Peripheral odontogenic fibroma

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Peripheral odontogenic fibroma
Other namesPFO
Specialty Dentistry

Peripheral odontogenic fibroma(PFO) is a fibrous connective tissue mass that is exophytic and covered in surface epithelium that contains odontogenic epithelium. [1] The World Health Organization (WHO) classifies peripheral odontogenic fibroma as a fibroblastic neoplasm with variable amounts of odontogenic epithelium that appears to be dormant. Dentine and/or cementum-like material may be present. [2]

Contents

Signs and symptoms

Peripheral odontogenic fibroma manifests clinically as an infrequent, benign, unencapsulated exophytic mass that can be sessile or pedunculated, red or pink, smooth-surfaced, and ulcerated in some cases. It is frequently found on the attached gingiva, mainly in the molar and premolar regions, though it can be found anywhere in the jaw. [3]

Diagnosis

Clinically, there is no way to differentiate peripheral odontogenic fibroma from other common fibrous gingival lesions, [4] including peripheral giant cell lesion, pyogenic granuloma, inflammatory fibrous hyperplasia, and peripheral ossifying fibroma. [5] Rarely have diffuse or multifocal lesions been reported. [4] Lesions that are larger may show signs of mineralization, although radiographic changes are uncommon, particularly in the early stages. [5] Histopathologic features include a proliferation of relatively cellular fibrous or fibromyxomatous connective tissue with variable amounts of odontogenic epithelium and occasionally foci of calcification in the form of dentinoid, cementicles, or bone. These features are similar to those of the central odontogenic fibroma. [6]

Treatment

The preferred course of treatment is conservative local excision. [7]

Outlook

The rate of recurrence varies wildly. According to some studies, peripheral odontogenic fibroma has a low recurrence rate. [8] One study showed a reccurence rate of 38.9%, [9] while nother study showed a reccurence rate of 50%. [10]

Epidemiology

The literature has reported a slight female predominance in this neoplasm, which occurs in a wide age range from the first to the ninth decades of life with a peak in the second and fourth decades. [11]

See also

Related Research Articles

<span class="mw-page-title-main">Ameloblastoma</span> Medical condition

Ameloblastoma is a rare, benign or cancerous tumor of odontogenic epithelium much more commonly appearing in the lower jaw than the upper jaw. It was recognized in 1827 by Cusack. This type of odontogenic neoplasm was designated as an adamantinoma in 1885 by the French physician Louis-Charles Malassez. It was finally renamed to the modern name ameloblastoma in 1930 by Ivey and Churchill.

Epulis fissuratum is a benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture. More simply, epulis fissuratum is where excess folds of firm tissue form inside the mouth, as a result of rubbing on the edge of dentures that do not fit well. It is a harmless condition and does not represent oral cancer. Treatment is by simple surgical removal of the lesion, and also by adjustment of the denture or provision of a new denture.

<span class="mw-page-title-main">Pyogenic granuloma</span> Vascular tumor on both mucosa and skin

A pyogenic granuloma or lobular capillary hemangioma is a vascular tumor that occurs on both mucosa and skin, and appears as an overgrowth of tissue due to irritation, physical trauma, or hormonal factors. It is often found to involve the gums, skin, or nasal septum, and has also been found far from the head, such as in the thigh.

A peripheral ossifying fibroma, also known as ossifying fibrous epulis, is “a gingival nodule which is composed of a cellular fibroblastic connective tissue stroma which is associated with the formation of randomly dispersed foci of mineralised products, which consists of bone, cementum-like tissue, or a dystrophic calcification. The lesion is considered part of an ossifying fibroma, but that is usually considered to be a jaw tumor. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, though not because they occur together. Instead, the three are associated with each other because they appear frequently on gingiva: pyogenic granuloma and peripheral giant cell granuloma. Some researchers believe peripheral ossifying fibromas to be related to pyogenic fibromas and, in some instances, are the result of a pyogenic granuloma which has undergone fibrosis and calcification.

<span class="mw-page-title-main">Dentigerous cyst</span> Medical condition

A dentigerous cyst, also known as a follicular cyst, is an epithelial-lined developmental cyst formed by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. It is formed when there is an alteration in the reduced enamel epithelium and encloses the crown of an unerupted tooth at the cemento-enamel junction. Fluid is accumulated between reduced enamel epithelium and the crown of an unerupted tooth.

