Role of collagen and immunostaining for TGF-β in the clinical andmicroscopic findings of pyogenic granuloma and peripheral ossifying fibroma

Background: Collagen is a component of Pyogenic Granuloma (PG) and Peripheral Ossifying Fibroma (POF) and performs different functions in these lesions. The objective of this study is to evaluate the role of collagen and immunostaining for Transforming Growth Factor beta (TGF-β) in the clinical and microscopic findings of PG and POF. Material and Methods: PG (n=20) and POF (n=20) were selected for clinical evaluation (sex, age, localization, size and evolution time) and microscopic analysis (picrosirius red staining for collagen analysis and immunohistochemistry for TGF-β) performed in the superficial and deep areas of the two lesions. ANOVA/Bonferroni and t-test, Pearson correlation and χ2 were used to compare the sites and parameters analyzed (p<0.05, GraphPad Prism 5.0). Results: The depth of PG presented the highest amount of collagen (p<0.001), and its surface showed the lowest amount of type 1 collagen (yellow-red strong birefringence). Type 1 collagen gradually increased in depth of PG, surface and depth of POF (p<0.001). The number of TGF-β+ cells was lower on the surface of PG compared with the depth of PG and the two areas of POF (p<0.001). Sex and localization did not affect these parameters, but the profile of collagen and immunostaining for TGF-β suffered from modifications by the time of evolution and the size of the lesion. Conclusions: Although PG and POF are reactive gingival lesions, the expression of TGF-β and its role in collagen showed different biological behaviors in these lesions, suggesting different biological origins for its components. (AU)

Clínica, epidemiología e imagenología del fibroma osificante y la displasia fibrosa del territorio cráneo-maxilofacial: revisión narrativa / Clinical, epidemiology and imaging of ossifiying fibroma and fibrous dysplasia of the cranio-maxillofacial territory: narrative review

Introducción: El fibroma osificante (FO) y la displasia fibrosa (DF) tienen características imagenológicas e histopatológicas similares que dificultan el diagnóstico diferencial. El propósito de la presente revisión narrativa es analizar las características clínicas, epidemiológicas e imagenológicas del FO y la DF, y evaluar la relación entre las características imagenológicas y las variantes histopatológicas del FO, en reportes y series de casos publicados.Materiales y métodos:Se realizó una búsqueda de reportes y series de casos de FO y DF entre 2017-2021 en PubMed, Scopus y Web of Science. Los casos debían tener suficiente información clínica, epidemiológica, histopatológica e imagenológica.Resultados:Se incluyeron 23 artículos con 25 lesiones: 17 FO y 8 DF. El tiempo de evolución de DF es más prolongado que FO. FO se ubica con mayor tendencia en complejo osteomeatal en comparación con DF. Sólo FO presentó alteraciones en piel, radiolucidez/hipodensidad periférica, perforación ósea y rizalisis externa, además, tuvo mayor tendencia al avance a espacios anatómicos adyacentes y a generar asimetría facial y/o craneal. FO psammomatoide y FO trabecular comparten patrones imagenológicos y tienen límites definidos corticalizados. FO convencional tuvo mayor tendencia a perforar corticales. DF puede tener límites mal definidos y definidos corticalizados. El FO mostró características imagenológicas de mayor agresividad que la DF.Conclusiones:La histología e imagenología por sí solas no son decisivas en el diagnóstico de FO y DF. Es imprescindible considerar conjuntamente clínica, imagenología e histopatología, enfatizando en las características que orienten el diagnóstico diferencial.(AU)

Introduction: Ossifying fibroma (OF) and fibrous dysplasia (FD) have similar imaging and histopathological characteristics, which make differential diagnosis difficult. The aim of this narrative review was to analyze the clinical, epidemiological and imaging characteristics of OF and FD, as well as to evaluate the relationship between imaging characteristics and histopathologic variants of OF, in reports and case series published.Materials and methods:A search of reports and case series of OF and FD between 2017-2021 in PubMed, Scopus and Web of Science was performed. The cases had to have enough clinical, epidemiological, histopathological and imaging information.Results:23 articles with 25 lesions were included: 17 OF and 8 FD. FD had a longer time of evolution than OF. OF is more likely to be in osteomeatal complex compared to FD. Only OF had skin alterations, peripheral radiolucency/hypodensity, bone perforation and external root resorption, in addition, it had a greater tendency to advance to adjacent anatomical spaces and generate facial and/or cranial asymmetry. Psammomatoid OF and trabecular OF share imaging patterns and have defined and corticated margins. Conventional OF had a greater tendency to cortical perforation. DF can have ill-defined and defined and corticated margins. OF has imaging characteristics of greater aggressiveness than FD.Conclusion:Histology and imaging alone are not decisive in OF and FD diagnosis. It is essential to consider clinical, imaging and histopathological evaluations as a whole, emphasizing in the characteristics that guide the differential diagnosis.(AU)

