Cancer Translational Medicine

CASE REPORT
Year
: 2018  |  Volume : 4  |  Issue : 6  |  Page : 167--169

Central odontogenic fibroma with unusual presenting symptoms


Aanchal Tandon, Bharadwaj Bordoloi, Safia Siddiqui, Rohit Jaiswal 
 Department of Oral Pathology and Microbiology, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
Dr. Bharadwaj Bordoloi
Rajdhani Apartment 1 (2b), Housefed, Dispur, Beltola Basistha Road, Guwahati - 781 006, Assam
India

Abstract

The central odontogenic fibroma is a rare benign odontogenic neoplasm. It arises from either dental follicle or periodontal ligament or dental papilla. The lesion is characterized by collagenous fibrous connective tissue, containing varying number of islands or strands of odontogenic epithelium. Here, we present a case report of odontogenic fibroma in a 20-year-old female patient with unusual presenting symptoms.



How to cite this article:
Tandon A, Bordoloi B, Siddiqui S, Jaiswal R. Central odontogenic fibroma with unusual presenting symptoms.Cancer Transl Med 2018;4:167-169


How to cite this URL:
Tandon A, Bordoloi B, Siddiqui S, Jaiswal R. Central odontogenic fibroma with unusual presenting symptoms. Cancer Transl Med [serial online] 2018 [cited 2019 Nov 14 ];4:167-169
Available from: http://www.cancertm.com/text.asp?2018/4/6/167/248971


Full Text



 Introduction



The central odontogenic fibroma (COF) is a rare benign neoplasm of mesodermal origin. It is one of the most ill-defined and least understood of all odontogenic neoplasms, with an incidence rate of 0.1%–1.5% of all odontogenic tumors and 6.1% if odontoma is excluded.[1] It is believed to originate from either dental follicle or periodontal ligament or dental papilla.[2]

The common site of occurrence is the molar and premolar areas in mandible, while anterior region being the common site in maxilla.[3] Recent reviews have reported an equal incidence of odontogenic fibroma (OF) in maxilla and mandible, corroborating similar findings by Daley and Wysocki.[4],[5]

The reported age range of occurrence is 4–80 years, with a mean age of 40 years.[1] A female predilection has been documented. The lesion appears as a slow growing, asymptomatic swelling that might exist for several years before becoming symptomatic.[4] The progressive growth may result in cortical expansion and mobility of the associated teeth.[3] On radiographs, COF can appear as a single well-defined radiolucency, or as a multilocular lesion, frequently associated with unerupted or displaced teeth.[4] There may be resorption of roots of adjacent teeth. The presence of calcified material may give COF a mixed radiolucent/radiopaque appearance. However, radiographic features of the COF are not diagnostic.[3]

The COF is characterized by collagenous fibrous connective tissue containing varying amounts of inactive-looking odontogenic epithelium.[2] However, the absence of odontogenic epithelium does not preclude a diagnosis of OF.[4] Here, we present a case of COF with unusual presenting symptoms and discuss its microscopic features.

 Case Report



A 20-year-old female patient presented with the chief complaint of pain and swelling in the region of the lower front teeth for 15 days, before which she was apparently asymptomatic. The pain was dull, intermittent, nonradiating and was relieved on medication. On oral examination, hard, nontender, nonfluctuating swelling was noticed on the labial vestibule in relation to teeth 41, 42, and 44. The overlying mucosa was normal in appearance. There was no sign of paresthesia and no cervical lymph node involvement. On radiographic examination, impacted 33, 43 and a well-defined radiolucency at the lower border of the mandible in relation to impacted 43 were noticed [Figure 1]. The dental, medical, personal, and family histories of the patient were un-remarkable. A provisional diagnosis of odontogenic keratocyst was made. Incisional biopsy was performed for histopathological examination. Grossly, it measured 1.2 × 1× 1 cm, oval, brownish-white and firm.{Figure 1}

The hematoxylin and eosin section showed highly cellular connective tissue stroma [Figure 2]. Islands and strands of odontogenic epithelium were seen distributed throughout the stroma [Figure 3] and [Figure 4], with some of the islands being compressed. The connective tissue stroma showed densely packed collagen fibers arranged parallel to each other, and in bundles, fibroblasts, a few blood vessels, extravasated red blood cells and a mild inflammatory infiltrate mainly comprising lymphocytes and plasma cells. No areas or foci of calcification and giant cell were detected. These histological findings confirmed the lesion as epithelial-rich type COF, as per the World Health Organization (WHO) criteria.{Figure 2}{Figure 3}{Figure 4}

The patient was treated conservatively by enucleation and curettage and was advised for regular follow-up.

