Recurrent calcifying aponeurotic fibroma of the hand: managing a rare hand tumour in an evolving healthcare landscape.

Calcifying aponeurotic fibroma (CAF) is a rare benign tumour originating from the aponeuroses of tendons and their bony insertions. A 15-year-old student presented to his general practitioner with a 1-year history of a progressively enlarging painless finger swelling. The lesion was excised by the local paediatric orthopaedic service and recurred over the course of the following 4 months. Histology confirmed a diagnosis of CAF. He was referred to our specialist hand surgery service and the lesion was excised along with the ulnar lateral band and the overlying skin. At 9 months, there was no clinical evidence of recurrence. We are the first group to report the potential benefit of including of the overlying skin in the histological specimen to reduce the residual disease burden. Our case illustrates the technical challenges and considerations of removing a large, recurrent CAF of the hand and highlights the importance of centralised specialist care.

Incidence of reactive hyperplastic lesions in the oral cavity: a 10 year retrospective study in Santa Catarina, Brazil / Incidência de lesões hiperplásicas reativas na cavidade bucal: estudo retrospectivo de 10 anos em Santa Catarina, Brasil

Abstract Introduction Reactive hyperplastic lesions develop in response to a chronic injury simulating an exuberant tissue repair response. They represent some of the most common oral lesions including inflammatory fibrous hyperplasia, oral pyogenic granuloma, giant cell fibroma, peripheral ossifying fibroma, and peripheral giant cell lesions. Objective The incidence of those lesions was investigated in an oral pathology service, and the clinical characteristics, associated etiological factors, concordance between the clinical and histopathological diagnostic was determined. Methods A total of 2400 patient records were screened from 2006 to 2016. Clinical features were recorded from biopsy reports and patients' files. Results A total of 534 cases of reactive hyperplastic lesions were retrieved and retrospectively studied, representing 22.25% of all diagnoses. The most frequent lesion was inflammatory fibrous hyperplasia (72.09%), followed by oral pyogenic granuloma (11.79%), giant cell fibroma (7.30%), peripheral ossifying fibroma (5.24%), and peripheral giant cell lesions (3.55%). Females were predominantly affected (74.19%), the gingiva and alveolar ridge were the predominant anatomical site (32.89%), and chronic traumatism was presented as the main etiological factor. The age widely ranges from the 1st decade of life to the 7th. Clinically, the reactive hyperplastic lesions consisted of small lesions (0.5-2 cm) and shared a strong likeness in color to the oral mucosa. The concordance between the clinical and histopathological diagnostic was high (82.5%). Conclusion Reactive hyperplastic lesions had a high incidence among oral pathologies. The understanding of their clinical features helps to achieve a clearer clinical and etiological diagnosis, and the knowledge of factors related to their development. This may contribute to adequate treatment and positive prognosis.

Resumo Introdução As lesões hiperplásicas reativas se desenvolvem em resposta a uma lesão crônica que estimula uma resposta acentuada de reparo tecidual. Elas representam uma das lesões orais mais comuns, inclusive hiperplasia fibrosa inflamatória, granuloma piogênico oral, fibroma de células gigantes, fibroma periférico ossificante e lesão periférica de células gigantes. Objetivo A incidência dessas lesões foi investigada em um serviço de patologia bucal e as características clínicas, os fatores etiológicos associados e a concordância entre os diagnósticos clínico e histopatológico foram determinados. Método Foram selecionados 2.400 registros de pacientes entre 2006 e 2016. As características clínicas foram registradas a partir de laudos de biópsia e dos prontuários dos pacientes. Resultados Um total de 534 casos de lesões hiperplásicas reativas foram recuperados e retrospectivamente estudados, representando 22,25% de todos os diagnósticos. A lesão mais frequente foi hiperplasia fibrosa inflamatória (72,09%), seguida por granuloma piogênico oral (11,79%), fibroma de células gigantes, (7,30%), fibroma periférico ossificante (5,24%) e lesão periférica de células gigantes (3,55%). O sexo feminino foi predominante (74,19%), a gengiva e a crista alveolar foram o local anatômico predominante (32,89%) e o traumatismo crônico foi demonstrado como o principal fator etiológico. A idade variou desde a 1ª década de vida até a 7ª. Clinicamente, as LHR consistiram em pequenas lesões (0,5 a 2 cm) que apresentaram uma forte semelhança de cor com a mucosa oral. A concordância entre o diagnóstico clínico e histopatológico foi alta (82,5%). Conclusão As lesões hiperplásicas reativas apresentaram alta incidência entre as patologias bucais. A compreensão das características clínicas ajuda na realização de um diagnóstico clínico e etiológico mais claro, bem como determinar os fatores relacionados ao seu desenvolvimento. Dessa forma contribui para um tratamento adequado e um prognóstico positivo.

Incidence of reactive hyperplastic lesions in the oral cavity: a 10 year retrospective study in Santa Catarina, Brazil.

