, Radiological and Histopathological Review of 74 Ossifying Fibromas

Abstract

Background Ossifying fibroma (OF) is a fibro-osseous lesion of the jaws and craniofacial bones. Accurate diagnosis can be challenging due to significant overlap of clinicopathological features. This study aimed to evaluate the clinical, radiological and histological features that can aid in diagnosis and identify characteristics that allow categorisation into the three subtypes: juvenile trabecular, psammomatoid and cemento-ossifying OF. Methods A total of 74 cases of OF were systematically reviewed for their principle features. Of these, 46 cases were evaluated for their radiographic features including size, location and relationship to the teeth. Histological assessment and stereological point counting were performed in 69 cases to assess the pattern, type and proportion of calcification, the nature of the stroma, the border of the lesion and the presence of secondary changes. Fisher’s exact test and Chi-squared tests were used to determine associations between clinicopathological parameters and maxillary, mandibular, odontogenic, non-odontogenic and psammomatoid or trabecular lesions. Results OF showed a female predilection (F: M; 2:1) and a slight bimodal age distribution with peaks in the second (23%) and fourth decades (27%) (Mean age: 32.4 years). 83% of cases presented as an intra-oral swelling, with the mandible being the most common site (73%). Histologically, a range of morphological patterns were seen, with 50% of cases showing mixed trabecular and psammomatoid features. However, there were no significant differences between the variants of OF in terms of age, gender or histological features. Conclusion Histological features of OF cannot be used to differentiate between the subtypes.

Management of ossifying fibroma of the bone of the maxilla: a case report and review of the literature

“…Several cases have been reported in English literature [ 3–7 ]. Jaw OF origin is believed to be odontogenic or from periodontal ligament progenitor cells [ 8 ]. The periodontal membrane has multipotent cells capable of forming cementum, lamellar bone, and fibrous tissue.…”

Maxillofacial Bone Involvement in Fibro-Osseous Lesions: Emphasizing the Significance of Differential Diagnosis

“…Likewise, psammoma-like bodies exhibited a spectrum of appearances, ranging from well-defined acellular spherical masses to less structured irregular masses, characterized by a basophilic core and peripheral hyalinization. Occasionally, these bodies manifested delicate, feathery outlines or fused into intricate ‘ginger root’ patterns [ 18 ].…”

Immunohistochemical analysis of osteoclastic and osteoblastic activity in ossifying fibroma and juvenile ossifying fibroma: A comparative study

“…An independent examiner reviewed the slides stained with hematoxylin and eosin to confirm the diagnosis. The samples, prepared as 5-micrometer sections, were analyzed and classified according to the WHO classification [ 2 ].…”

“…The term “cemento-ossifying” is still utilized in the most recent World Health Organization (WHO) classification (2022) to describe a variant that develops in the parts of the jaws supporting teeth and is believed to originate from odontogenic tissues. The term “juvenile” has been eliminated from the classification, given that psammomatoid variants can occur across a wide age range [ 2 ].…”