RESUMO
BACKGROUND: This systematic review aimed to incorporate published data regarding synchronous cemento-ossifying fibromas (COF), with an analysis of their demographic and clinicopathological characteristics. MATERIAL AND METHODS: Case reports and case series of synchronous COF were searched in PubMed, Web of Science, Scopus, EMBASE, and LILACS according to the PRISMA (2020) statement. Also, a manual search was carried out and the grey literature was assessed. A descriptive statistical analysis was performed. RESULTS: Nineteen studies comprising 20 cases of synchronous COF were included. The mean age at diagnosis was 35 years (±13.8), with a predominance of female patients (n=12/60%). In 13 cases (65%) the mandible and the maxilla were affected simultaneously. In two cases (10%) first-degree relatives (parents or siblings) had been previously diagnosed with COF. The diagnostic hypotheses were reported in 8 cases (40%), with florid cemento-osseous dysplasia, ameloblastic fibroodontoma, calcifying cystic odontogenic tumor, osteoma and cementoblastoma being cited in the differential diagnosis. Among the cases with details about management (n=17), eleven were treated by surgical enucleation and/or excision (64.7%). Follow-up was provided for 10 cases (50%), with a mean period of 44.7±62.19 months. Recurrence occurred in three of informed cases. CONCLUSIONS: Synchronous manifestation of COF is rare. Female patients around the 3rd decade of life are more commonly affected. Bilateral involvement of the mandible and maxilla is the most common clinical presentation.
Assuntos
Fibroma Ossificante , Humanos , Fibroma Ossificante/patologia , Fibroma Ossificante/diagnóstico , Feminino , Neoplasias Primárias Múltiplas/patologia , Neoplasias Mandibulares/patologia , Cementoma/patologia , Adulto , Masculino , Neoplasias Maxilares/patologiaRESUMO
BACKGROUND: Fibrous dysplasia (FD) and cemento-ossifying fibroma (COF) are the most common gnathic fibro-osseous lesions. These diseases exhibit remarkable overlap of several clinicopathological aspects, and differential diagnosis depends on the combination of histopathological, radiographic, and clinical aspects. Their molecular landscape remains poorly characterized, and herein, we assessed their proteomic and phosphoproteomic profiles. METHODS: The quantitative differences in protein profile of FD and COF were assessed by proteomic and phosphoproteomic analyses of formalin-fixed paraffin-embedded tissue samples. Pathway enrichment analyses with differentially regulated proteins were performed. RESULTS: FD and COF exhibited differential regulation of pathways related to extracellular matrix organization, cell adhesion, and platelet and erythrocytes activities. Additionally, these lesions demonstrated distinct abundance of proteins involved in osteoblastic differentiation and tumorigenesis and differential abundance of phosphorylation of Ser61 of Yes-associated protein 1 (YAP1). CONCLUSIONS: In summary, despite the morphological similarity between these diseases, our results demonstrated that COF and DF present numerous quantitative differences in their proteomic profiles. These findings suggest that these fibro-osseous lesions trigger distinct molecular mechanisms during their pathogenesis. Moreover, some proteins identified in our analysis could serve as potential biomarkers for differential diagnosis of these diseases after further validation.
