Mandible & maxilla

Benign mesenchymal odontogenic tumors

Odontogenic fibroma



Topic Completed: 1 February 2018

Minor changes: 16 June 2021

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PubMed Search: Odontogenic fibroma maxilla [title] pathology

Anthony Martinez, M.D.
Kelly Magliocca, D.D.S., M.P.H.
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Cite this page: Martinez, A. Odontogenic fibroma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillaodontogenicfibroma.html. Accessed October 21st, 2021.
Definition / general
  • Rare, benign mesenchymal odontogenic tumor composed of mature fibrous tissue with variable amounts of inactive appearing odontogenic epithelium
    • Calcification may be present
  • Two common variants:
    • Intraosseous or central odontogenic fibroma
    • Extraosseous or peripheral odontogenic fibroma, centered in gingival tissues associated with tooth bearing regions of jaws
  • Rare variants (see Microscopic (histologic) description)
Essential features
  • Strands or nests of odontogenic epithelium, with or without calcification, set in a variably cellular fibrocollagenous stroma
Terminology
  • Odontogenic fibroma
  • Central odontogenic fibroma
  • Peripheral odontogenic fibroma
Epidemiology
Sites
  • Mandible and maxilla affected equally
  • Peripheral odontogenic fibroma
    • More common along anterior gingival region
  • Central odontogenic fibroma
    • Most involving mandible are posterior to first molar
    • Most involving maxilla are anterior to first molar
Clinical features
  • Can be asymptomatic
  • If symptomatic, can present with swelling and pain
Diagnosis
  • Diagnosis dependent on clinical, radiologic and pathologic correlation
Radiology description
  • Can present as a unilocular or multilocular radiolucency with distinct borders
  • Root resorption and displacement of teeth have been reported
  • ~10% exhibit radiopaque flakes that correlate with calcification
Radiology images

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IOPA showing irregular radiopaque masses

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Multilocular radiolucency near 21, 22, 63, 24 and 25

Prognostic factors
Case reports
Treatment
  • Peripheral odontogenic fibromas are usually treated by excision
  • Central odontogenic fibromas are usually treated by enucleation and curettage
Clinical images

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Gingival masses

Gross images

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Surgical intervention of odontogenic fibroma

Microscopic (histologic) description
  • Consists of variably cellular fibrocollagenous tissue with scattered, small, inactive odontogenic epithelium in strands, cords or nests
    • Calcification can be seen in association with odontogenic epithelium and when extensive could consider classification as ossifying variant of odontogenic fibroma
  • Rare Variants and Associations:
    • Ossifying variant of odontogenic fibroma: epithelial odontogenic islands intimately admixed with bone trabeculae (see Fig. 8 below)
    • Granular cell odontogenic fibroma: variant characterized by granular cell appearance within the odontogenic epithelium or stromal granular cells
    • Central odontogenic fibroma (COF) with amyloid-like protein deposition
      • Characteristic COF with ovoid or globular acellular hyalinized structures and possible areas of periepithelial amyloid deposition (cuffing)
      • Deposits positive for Congo red and demonstrated green birefringence under polarized light examination
      • A positive immunohistochemical reaction pattern employing antibodies to odontogenic ameloblast associated protein (ODAM) confirmed that this protein is, in fact, odontogenic amyloid, as found in developing tooth germs (see Fig. 9 below)
    • Central odontogenic fibroma associated with central giant cell granuloma (CGCG)
  • Microscopic (histologic) images

    Contributed by Kelly Magliocca, D.D.S., M.P.H.
    Odontogenic fibroma

    Odontogenic fibroma

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    Case 1: Odontogenic fibroma with extensive calcification - 6x and 20x

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    Case 2: Odontogenic fibroma with giant cell reaction/giant cell granuloma


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    Case 3: Odontogenic fibroma - 6x, 8x, 15x and 20x



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    Odontogenic fibroma of the maxilla

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    COF and dentigerous cyst in the maxilla

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    Islands of odontogenic epithelium within a cellular fibrous stroma


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    Features of peripheral odontogenic fibroma

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    Fig. 7 Odontogenic fibroma with central giant cell lesion

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    Fig. 8 Ossifying variant of COF

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    Fig. 9 Amyloid variant of COF

    Positive stains
    Differential diagnosis
      Central odontogenic fibroma
    • Ameloblastic fibroma
      • Composed of odontogenic epithelial component strands, cords and islands that may exhibit peripheral palisading, reverse polarization and stellate reticulum
      • Primitive appearing stroma that is delicate and lobular in appearance
    • Desmoplastic fibroma
      • Composed of fascicles of variably SMA positive myofibroblasts
      • Consider desmoid tumor of bone
    • Hyperplastic dental follicles with odontogenic fibroma-like islands
    • Odontogenic myxoma
      • Spindled to stellate cells with eosinophilic cytoplasm set in myxoid matrix
      • Binucleated "heart shaped" cells, mitoses and minimal atypia can be seen
      • If abundant collagen is present, the term myxofibroma or fibromyxoma has been used
      • Occasional scattered epithelial rests can be seen
    • Sclerosing odontogenic carcinoma
      • Rare, primary intraosseous carcinoma of the jaws with bland cytology, markedly sclerotic stroma and aggressive pattern of infiltration
      • Single file thin cords, nests and strands of epithelium in a densely sclerotic stroma
      • Epithelium or stroma may dominate in different areas
      • Epithelium may be so compressed so as to be best seen with immunohistochemistry (such as cytokeratin AE1 / 3)
      • Cytologically, individual epithelial cells are bland with uncommon mitoses
      • Cytoplasm may show vacuolation or partial clearing
      • Despite the bland cytological appearance, there is invasion of skeletal muscle and commonly, perineural invasion

    Peripheral odontogenic fibroma
    • Irritation fibroma
      • Nodular lesion with a dermal proliferation of haphazard collagen bundles in response to local irritation
    • Peripheral giant cell granuloma
      • Proliferation of multinucleated giant cells, plump oval mononuclear cells and hemorrhage
      • Has similar appearance to solid aneurysmal bone cyst but without USP6 rearrangements
    • Pyogenic granuloma (lobular capillary hemangioma)
      • Lobular proliferation of well formed, small capillary vascular channels with larger, feeder vessels
      • Can show ulceration
    Board review style question #1
      A mandibular mass that is radiolucent by plain radiograph, is characterized by strands or nests of inactive appearing odontogenic epithelium, with or without calcification, set in a variably cellular fibrocollagenous stroma.

      Which of following is the best diagnosis?

    1. Central odontogenic fibroma
    2. Desmoplastic fibroma
    3. Odontogenic myxoma
    4. None of the above
    Board review style answer #1
    A. Central odontogenic fibroma

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    Reference: Odontogenic fibroma
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