• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.1
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• pp.48-51
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• 2015

Cemento-ossifying fibromas are benign tumors, and, although cases of an aggressive type have been reported, no cases of cemento-ossifying fibroma transforming into osteosarcoma have been documented previously. Low-grade osteosarcoma is a rare type of primary bone tumor, representing 1%-2% of all osteosarcomas. A 45-year-old female patient was diagnosed with cemento-ossifying fibroma, treated with mass excision several times over a period of two years and eight months, and followed up. After biopsy gathered because of signs of recurrence, she was diagnosed with low-grade osteosarcoma. The patient underwent wide excision, segmental mandibulectomy, and reconstruction with fibula free flap. The aim of this report is to raise awareness of the possibility that cemento-ossifying fibroma can transform into osteosarcoma and of the consequent necessity for careful diagnosis and treatment planning.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.21 no.2
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• pp.261-273
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• 1991

This study was undertaken to document and better defined this condition to help clarify this clinical and radiographical appearances by the analysis of clinical and radiographical features of fibro-osseous lesions in the jaws. A study was made of a series of 128 cases with fibro-osseous lesions. The obtained results were as follows. 1. Fibrous dysplasia of the jaws occurred with equal predilection for males and females. But the females occurred in 68% of cemento-ossifying fibroma and 75% of periapical cemental dysplasia. 2. 43% of fibrous dysplasia and 32% of cemento-ossifying fibroma occurred in the 2nd decades and 33% of periapical cemental dysplasia in 5th decades. 3. 62% of fibrous dysplasia occurred in the maxilla, 73% of cemento-ossifying fibroma in mandible, 90% of periapical cemental dysplasia in mandible. 4. 98% of fibrous dysplasia occurred in premolar-molar region, 77% of cemento-ossifying fibroma in molar region, 68% of periapical cemental dysplasia in incisor region. 5. In serial radiographic features, mature stage were 55% of fibrous dysplasia, 45% of cemento-ossifying fibroma, 59% of periapical cemental dysplasia. 6. 87% of fibrous dysplasia had monostotic lesion, 67% of periapical cemental dysplasia had multiple lesions. 7. In fibrous dysplasia and cemento-ossifying fibroma, migration of tooth occurred in 61.7% and 36.4%, retention of tooth occurred in 4.3% and 9.1%, loss of lamina dura occurred in 6.4% and 9.1%, and root resorption had not occurred in fibrous dysplasia, but occurred in 18% of cemento-ossifying fibroma, displacement of mandibular canal occurred in 14.9% and 31.8%.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.297-308
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• 1989

These are two case reports of recurrent ossifying and cemento-ossifying fibroma in a year or 5 months following conservative treatment. Ossifying fibroma or cemento-ossifying is a relatively uncommon benign fibro-osseous tumor of the jaws, and is generally believed to originate from periodontal ligaments. In recent, it is not demanded more differentiation of ossifying, cementifying and cemento-ossifying fibroma due to the thought that these lesions represent a spectrum of the same disease process rather than separate entities. The tumor commonly presents as an asymptomatic mass lesion and is usually well-circumscribed clinically so that conservative surgical excision has been the treatment of choice, but on occasion extended surgical procedures may become necessary, especially for those tumors which demonstrate rapid expansions and are poorly encapsulated (either initially or when recurrent) and when tumor growth is progressed aggressively or recurrent. En-bloc resection of mandible with iliac bone and inferior alveolar nerve graft was performed in case 1, recurrent cemento-ossifying fibroma of 32-year old male patient, and extended surgical enucleation of mass including normal marginal bone was done in case 2, recurrent ossifying fibroma of 72-year old female patient. By follow-up check of the patients, we obtained good result without any sings of recurrence.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.2
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• pp.200-206
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• 2005

Cemento-ossifying fibroma of the jaws is well circumscribed, generally slow-growing, benign lesions which enlarge in an expansile manner. Clinically it presents as a slowly enlarging lesion commonly in the premolar-molar area of the mandible and only occasionally in the maxilla and other locations. It occurs twice as often in females and primarily in the 20 to 30 year age group. Differential diagnosis should be peformed, preferably with other fibro-osseous lesions such as fibrous dysplasia. A faster growing and more destructive variant of cemento-ossifying fibroma sometimes occurs in patients under age 15 and is termed juvenile (aggressive) ossifying fibroma. Treatment is surgical removal with the extent depending on the size and location of the individual lesion. Recurrence is considered rare. A case involving a 12-year-old male patient with delayed eruption of right mandibular canine is discussed. Following an incisional biopsy, the histopathologic diagnosis established was cemento-ossifying fibroma. After the surgical enucleation of the lesion, no sign of recurrence was detected.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.484-487
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• 2010

Cemento-ossifying fibroma is a true osteogenic neoplasm. It is also called as ossifying fibroma or cementify-ing fibroma. Small lesions seldom cause any symptoms and are detected only on radiographic examination. Large lesions result in a painless swelling of the involved bone. In radiographic features the lesion most often is well defined and unilocular. It may appear completely radiolucent, or more often varying degrees of rdiopacity. It is composed of fibrous tissue that contains a variable mixture of bony trabeculae,cementum-like spherules, or both. Treatment of most lesions generally is enucleation of tumor. However, some lesions which have grown large and destroyed considerable bone, may necessitate surgical resection and bone grafting. This case was the bony lesion that was found by accident in patient with mandibular left body and subcondylar fracture. In radiographic examination, there was a mixed radiolucent and radiopaque lesion in mandibular left body area with fracture line. We treated on mandibular left body and subcondylar fracture and enucleated the lesion on the left body area simultaneously. At surgical exploration, the lesion was well demarcated from the surrounding bone, thus permitting relatively easy separation of the tumor from its bony bed. In histopathologic examination, the lesion contained bony trabeculae and cementum-like spherules within a background of cellular fibrous connective tissue. It finally diagnosed as cemento-ossify-ing fibroma from the result of biopsy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.70-75
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• 2000