Peripheral ossifying fibroma: A 20-year retrospective studywith focus on clinical and morphological features

Background: Peripheral Ossifying Fibroma (POF) is a reactive hyperplastic lesion that exclusively occurs in thegingiva and is characterized by the deposition of dystrophic calcification, cementum-like tissue, and immatureand mature bone within the connective tissue. The objective of the present study was to perform a retrospectiveanalysis of clinicopathologic features of POF.Material and Methods: Clinical and histopathological data were obtained from biopsy records and histopathological reports from a Brazilian reference service in Oral Pathology (1999 - 2020). Morphological analysis wasperformed to evaluate features related to the mesenchymal component, inflammatory infiltrate, ulceration, andmineralized tissue.Results: A total of 270 POFs were diagnosed during the study period. A higher frequency was observed in females(71.9%) between the third (22.9%) and fourth (23.3%) decades of life. The anterior upper gingiva (29.1%) wasthe most affected region. Mature (86.7%) and immature (52.6%) bone tissue were the most frequent. There was asignificant association between immature bone deposition and lesions with size ≤ 1.7 cm (p = 0.041); immaturebone and cement-like tissue deposition with an evolution time ≤ 16 months (p < 0.001); deposition of immaturebone and mesenchymal hypercellularization (p < 0.001); deposition of dystrophic calcification and the presenceof ulceration (p < 0.001).Conclusions: The clinical characteristics corroborate the findings in the literature. The heterogeneous distributionand quantity of mineralized tissues found in the analyzed cases support the theory that the different mineralizedtissues constitute a spectrum of clinical maturation of POF. (AU)

Clínica, epidemiología e imagenología del fibroma osificante y fibroma cemento osificante: revisión de casos reportados en la literatura / Clinic, epidemiology and imagenology of the ossifying fibroma and cemento ossifying fibroma: a review of cases reported in the literature

Introducción: El fibroma osificante (FO) y el fibroma cemento osificante (FCO) son patologías distintas, que hasta el 2017 se consideraban como una. A la fecha no se han comparado las características del FO y el FCO. La presente revisión tuvo como objetivo analizar características clínicas, epidemiológicas e imagenológicas del FO y FCO en los casos publicados. Materiales y métodos: Se realizó una búsqueda de casos clínicos de FO y FCOpublicados desde el año 2015 en PubMed, Scopus y Web of Science, mediante la estrategia de búsqueda ("Ossifying Fibroma" OR "Cemento Ossifying Fibroma") AND (Craniofacial OR Jaws). Los casos debían presentar información clínica, imagenológica e histológica suficientes para confirmar su diagnóstico, patrón histológico y comparar sus características. Revisión: Se incluyeron 32 artículos, con 32 casos y 34 lesiones, siendo 6 FCO y 28 FO. Los FO y FCO se diferencian por su edad y ubicación: mientras los FCO se presentan en edades adultas, exclusivamente en los maxilares y en relación con tejidos dentarios, los FO lo hacen principalmente en niños y jóvenes, y en cualquier hueso. Los FO y FCO tienen las mismas características imagenológicas: son lesiones uniloculares o multiloculares, con distintos grados de radiodensidad, límites definidos y una radiolucidez periférica. Sin embargo, los casos de FO trabecular pueden no presentar esta radiolucidez periférica. Conclusión: Los FO y FCO son patologías, clínica y epidemiológicamente similares, y con las mismas características imagenológicas. Por lo que establecer diferencias histológicas es esencial para un correcto diagnóstico. (AU)