 Discussion



COF is an elusive tumor because of its rarity.[3] Though it appears very similar to the other odontogenic tumors, its own histopathologic and clinical features separate it as a distinct neoplasm.[6] The lesion is most common in the posterior mandibular region.[3] However, the site of occurrence, in this case, was anterior mandibular region. The lesion is most commonly asymptomatic with pain being an uncommon feature. However, in the present case, dull intermittent pain was a presenting symptom.

OF is defined by the WHO as a benign odontogenic neoplasm of fibroblastic origin, characterized by relatively mature collagenous fibrous tissue, with or without varying amounts of embedded inactive-looking odontogenic epithelium and with the potential to occur in either central or extraosseous location. The extraosseous counterpart is designated as peripheral OF.[3]

At present, two variants of OF can be distinguished: the epithelium – poor type and the epithelium – rich type, formerly known as simple and complex (or the WHO) types, respectively.[3] The epithelium-poor type is composed of stellate fibroblasts, often arranged in a whorled pattern with fine collagen fibrils and considerable ground substance. Small foci of odontogenic epithelium may or may not be present. Occasional foci of dystrophic calcification may be present. The epithelium-rich type is more complex and consists of cellular mature fibrous connective tissue with collagen fibers arranged in interlacing bundles, in which sparse or often conspicuous strands of odontogenic epithelium are found. The fibrous component may vary from myxoid to densely hyalinized. Calcifications composed of cementum-like material or dentinoid are present in some cases.[7],[8] Cases of COF associated with a giant cell granuloma-like component have also been reported. Whether this is a collision tumor, biphasic lesion or OF-induced giant cell response is still controversial.[8]

Histological features of the present case are consistent with the supportive literature of epithelial-rich COF. Islands of the odontogenic epithelium of varying shape and size were distributed throughout a dense, fibrous collagenous stroma along with elongated, stellate-shaped fibroblasts, and a few scattered blood vessels.

Differential diagnosis of COF includes desmoplastic fibroma, ameloblastic fibroma, desmoplastic ameloblastoma, odontogenic myxoma, traumatic bone cyst and dentigerous cyst.[6],[9]

The COF is generally treated by enucleation and curettage. A few recurrences have been reported, but the prognosis is excellent. Long-term regular follow-up is recommended.[6],[10] In the present case, the patient has been kept on follow-up till date, and there were no signs of recurrence.

 Conclusion



COF is a benign neoplasm, the successful management of which demands careful histopathological examination, accurate preoperative diagnosis and long-term regular follow-up.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Pippi R, Santoro M, Patini R. The central odontogenic fibroma: how difficult can be making a preliminary diagnosis. J Clin Exp Dent 2016; 8 (2): e223–5.
2Covani U, Crespi R, Perrini N, Barone A. Central odontogenic fibroma: a case report. Med Oral Patol Oral Cir Bucal 2005; 10(Suppl 2): E154–7.
3Reichart PA, Philipsen HA. Odontogenic Tumors and Allied Lesions. London: Quintessence; 2004.
4Armas JM, Hunter KD, Jenkins WM. Odontogenic fi broma: an unusual presentation. J Oral Maxillofac Pathol 2008; 12 (2): 68–71.
5Daley TD, Wysocki GP. Peripheral odontogenic fibroma. Oral Surg Oral Med Oral Pathol 1994; 78 (3): 329–36.
6EI Harti K, Oujilal A, EI Wady W. Central odontogenic fibroma of the maxilla. Indian J Dent 2015; 6 (4): 217–20.
7Santoro A, Pannone G, Ramaglia L, Bufo P, Lo Muzio L, Saviano R. Central odontogenic fibroma of the mandible: a case report with diagnostic considerations. Ann Med Surg (Lond) 2015; 5: 14–8.
8Neville BW, Damm DD, Allen CM, Bouquet JE. Oral and Maxillofacial Pathology. 2nd ed. Philadelphia: W.B. Saunders; 2001.
9Daskala I, Kalyvas D, Kolokoudias M, Vlachodimitropoulos D, Alexandridis C. Central odontogenic fibroma of the mandible: a case report. J Oral Sci 2009; 51 (3): 457–61.
10Gardner DG. Central odontogenic fibroma current concepts. J Oral Pathol Med 1996; 25 (10): 556–61.