The importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws: Study of 276 cases.

PURPOSE: Benign fibro-osseous lesions (BFOLs) are heterogeneous intraosseous disease processes sharing overlapping histopathologic features and demonstrate a wide range of biological behavior. The aim of this study is to highlight the importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws. MATERIALS AND METHODS: This is a cross-sectional retrospective study evaluating the three main groups of BFOLs: Cemento-osseous dysplasia, ossifying fibromas, and fibrous dysplasia. Previously diagnosed BFOL cases were searched for thoroughly from the archives of Istanbul University, Institute of Oncology, Department of Tumor Pathology in between 2005 and 2015. Clinical and radiological data of these cases were identified and recorded. The histopathologic features were reevaluated from the H&E-stained slides. RESULTS: A total of 276 BFOL cases were identified and reevaluated for the study. The most common BFOL type was cemento-osseous dysplasia (n = 135), followed by cemento-ossifying fibroma (n = 77), fibrous dysplasia (n = 53) and juvenile ossifying fibroma (n = 11). The female/male ratio was 3.4:1 with a strong predilection for the 4th decade (n = 102). The mandible (n = 209) was the predominantly affected jaw. Prominent osteoblastic rimming around the bony lesion was commonly observed for cemento-ossifying fibroma (n = 60/77), followed by cemento-osseous dysplasia (n = 23/135). Predominant ossification patterns showed some differences among the groups. The most common radiological feature was the mixed radiolucent/radiopaque internal structure. CONCLUSION: Our results document various clinical, radiological and histopathologic findings of BFOLs. Even some histopathologic differences are observed, clinical and radiographic correlation is mandatory prior to the definitive histopathologic diagnosis of BFOLs for the prevention of possible misdiagnoses or inappropriate treatments.

Fibrous dysplasia of skull.

BACKGROUND AND OBJECTIVE: Fibrous dysplasia (FD) is a kind of benign but chronically progressive bone lesion. There is a lack of standard therapy for craniofacial FD because situations are protean. This study aimed at analyzing the clinical characteristics of craniofacial FD and suggesting strategies of treatment according to different situations. PATIENTS AND METHODS: We retrospectively reviewed 81 patients diagnosed as having an FD of the craniofacial region in West China Hospital between 1996 and 2009. The data and follow-up information were collected and analyzed using SPSS 13.0. RESULTS: Patients were between 5 to 71 years old, with an average age of 23.94 years; 61.73% of the patients were female. The sizes of the lesion range from 1.5 x 2 cm to 15 x 10 cm, most commonly affecting the frontal bones. Painless mass was the most common symptom, and vision loss was the most serious result. Of these patients, 86.4% underwent surgical treatment, 65.4% were followed up, and 86.8% did not show sign of recurrence. The bone defect was best restored with titanium mesh in recent years, and the gross cosmetic results of cranial reconstruction were favorable. CONCLUSIONS: Fibrous dysplasia of the skull in most cases is preferred to be treated with whole excision and immediate reconstruction with titanium mesh.

A retrospective clinico-pathologic analysis of cemento-osseous dysplasia in a South African patient population.

BACKGROUND: Cemento-osseous dysplasia (COD) is a fibro-osseous jaw bone lesion. The affected bone in COD progressively becomes sclerotic, poorly vascularized and susceptible to secondary osteomyelitis. OBJECTIVE: To provide a clinico-pathologic appraisal of COD in a South African patient population. METHODS: Archived records of 133 patients diagnosed with COD were reviewed for patient demographics, COD location, COD type, osteomyelitis or simple bone cyst secondary to COD. RESULTS: The mean age was 53.4 ± 13.5 years with a 94.7% female predilection. COD mainly affected the mandible (57.1%), followed by involvement of both jaws (38.3%) and maxilla (4.5%). Florid COD was the most prevalent (69.9%), followed by focal COD (18%) and periapical COD (12%). Florid COD showed a clear trend of increasing with age, peaking in the sixth decade and decreasing thereafter. Osteomyelitis and simple bone cyst presented as complications of COD in 74.4% and 5.3% of cases respectively, while 21.8% of all cases of jaw osteomyelitis during the study period were secondary to COD. CONCLUSION: A higher frequency of jaw osteomyelitis secondary to COD was found compared to previous studies. No significant association was shown between any of the COD types and secondary osteomyelitis.

Orofacial tumours in suburban Nigerian children and adolescents.

We report the type and distribution of orofacial tumours in south-western Nigerian children and adolescents. The 512 records of patients with oral and maxillofacial tumours in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from 1991 to 2001, were searched and the 146 records (28%) of patients aged 19 years and less were reviewed. Their mean age was 10 years (female:male ratio 1:1.4). Of the 146 tumours 74 (51%) were malignant and 72 (49%) were benign. Of the latter 31 were from soft tissue and 41 were from the jaw (20 odontogenic and 21 non-odontogenic). The most common benign soft tissue and jaw tumours were gingival epulis and ameloblastoma respectively. Of the malignant tumours 67 were lymphomas, 5 sarcomas and 2 carcinomas.