Introduction: Ossifying fibroma (OF) and cemento ossifying fibroma (COF) are different pathologies, which until 2017 where considered as one. To date, the features of OF y COF have not been compared. This aim of this review was to analyze clinical, epidemiological and imaging features of OF and COF in published case reports. Materials and methods: A search of clinical cases of OF and COF published since 2015 was performed on PubMed, Scopus and Web of Science, using the search strategy ("Ossifying Fibroma" OR "Cemento Ossifying Fibroma") AND (Craniofacial OR Jaws). The cases had to haveenough clinical, imaging and histological information to confirm their clinical diagnosis, histological pattern and compare their features. Review: 32 articles were included, with 32 cases and 34 lesions, being 28 OF and 6 COF. OF and COF differ by age and location: while COF occur in adult ages, exclusively in the jaws and in relation to dental tissues, OF occur mainly in children and young people, and in any bone. OF and COF have the same imaging characteristics: they are unilocular or multilocular lesions, with different degrees of radiodensity, defined limits and a peripheral radiolucent area. However, cases of trabecular OF may not present this peripheral radiolucent area. Conclusions: OF and COF are similar pathologies clinically and epidemiologically, with the same imaging characteristics. So, establishing histological differences is essential for an accurate diagnosis. (AU)

Planificación digital en tratamiento de fibroma osificante juvenil psamomatoide maxilar. Presentación de un caso / Digital planning in the treatment of juvenile maxillary psamomatoid ossifying fibroma. Presentation of a case

Los fibromas osificantes son neoplasias fibro-óseas benignas que afectan al esqueleto craneofacial y mandibular. El fibroma osificante psamomatoide juvenil es una variante rara del fibroma osificante, la que puede ser localmente agresiva y con una alta tasa de recidiva. Se presenta el caso de una paciente de 15 años con antecedentes mórbidos de hipotiroidismo e hiperparatiroidismo, quien consulta por aumento de volumen y desplazamiento de dientes en maxilar derecho. El resultado histopatológico fue compatible con fibroma osificante psamomatoide juvenil. Dado el contexto hospitalario durante la pandemia de COVID-19, el tratamiento consistió en hemimaxilectomía con autoinjerto libre de cresta ilíaca mediante planificación digital. (AU)

Ossifying fibromas are benign fibro-osseous neoplasms that affect the craniofacial and mandibular skeleton. Juvenile psamomatoid ossifying fibroma is a rare variant of ossifying fibroma, which can be locally aggressive, and with a high recurrence rate. We present the clinical case of a 15-year-old patient with a morbid history of hypothyroidism and hyperparathyroidism, who consulted for increased volume and displacement of teeth in the right maxilla. The histopathological result was consistent with juvenile psamomatoid ossifying fibroma. Owing to the hospital situation during the COVID-19 the treatment consisted of hemimaxillectomy with iliac crest autograft using digital planning. (AU)

Juvenile ossifying fibroma of the maxillofacial region: analysis of clinico-pathological features and management / Fibroma osificante juvenil de la región maxilofacial: Análisis de características y manejo clínico-patológico

Background: The diagnosis and management of juvenile ossifying fibroma (JOF) remains a highly debated topicwith paucity of studies with long-term follow-up, hence the aim of this study was to report on the clinico-patho-logical features and management of these neoplasms.Material and Methods: A retrospective analysis was performed on all histopathologically confirmed JOF pre-senting at two tertiary hospitals in Cape Town, South Africa over a period of 39 years. Clinical, demographic,histopathological and radiological features were analyzed. Surgical methods were documented and a minimumpost-operative follow-up of 12 months was a prerequisite.Results: Seventeen patients met the inclusion criteria and were included in this study. Overall, the ages of patientsranged from 3–31 years (mean= 13 years) with male to female ratio of 1.8:1. The ages of patients diagnosed withTrabecular JOF were significantly younger than patients with Psammomatoid JOF (P = 0.01). The majority ofpatients presented with marked swelling (88.2%). Interestingly, most neoplasms occurred in the mandible (76.5%)with all Psammomatoid JOF uncharacteristically occurring in the mandible. There was only one case of Trabecu-lar JOF occurring in the sinonasal area. Most neoplasms appeared as unilocular (76.5%) and well-defined (82.4%)with mixed radio-density (70.6%) on radiographs and computed tomography. Curettage with peripheral ostectomywas shown to be the least invasive method with an acceptable recurrence rate (10%). Six lesions underwent resec-tion without any recurrences however caused high morbidity to these young patients.Conclusions: The high number of lesions occurring in the mandible for both variants of JOF demonstrates that siteshould not be a major determining factor in the diagnosis of JOF. Moreover, curettage with peripheral ostectomy...(AU)