Assuntos
Cementoma , Fibroma Ossificante , Displasia Fibrosa Óssea , Cementoma/diagnóstico , Cementoma/patologia , Diagnóstico Diferencial , Fibroma Ossificante/metabolismo , Displasia Fibrosa Óssea/patologia , Humanos , ProteômicaRESUMO
Objetivo: o fibroma ossificante trabecular juvenil (FOJT) é uma lesão fibro-óssea incomum, benigna, porém de comportamento agressivo. Ocorre, frequentemente, em crianças e adolescentes, com maior acometimento em maxila e mandíbula. O presente relato aborda os aspectos clínicos, imaginológicos, histopatológicos, imuno-histoquímicos e o tratamento de um caso de FOTJ. Além de discutir suas similaridades com o osteossarcoma de baixo grau e as alternativas para o seu diagnóstico. Relato de caso: paciente do sexo masculino, com 12 anos de idade, apresentando aumento de volume em mandíbula no lado esquerdo, perda de função mastigatória e de fala, com tempo de evolução de seis meses. Radiograficamente, a lesão apresentava aspecto unilocular, com limites definidos e de padrão misto. O tratamento consistiu em cirurgia de enucleação total da lesão, seguida de curetagem sob anestesia geral. A histopatologia e a ausência de marcação para MDM2 e CDK4 na imuno-histoquímica confirmaram o diagnóstico de FOTJ e excluíram o de osteossarcoma de baixo grau. No controle pós-operatório de 20 dias, o paciente relatou melhora da parestesia, da função mastigatória e da fala e ausência de dor. Não se observou recidiva no acompanhamento de 1 ano após a cirurgia. Considerações finais: a similaridade dos aspectos clínico, imaginológico e microscópico entre FOJT e osteossarcoma de baixo grau pressupõe o estudo imuno-histoquímico com os arcadores MDM2 e CDK4, minimizando equívocos no diagnóstico e orientando de forma mais eficiente o plano de tratamento adotado.(AU)
Objective: juvenile Trabecular Ossifying Fibromas (JTOF) are uncommon benign fibro-osseous lesions with a local aggressive behavior. They frequently occur in children and adolescents involving the jaw bones. This report addresses the clinical, imaging, histopathological, and immunohistochemical aspects and the treatment of a case of JTOF. In addition, it discusses similarities between JTOF and low-grade osteosarcomas and alternatives for their diagnosis. Case report: male patient, 12 years old, with a tumor in his left mandible, loss of masticatory function and speech, with a 6-month time course. Radiographically, the lesion had an unilocular aspect, with defined borders and a mixed image pattern. Treatment consisted surgical enucleation, followed by bone curettage, under general anesthesia. Histopathology presented fibrous stroma interspaced with bone trabeculae without signs of cellular malignancy. MDM2 and CDK4 markers in immunohistochemistry, confirmed the diagnosis of JTOF and excluded low-grade osteosarcoma. At the 20-day postoperative follow-up, the patient reported improvement in paresthesia, masticatory function and speech, and the absence of pain. Evaluation 1 year after surgery showed no signs of local recurrence. Final considerations: the similarity of clinical, imaging, and microscopic aspects between JTOF and low-grade osteosarcoma prompts an immunohistochemical study including MDM2 and CDK4 markers in order to improve final diagnosis and guide the treatment plan more efficiently.(AU)
Assuntos
Humanos , Masculino , Criança , Cementoma/patologia , Neoplasias Mandibulares/patologia , Imuno-Histoquímica , Cementoma/cirurgia , Cementoma/diagnóstico , Neoplasias Mandibulares/cirurgia , Neoplasias Mandibulares/diagnóstico , Osteossarcoma/diagnóstico , Diagnóstico DiferencialRESUMO
Differential diagnosis among fibrous dysplasias, cemento-ossifying fibromas and cemento-osseous dysplasias is difficult, since there is considerable overlap of histologic features, but also extremely important, since they differ greatly in etiology, clinical behaviour, prognosis and terapeuthic approach. There is no data about the use of immunohistochemistry, a viable and accessible technique, for this purpose. The objective of this study was to investigate, comparatively, the immunohistochemical expression of major non-collagenous proteins (osteonectin [ON], osteopontin [OP], bone sialoprotein [BSP] and osteocalcin [OC]) of mineralized tissue extracellular matrix in 22 cases of fibrous dysplasias, 16 of cemento-ossifying fibromas and 16 of cemento-osseous dysplasias. ON maintained the same expression profile in all cases; the staining for OP was negative in fusiform cells producing cementoid globules and weak, as well as heterogeneous, in high mineralized matrixes; there was negativity for BSP in cementoid globules and in the fusiform cells that produce them, differently from the strong positive expression found in the majority of bone trabeculae and their peripheral cuboidal osteoblasts; and finally, the immuno-reactivity for OC was weak, except in cuboidal osteoblasts and osteocytes. We can conclude that the nature of mineralized structure and the cellular phenotype are much more responsible for variability in immunohistochemical profile than the type of lesion (fibrous dysplasias, cemento-ossifying fibromas and cemento-osseous dysplasias) which makes difficult, at least for a while, the use of these proteins with diagnosis purpose.
