Cementoblastoma en maxilar: reporte de caso / Maxillary cementoblastoma: report of a case

El cementoblastoma, también llamado cementoma verdadero, fue reconocido primeramente por Norberg en 1930. Este se encuentra dentro de los tumores derivados del ectomesenquima odontogénico y puede estar asociado con múltiples dientes. Se encuentran publicados en la literatura muchos casos de cementoblastoma, pero pocos reportan un seguimiento adecuado. Sólo Brannon y col. realizaron un seguimiento de 35 casos, encontraron algunas características clínicas como dolor, expansión y erosión de las corticales, comunes de los casos recidivantes, siendo la resección segmental o en bloque, un factor decisivo para la no recidiva, hemos tomado como referencia su trabajo por la representatividad y la manera que abordaron el tema. Este trabajo tiene como objetivo informar y evidenciar el manejo de un caso de cementoblastoma; describir una situación clínica de una paciente con un cementoblastoma benigno en maxilar superior izauierdo, asociado a un canino temporal y un primer molar, y presentar histopatología revisión de la literatura, tratamiento quirúrgico, rehabilitación y seguimiento a través de los años en los cuales la paciente no presentó recidiva.

Fibro-osseous disease: harmonizing terminology with biology.

Classification systems and associated terminology are inherently slow in reflecting rapidly unfolding scientific discoveries in the mechanism and presentation of diseases. Misleading concepts, which often have historical value only, may become entrenched in the literature, leading to confusion and inaccurate communication. The purpose of this communication is to stimulate discussion and debate on inappropriate terminology associated with fibro-osseous disease that continues to be perpetuated in the literature. Use of the terms "cementum," "aggressive," "active," "gigantiform," and "maturation" are questioned, and the criteria applied to the interpretation of secondary changes in fibro-osseous lesions critically are evaluated.

[Benign odontogenic ectomesenchymal tumors]. / Benigne odontogene ektomesenchymale Tumoren.

The group of odontogenic ectomesenchymal tumors consists of odontogenic fibroma (epithelium-rich and epithelium-poor types), odontogenic myxoma, and cementoblastoma. Whereas odontogenic fibromas and cementoblastomas are very rare lesions, odontogenic myxoma is the fourth common odontogenic tumor, preceded only by keratocystic odontogenic tumor, the odontomas, and ameloblastoma. The diagnosis of cementoblastoma rests on its connection to the root of a tooth. The differentiation of odontogenic fibroma and myxoma from other lesions, especially from normal structures such as dental follicles and papillae, may be challenging if the X-ray appearance (localized osteolysis containing a tooth) is not appreciated and subtle histological clues (remainders of inner enamel epithelium at the surface of the lesion, dentin fragments) are not properly recognized. While odontogenic fibromas have almost no tendency for recurrence and are treated by enucleation or local excision, cementoblastomas and especially odontogenic myxomas have a high percentage of recurrence if intralesional procedures are applied. Hence, complete resection with free margins is recommended--at least for larger odontogenic myxomas and, especially, lesions in the maxilla--to prevent further extension to the orbita or base of the skull.

[Benign epithelial odontogenic tumors]. / Benigne epitheliale odontogene Tumoren.

The group of benign epithelial odontogenic tumors consists of the four member types of the ameloblastoma family (solid/multicystic, extraosseous/peripheral, desmoplastic, unicystic), squamous odontogenic tumors, calcifying odontogenic tumors, adenomatoid odontogenic tumors, and keratocystic odontogenic tumors, the former "keratocysts" that were recently reclassified by the World Health Organization and are now regarded as tumors. The latter are by far the most frequent tumors in this group, followed by solid/multicystic ameloblastoma. Although the etiology of these lesions is still unknown, a close relationship to normal tooth development is obvious, which is partially imitated by some tumors. Despite some similarities to each other, at least in part, the biological behavior of these lesions is quite different, as are treatment modalities. The diagnosis is essentially based on localization (intraosseous vs. extraosseous/peripheral) and histology, whereupon the correlation of histological findings with radiographic morphology may be of additional diagnostic value. Because of the range of variation, immunohistochemical investigations are not helpful in diagnosing a particular case.

Periapical cemental (fibrous) dysplasia. Clinical, radiographic and pathologic aspects in 7 reported cases.