<span class="mw-page-title-main">Buccal exostosis</span> Medical condition

A buccal exostosis is an exostosis on the buccal surface of the alveolar ridge of the maxilla or mandible. More commonly seen in the maxilla than the mandible, buccal exostoses are considered to be site specific. Existing as asymptomatic bony nodules, buccal exostoses don’t usually present until adult life, and some consider buccal exostoses to be a variation of normal anatomy rather than disease. Bone is thought to become hyperplastic, consisting of mature cortical and trabecular bone with a smooth outer surface. They are less common when compared with mandibular tori.

Giant-cell fibroma is a benign localized fibrous mass. It often mimics other fibroepithelial growths and can be distinguished by its histopathology. The exact cause of giant-cell fibromas is unknown however there is no evidence to show that it can be caused by irritation. Giant-cell fibromas can be removed by surgical incision, electrosurgery, or laser excision.

<span class="mw-page-title-main">Central giant-cell granuloma</span> Medical condition

Central giant-cell granuloma (CGCG) is a localised benign condition of the jaws. It is twice as common in females and is more likely to occur before age 30. Central giant-cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings.

<span class="mw-page-title-main">Odontogenic keratocyst</span> Medical condition

An odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior mandible and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts.

Lateral periodontal cysts (LPCs) are defined as non-keratinised and non-inflammatory developmental cysts located adjacent or lateral to the root of a vital tooth.” LPCs are a rare form of jaw cysts, with the same histopathological characteristics as gingival cysts of adults (GCA). Hence LPCs are regarded as the intraosseous form of the extraosseous GCA. They are commonly found along the lateral periodontium or within the bone between the roots of vital teeth, around mandibular canines and premolars. Standish and Shafer reported the first well-documented case of LPCs in 1958, followed by Holder and Kunkel in the same year although it was called a periodontal cyst. Since then, there has been more than 270 well-documented cases of LPCs in literature.

Botryoid odontogenic cyst (BOC) is a type of developmental odontogenic cyst that is extremely rare. It is thought to be a lateral periodontal cyst (LPC) variant with a higher risk of recurrence. Weathers and Waldron coined the term BOC in 1973. Adults over the age of 50 are the most affected. BOC appears as a slow-growing lesion that is symptomatic in approximately 70% of cases.

<span class="mw-page-title-main">Calcifying odontogenic cyst</span> Medical condition

Calcifying odontogenic cyst (COC) is a rare developmental lesion that comes from odontogenic epithelium. It is also known as a calcifying cystic odontogenic tumor, which is a proliferation of odontogenic epithelium and scattered nest of ghost cells and calcifications that may form the lining of a cyst, or present as a solid mass.

<span class="mw-page-title-main">Ameloblastic fibroma</span> Medical condition

An ameloblastic fibroma is a fibroma of the ameloblastic tissue, that is, an odontogenic tumor arising from the enamel organ or dental lamina. It may be either truly neoplastic or merely hamartomatous. In neoplastic cases, it may be labeled an ameloblastic fibrosarcoma in accord with the terminological distinction that reserves the word fibroma for benign tumors and assigns the word fibrosarcoma to malignant ones. It is more common in the first and second decades of life, when odontogenesis is ongoing, than in later decades. In 50% of cases an unerupted tooth is involved.

<span class="mw-page-title-main">Odontoma</span> Benign tumour of dental tissue

An odontoma, also known as an odontome, is a benign tumour linked to tooth development. Specifically, it is a dental hamartoma, meaning that it is composed of normal dental tissue that has grown in an irregular way. It includes both odontogenic hard and soft tissues. As with normal tooth development, odontomas stop growing once mature which makes them benign.

The calcifying epithelial odontogenic tumor (CEOT), also known as a Pindborg tumor, is an odontogenic tumor first recognized by the Danish pathologist Jens Jørgen Pindborg in 1955. It was previously described as an adenoid adamantoblastoma, unusual ameloblastoma and a cystic odontoma. Like other odontogenic neoplasms, it is thought to arise from the epithelial element of the enamel origin. It is a typically benign and slow growing, but invasive neoplasm.

