Central Odontogenic Fibroma with the Presence of Large Fibroblasts of Varying Morphology
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CASE REPORTS
Central Odontogenic Fibroma with the Presence of Large Fibroblasts of Varying Morphology Victor Costa1 · Ana Lia Anbinder1 · Fernanda Herrera1 · Nayara Rodrigues1 · Ana Sueli Rodrigues Cavalcante1 · Estela Kaminagakura1 Received: 21 January 2020 / Accepted: 17 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A patient with an odontogenic fibroma (OF) with the presence of fibroblasts of varying morphology is presented, and the main microscopic differential diagnosis is discussed. Case report: a 51-year-old man complained of a swelling in the anterior region of the mandible. The panoramic radiograph showed a radiolucent, well-defined multilocular image, with displacement of the roots of the left mandibular incisors and canine. A cone beam computed tomography examination revealed a hypodense image, with delicate bone spicules inside, divergence of the tooth roots and destruction of the buccal cortical bone. Under the differential diagnosis of a desmoplastic ameloblastoma or a squamous odontogenic tumor, an incisional biopsy was made. Microscopically, deeply collagenized tissue with scarce odontogenic epithelium islands, large fibroblasts of varying morphology and calcified material was observed. A diagnosis of OF was made. Surgical removal was carried out, and the specimen was examined. Identical aspects were found, and the immunohistochemical reaction for pan-cytokeratin was carried out to identify the odontogenic epithelial cells. The definitive diagnosis of OF was confirmed, and we emphasize the importance of the correlation of all characteristics for a definitive diagnosis. Keywords Odontogenic tumor · Desmoplasia · Large fibroblast
Introduction Odontogenic fibroma (OF) is an uncommon neoplasm of mature fibrous connective tissue, with variable amounts of inactive-looking odontogenic epithelium. The following two topographical variants have been identified: peripheral (or extraosseous) and central (or intraosseous) [1]. Central OF often occurs in women about 35 years of age, presenting no predilection for the maxilla or mandible [1, 2]. A large tumor can be associated with pain, bone expansion and loss of teeth [1]. It usually presents as a well-circumscribed uni- or multilocular radiolucency which can cause root resorption [1, 3]. Microscopically, central OF is composed of moderately cellular or collagenous connective tissue with varying * Estela Kaminagakura [email protected] 1
Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), Av. Eng. Francisco José Longo 777, São José dos Campos 12245‑000, Brazil
amounts of inactive-looking odontogenic epithelial islands or strands. Odontogenic epithelium may vary from being totally absent to being a conspicuous feature [1, 4], making the diagnosis somewhat difficult. A central OF with unusual microscopical features showing scarce odontogenic epithelium islands, considerable amounts of fibroblasts of varying morphology and calcification is repor
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