PDF(Pubmed)
Abstract：
BACKGROUND: Peripheral ossifying fibroma is a nonneoplastic inflammatory hyperplasia that originates in the periodontal ligament or periosteum in response to chronic mechanical irritation. Peripheral ossifying fibroma develops more commonly in young females as a solitary, slow-growing, exophytic nodular mass of the gingiva, no more than 2 cm in diameter. While various synonyms have been used to refer to peripheral ossifying fibroma, very similar names have also been applied to neoplastic diseases that are pathologically distinct from peripheral ossifying fibroma, causing considerable nomenclatural confusion. Herein, we report our experience with an unusual giant peripheral ossifying fibroma with a differential diagnostic challenge in distinguishing it from a malignancy.
METHODS: A 68-year-old Japanese male was referred to our department with a suspected gingival malignancy presenting with an elastic hard, pedunculated, exophytic mass 60 mm in diameter in the right maxillary gingiva. In addition to computed tomography showing extensive bone destruction in the right maxillary alveolus, positron emission tomography with computed tomography revealed fluorodeoxyglucose hyperaccumulation in the gingival lesion. Although these clinical findings were highly suggestive of malignancy, repeated preoperative biopsies showed no evidence of malignancy. Since even intraoperative frozen histological examination revealed no malignancy, surgical resection was performed in the form of partial maxillectomy for benign disease, followed by thorough curettage of the surrounding granulation tissue and alveolar bone. Histologically, the excised mass consisted primarily of a fibrous component with sparse proliferation of atypical fibroblast-like cells, partly comprising ossification, leading to a final diagnosis of peripheral ossifying fibroma. No relapse was observed at the 10-month follow-up.
CONCLUSIONS: The clinical presentation of giant peripheral ossifying fibromas can make the differential diagnosis from malignancy difficult. Proper diagnosis relies on recognition of the characteristic histopathology and identification of the underlying chronic mechanical stimuli, while successful treatment mandates complete excision of the lesion and optimization of oral hygiene. Complicated terminological issues associated with peripheral ossifying fibroma require appropriate interpretation and sufficient awareness of the disease names to avoid diagnostic confusion and provide optimal management.
METHODS: A 68-year-old Japanese male was referred to our department with a suspected gingival malignancy presenting with an elastic hard, pedunculated, exophytic mass 60 mm in diameter in the right maxillary gingiva. In addition to computed tomography showing extensive bone destruction in the right maxillary alveolus, positron emission tomography with computed tomography revealed fluorodeoxyglucose hyperaccumulation in the gingival lesion. Although these clinical findings were highly suggestive of malignancy, repeated preoperative biopsies showed no evidence of malignancy. Since even intraoperative frozen histological examination revealed no malignancy, surgical resection was performed in the form of partial maxillectomy for benign disease, followed by thorough curettage of the surrounding granulation tissue and alveolar bone. Histologically, the excised mass consisted primarily of a fibrous component with sparse proliferation of atypical fibroblast-like cells, partly comprising ossification, leading to a final diagnosis of peripheral ossifying fibroma. No relapse was observed at the 10-month follow-up.
CONCLUSIONS: The clinical presentation of giant peripheral ossifying fibromas can make the differential diagnosis from malignancy difficult. Proper diagnosis relies on recognition of the characteristic histopathology and identification of the underlying chronic mechanical stimuli, while successful treatment mandates complete excision of the lesion and optimization of oral hygiene. Complicated terminological issues associated with peripheral ossifying fibroma require appropriate interpretation and sufficient awareness of the disease names to avoid diagnostic confusion and provide optimal management.
摘要：
背景：外周骨化性纤维瘤是一种非肿瘤性炎性增生，起源于牙周膜或骨膜，以响应慢性机械刺激。周围骨化性纤维瘤在年轻女性中更常见，生长缓慢,牙龈的外生性结节，直径不超过2厘米。虽然各种同义词已被用来指代周围骨化性纤维瘤，非常相似的名称也适用于病理上与周围骨化纤维瘤不同的肿瘤疾病，引起相当大的术语混乱。在这里，我们报告了我们对一个不寻常的巨大周围骨化性纤维瘤的经验，在区分其与恶性肿瘤方面存在鉴别诊断挑战。
方法：一名68岁的日本男性被转诊到我们部门，怀疑牙龈恶性肿瘤，有花梗，右上颌牙龈中直径为60毫米的外生性肿块。除了计算机断层扫描显示右侧上颌骨广泛的骨破坏，正电子发射断层扫描和计算机断层扫描显示牙龈病变中氟脱氧葡萄糖过度积累。尽管这些临床表现高度提示恶性肿瘤，重复的术前活检显示没有恶性肿瘤的证据.由于即使术中冷冻组织学检查也没有发现恶性肿瘤，手术切除以上颌骨部分切除术的形式进行良性疾病，然后彻底刮除周围的肉芽组织和牙槽骨。组织学上,切除的肿块主要由纤维成分组成，稀疏增生的非典型成纤维细胞样细胞，部分包括骨化，导致周围骨化性纤维瘤的最终诊断。在10个月的随访中没有观察到复发。
结论：周围巨大骨化性纤维瘤的临床表现可能使其与恶性肿瘤的鉴别诊断变得困难。正确的诊断依赖于对特征性组织病理学的识别和潜在的慢性机械刺激的识别。而成功的治疗要求完全切除病变并优化口腔卫生。与周围骨化性纤维瘤相关的复杂术语问题需要对疾病名称进行适当的解释和足够的认识，以避免诊断混乱并提供最佳管理。
方法：一名68岁的日本男性被转诊到我们部门，怀疑牙龈恶性肿瘤，有花梗，右上颌牙龈中直径为60毫米的外生性肿块。除了计算机断层扫描显示右侧上颌骨广泛的骨破坏，正电子发射断层扫描和计算机断层扫描显示牙龈病变中氟脱氧葡萄糖过度积累。尽管这些临床表现高度提示恶性肿瘤，重复的术前活检显示没有恶性肿瘤的证据.由于即使术中冷冻组织学检查也没有发现恶性肿瘤，手术切除以上颌骨部分切除术的形式进行良性疾病，然后彻底刮除周围的肉芽组织和牙槽骨。组织学上,切除的肿块主要由纤维成分组成，稀疏增生的非典型成纤维细胞样细胞，部分包括骨化，导致周围骨化性纤维瘤的最终诊断。在10个月的随访中没有观察到复发。
结论：周围巨大骨化性纤维瘤的临床表现可能使其与恶性肿瘤的鉴别诊断变得困难。正确的诊断依赖于对特征性组织病理学的识别和潜在的慢性机械刺激的识别。而成功的治疗要求完全切除病变并优化口腔卫生。与周围骨化性纤维瘤相关的复杂术语问题需要对疾病名称进行适当的解释和足够的认识，以避免诊断混乱并提供最佳管理。