<span class="mw-page-title-main">Heck's disease</span> Medical condition

Heck's disease, also known as Focal Epithelial Hyperplasia, is an asymptomatic, benign neoplastic condition characterized by multiple white to pinkish papules that occur diffusely in the oral cavity. Can present with slightly pale, smooth or roughened surface morphology. It is caused by the human papilloma virus types 13 and 32. It exhibits surface cells with vacuolated cytoplasm around irregular, pyknotic nuclei and occasional cells with mitosis-like changes within otherwise mature and well-differentiated epithelium. A distinguishing histologic feature is elongated rete ridges with mitosoid bodies. It shows 'cobblestone' appearance clinically. It was first identified in the Aboriginal population of North America.

Epulis is any tumor like enlargement situated on the gingival or alveolar mucosa. The word literally means "(growth) on the gingiva", and describes only the location of the mass and has no further implications on the nature of the lesion. There are three types: fibromatous, ossifying and acanthomatous. The related term parulis refers to a mass of inflamed granulation tissue at the opening of a draining sinus on the alveolus over the root of an infected tooth. Another closely related term is gingival enlargement, which tends to be used where the enlargement is more generalized over the whole gingiva rather than a localized mass.

A ghost cell is an enlarged eosinophilic epithelial cell with eosinophilic cytoplasm but without a nucleus.

<span class="mw-page-title-main">Gingival cyst</span> Medical condition

Gingival cyst, also known as Epstein's pearl, is a type of cysts of the jaws that originates from the dental lamina and is found in the mouth parts. It is a superficial cyst in the alveolar mucosa. It can be seen inside the mouth as small and whitish bulge. Depending on the ages in which they develop, the cysts are classified into gingival cyst of newborn and gingival cyst of adult. Structurally, the cyst is lined by thin epithelium and shows a lumen usually filled with desquamated keratin, occasionally containing inflammatory cells. The nodes are formed as a result of cystic degeneration of epithelial rests of the dental lamina.

The ameloblastic fibro-odontoma (AFO) is essentially a benign tumor with the features characteristic of ameloblastic fibroma along with enamel and dentin. Though it is generally regarded as benign, there have been cases of its malignant transformation into ameloblastic fibrosarcoma and odontogenic sarcoma. Cahn LR and Blum T, believed in "maturation theory", which suggested that AFO was an intermediate stage and eventually developed during the period of tooth formation to a complex odontoma thus, being a hamartoma.

References

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  2. Kramer, I. R. H.; Pindborg, J. J.; Shear, M. (1992). "Histological Classification of Odontogenic Tumours". Histological Typing of Odontogenic Tumours. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 7–9. doi:10.1007/978-3-662-02858-2_2. ISBN   978-3-540-54142-4.
  3. Nikam, ShitalSudhakar; Gadgil, RajeevM; Bhoosreddy, AjayR; Shah, KaranR (2015). "Peripheral odontogenic fibroma: A case report and review of literature". Journal of Indian Academy of Oral Medicine and Radiology. Medknow. 27 (1): 140. doi: 10.4103/0972-1363.167138 . ISSN   0972-1363.
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  5. 1 2 Patel, Stavan; Vakkas, John; Mandel, Louis (2011). "Recurrent peripheral odontogenic fibroma. Case report". The New York State Dental Journal. 77 (4): 35–37. PMID   21894830.
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  8. Slabbert, Hein de Villiers; Altini, Mario (1991). "Peripheral odontogenic fibroma: A clinicopathologic study". Oral Surgery, Oral Medicine, Oral Pathology. Elsevier BV. 72 (1): 86–90. doi:10.1016/0030-4220(91)90195-i. ISSN   0030-4220.
  9. Daley, Tom D.; Wysocki, George P. (1994). "Peripheral odontogenic fibroma". Oral Surgery, Oral Medicine, Oral Pathology. Elsevier BV. 78 (3): 329–336. doi:10.1016/0030-4220(94)90064-7. ISSN   0030-4220. PMID   7970594.
  10. Ritwik, Priyanshi; Brannon, Robert B. (2010). "Peripheral odontogenic fibroma: a clinicopathologic study of 151 cases and review of the literature with special emphasis on recurrence". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. Elsevier BV. 110 (3): 357–363. doi:10.1016/j.tripleo.2010.04.018. ISSN   1079-2104. PMID   20674403.
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Further reading