Multicentric peripheral ossifying fibroma: A case report and review of the literature
A healthy 11-year-old boy presented to the Postgraduate Department of Periodontics and Oral Implantology, with ‘slow-growing, painless, soft tissue masses in the maxillary posterior regions bilaterally’ that enlarged gradually for two months. The lesions started as small papules one year back. According to the patient, the lesions had been present for approximately two months and his mother stated that it had just recently become visible between the teeth [Figures and ]. Totally there were approximately five lesions, three in the maxilla and two in the mandible. In the mandible, the lesions were present between the lower right first premolar and deciduous first molar and on the left side between the deciduous first and second molar. As reported by the patient, the lumps were interfering with his bite and felt uncomfortable. Occasionally, bleeding occurred when he brushed his teeth.\nThe lesions initially occurred on one side of the mouth and in a subsequent course of time involved both sides. Both the maxillary and mandibular gingivae were affected and the growths appeared as nodular masses, with erythematous and ulcerated surfaces. The growths were sessile and firm in consistency measuring anywhere between 5 mm and 3 cm in diameter. The lesions appeared reddish-pink in color and were slightly pedunculated, with what appeared to be a broad-based attachment. The lesions were not fluctuant, nor did they blanch with pressure, but had a rubbery consistency. The lesions were tender to firm pressure, but not to light palpation.\nPanoramic radiographs were obtained []. The radiographs did not reveal any abnormality and there was no finding pertaining to the multiple exophytic lesions.\nThe laboratory tests performed included, a complete blood hemogram and lipid and thyroid profiles. All the test results were within normal limits except for the total leukocyte count, which was slightly more than normal (12800/mm3 of blood).\nOn histopathological examination, upon low power magnification (4x), the lesional tissue exhibited a keratinized stratified squamous epithelium (gingiva), overlying a fibrous connective tissue stroma exhibiting dense interlacing bundles of collagen and numerous ossifications []. High power magnification (40x) showed pink homogenous calcified tissue (ossification), with a presence of osteocytes entrapped in the lacunae []. The histology for all the lesions was the same. The picture is consistent with the clinical diagnosis of POF.\nUnder local anesthesia, the lumps were excised completely using a scalpel. The tissue was submitted to the Oral Pathology Division for histopathological diagnosis. The deciduous teeth present in the lesion were also removed and included in the biopsy specimen. The adjacent teeth were scaled to remove any local irritants.\nThe patient presented for a follow-up examination 20 days postoperatively. The surgical site appeared to be healing well [Figures and ]. There was no evidence of recurrence of the lesion and the child was asymptomatic.