Central odontogenic fibroma of the maxilla

Abstract

The central odontogenic fibroma (COF) is a rare benign odontogenic mesenchymal tumor of jaw bones. The World Health Organization (WHO) recognizes two variants of COF namely: 1) Epithelial-rich type (WHO) and 2) epithelial-poor type (simple type). Rare variants like ossifying COF, COF associated with giant cell lesions, and amyloid have been documented. This article presents a case of an epithelial-rich variant of COF in a 24-year-old female. It presented as a bony swelling of the maxilla and appeared as a mixed lesion in radiographs. Histopathology showed a highly cellular fibrous connective tissue stroma with plump fibroblasts and long strands of odontogenic epithelium exhibiting mild eosinophilic to clear cytoplasm. Numerous cementum-like hematoxyphilic calcifications of various sizes akin to dentin or acellular cementum were observed. We believe that clinical and radiographic features of this case may add valuable knowledge to the already existing literature.

Epithelium Rich Type Central Odontogenic Fibroma in Maxilla a Case Report and Review of Literature

“…COF affect wide age ranged mainly between the 2nd and 4th decades of life. In 2005, Barnes et al found that COF has a female predilection [11]. On the other hand, Tkeoka reviewed eighteen Japanese cases from 1980-2010 found that COF affect both gender equally [9].…”

“…Epithelium-rich type-containing fibrous tissue in myxoid area associated with odontogenic epithelium and features of dysplastic dentine or cementum-like tissue [13]. The different histologically was attributed to the tissue of origin [11]. In a study done on dogs in 1983, it has been suggested that epithelium-poor type is derived from the dental follicle and the epithelium-rich type arises from the periodontal ligament [14].…”

“…Since 1992, WHO publication doesn't use the term 'WHO type' instead odontogenic fibroma complex type" or "fibroblastic odontogenic fibroma has been widely accepted [10]. The recent (WHO 2005) classify COF histologically into only two subtypes; Epithelium poor and Epithelium-rich type [11]. Epithelium poor type-is usually an expansile fibrous neoplasm with varying collagenous fibrous connective tissue containing nests of odontogenic epithelium [10].…”

“…CGCG is positive to CD68 and epithelium cords that are poisitive to marker CK19, which indicates that this is an odontogenic lesion [1]. Second, it considered to be a collision, hybrid lesion of the COF/CGC as a result of incidental occurrence of COF (Epithelium rich-type) in synchronizing with giant cell granuloma [11]. The third proposal, suggest that COF is induced as secondary lesion by the growth factor from primary CGCG lesion producing more proliferation of odontogenic epithelium [1].…”

Central Odontogenic Fibroma of Simple Type

“…The WHO variant is considered as a mesenchymal odontogenic tumor and is comprised of two distinct cell types, a fibrous element, and an epithelial component that resembles dental lamina or its remnants. In contrast, the non-WHO variant lacks an epithelial component and is said to be a monomorphic fibroblastic tumor, purported to be of odontogenic mesenchymal origin and ostensibly derived from pulpal or follicular fibroblasts [9]. …”