AIM: Periapical cemental dysplasia (PCD) is a relatively common, well-defined pathology. Because of the structural similarities existing in the group of the so-called "fibro-(cemento)-osseus lesions" of the jaws, to which PCD belongs, clinical and radiographic findings are probably more diagnostic than histology. The aim of the present paper is to analyse some new cases of PCD and to compare their clinical, radiographic and histologic features to those reported by the international literature. METHODS: Seven new cases of PCD are presented here; they were observed in a 12-year period of time. All the patients are white women and 6 lesions exceeded 1 cm in diameter. Only 2 patients were surgically treated, but all of them are still today clinically and radiographically followed. RESULTS: Clinical, radiographic and histologic data of our cases are generally in agreement with those provided by the international literature. CONCLUSION: Finally, stress is laid on the existing difficulty, at present as well as in the past, of establishing definitive classification criteria for all fibro-cemento-osseous lesions of the jaws.

Focal cemento-osseous dysplasia involving a mandibular lateral incisor.

AIM: To report a case of focal cemento-osseous dysplasia (FCOD) affecting a single tooth misdiagnosed as an inflammatory periapical lesion. SUMMARY: The patient, a black 47-year-old woman complained of pain affecting the right side of the mandible. Routine X-ray examination discovered a periapical radiolucency on the mandibular left lateral incisor (tooth 32), which was otherwise normal and not carious. As the response of this tooth to a vitality test was doubtful, the lesion was diagnosed as a periapical granuloma or cyst secondary to pulpal necrosis. Endodontic treatment and curettage of the periapical lesion were performed, and histological examination of the curettage material revealed a localized osseous dysplasia. KEY LEARNING POINTS: FCOD may rarely affect only one tooth, resembling a periapical granuloma or cyst. Careful diagnosis is of paramount importance in cases of questionable periapical lesions affecting normal-looking teeth, before beginning treatment. FCOD generally requires no treatment. Biopsy is warranted in case of doubt.

Florid cemento-osseous dysplasia: a systematic review.

OBJECTIVES: To evaluate the principal features of florid cemento-osseous dysplasia (FCOD) by systematic review (SR), with particular regard to comparison of Oriental with non-Oriental populations, and of reports derived from pathology files with those from non-pathology sources. METHODS: All alternative names for FCOD were used as search terms for two electronic databases, namely Medline and "Web of Science". Only multiple forms of cemento-osseous dysplasia occurring in a series in the reporting authors' case load were considered. RESULTS: Medline produced more SR-identified reports. The search terms "Cementoma" and "Osseous Dysplasia" were the most effective for both databases. One hundred and fifty-eight cases of FCOD were observed in 17 series of patients reported in 16 SR-identified reports. Fifty-nine percent of cases were found in Blacks, 37% in Orientals and 3% in Caucasians. Ninety-seven percent were females. Fifty percent of cases in the SRs were observed incidentally. Pain was most frequent in those with presenting symptoms, and was significantly more frequent in the Oriental series. In two studies on the same Chinese community, those cases found incidentally on radiographs alone were significantly younger than those with symptoms in the pathology files. CONCLUSION: The nomenclature for FCOD is extensive, but older and more general terms were more effective in recalling SR-identified reports. Cases in a report based on pathology files appear to be older than those in a report based on radiology alone files. With the exception of a higher prevalence of pain in Orientals, mainly Chinese, there did not appear to be any differences in presentation compared with that observed in Black communities.

Florid cemento-osseous dysplasia in a young Chinese man. Case report.

Florid cemento-osseous dysplasia refers to a group of fibro-osseous lesions which are exuberant, multiquadrant and arise from the tooth-bearing area of the jaws. It is classically described as a condition occurring almost exclusively in middle-aged black women. A case of florid cemento-osseous dysplasia occurring in a young Chinese male is reported which was rare in regard to race and sex. This 20 year old Chinese man presented with huge symmetrical bony lesions in all four quadrants of the jaws. Clinical presentation, radiological findings and histological features of the excised specimens are described. Treatment of the lesions was unusual. Curettage was first done with minimal benefit and it was followed by mandibular recontouring to improve facial appearance. The outcome of these procedures will be discussed.

Maxillofacial fibro-osseous lesions: classification and differential diagnosis.

A large diversity of lesions may involve the maxillofacial bones. Some occur exclusively at this site. Other lesions at this location have features that are different from similar lesions occurring elsewhere in the skeleton. This site-dependent morphology applies especially to fibro-osseous lesions, which will be discussed in this report. Fibrous dysplasia shows evenly distributed islands of woven bone that fuse with surrounding bone. The presence of lamellar bone and osteoblastic rimming does not contradict that diagnosis as they would for lesions occurring outside the maxillofacial bones. Ossifying fibromas are demarcated or encapsulated. They show a broad variation in mineralized material that may be woven bone as well as lamellar bone or may be present as rounded cell-poor particles regarded as a form of cementum. Specific subtypes are juvenile ossifying fibroma and psammomatoid ossifying fibroma, both of which contain cellular stroma exhibiting mitotic activity. Lesions known as periapical cemental dysplasia can be found in the tooth-bearing jaw area and are similar to ossifying fibroma but without demarcation. These lesions may be focal, involving one or a few adjacent teeth; when they are more widely distributed, they are named florid cemento-osseous dysplasia. Periapical cemental dysplasia should be distinguished from cementoblastoma, a lesion similar to osteoblastoma but connected with tooth apices. Ossifying fibroma may resemble well-differentiated osteosarcoma as ossifying fibroma may be more cellular and may have a higher number of mitoses than osteosarcoma.