Tumor fibromixoide osificante maligno supraclavicular / Supraclavicular malignant ossifying fibromyxoid tumor

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Adyuvancia en tratamiento quirúrgico de fibroma osificante. A propósito de un caso / Adjuvance in surgical treatment of ossifying fibroma. Case report

El fibroma osificante es una neoplasia osteogénica benigna que representa el 3.1% de los tumores orales y el 9.6% de las lesiones gingivales. Su tratamiento de elección es la enucleación por curetaje completado hasta márgenes de hueso sano, con una recurrencia de aproximadamente el 7-20% probablemente por remoción incompleta, irritación continua o daño repetido. Presentamos un caso clínico en el que complementamos el tratamiento quirúrgico con métodos adyuvantes para disminuir la recurrencia y acelerar la regeneración ósea mediante uso de nitrógeno líquido y hueso liofilizado cadavérico combinados con plasma rico en plaquetas. En el control postoperatorio a los 6 meses no evidenciamos recurrencia clínica o radiológica y comprobamos regeneración ósea acelerada. Sugerimos el uso en este tipo de lesiones de nitrógeno líquido como adyuvante para la prevención de recurrencia, hueso liofilizado para favorecer la regeneración ósea guiada y plasma rico en plaquetas para acelerar el proceso de curación ósea

Ossifying fibroma is a benign osteogenic neoplasm, representing 3.1% of oral tumors and 9.6% of gingival lesions. Enucleation by curettage is the treatment of choice, completed to healthy bone margins, with a recurrence of approximately 7-20%, probably due to incomplete removal, continued irritation or repeated damage. We describe a clinical case ttreated in combination with adjuvant methods to decrease recurrence and accelerate bone regeneration, with the placement of liquid nitrogen and cadaveric lyophilized bone, combined with platelet-rich plasma. Post-operative control at 6 months showed no clinical or radiological evidence of recurrence and the presence of accelerated bone regeneration. We suggest liquid nitrogen as an adjuvant for the prevention of recurrence and bone regeneration guided with lyophilized bone in conjunction with platelet-rich plasma as a feasible option to accelerate the bone healing process

Noi de 13 anys amb lesió òssia osteolítica / No disponible

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Cherubism. A case report / Querubismo. Discusión de un caso

Cherubism is a rare disorder with autosomal dominant inheritance. It is classified as a benign fibro-osseous lesions and may involve either facial bone. Its typical dentofacial deformities are caused by mutations in the SH3BP2 gene. The protein encoded by SH3BP2 had a significant role in the regulation of osteoblasts and osteoclasts. Accordingly with the radiological findings, differential diagnoses includes fibrous dysplasia, giant cell granuloma, osteosarcoma, juvenile ossifying fibroma, fibrous osteoma, odontogenic cyst and hyperparathyroidism. The aim of the present report is twofold. First, we examine the importance of the proper management of these cases. Second, we describe this rare syndrome with the goal of proposing suitable treatments (AU)

El querubismo es una enfermedad rara. Presenta herencia autosómica dominante y es clasificada como una enfermedad fibroósea benigna. Las deformidades típicas de esta dolencia se deben a la alteración del gen SH3BP2 y pueden afectar a cualquier hueso del macizo facial. La proteína codificada por este gen es fundamental para el correcto funcionamiento de osteoblastos y osteoclastos. El diagnóstico diferencial debe incluir: displasia fibrosa, granuloma de células gigantes, osteosarcoma, fibroma osificante juvenil, fibroma osteoide e hiperparatiroidismo (AU)

Large peripheral ossifying fibroma: clinical, histological, and immunohistochemistry aspects. A case report / Gran fibroma osificante periférico: aspectos clínicos, histológicos e inmunohistoquímicos. Presentación de un caso

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Fibroma osificante orbitario, a propósito de un caso / Orbital ossifying fibroma: A case report