Intra-osseous lesions in Greek children and adolescents. A study based on biopsy material over a 26-year period.

OBJECTIVE: The purpose of this retrospective study was to investigate the spectrum of oral intra-osseous lesions in a Greek population, consisting of children and adolescents under 18 years of age. MATERIAL AND METHODS: Data was obtained from the histopathological reports that accompanied biopsy request forms, which were retrieved from the files of the Oral Pathology Department, Faculty of Dentistry, University of Athens, during a 26-year period. A retrospective analysis with respect to patients' age and gender, frequency and location of the lesions was performed. The lesions were classified into cystic (odontogenic and non-odontogenic) and solid lesions (odontogenic and non-odontogenic). The patients were divided into three age groups: a) 0-6 years old, b) 7-12 years old and c) 13-18 years old. RESULTS: 474 intra-osseous lesions were detected and represented 2.38% out of a total of 19933 biopsies. Male/female ratio was 1.25/1. The majority of the lesions was located in the mandible (49.8%) and occurred in the third age group of patients (58.7%). Odontogenic cysts represented the most frequent intraosseous lesion (64.1%) followed by non-odontogenic solid lesions representing 22.5% of the intra-osseous population. The most frequently encountered lesions in descending order were radicular (36.3%) and dentigerous (18%) cysts, keratocysts (9.5%), apical granulomas (7.6%), odontomas (6%) and fibrous dysplasia (5%). Only 6 malignant lesions were reported (1.3%). CONCLUSIONS: This clinicopathologic study revealed that a broad spectrum of mostly benign bony lesions may occur during childhood.

Fibro-osseous lesions of the jaw: a review of 133 cases from Nigeria.

A review of 133 cases of fibro-osseous lesions seen and treated at the University College Hospital, Ibadan, Nigeria, is presented. The age of patients at time of diagnosis ranged from 4 years to 68 years, although over 56 percent occurred in the first two decades of life. The maxilla was more commonly affected and there was a female preponderance in the incidence. Radical surgery was often indicated and performed because of the extent of lesions when presented. Early attempts at graft reconstructions were largely abandoned because of high failure rates. Tumor recurrences or growth cessations were not predictable as some lesions regressed after minor interventions while others grew rather rapidly following radical surgery.

Oral tumours in Tanzanian children based on biopsy materials examined over a 15-year period from 1982 to 1997.

AIM: To provide information on the types and distribution of oral tumours and tumour-like lesions occurring in a Tanzanian child population aged 0-16 years. DESIGN: Retrospective study of biopsy results from hospital records from 1982-1997. SETTING: Department of Histopathology, the Muhimbili Medical Centre (MMC) in Dar es Salaam. INTERVENTION/ METHODS: A total of 158 biopsy results, from 75 girls and 83 boys, were retrieved and studied. RESULTS: Malignant tumours were the most frequent (43.0%) followed by benign tumours (30.4%) and tumour-like lesions (26.6%). Burkitt's lymphoma was the most frequent malignant tumour accounting for 88.2% of all malignancies followed by squamous cell carcinoma (4.4%) and oral Kaposi's sarcoma (2.9%). Fibroma, papilloma and haemangioma were the most frequent benign tumours constituting 27.1%, 14.6% and 12.5%, respectively. Odontogenic cysts were the most frequent tumour-like lesions (28.6%) followed by fibrous dysplasia (19%) and giant cell granuloma (16.7%). CONCLUSION: The six most common oral lesions were Burkitt's lymphoma, fibroma, odontogenic cysts, fibrous dysplasia, papilloma and giant cell granuloma.

A retrospective study of oral and maxillofacial biopsy lesions in a pediatric population from southern Taiwan.

This is a retrospective study of biopsied oral lesions (N = 534) in a pediatric population (0-15 years old) in southern Taiwan. In this study, we included 6% of the 9672 biopsies performed from 1985 through 1996. The lesions were divided into three groups according to patients' ages, 0-5 years old; 6-10 years old; and 11-15 years old The majority of the samples were from the oldest age group (273/518). With the exclusion of normal tissues (N = 26), 518 samples were classified into four categories: inflammatory lesions, cystic lesions, tumor or tumor-like lesions, and other lesions. The largest number of lesions occurred in the inflammatory lesion group (46%). The 12 most frequently occurring lesions contributed about 78% of all the biopsies in the three age groups (0-15 years old). Frequencies of the lesions of mucous extravasation phenomenon, dentigerous cyst, fibrous dysplasia, and odontonia in our three pediatric age groups showed a significant proportion in the biopsies of the same lesions in the group of patients of all ages. These information may be valuable for both epidemiology and teaching.

