ABSTRACT
OBJECTIVE: The aim of this study was to report the clinicopathologic features of 62 cases of central odontogenic fibroma (COdF). STUDY DESIGN: Clinical and radiographic data were collected from the records of 13 oral pathology laboratories. All cases were microscopically reviewed, considering the current World Health Organization classification of tumors and were classified according to histopathologic features. RESULTS: There were 43 females and 19 males (average age 33.9 years; range 8-63 years). Clinically, COdF lesions appeared as asymptomatic swellings, occurring similarly in the maxilla (n = 33) and the mandible (n = 29); 9 cases exhibited palatal depression. Imaging revealed well-defined, interradicular unilocular (n = 27), and multilocular (n = 12) radiolucencies, with displacement of contiguous teeth (55%) and root resorption (46.4%). Microscopically, classic features of epithelial-rich (n = 33), amyloid (n = 10), associated giant cell lesion (n = 7), ossifying (n = 6), epithelial-poor (n = 3), and granular cell (n = 3) variants were seen. Langerhans cells were highlighted by CD1a staining in 17 cases. Most patients underwent conservative surgical treatments, with 1 patient experiencing recurrence. CONCLUSIONS: To the best of our knowledge, this study represents the largest clinicopathologic study of COdF. Most cases appeared as locally aggressive lesions located in tooth-bearing areas in middle-aged women. Inactive-appearing odontogenic epithelium is usually observed within a fibrous/fibromyxoid stroma, occasionally exhibiting amyloid deposits, multinucleated giant cells, or granular cells.
Subject(s)
Fibroma , Odontogenic Tumors , Adolescent , Adult , Child , Female , Fibroma/diagnostic imaging , Fibroma/surgery , Humans , Male , Mandible , Maxilla , Middle Aged , Neoplasm Recurrence, Local , Odontogenic Tumors/diagnostic imaging , Odontogenic Tumors/surgery , Young AdultABSTRACT
O objetivo deste estudo é descrever as características clinicopatológicas e imuno-histoquímicas de 5 novos casos de Fibroma Odontogênico Central (FOC). Cinco casos diagnosticados como FOC foram obtidos ao longo de um período de 20 anos (1997 a 2017) a partir dos arquivos do Laboratório de Patologia Oral do Departamento de Patologia e Diagnóstico Oral da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro (FO-UFRJ), Brasil. Os achados clínicos e radiográficos dos pacientes foram coletados nos prontuários dos pacientes. Todos os pacientes eram mulheres com média de idade de 42,2 anos (variando de 19 a 63 anos). Quatro casos (80%) afetaram a porção posterior da mandíbula e um caso (20%) ocorreu na região posterior da maxila. Dois casos foram classificados como FOC convencional rico em epitélio; os outros três casos foram diagnosticados como FOC associado ao GCCG, variante de células granulares do FOC e variante ossificante do FOC. Radiograficamente, os tumores apareceram como lesões radiolúcidas multiloculares (60%), biloculares (20%) e uniloculares (20%) com expansão e ruptura das corticais ósseas (80%) e deslocamento dentário (40%). Todos os casos foram tratados por excisão cirúrgica conservadora, sem evidência de recidiva após acompanhamento de 7 meses a 15 anos. As ilhas epiteliais de todos os casos foram positivas para citoqueratina AE1/AE3 em padrão citoplasmático e CD138 em padrão de membrana. As células estromais estreladas e fusiformes foram negativas para α-actina de músculo liso e positivas para citoqueratina AE1/AE3 em um caso. Células dendríticas de Langerhans entrelaçadas ao redor de ilhas epiteliais foram evidenciadas por CD1a em um caso, o qual mostrou células granulares estromais positivas para CD138 e CD163. O índice de Ki-67 foi baixo (<1%) nos componentes epiteliais e estromais de todos os casos. Os FOCs são tumores odontogênicos incomuns de morfologia típica e comportamento clínico não agressivo. Na presente série de casos, FOCs afetaram as regiões posteriores da mandíbula (quatro casos) e maxila (um caso) de cinco mulheres de meia-idade do Brasil. (AU)
The aim of this study is to describe the clinicopathological features of 5 new cases of central odontogenic fibroma (COF) and the immunohistochemical findings of 4 of them. Five cases diagnosed as COF were retrieved over a 20-year period (1997 to 2017) from the files of the Oral Pathology Laboratory of the Department of Oral Diagnosis and Pathology, School of Dentistry of the Federal University of Rio de Janeiro Brazil. Clinical and radiographic findings of the patients were collected from the patients' charts. All patients were women with mean age of 42.2 years (ranging from 19 to 63 years). Four cases (80%) affected the posterior mandible and one case (20%) occurred in the posterior maxilla. Two cases were classified as epithelial-rich conventional COF; the other three cases were diagnosed as COF associated to CGCG, granular cell variant of COF, and ossifying variant of COF. Tumors appeared as multilocular (60%), bilocular (20%) and unilocular (20%) radiolucencies with expansion and rupture of bone cortices (80%) and tooth displacement (40%). All cases were treated by conservative surgical excision, with no evidence of recurrence after follow-up ranging from 7 months to 15 years. The epithelial islands of all cases were positive for cytokeratin AE1/AE3 in cytoplasmic pattern and CD138 in membrane pattern. The stellate and spindle-shaped stromal cells were negative for α-smooth muscle actin (SMA), and positive for cytokeratin AE1/AE3 in one case. Langerhans dendritic cells entwined around epithelial islands were highlighted byCD1a in one case, which showed stromal granular cells positive for CD138 and CD163. Ki-67 index was low (<1%) in both epithelial and stromal components of all cases. COFs are uncommon odontogenic tumors of typical bland morphology and non-aggressive clinical behavior. In the present series, COFs affected the posterior regions of mandible (four cases) and maxilla (one case) of five middle-aged women from Brazil. (AU)