CASO CLÍNICO: Se presenta el caso de un varón de 34 años que consultó por dolor en canto interno de ojo izquierdo, con diplopía y proptosis progresiva. Con exoftalmos y masa palpable en canto interno, la tomografía computarizada reveló una lesión que la biopsia confirmó como fibroma osificante. DISCUSIÓN: El fibroma osificante es una lesión fibro-ósea benigna que afecta en su mayoría a la mandíbula. La presentación clínica y sus complicaciones varían según su localización. La clínica, tomografía computarizada e histopatología son fundamentales para el diagnóstico definitivo. El tratamiento quirúrgico es multidisciplinario y el seguimiento es a largo plazo

CLINICAL CASE: The case concerns a 34 year-old man, who presented with pain in the medial canthus in his left eye, with proptosis and diplopia. The examination showed exophthalmus and a palpable mass at the inner canthus. The computed tomography revealed a lesion, which was confirmed by biopsy to be a ossifying fibroma. DISCUSSION: Ossifying fibroma is a benign fibro-osseous lesion that mostly affects the jaw. Clinical presentation and complications vary according to its location. Clinical examination, imaging, and histopathology are essential for definitive diagnosis. Surgical treatment is multidisciplinary and long-term follow up is needed

Fibroma osificante de seno etmoidal con invasión orbitaria: a propósito de un caso / Ossifying fibroma of the ethmoid sinus with orbital invasion: a case report

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¿Cuál es su diagnóstico? / What is your diagnosis?

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Diagnóstico histológico del tumor fibromixoide osificante: 2 casos en los últimos 20 años / Histologic diagnosis of ossifying fibromyxoid tumor: 2 cases in the past 20 Years

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Fibroma osificante: a propósito de un caso. Revisión de la literatura / Ossifying fibroma: report of a case. Review of the literatura

Introducción: El fibroma osificante forma parte del grupo de las lesiones fibro-óseas. Son benignas y su característica fundamental es la sustitución de hueso normal por tejido que contiene colágeno, fibroblastos y cantidades variables de tejido mineralizado. Se presenta habitualmente en mujeres, entre la tercera y cuarta décadas de la vida. Suele producirse en la mandíbula y puede provocar tumefacción de la zona y rizólisis de los dientes adyacentes. El tratamiento consiste en la enucleación completa de la lesión. Caso clínico: Paciente varón de 30 años, acude al servicio de cirugía bucal y maxilofacial del hospital Virgen de la Paloma, tras haber estado previamente en urgencias por inflamación y tumefacción de la región mandibular izquierda de un año de evolución. En las pruebas radiológicas se observó en dicha zona una lesión radiolúcida con un halo esclerótico alrededor. El diagnóstico definitivo tras la exéresis quirúrgica de la lesión fue de fibroma osificante. Discusión: El fibroma osificantees una lesión fibro-ósea de naturaleza benigna, aunque puede provocar deformidad, desplazamiento y rizólisis de los dientes adyacentes. Por sus diferentes patrones radiográficos y al ser habitualmente unilocular existe un amplio número de lesiones con las que se debe hacer un diagnóstico diferencial, aunque en casos de lesiones múltiples, muchos se deban a alteraciones hormonales como la hipercalcemia asociada al hiperparatiroidismo. Conclusión: El correcto manejo hace imprescindible realizar un diagnóstico diferencial con otras entidades debido a los diferentes tratamientos que cada patología requiere (AU)

Introduction: Ossifying fibroma is part of the group of fibro-osseus lesions. They are benign, but its essential feature is the replacement of regular bone tissue with collagen, fibroblasts and varying amounts of mineralized tissue. It usually occurs in women between third and fourth decades of life. It normally affects the jaw and can cause swelling in the area and rhizolysis of adjacent teeth. Treatment is based in a complete enucleation of the lesion. Case report: A 30 year old man comes to the oral and maxillofacial service after having previously been in the emergency service because of inflammation and swelling of the left mandibular region of a year of evolution. Radiological evidences show a radiolucent lesion with a sclerotic halo around. Final diagnosis after surgical excision was ossifying fibroma. Discussion: Ossifying fibroma is a fibro-osseus benign lesion, but it can cause deformity, displacement and rhizolysisof nearby teeth. For different radiographic patterns and being usually unilocular there is a large number of injuries that should be taken into account for a differential diagnosis; although in cases of multiple lesions, many are due to hormonal abnormalities such as hypercalcemia associated with hyperparathyroidism. Conclusion: The proper management is essential to make a differential diagnosis with other entities due to the different treatments that each condition requires (AU)

