Oral cavity & oropharynx

Soft tissue tumors & proliferations

Peripheral ossifying fibroma



Last author update: 8 November 2022
Last staff update: 8 November 2022

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PubMed Search: Peripheral ossifying fibroma

Timothy Fielder, M.B.B.S., B.Med.Sci.
Ruta Gupta, M.D.
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Cite this page: Fielder T, Gupta R. Peripheral ossifying fibroma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/oralcavityperipheralossifyingfibroma.html. Accessed December 9th, 2022.
Definition / general
  • Reactive gingival proliferation characterized by spindle cell proliferation with calcification or ossification
Essential features
  • Reactive gingival lesion; thought to be associated with chronic irritation
  • Spindle cell proliferation with calcification or ossification within gingival connective tissue
Terminology
  • Other terms include peripheral cementifying fibroma, peripheral cemento-ossifying fibroma, ossifying fibrous epulis, calcifying fibrous epulis (J Indian Soc Periodontol 2014;18:527)
  • Should not be confused with odontogenic / central bone tumors, such as ossifying fibroma and cemento-ossifying fibroma
ICD coding
  • ICD-10:
    • K06.8 - other specified disorders of gingiva and edentulous alveolar ridge
    • K13.6 - irritative hyperplasia of oral mucosa
Pathophysiology
Etiology
Clinical features
Diagnosis
  • Difficult to distinguish clinically from other entities (pyogenic granuloma, oral irritation fibroma, giant cell fibroma, peripheral giant cell granuloma, metastatic lesions)
  • Readily diagnosed histologically with high interobserver concordance (Med Oral Patol Oral Cir Bucal 2022;27:e460)
Radiology description
Radiology images

Contributed by Molly Housley Smith, D.M.D.
Visible ossification

Visible ossification

Prognostic factors
Case reports
Treatment
Clinical images

Contributed by Molly Housley Smith, D.M.D.
Nodular mass

Nodular mass

Multilobular red growth

Multilobular red growth



Images hosted on other servers:

Typical clinical appearance

17 year old boy

21 year old man

25 year old man

26 year old man

31 year old man

Gross description
Gross images

Contributed by Molly Housley Smith, D.M.D.
Partially calcified mass

Partially calcified mass

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Timothy Fielder, M.B.B.S., B.Med.Sci., Ruta Gupta, M.D. and Molly Housley Smith, D.M.D.
Well demarcated mucosal lesion

Well demarcated mucosal lesion

Ulceration

Ulceration

Metaplastic ossification

Metaplastic ossification

Ossification and calcification

Ossification and calcification

Lamellar bone

Lamellar bone


Collagenous matrix

Collagenous matrix

Woven bone

Woven bone

Peripheral cemento-ossifying fibroma

Peripheral cemento-ossifying fibroma

Cementum-like bone

Cementum-like bone

Positive stains
Sample pathology report
  • Gingiva, excision:
    • Peripheral ossifying fibroma (see comment)
    • Comment: Sections include oral squamous mucosa with underlying connective tissues and show features of a peripheral ossifying fibroma. The mucosa shows focal ulceration with organizing granulation tissue. The submucosal tissues show a well demarcated but unencapsulated lesion composed of areas of fibrosis and metaplastic ossification. There is no dysplasia or malignancy.
Differential diagnosis
Board review style question #1
Which of the following is true regarding peripheral ossifying fibroma?

  1. It is a reactive gingival proliferation thought to occur in response to irritation or trauma
  2. It is histologically characterized by lobulated growth of capillary sized vessels with a central feeder vessel
  3. It is molecularly characterized by recurrent internal tandem duplication of BCOR
  4. It is most common in males over 50
Board review style answer #1
A. It is a reactive gingival proliferation thought to occur in response to irritation or trauma

Comment Here

Reference: Peripheral ossifying fibroma
Board review style question #2

A 24 year old woman presents with a 1 cm anterior maxillary gingival nodule. What is the favored diagnosis?

  1. Central ossifying fibroma
  2. Oral irritation fibroma
  3. Peripheral ossifying fibroma
  4. Pyogenic granuloma
Board review style answer #2
C. Peripheral ossifying fibroma

Comment Here

Reference: Peripheral ossifying fibroma
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