Lesions related to the formation of bone, cartilage or cementum arising in the oral area: a statistical study and review of the literature.

This report contains a statistical review of 559 cases of lesions forming hard tissues that were diagnosed by the departments of Clinical Pathophysiology and of Pathology at Tokyo Dental College from 1966 to 2001. Sixteen kinds of lesions which were related to the formation of bone, cartilage or cementum were analysed: osteoma, osteo-chondroma, chondroma, osteoid osteoma, osteoblastoma, ossifying fibroma, cemento-ossifying fibroma, cementifying fibroma, so-called cementoma, cementoblastoma, gigantiform cementoma, periapical cemental dysplasia, osteosarcoma, chondrosarcoma, fibro-osseous lesion, and fibrous dysplasia of bone. The most common lesion was osteoma (203 cases). There is a marked tendency for this condition to occur in females (201 males cases and 358 female cases). The patients' ages ranged from 3 to 84 years, and the mean was 40.1 years old. Lesions with hard tissue formation were observed most frequently in the third decade and in the mandibular molar region.

A Clinicopathologic Analysis of 207 Cases of Benign Fibro-Osseous Lesions of the Jaws.

Benign fibro-osseous lesion (BFOL) is a distinct group of jaw entities composed of fibrocellular tissue and mineralized materials. In this study, we examined the epidemiological, clinical, and pathological features of patients with BFOL. Records and microslides of 207 BFOLs submitted to pathology service were retrospectively reviewed. Overall, fibrous dysplasia (FD) was the most prevalent (36.7%), followed by ossifying fibroma (OF; 32.4%), osseous dysplasia (OD; 24.6%), and juvenile ossifying fibroma (JOF; 6.3%). Female predilection was noted. FD and JOF were common in maxilla, whereas most OF and OD affected the mandible. Most patients with FD and OF presented with painless swelling, while patients with OD were symptomless. The majority of FD specimens showed woven bone, while a mixture of woven bone and cementum-like materials was often noted in OF and OD. Our data show variations in the clinicopathologic features of BFOLs. A thorough examination of all aspects of BFOL patients is imperative for accurate diagnosis.

Benign fibro-osseous lesions: clinicopathologic features from 143 cases diagnosed in an oral diagnosis setting.

OBJECTIVE: The aim of this study was to report the clinicopathologic and radiologic features of 143 benign fibro-osseous lesions (BFOLs). STUDY DESIGN: Clinical and radiologic information were retrieved from the patients files, and histologic features were reviewed from hematoxylin and eosin-stained histologic slides. RESULTS: There were 22 ossifying fibromas (OFs), 21 fibrous dysplasias (FDs) and 100 osseous dysplasias (ODs; 65 florid, 18 focal, and 17 periapical). The mean age of the FD/OF patients was a decade lower than those with OD. The mandible was more affected than the maxilla, except in FDs. All FDs and OFs presented local swelling, whereas this was observed in <40% of the ODs. Radiologic images of the florid/periapical ODs and OFs were predominantly mixed, whereas FDs and focal ODs were predominantly radiopaque. CONCLUSIONS: Florid OD, OF, and FD were the most common diagnoses, and the clinicopathologic and radiologic features were somewhat distinct from the characteristics of other populations.

Benign fibro-osseous lesions of the jaws in children. A 12-year retrospective study.

INTRODUCTION: Fibro-osseous lesions, a diverse group of bone disorders including developmental, reactive or dysplastic diseases and neoplasms, share overlapping clinical, radiographic and histopathologic features and demonstrate a wide range of biological behaviour. AIM: To evaluate the characteristics, treatment and outcome of benign fibro-osseous lesions of the jaws in children. PATIENTS AND METHOD: All patients with fibro-osseous lesions of the jaws treated at the department of Oral and Maxillofacial Surgery of the «A & P Kyriakou¼ Children's Hospital of Athens from 2000 to 2011 were included in this study. Data were retrieved from patients' files and their present situation was registered. RESULTS: Sixteen males and 10 females (mean age 8.5 years) were treated. Fibrous dysplasia was most often encountered (26.9%), and the mandible was the most frequent location (76.9%). All cases were surgically treated and histopathologically confirmed. Marginal ostectomy was performed in 7 cases, partial ostectomy in 4, enucleation and curettage in 10 and trimming-remodelling in 5 cases. Mean follow-up was of 5.5 years with no recurrence, except in one case of fibrous dysplasia. CONCLUSIONS: Fibro-osseous lesions, although sharing similar microscopic features, exhibit a variety of clinical behaviour rendering their treatment highly individualized.

A prospective epidemiological study for odontogenic and non-odontogenic lesions of the maxilla and mandible in Queensland.

