Psammomatoid Juvenile Ossifying Fibroma Involving Upper Jaw: A Rare Case Report

Abstract

Juvenile ossifying fibroma (JOF) is a fibro-osseous neoplasm, rare in occurrence and usually seen in young children. JOF is locally aggressive spreads quickly and is defined as a variant of ossifying fibroma. There are two types of ossifying fibroma depending on histopathology and classified as Psammomatoid juvenile ossifying fibroma (PJOF), Trabecular juvenile ossifying fibroma (TJOF). Both the types affect skull bones with the trabecular type being more common in the jaws- maxillofacial region and the psammomatoid type being more common in the paranasal sinuses, ethmoid sinuses- craniofacial region. Complete excision is mandatory because JOF's have an extremely high rate of recurrence. A rare case of PJOF involving right maxilla sparing paranasal sinuses in a 15-year-old male patient with clinical, radiographic and histopathological features is discussed.

Keywords: Fibrous Dysplasia; Maxilla; Odontogenic tumour.

[Table/Fig-1]:

Extra oral view of patient showing mild obliteration of right nasolabial fold

[Table/Fig-2]:

Intra oral view of buccal aspect with arrows showing anterior and inferior margins of the swelling

[Table/Fig-3]:

Intra oral view of palatal extension of the lesion shown with an arrow

[Table/Fig-4]:

Intraoral periapical radiograph showing mixed radiodensity marked with an arrow, 14, 15 teeth show root divergence

[Table/Fig-5]:

Occlusal radiograph marked with arrows showing buccal palatal extension of lesion with ossifications

[Table/Fig-6]:

Orthopantomograph showing relatively defined radiolucent lesion apical to 14, 15 marked with arrows

[Table/Fig-7]:

Paranasal Sinus view of skull radiograph marked with arrows show no involvement of right maxillary sinus, right orbit

[Table/Fig-8]:

CT coronal view marked with an arrow show borders of lesion, primarily radiolucent with irregular and scattered calcifications

[Table/Fig-9]:

CT axial view showing margins of lesion, arrows indicating a relatively circumscribed lesion on the right maxilla

[Table/Fig-10]:

Intraoral image showing incisional biopsy site

[Table/Fig-11]:

Intraoral image showing sutures placed at incision biopsy site

[Table/Fig-12]:

Photomicrograph (10X) H&E stained sections showing ossicles indicated with an arrow, resembling psammoma- like bodies

[Table/Fig-13]:

Magnified photomicrograph (40X) of psammoma- like bodies, indicated with an arrow showing peripheral brush border appearance

[Table/Fig-14]:

Intraoperative image showing surgical enucleation

[Table/Fig-15]:

Image showing volume of gross specimen

[Table/Fig-16]:

Immediate postoperative intraoral image after excision of lesion and extraction of 14

[Table/Fig-17]:

Eighth month postoperative intraoral image showing no signs of recurrence at enucleated site indicated with an arrow

[Table/Fig-18]:

Eighth month postoperative IOPA showing normal trabecular pattern indicated with an arrow at the site of excised lesion

[Table/Fig-19]:

Eighth month postoperative OPG showing diminished radiolucency apical to 13, 15 indicated with an arrow