The cemento-ossifying fibroma is a well-demarcated and occasionally encapsulated neoplasm composed of fibrous tissue that contains varying amounts of calcified tissue resembling bone, cementum, or both. The greatest number of cases are encountered during the third and fourth decades of life and there is a definite female predilection, with female-to-male ratios as high as 5 : 1 being reported. The mandible is involved far more than the maxilla, and 90 percent of all cases are located in the mandible. The mandibular premolar-molar area is the most common site. Radiographically, the lesion is most often well defined and unilocular. Depending on the amount of calcified produced in the tumor, it may appear as completely radiolucent ; more often it shows varying degrees of radiopacity. Some lesions may be largely radiopaque with a radiolucent halo. On microscopic study, the tumor is composed of fibrous tissue of varying degrees of cellularity containing calcified material. This may be in the form of trabeculae of osteoid and bone or basophilic ovoid calcifications that resemble cementum-like material. Admixture of the two types of calcifications are commonly seen. On this case, large cemento-ossifying fibroma has grown in the mandible and this lesion was treated by complete surgical excision and posterior iliac bone graft. A review of literature and a report of a case of cemento-ossifying fibroma are presented.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.27 no.2
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• pp.161-172
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• 1997

The purpose of this study was to know the proper diagnosis and to establish the treatment plan of cementifying and ossifying fibroma in the jaws through the clinical, raiological, and histopathologic considerations. The authors compared and analyzed the c1inicoradiologic features of the thirteen cases of cementifying and ossifying fibroma, diagnosed at the Dental college hospital in Yonsei university, Seoul, Korea, during the period from 1980 to 1995. The obtained results were as follows : 1. Cementifying and ossifying fibroma occured in the mean age, 44 years, ranged from 29 to 65 years and the male to female ratio was approximately 1:5. 2. Swelling was the most common frequent presenting complaints. Other reported symptoms included pain, tooth mobility and asymptom. 3. The frequency of the lesions was twelve cases in the mandible and one case in the maxilla. And eleven of thirteen cases were distributed on the premolar and molar region. 4. Radiologically, eight of thirteen cases were well defined lesions, five cases were relatively well defined lesions. And nine of thirteen cases were mixed lesions, three cases were radiopaque lesions, and only one case was purely radiolucenct lesion. 5. Histologically, seven of thirteen cases were classified ossifying fibroma, four cases were cemento-ossifying fibroma, and two cases were cementifying fibroma.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.1
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• pp.158-164
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• 1990

This is a case of cemento-ossifying fibroma in mandible, one of fibro-osseous lesions arising in periodontal ligament, with review of literature for fibro-osseous lesions. En-bloc resection of mandible with alloplastic material ($Pyrost^{\circledR}$) was performed in cemento-ossifying fibroma of 20-year young male patient. By follow-up check of the patient, we obtained good result without any signs of recurrence.

• Imaging Science in Dentistry
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• v.40 no.1
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• pp.53-58
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• 2010

Common radiographic appearances of ossifying fibroma (OF) are well demarcated margin, radiolucent or mixed lesion. Lesions for the radiographic differential diagnosis with OF include fibrous dysplasia, focal cemento-osseous dysplasia. Other confusing lesions might be the mixed lesions such as calcifying odontogenic cyst, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor, and benign cementoblastoma. We reported three cases of OF in posterior mandible. These cases showed a little distinguished radiographic features of OF and diagnosed from a combination of clinical, radiographic, and histopathologic information. We need to further refine radiographic and histopathological features of OF and other confusing lesions with literatures review because some cases of these lesions are not easily differentiated radiographically and histopathologically.

• The Korean Journal of Oral and Maxillofacial Pathology
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• v.42 no.6
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• pp.189-198
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• 2018

A 31 years old female had been suffered from a bony swelling in right premolar region of the mandible for 12 years, recently grown rapidly. A fistula tract developed on the right anterior mandibular border, but the lesion was relatively asymptomatic. In the radiological examination, the tumor mass was irregularly mixed with radiolucent and radiopaque areas, forming multiple cystic spaces. Under the diagnosis of calcifying odontogenic cyst, the mandibular mass was resected and examined pathologically. After decalcification, the dissected tumor mass showed multiple small cystic spaces and calcifying fibrous tissue, mimicking calcifying odontogenic cyst or ameloblastoma. Histological observation showed many calcifying cementoid materials and ossifying trabeculae. The cystic spaces were turned out to be dilated vascular channels lined by endothelial cells, containing plasma fluid. However, the main lesion was diagnosed as cemento-ossifying fibroma (COF), and the atypical vascular channels were greatly dilated and gradually expanded the whole tumor mass. The present COF was examined through immunohistochemical (IHC) array, and investigated for tumor cell characteristics, exhibiting abnormal ossification and aneurysmal cystic changes. IHC array disclosed that the tumor cells grew progressively in the lack of apoptosis, and that they showed lower expression of RUNX2 than BMP-2, RANKL, and OPG, and increases of protein expression in $HIF-1{\alpha}$, VEGF-A, and CMG2. These data suggested that the reduced expression of RUNX2, osteoblast differentiation factor, be relevant to abnormal ossification of COF, and that the consistent expressions of angiogenesis factors be relevant to de novo angiogenesis in COF, subsequently resulted in aneurysmal cystic changes.