Assuntos
Cementoma/diagnóstico , Fibroma Ossificante/diagnóstico , Displasia Fibrosa Óssea/diagnóstico , Sialoproteína de Ligação à Integrina/metabolismo , Osteocalcina/metabolismo , Osteonectina/metabolismo , Osteopontina/metabolismo , Osso e Ossos/patologia , Cementoma/metabolismo , Cementoma/patologia , Diagnóstico Diferencial , Fibroma Ossificante/metabolismo , Fibroma Ossificante/patologia , Displasia Fibrosa Óssea/metabolismo , Displasia Fibrosa Óssea/patologia , HumanosRESUMO
PURPOSE: The aims of this study were to describe the clinical and radiologic features of 383 fibro-osseous lesions (FOLs) from an oral pathology reference service in Brazil and to compare the findings with previous studies. The hypothesis of the study was that the most common type of FOL would differ from other investigations. MATERIALS AND METHODS: We conducted a descriptive and retrospective study with review of the records of the clinical and biopsy services (1990 to 2015). All records of the patients included showed a definitive diagnosis of FOL. The primary outcome variable was the type of FOL, and the predictor variables were gender, age, ethnicity, location, and clinical and radiologic characteristics. Descriptive analyses and χ2 tests were performed. The P value was set at .05. RESULTS: From the 27,998 records available, 383 showed FOLs, with 187 (48.8%) being cemento-osseous dysplasias (CODs), 103 (26.9%) being fibrous dysplasias (FDs), and 93 (24.3%) being ossifying fibromas (OFs). The mean age of the patients was 38.5 ± 17.5 years. CODs presented a predilection for female gender (n = 314, 82.0%), African descent (n = 134, 71.6%), and the mandible (n = 248, 64.6%). The most common radiologic feature was a mixed radiolucent-radiopaque image (n = 149, 51.7%). FDs and OFs were commonly diagnosed during the first and second decades of life (P < .001), whereas CODs were more frequently diagnosed beyond the third decade (P < .001). Secondary osteomyelitis was more significantly observed in CODs (P < .001) than in FDs and OFs. Swelling was more frequently reported for FDs and OFs than for CODs (P < .001). CONCLUSIONS: CODs were the most frequently observed FOLs in this Brazilian population. Female patients, patients of African descent, and patients with mandibular localization were most commonly affected by these conditions. The most common type of FOL differed from that in similar case reports or series from various geographic locations. It is believed that the data source (clinical and/or biopsy services) can directly influence the outcome.
Assuntos
Cementoma/patologia , Fibroma Ossificante/patologia , Displasia Fibrosa Óssea/patologia , Doenças Maxilomandibulares/patologia , Neoplasias Maxilomandibulares/patologia , Adolescente , Adulto , Brasil , Cementoma/diagnóstico por imagem , Criança , Diagnóstico Diferencial , Feminino , Fibroma Ossificante/diagnóstico por imagem , Displasia Fibrosa Óssea/diagnóstico por imagem , Humanos , Doenças Maxilomandibulares/diagnóstico por imagem , Neoplasias Maxilomandibulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia Panorâmica , Estudos RetrospectivosRESUMO
El cementoblastoma, también llamado cementoma verdadero, fue reconocido primeramente por Norberg en 1930. Este se encuentra dentro de los tumores derivados del ectomesenquima odontogénico y puede estar asociado con múltiples dientes. Se encuentran publicados en la literatura muchos casos de cementoblastoma, pero pocos reportan un seguimiento adecuado. Sólo Brannon y col. realizaron un seguimiento de 35 casos, encontraron algunas características clínicas como dolor, expansión y erosión de las corticales, comunes de los casos recidivantes, siendo la resección segmental o en bloque, un factor decisivo para la no recidiva, hemos tomado como referencia su trabajo por la representatividad y la manera que abordaron el tema. Este trabajo tiene como objetivo informar y evidenciar el manejo de un caso de cementoblastoma; describir una situación clínica de una paciente con un cementoblastoma benigno en maxilar superior izauierdo, asociado a un canino temporal y un primer molar, y presentar histopatología revisión de la literatura, tratamiento quirúrgico, rehabilitación y seguimiento a través de los años en los cuales la paciente no presentó recidiva.
