Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 14, 2017
Facial Ossifying Fibroma
- Background:
- Most ossifying fibromas of the craniofacial skeleton grow slowly and can result in bone expansion with facial asymmetry and painless swelling.
- In the craniofacial region, there are 2 apparent clinicopathologic variants of ossifying fibroma: the conventional slow-growing ossifying fibroma and the so-called juvenile active (aggressive) ossifying fibroma. Overall, ossifying fibromas are more common in women than in men.
- Clinical Presentation:
- Most tumors are asymptomatic but can cause considerable facial asymmetry, as well as tooth displacement and dental malocclusion.
- Key Diagnostic Features:
- Typically appears as a solitary, well-defined, unilocular, focally expansile lesion with sharp margins, ground-glass attenuation, and no low-attenuation halo.
- Occasionally a sclerotic border may be seen.
- Differential Diagnoses:
- Fibrous dysplasia is seen as a heterogeneous lesion with ground-glass attenuation and a wide, ill-defined transition zone, a feature that helps differentiate it from ossifying fibroma.
- Pyogenic granulomata are small, highly vascular nonneoplastic lesions involving gingival tissues, with a tendency to hemorrhage.
- Ameloblastic fibro-odontoma is associated with varying degrees of inductive dental hard tissues such as enamel and dentin.
- Radiology findings depend largely on the amount of hard tissues present in the lesion, with the calcific density in the lesion varying from homogeneous masslike structures to multiple spots or striations. This variation may be correlated with tumor maturation.
- Plasmocytoma are typically seen as well-defined, “punched-out” lytic lesions with associated soft-tissue masses, similar in appearance to most metastatic lesions.
- There are often erosion, expansion, and destruction of bone cortex, sometimes with thick ridging around the periphery.
- Treatment:
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Treatment for conventional ossifying fibroma is simple enucleation, and recurrence is uncommon.
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