INTRODUCTION: Reactive hyperplastic lesions develop in response to a chronic injury simulating an exuberant tissue repair response. They represent some of the most common oral lesions including inflammatory fibrous hyperplasia, oral pyogenic granuloma, giant cell fibroma, peripheral ossifying fibroma, and peripheral giant cell lesions. OBJECTIVE: The incidence of those lesions was investigated in an oral pathology service, and the clinical characteristics, associated etiological factors, concordance between the clinical and histopathological diagnostic was determined. METHODS: A total of 2400 patient records were screened from 2006 to 2016. Clinical features were recorded from biopsy reports and patients' files. RESULTS: A total of 534 cases of reactive hyperplastic lesions were retrieved and retrospectively studied, representing 22.25% of all diagnoses. The most frequent lesion was inflammatory fibrous hyperplasia (72.09%), followed by oral pyogenic granuloma (11.79%), giant cell fibroma (7.30%), peripheral ossifying fibroma (5.24%), and peripheral giant cell lesions (3.55%). Females were predominantly affected (74.19%), the gingiva and alveolar ridge were the predominant anatomical site (32.89%), and chronic traumatism was presented as the main etiological factor. The age widely ranges from the 1st decade of life to the 7th. Clinically, the reactive hyperplastic lesions consisted of small lesions (0.5-2cm) and shared a strong likeness in color to the oral mucosa. The concordance between the clinical and histopathological diagnostic was high (82.5%). CONCLUSION: Reactive hyperplastic lesions had a high incidence among oral pathologies. The understanding of their clinical features helps to achieve a clearer clinical and etiological diagnosis, and the knowledge of factors related to their development. This may contribute to adequate treatment and positive prognosis.

Fibroma ossificante periférico ­ relato de caso / Peripheral ossifying fibroma ­ case report

O fibroma ossificante periférico (FOP) é um crescimento gengival de natureza tipicamente reacional e não neoplásico. Clinicamente tem aspecto nodular, séssil ou pedunculado, de coloração variante do vermelho ao rosa. Como características histopatológicas, apresenta um epitélio escamoso estratificado com tecido fibroso rico em fibroblastos. O FOP tem predileção pelo gênero feminino, estando mais ocorrente entre a segunda e terceira década de vida. O objetivo deste trabalho foi apresentar um relato de caso clínico em paciente do gênero feminino e realizar breve revisão da literatura sobre o tema (AU).

Peripheral ossifying fibroma (POF) is a gingival growth of reactive and non-neoplastic nature. Clinically it has nodular, sessile or pedunculate appearance, with a variant coloration from red to pink. As histopathological features, it presents a stratified squamous epithelium with fibrous tissue rich in fibroblasts. POF is prevalent in the female gender, being more frequent between the second and third decade of life. The objective of this study was to present a clinical case report of a female patient and to carry out a brief literature review on this subject (AU).

Estudo comparativo da atividade proliferativa celular do fibroma ossificante periférico e da lesão de células gigantes periférica / Comparative study of the proliferative activity of the peripheral giant cells lesion and of peripheral ossifying fibroma

Foi realizado um estudo clínico retrospectivo descritivo e histoquímico de casos do fibroma ossificante periférico (FOP) e da lesão de células gigantes periférica (LCGP), coletados aleatoriamente no arquivo do Serviço de Diagnóstico Histopatológico da Universidade de Passo Fundo. O objetivo do trabalho foi comparar as atividades proliferativas celulares dessas lesões, visando o estabelecimento de uma conduta terapêutica adequada para cada uma das enfermidades. Os dados referentes ao sexo, idade, raça, localização da lesão e ocorrência de recidiva foram analisados e, o número de regiões organizadoras nucleolares (NORs) por núcleo de células ovóides foi determinado por meio do método de impregnação pela prata (Ag-NOR). Os resultados obtidos para o FOP foram de prevalência da lesão em mulheres (70%) da raça branca (60%) com média de idade de 28,11 anos, maior ocorrência da lesão na maxila anterior e índice de recidiva de 30%. O número médio de NORs foi de 1,72 para cada núcleo. Já para a LCGP, o sexo feminino também atingiu 70%, porém a média de idade foi de 42,90 anos e 100% dos pacientes pertenciam à raça branca. A ocorrência da lesão foi maior na região mandibular anterior e apresentou um índice de 20% de recidiva. Nesta lesão, o número médio de NORs foi de 1,93 por núcleo. Contudo, nos testes de correlação, nenhuma das características clínicas apresentou associação com o número médio de NORs por núcleo e a comparação desse número médio por núcleo nas LCGPs e nos FOPs não mostrou diferença significativa entre os grupos.

A retrospective clinical descritive and histochemical study envolving cases of periferic bone fibroma and of periferic giant cell lesion, randomly collected from the archives of Histophatologic Diagnostic Service of University of Passo Fundo was made. The objective of this work was to compare the proliferating cellular activities of these lesions, aiming the establishment of an adequate therapeutic conduct to each one of the disorders. The datas referring to the gender, age, race, position of the lesion and recurrence occurrence were analized and considered and the NORs’ numbers by egg-shaped cells’ nucleus were analized through the impregnation of silver method (Ag-NOR), getting as a result of periferic bone fibroma, 70% women, with an age average of 28.11 years old, where 60% of the pacients were white, and with the lesion’s position more often being on the front upper jaw, with the recurrence’s index up to 30%. The NORs’ average number was of 1.72 to each nucleus. On the periphery giant cell lesion, the female gender had also achieved 70%, however the age’s average was of 42.90 and 100% were white. The occurrence of the lesion was higher on the front inferior jaw and had showed a recurrence’s index of 20%. The NORs’ average of this lesion was 1.93 to each nucleus. Nevertheless, on the correlation’s tests none of these clinic characteristics showed a connection with the higher average’s number of NORs by nucleus and the comparison of NORs average’s number by nucleus on periphery bone fibroma and periphery giant cell lesion did not show a significant difference between the groups.

