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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
CASE REPORT Table of Contents   
Year : 2008  |  Volume : 12  |  Issue : 2  |  Page : 72-74
 

Multifocal peripheral odontogenic fibroma


Department of Oral and Maxillofacial Pathology, M. M. College of Dental Sciences and Research, Mullana, Ambala, India

Correspondence Address:
Sangeeta Palaskar
Department of Oral and Maxillofacial Pathology, M. M. College of Dental Sciences and Research, M. M. University, Mullana, Ambala, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-029X.44582

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   Abstract 

A 35-year-old woman was presented with diffuse, sessile, firm, and exophytic lesions in molar premolar region in both the jaws. The patient had poor oral hygiene, with grade I mobility of first molars in both the jaws. Orthopantamograph showed horizontal bone loss in relation to the same. A clinical diagnosis of hyperplastic gingivitis was made. Incisional biopsies followed by microscopic examination revealed a pattern of peripheral odontogenic fibroma (WHO type). Peripheral odontogenic fibroma (POdF) is characteristically described as a solitary neoplasm, and very few cases of diffuse peripheral odontogenic fibroma have been reported in literature. Despite the rarity of POdF presenting as a diffuse lesion, the lesion should be included as a possible differential diagnosis of diffuse single or multiple gingival lesions.


Keywords: Peripheral odontogenic fibroma, maxilla, odontogenic tumor, WHO type


How to cite this article:
Kamal R, Palaskar S, Shetty VP, Bhushan A. Multifocal peripheral odontogenic fibroma. J Oral Maxillofac Pathol 2008;12:72-4

How to cite this URL:
Kamal R, Palaskar S, Shetty VP, Bhushan A. Multifocal peripheral odontogenic fibroma. J Oral Maxillofac Pathol [serial online] 2008 [cited 2020 Jul 7];12:72-4. Available from: http://www.jomfp.in/text.asp?2008/12/2/72/44582



   Introduction Top


The odontogenic fibroma is defined by WHO as a benign odontogenic neoplasm of fibroblastic origin characterized by relatively mature collagenous fibrous tissue and varying amounts of odontogenic epithelium with potential to occur in either a central or extraosseous location. The extraosseous counterpart is designated peripheral odontogenic fibroma (POdF). [1]

POdF was designated, specifically in the past, also as 'odontogenic gingival epithelial hamartoma' by Baden and his co-workers and as a 'peripheral ameloblastic fibrodentinoma' by numerous oral pathologists such as McKelvy and Cherrick. [2]

POdF is an uncommon lesion of the gingiva. POdF appears to be slow growing, often present for a number of years. POdF is generally described as a solid, firmly attached gingival mass, sometimes arising between teeth and sometimes displacing teeth. [2] Thus, most of the POdF's described in literature presented as single, focal swellings. [3] Hence POdF may be mistaken for more common exophytic gingival lesions such as fibrous hyperplasia or pyogenic granuloma. [4]

Further, very few accepted cases of POdF presenting as a diffuse lesion have been reported in literature. These include three cases reported by Weber et al. in 1992 presenting with the histologic appearance of POdF and diffuse involvement of the gingiva, of which one case was associated with dermatological and ocular abnormalities. [3]

The purpose of this article is to describe a rare case of POdF presenting as a diffuse gingival lesion.


   Case Report Top


A 35-year-old woman presented with the chief complaint of bleeding from the gums and mobility of the teeth since 7 months. Extraoral examination revealed no significant findings. Intraoral examination revealed bilateral exophytic nodular enlargements, extending from the first premolar to third molar region on buccal and lingual aspects of mandibular gingiva and from first premolar to third molar region on palatal aspects of right maxillary gingiva, measuring 4×2 cm approximately [Figure 1]. The surface of the lesions was erythematous. The surface was intact except in some areas where it showed ulceration, which could be due to trauma from opposing teeth. The patient claimed that she noticed the lesions 7 months back, and there has been no increase in size since then. Family and medical history was not significant. First molars in both the jaws were moderately afflicted by plaque and calculus deposits, had grade I mobility, and were associated with pockets measuring 3 to 4 mm in depth. Radiographic examination showed horizontal bone loss in relation to first molars in both the jaws, which could be attributed to periodontitis [Figure 2]. A clinical diagnosis of hyperplastic gingivitis was made. Incisional biopsies were performed from all three sites from the periphery of the lesion. Microscopically, of all the sections showed highly cellular connective tissue consisting of spindle-shaped cells with plump and oval nuclei and scattered islands, strands, or follicles of odontogenic epithelium [Figure 3],[Figure 4],[Figure 5]. Overlying epithelium was hyperplastic. Sub-epithelial connective tissue was infiltrated with chronic inflammatory cells. Areas of calcifications resembling dentinoid and osteoid were seen within cellular connective tissue. The patient was referred to the Department of Periodontics for oral prophylaxis and was advised excisional biopsy for the POdF lesions, which she refused to undergo. Follow-up of the case is not available.


