Aggressive Multilocular Osteoblastoma in the Mandible: A Rare and Difficult Case to Diagnose

Abstract

Osteoblastoma is a benign neoplasia and is uncommon in the jaws. In some cases, this lesion presents extremely aggressive local characteristics and is termed aggressive osteoblastoma. Because the clinical, radiographic and histopathologic characteristics are similar to those of a variety of benign and malignant tumors, it poses a diagnostic dilemma. This report presents a case of an aggressive osteoblastoma in the mandible and discusses the differential diagnosis of this lesion. A 13-year-old white male sought the Stomatology Clinic at the State University of Paraíba, Campina Grande, PB, Brazil, complaining of asymptomatic swelling on the left side of his face. Cone-beam computerized tomography showed a multilocular, hypodense bone lesion, located in the body of the left mandible and lower third of the ascending ramus. The initial diagnostic hypothesis was juvenile ossifying fibroma or osteosarcoma. After histopathologic examination, the final diagnosis was aggressive osteoblastoma. Surgical resection with a safety margin was performed. There was no evidence of recurrence after a follow-up period of 4 years.

Agressive osteoblastoma in a seven-year-old girl’s mandible: Treatment and six-year monitoring

“…In histological aspects, the osteoid osteoma and the osteoblastoma are similar [6] . They consist of a mineralized matrix (osteoid tissue islands with varying degrees of calcification) with numerous hyperchromatic osteoblasts and occasionally giant cells similar to osteoclasts in a highly vascularized fibrous stroma [12] .…”

“…In both clinical and histological terms, a distinctive diagnosis for osteoblastomas varies between benign and malignant tumors, such as cementoblastoma, osteoid osteoma, fibrous dysplasia, ossifying fibroma, focal cemento-osseous dysplasia to low-grade osteosarcoma [6] .…”

“…The treatment for osteoblastoma is defined by a complete excision of the lesion or curettage [6] . There are reports of regression after biopsy or incomplete removal, suggesting that the osteoblastoma may be a reactive process [7] .…”

Osteoblastoma agressivo recorrente da coluna cervical tratado com sucesso com radioterapia

“…3 Os ossos mais comumente afetados são a coluna vertebral, 9% no segmento cervical, e ossos longos. 4 As taxas de recorrência do OA são de até 50%. 2 A apresentação clínica é diversificada quando relacionada à área afetada, incluindo muitos casos assintomáticos no diagnóstico.…”

“…2 A apresentação clínica é diversificada quando relacionada à área afetada, incluindo muitos casos assintomáticos no diagnóstico. 4 No nosso caso, a queixa do paciente foi inchaço com rápido crescimento na área cervical, facilitando o diagnóstico.…”