Fibroma ossificante periférico: relato de um caso clínico / Peripheral ossifiyng fibroma: a clinical case report

O fibroma ossificante periférico é um crescimento não neoplásico da gengiva classificado como uma lesão hiperplásica inflamatória reativa, sua origem é incerta mas parece estar relacionada ao ligamento periodontal. Clinicamente apresenta-se como uma massa gengival firme, frequentemente séssil e de crescimento lento. Geralmente é da mesma cor da mucosa gengival, podendo ser ligeiramente avermelhado. Fatores irritan-tes da mucosa como força mastigatória, placa, cálculos dentários e impacção de alimen-tos normalmente estão associados à lesão. Este trabalho tem por objetivo relatar um caso clínico de fibroma ossificante periférico, sua etiologia, características clínicas, radiográficas, histológicas, patológicas e tratamento...

Fibroma ossificante periférico: relato de caso e histórias de recidivas / Peripheral ossifying fibroma: case report and recurrence histoy

O fibroma ossificante periférico apresenta-se como uma das lesões hiperplásicas inflamatórias reacionais mais comuns da cavidade bucal. Sua localização mais frequente é na papila interdentária anterior da maxila. Aparece clinicamente como um crescimento focal de tecido bem delimitado e seu aspecto histopatológico mais marcante consiste na presença de calcificações em um estroma de tecido conjuntivo com inúmeros fibroblastos. O tratamento recomendado é a excisão cirúrgica total da lesão, que apresenta alto índice de recidiva, em média de 15 por cento. O presente trabalho tem como objetivo relatar um caso clínico de fibroma ossificante periférico com história de três recidivas

Peripheral ossifying fibroma in a child: report of case.

A typical peripheral ossifying fibroma in the anterior maxilla of an 11-year-old boy is presented. The importance of differential diagnosis and proper treatment for prevention of recurrence is discussed.

[Ossifying fibroma of the face and hyperparathyroidism in a chronic hemodialysis patient]. / Fibrome ossifiant de la face et hyperparathyroïdie chez une hémodialysée chronique.

The bony complications in secondary hyperparathyroidism in chronic renal failure are varied. The ossifying fibroma is a rare manifestation. We report a case of a 40 years old woman with indeterminate nephropathy undergoing hemodialysis since 1982. Since may 1995, the patient had a diffuse and intensive bone pain of the two inferior members inducing functional importance with apparition of endobuccal tumefaction in the hard palate with an important increase of the volume of the maxillo-mandibular complex six months later associated to disturbances of the deglutition and phonation. In december 1995, the serum parathyroid hormone level is measured at 1527.6 pg/ml and the serum alkaline phosphatase level at 1620 UI/l. The bony lesions are disseminated to all the skeleton in the form of a demineralization with an ossifying expansive process affecting the maxillo-mandibular complex. Calcemia was at 2.3 mmol/l and phosphoremia at 2.1 mmol/l. The surgical biopsy of this pseudotumor showed an aspect of ossifying fibroma. The cervical echography showed a left inferior parathyroid nodular. In june 1996, a subtotal parathyroidectomy was done. The 9th day after surgery, the serum parathyroid hormone level was at 103 pg/ml with normal calcemia and phosphoremia. Five years later, the volume of the tumor reduced moderately. This observation induces 3 commentaries: the bony manifestations associated to secondary hyperparathyroidism have sometimes a tumoral aspect, the ossifying fibroma may be for known as well as the brown tumor and the treatment of these tumors in complex justifying furthermore a rigorous prevention of the hyperparathyroidism in hemodialyzed patients.

Fibroma ossificante periférico / Peripherical fibroma ossifying

Neste trabalho os autores discutem a etiologia, características clínicas, aspectos radiográficos e causas das recidivas do fibroma ossificante periférico

Fibroma cemento osificante periférico. Caso clínico y revisión de la literatura / Peripheral cemento-ossifying fibroma. Clinical case and review of the literature

Se presenta un caso de fibroma cemento osificante periférico en una paciente de 2 años de edad, con características particularmente recidivantes y de rápido crecimiento. Se revisa la literatura y se analizan las características de esta lesión, discutiendo el carácter reactivo y no neoplásico de esta enfermedad

Fibroma ossificante: relato de um caso / Ossifying fibroma: report of a case

Os autores apresentam um caso clínico de fibroma ossificante em paciente de 46 anos de idade. Säo discutidos a etiopatogenia, aspectos clínicos, radiográficos e microscópicos e diagnóstico diferencial