   Discussion Top


Peripheral odontogenic fibroma (POdF) is a rare benign mesenchymal odontogenic neoplasm with or without odontogenic epithelium, which typically presents as a raised firm, painless, smooth-surfaced gingival mass. [2] It is considered to be the mucosal analog to the central odontogenic fibroma. [4] Though peripheral odontogenic tumors are rare, comprising only 0.05% of all biopsy specimens, POdF is the most common peripheral odontogenic tumor, even more common than its central counterpart by a ratio of 1.4:1. [6]

The POdF has been widely accepted as an odontogenic tumor of mesenchymal origin. The epithelial component has been considered inactive despite the fact that in some lesions the epithelium is abundant and occasionally the dominant feature, which has led some investigators to question the possibility of a mixed odontogenic origin for the lesion. [7] Weber et al. reported three cases of diffuse POdF and are of the opinion that diffuse POdF should be considered a solitary or diffuse hamartomatous lesion caused by uncontrolled induction in the gingiva in a local or diffuse manner rather than a true neoplasm. [3]

There is a wide age range, which extends from the first to ninth decade of life, with incidence showing a slight increase in the third decade. There is equal gender distribution, with some studies finding a slight female predilection; and others, a slight male predilection. [8] It seems to affect Whites more often than it does Blacks; [7] however, some studies have noted a higher prevalence in Blacks. [9] The POdF can arise throughout either arch but tends to occur in the mandibular canine-premolar and maxillary anterior areas. [5]

The differential diagnosis includes inflammatory lesions such as fibrous hyperplasia, peripheral fibroma, peripheral ossifying fibroma; [10] peripheral odontogenic tumors; [11] peripheral giant cell granuloma, pyogenic granuloma, epulis fissuratum, and gingivitis. [10] Differential diagnosis for the generalized gingival enlargement-like lesions includes hyperplastic gingivitis, drug-related gingival hyperplasia, gingival fibromatoses, and various systemic diseases. [10]

The histologic spectrum of POdF (WHO type) is characterized by relatively mature collagenous fibrous tissue and varying amounts of odontogenic epithelium. Granular cell type of POdF is a histological variant that shows the presence of numerous stromal granular cells. [5]

The treatment is to ensure complete surgical excision of the lesion, which frequently results in a mucogingival defect. The combination of excisional biopsy and periodontal plastic surgery is a one-step procedure, which seems to be suitable in most areas of the mouth, regardless of esthetic significance. [12] The recurrence rate of POdF has been reported to be from very low to as high as 38.9%. [4],[7]

This case report presents a case of multifocal POdF involving posterior segments of maxillary and mandibular gingiva in a 35 year-old female, that presented clinically as an inflammatory gingival enlargement with periodontitis of the affected tooth. Histopathological examination revealed the lesion to be POdF. Hence, this case report emphasises the role of biopsy in diagnosis of such misleading presentations.

 
   References Top

1.Pindborg JJ, Kramer IR, Torloni H. Histological typing of Odontogenic tumors, jaw cysts and allied lesions. International histological classification of tumors No.5. Geneva: World Health Organization; 1971. p. 30-1.  Back to cited text no. 1    
2.Shafer, Hine, Levy. Textbook of Oral Pathology. 5 th ed.   Back to cited text no. 2    
3.Weber A, Van Heerden WF, Ligthelm AJ, Raubenheimer EJ. Diffuse peripheral odontogenic fibroma: Report of 3 cases. J Oral Pathol Med 1992;21:82-4.  Back to cited text no. 3    
4.Michaelides PL. Recurrent peripheral odontogenic fibroma of the attached gingiva: A case report. J Periodontol 1992;63:645-7.  Back to cited text no. 4    
5.Rinaggio J, Cleveland D, Koshy R, Gallante A, Mirani N. Peripheral granular cell odontogenic fibroma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:676-9.  Back to cited text no. 5    
6.Buchner A, Merrell PW, Carpenter WM. Relative frequency of peripheral odontogenic tumors: A study of 45 new cases and comparison with studies from literature. J Oral Pathol Med 2006;35:385-91.  Back to cited text no. 6    
7.Gardener DG. The peripheral odontogenic fibroma: An attempt at clarification. Oral Surg Oral Med Oral Pathol 1982;54:40-8.   Back to cited text no. 7    
8.Martelli-Júnior H, Mesquita RA, de Paula AM, Pκgo SP, Souza LN. Peripheral odontogenic fibroma (WHO type) of the newborn: A case report. Int J Paediatr Dent 2006;16:376-9.  Back to cited text no. 8    
9.de Villiers Slabbert H, Altini M. Peripheral odontogenic fibroma: A clinicopathologic study. Oral Surg Oral Med Oral Pathol 1991;72:86-90.  Back to cited text no. 9    
10.Manor Y, Merdinger O, Katz J, Taicher S. Unusual peripheral odontogenic tumors in the differential diagnosis of gingival swellings. J Clin Periodontol 1999;26:806-9.  Back to cited text no. 10    
11.Ide F, Obara K, Mishima K, Saito I, Horie N, Shimoyama T, et al . Peripheral odontogenic tumor: A clinicopathologic study of 30 cases, General features and hamartomatous lesions. J Oral Pathol Med 2005;34:552-7.  Back to cited text no. 11    
12.Bosco AF, Bonfante S, Luize DS, Bosco JM, Garcia VG. Periodontal Plastic surgery associated with treatment for the removal of gingival overgrowth. J Periodontol 2006;77:923-9.  Back to cited text no. 12    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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