Fibroma osificante juvenil trabecular mandibular: presentación de un caso con reconstrucción inmediata mediante un injerto libre de la cresta ilíaca y costocondral / Juvenile trabecular ossifying fibroma: presentation of a case with immediate costochondral-iliac crest reconstruction

El fibroma osificante juvenil (FOJ) es una lesión fibro-ósea benigna pero con potencial biológico agresivo que afecta al esqueleto craneofacial. Su evolución clínica es rápida, manifestándose principalmente por una asimetría facial de poco tiempo de evolución. Radiográficamente es una lesión radiolúcida uni o multilocular bien definida con contenido radiopaco variable. El tratamiento puede variar dependiendo de las características clínicas, imagenológicas e histopatológicas específicas de cada lesión, sin embargo, un tratamiento agresivo con resección es el más indicado. Se presenta un caso de un niño con extenso FOJ trabecular (FOJT) mandibular. Se realizó la resección completa de la lesión con un margen de seguridad y reconstrucción inmediata con un injerto de la cresta ilíaca y costocondral. Se realizaron controles postoperatorios durante 7 años en los que no se observaron signos de recidiva asociados a una reconstrucción funcional y estética exitosa (AU)

Juvenile ossifying fibroma (JOF) is a benign fibro-osseous lesion with an aggressive biological behavior in most cases. The clinical course is fast, manifesting mainly as a facial asymmetry. Radiographically it presents as a well-defined, uni- or multi-locular radiolucent lesion with variable radiopaque areas. Treatment may vary depending on the clinical, imaging and histopathological specific pattern, but generally an aggressive treatment with resection is the most appropriate. We report a case of a child with an extensive trabecular JOF (TFOJ) of the mandible. We performed a complete resection of the lesion with a security margin and immediate reconstruction with a costochondral-iliac crest bone graft. Postoperative controls were performed for seven years, during which there were no signs of recurrence, demonstrating a successful functional and anesthetic reconstruction (AU)

Lesión polipoide en la encía / Polypoid Lesion of the Gum

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Nueva entidad en el diagnóstico diferencial de los tumores del ganglio geniculado: lesión del tejido conectivo fibroso del nervio facial / A new entity in the differential diagnosis of geniculate ganglion tumours: fibrous connective tissue lesion of the facial nerve

Dentro del diagnóstico diferencial de las lesiones del ganglio geniculado nos encontramos principalmente con los schwannomas, hemangiomas y meningiomas. Se presenta el caso de un paciente cuya clínica y hallazgos radiológicos imitaban la presentación de un schwannoma del nervio facial. Los estudios anatomopatológicos revelaron una lesión con fascículos nerviosos desestructurados por intensa colagenización, por lo que se denominó lesión fibrosa del tejido conectivo fibroso del nervio facial (AU)

Differential diagnosis of geniculate ganglion tumours includes chiefly schwannomas, haemangiomas and meningiomas. We report the case of a patient whose clinical and imaging findings mimicked the presentation of a facial nerve schwannoma. Pathological studies revealed a lesion with nerve bundles unstructured by intense collagenisation. Consequently, it was called fibrous connective tissue lesion of the facial nerve (AU)

Management of fibro-osseous lesions of the craniofacial area. Presentation of 19 cases and review of the literature

Introduction: Fibro-osseous lesions constitute a rare benign type of pathology with a non-odontogenic lineage that affect the craniofacial area. According to Waldrom’s classification, these lesions are divided into: fibrous dysplasia (FD), cemento-ossifying fibroma (COF) and desmoplastic fibroma (DF).Material and Methods: A retrospective study was performed on patients diagnosed with fibro-osseous lesions of the craniofacial area at the Hospital Universitario La Fe, Valencia, during 1987-2009. A total of 19 cases were collected:15 cases compatible with an FD diagnosis, 3 cases with a COF diagnosis and 1 case with a DF diagnosis. Results: In the differential diagnosis, entities having similar clinical manifestations in the maxillofacial area with possible involvement of teeth or manifestations present as an asymptomatic radiolucent image should be ruled out. We hereby present the management and development of patients treated in our hospital for fibro-osseous lesions. Conclusions: Fibro-osseous lesions share many clinical and radiological characteristics in common, with histological features confirming the nature of the lesion. Management of patients should be individualized and casespecific, assessing the clinical evolution of each case and taking into account the benign nature and growth behavior of this type of tumors (AU)