Assuntos
Feminino , Humanos , Adolescente , Cementoma/classificação , Cementoma/patologia , Cementoma/reabilitação , Cementoma/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , RecidivaRESUMO
A Displasia Cement ria Periapical um tumor odontognico de origem mesenquimal, derivado do ligamento periodontal. Por nÆo apresentar sinais e sintomas, normalmente descoberto em exames radiogr ficos de rotina. O aspecto radiogr fico semelhante a lesães periapicais de origem endodntica, o que pode confundir o cl¡nico no momento do diagn¢stico e lev -lo a um tratamento desnecess rio. O objetivo deste trabalho foi relatar um caso cl¡nico de Displasia Cement ria Periapical, apresentar as caracter¡sticas, bem como ressaltar a importncia do correto diagn¢stico diferencial.
Periapical Cemento Dysplasia is an odontogenic tumor of mesenchymal origin, derived from the periodontal ligament. Because it doesnt show signs and symptoms, it is usually discovered on routine radiographic examination. The radiographic appearance is similar to periapical lesions of endodontic origin, which can confuse the clinician at the time of diagnosis and lead to an unnecessary treatment. The aim of this study was to report a case of Periapical Cemento Dysplasia, and present its characteristics as well as underscoring the importance of the proper diagnosis.
Assuntos
Humanos , Feminino , Adulto , Cementoma/patologia , Cisto Radicular/patologia , Doenças Periodontais/diagnóstico , Granuloma Periapical/patologia , Tumores Odontogênicos/patologia , Tomografia Computadorizada por Raios X/instrumentaçãoRESUMO
Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. It usually exhibits as multiple radiopaque cemetum-like masses distributed throughout the jaws. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. Computed tomography, because of its ability to give axial, sagittal, and frontal views, is useful in the evaluation of these lesions. This paper presents the case of a patient who was diagnosed with FCOD on the basis of clinical and radiographic findings.
Assuntos
Processo Alveolar/patologia , Cementoma/patologia , Neoplasias Mandibulares/patologia , Neoplasias Maxilares/patologia , Adulto , Perda do Osso Alveolar/etiologia , Perda do Osso Alveolar/cirurgia , Processo Alveolar/diagnóstico por imagem , Cementoma/complicações , Cementoma/diagnóstico por imagem , Cemento Dentário/patologia , Feminino , Displasia Fibrosa Óssea/diagnóstico por imagem , Displasia Fibrosa Óssea/patologia , Humanos , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Maxilares/complicações , Neoplasias Maxilares/diagnóstico por imagem , Radiografia , Extração Dentária , Resultado do Tratamento , População BrancaRESUMO
This article describes the case of a 34-year-old woman whose prosthodontist had referred her for root canal treatment of tooth No. 10, due to an initial diagnosis of apical periodontitis. Although periapical radiolucencies were present, teeth No. 10 and 11 responded positively to pulp vitality tests. A series of periapical radiographs revealed circumscribed periapical radiolucencies on teeth No. 21 and 28, while teeth No. 23, 24, and 27 were associated with mixed radiolucent/radiopaque periapical lesions. All teeth responded to cold stimulus. Based on the clinical and radiographic findings, a diagnosis of periapical cemento-osseous dysplasia was suggested. A re-evaluation 12 months later confirmed this diagnosis. Tooth No. 10 was restored and the patient was scheduled to return for clinical and radiographic follow-up after one year and three years.