[Giant cementifying fibroma of the maxillary sinus. Apropos of a case]. / Fibrome cémentifiant géant du sinus maxillaire. A propos d'un cas.

The case of a patient presenting with a gigantiform fibrous cementoma of the maxillary sinus is described. The diagnostic, the treatment and the histologic classification of the cementifying tumours is reviewed in light of the present literature.

The cementomas--a clinicopathological re-appraisal.

The aim of this study was to assess whether sub-classification of cemental tumors was warranted and to define the clinicopathological features of the definitive entities. Our sample consisted of 127 cases which were divided into the following categories; gigantiform cementoma (84 per cent), cementifying fibroma (12 per cent), benign cementoblastoma (4 per cent). Gigantiform cementoma lesions were either single, multiple or florid and ranged in size from 1 to 10 cm. Most occurred in patients in their 6th and 7th decades who were black (78 per cent) and female (96 per cent). All lesions showed typical solid sheets of acellular cementum and some (22 per cent) were characterised by peripheral proliferative areas which were often indistinguishable from lesions of cementifying fibroma and periapical cemental dysplasia. Infection and sequestration was very common (54 per cent). No cases of periapical cemental dysplasia were found and we suggest that this lesion is a variant of gigantiform cementoma. We believe cementifying fibroma to be part of the histomorphological spectrum of cemento-ossifying fibroma. Cemento-osseous dysplasia is a more accurate and appropriate term than gigantiform cementoma and we recommend the following classification for cemental 'tumors': cemento-ossifying fibroma; cementoblastoma; cemento-osseous dysplasia, single, multiple and florid sub-types.

Cementoma--presentation predicates approach.

Cementomas are benign jaw tumors that originate from periodontal ligament elements. Four classifications of cementomas are described: periapical fibrous dysplasia, benign cementoblastoma, cementifying fibroma, and florid osseous dysplasia. Usual treatment regimens vary from observation to limited surgical resection based upon tumor type and clinical characteristics. We present an unusual case report of an extensive cementifying fibroma that required mandibular and inferior alveolar nerve resection followed by osseous and neural reconstruction.

Familial gigantiform cementoma: classification and presentation of a large pedigree.

Very few cases of gigantiform cementoma have been reported, and those associated with a positive family history are especially rare. Confusion exists about the relationship of gigantiform cementoma to florid osseous dysplasia, cementifying fibroma, and diffuse chronic sclerosing osteomyelitis. It has been unclear whether gigantiform cementoma should be accorded the status of a separate entity. In this article, we report our findings on a family that, over five generations, has exhibited clinical, radiographic, and/or histologic findings consistent with the designation familial gigantiform cementoma. This pedigree consists of 55 members. Significant heterogeneity in expression of this trait was noted. The pattern of occurrence of the trait is consistent with an autosomal dominant mode of inheritance with variable expressivity of the phenotype. We suggest that familial gigantiform cementoma should be recognized as a separate entity.

Fibro-osseous lesions of the jaws.

During the 15 years since the author's 1970 paper on fibro-osseous lesions of the jaws, the subject has continued to interest the clinician and pathologist. Several new entities have been delineated during this period, and new concepts and controversies regarding the diagnosis and management of these lesions have arisen. A classification of fibro-osseous jaw lesions that the author has found to be workable is presented, and criteria for their diagnosis and management based on the authors' experience is discussed.

[Classification of benign tumors and cysts of the jaws]. / Classification des tumeurs bénignes et kystes des maxillaires.

On the basis of 324 cases of maxillary tumours, the authors review the classification of these neoplasms. The most frequent tumours are benign epithelial odontogenic tumours, which represent 55% of all tumours. The most common of these tumours is the ameloblastoma, followed by the odontomas. Most of the tumours of non-dental origin are benign (72% of this group). Amongst the malignant tumours, osteosarcomas are much more common than chondrosarcomas. The authors also discuss the various types of cyst and their respective relative frequency.