Multicentric peripheral ossifying fibroma

Abstract

Peripheral ossifying fibroma (POF) is a common solitary gingival growth thought to arise from the periodontal ligament. Though the etiology of POF remains unknown, some investigators consider it an inflammatory or reactive process, while others suggest it is a neoplastic process. In this report, we present and discuss a unique case of multicentric POF, affecting the maxillary and mandibular gingiva of a 49-year-old Caucasian female with meticulous oral hygiene and routine dental care. Though biopsy samples from multiple sites revealed similar histopathologic features, consistent with POF, the fact that there was a multicentric presentation is a unique phenomenon for this lesion. Multicentric lesions presenting in the oral and maxillofacial region are not typical, but have been observed in conditions associated with known genetic mutations, such as nevoid basal cell carcinoma syndrome (multiple odontogenic keratocysts), multiple endocrine neoplasia type II (multiple neuromas), neurofibromatosis (multiple neurofibromas) and Gardner syndrome (multiple neoplasms). This case is the first one to demonstrate that there may be a multicentric variant of POF that has not been previously recognized, and given the clinical presentation and multifocal nature of disease, the lesions in this patient are likely the result of genetic mutation(s) that predisposes to gingival soft tissue overgrowths containing mineralized product.

Peripheral ossifying fibroma

“…It is a fairly common lesion, comprising nearly 3% of oral lesions biopsied in one study, approximately 1%-2% in other studies [8][9][10][11]. In 1993, Das and Das obtained similar results, with 1.6% POFs among 2,370 intraoral biopsies [12]. POF may present as a pedunculated nodule, or it may have a broad attachment base [2,5,14].…”

“…In an isolated case of multicentric POF, Kumar and others noted the presence of a lesion at an edentulous site in a 49-year-old woman, which once again raises questions regarding the pathogenesis of this type of lesion [12]. In the present case it may be due to hormonal influence.…”

“…Many names have been given to similar lesions, such as epulis, peripheral fibroma with calcification, peripheral ossifying fibroma, calcifying fibroblastic granuloma, peripheral cementifying fibroma, peripheral fibroma with cementogenesis and peripheral cemento-ossifying fibroma [2,4,[9][10][11]. The sheer number of names used for fibroblastic gingival lesions indicates that there is much controversy surrounding the classification of these lesions [6,12].…”

Fibrome cémento-ossifiant périphérique maxillaire postérieur

“…La gencive qui recouvre la tumeur peut être d'aspect normal ou ulcéré. Généralement, il s'agit d'une lésion isolée, mais un cas de FCOP multicentrique a été rapporté dans la littérature [13]. L'exploration radiographique n'objective, en général, pas de lyse osseuse sous-jacente à la lésion.…”

Peripheral Ossifying Fibroma Secondary to Pulpo-Periodontal Irritation

“…The lesion was diagnosed to have occurred secondary to a pulpo-periodontal irritation. It has been suggested that a peripheral ossifying fibroma originates from the cells of the periodontal ligament, because, it exclusively occurs in gingival tissues which are close to the periodontal ligaments; oxytalin fibres are often found within the mineralized matrix of the lesion; the age distribution of its occurrence is inversely proportional to the number of permanent teeth which are lost; and the fibrocellular response of a peripheral ossifying fibroma is similar to that of other reactive gingival lesions which originate from the periodontal ligament [6,7].…”