OBJECTIVES: Investigate the epidemiological profile for odontogenic and non-odontogenic intra-osseous lesions in the Queensland population (4.56 million) over 12 months. STUDY DESIGN: The following data were prospectively collected from all Queensland histopathology laboratories in 2011: gender, age at diagnosis, location of lesion, histopathological diagnosis of the lesion and the patient's postcode. RESULTS: Six-hundred and thirty-three lesions were collected, comprising 540 odontogenic cysts and 93 odontogenic tumors. Radicular cyst was the most frequently diagnosed lesion (247/540, 45.7%). The overall incidence of odontogenic tumors was 20.4/million. Keratocystic odontogenic tumor was the highest (15.1/million), followed by ameloblastoma (2.41/million) with odontoma and calcifying cystic odontogenic tumor having the same incidence (1.1/million). The 39 non-odontogenic intra-osseous lesions had an overall incidence of 8.55/million. Nasopalatine cysts had an incidence of 2.19/million, followed by fibrous dysplasia and central giant cell granuloma (1.97/million). CONCLUSIONS: Odontogenic tumors are 5 times less common than cysts. Non-odontogenic lesions are rare, with benign lesions 6.8 times more common than malignant lesions.

Fibrous dysplasia: a systematic review.

OBJECTIVES: To evaluate the principal features of fibrous dysplasia (FD) by systematic review (SR) and to compare their frequencies between four global groups. METHODS: The databases searched were the PubMed interface of Medline and LILACS. Only those reports of FD which occurred in a series in the reporting authors' caseload were considered. All cases were confirmed fibro-osseous lesions histopathologically. The SR-included series must also have included radiographs. RESULTS: Of the 106 reports considered (including the Hong Kong report), 31 reports and a total of 788 cases were included in the SR. 11 SR-included series were in languages other than English. FD affected both genders equally, but was 50% more prevalent in the maxilla. The mean age at first presentation was 24 years. The decade with the greatest frequency was the second, in which males accounted for 63%. The main symptom in 90% of all SR-included cases was swelling (including deformation of the jaws). Not one SR-included case directly involved the ocular apparatus. All cases displayed buccolingual expansion; all mandibular cases exhibited downward displacement of the lower border of the mandible and almost all maxillary cases involved the maxillary antrum. Only 35% of reports included follow-up; 18% of cases recurred or were reactivated. Not one case displayed sarcomatous change. CONCLUSIONS: Long-term follow-up of large series that would have revealed the long-term outcomes of FD was lacking. This is necessary because many cases do not burn out at the end of adolescence, as expected of a hamartoma, but are reactivated.

Fibrous dysplasia of jaws in Thais.

A clinico-radiologic-histologic review of fibrous dysplasia of the jaw in ninety-one Thai patients were studied. The lesions showed a slight predilection for females and for the maxilla. The mean age of patients was about 22 years. From available radiographic findings in 11 cases, 9 cases showed radiolucent lesions with ground glass appearance and 7 out of these cases had an ill defined border. Two out of 11 cases had mixed radiolucent radiopaque lesions and one of these had a well-defined border. Histologically, approximately half of the cases showed features of metaplastic woven bone in fibrous stroma. The peak incidences of woven bone and osteoid substance were between the ages of 11 and 20 years but for lamella bone only, the incidence was increased to the age of 31 and 40 years. The stromal component of each individual case showed variable amounts of fibroblasts, collagen fibers, vascularization and giant cells.

Benign fibro-osseous lesions of the jaw bones in Jamaica: analysis of 32 cases.

OBJECTIVE: It is intended to analyse all the cases of benign fibro-osseous lesions seen at the two major public hospitals in Jamaica over a 15-year period and to compare our result with what has been previously documented by other authors. No such analysis has been carried out in Jamaica or elsewhere in the English-speaking Caribbean. MATERIALS AND METHODS: The case files of patients histologically diagnosed to have a fibro-osseous lesion at both the Kingston Public Hospital and the Cornwall Regional Hospital in Jamaica from 1980 to 1995 were retrieved and information about these lesions was documented. The WHO classification for benign fibro-osseous lesions was used. RESULTS: A total of 32 cases of benign fibro-osseous lesions were recorded over the 15-year period. Of these, 15 were histologically reported as fibrous dysplasia, 10 as ossifying fibroma, three as gigantiform cementoma, one each as periapical cemental dysplasia and cementoblastoma, and two cases of recurrent fibrous dysplasia. With the exception of gigantiform cementoma the age at presentation for these lesions is not consistent and this can be particularly noted for ossifying fibroma and fibrous dysplasia, both of which occurred between the age of 10 and 68 years. CONCLUSION: These lesions are more common in females, furthermore it is suggested that the inconsistent age at presentation for some of these lesions may be peculiar to Jamaica, and may be due to delay in reporting a lesion by the patient, as routine dental examination is not a common practice.