Juvenile psammomatoid ossifying fibroma: An unusual case report
A 14-year-old female patient reported with the chief complaint of large painless swelling on the right lower jaw region since 1 year. The swelling had rapidly grown since 5 months to attain its present size. There was no history of trauma, pain, any discharge and extraction of any teeth. The right side submandibular lymph node was palpable, single in number, about 1 cm in size, mobile, soft in consistency and non-tender on palpation.\nExtraorally a diffuse swelling was present on the right lower side of face, approximately 10 cm × 6 cm in size, extending anteroposteriorly 2 cm away from the midline on left side until right angle of mandible and superoinferiorly from a line connecting angle of mouth to angle of mandible until 2.5 cm below the lower border of mandible. Color and temperature of overlying skin was normal. It was non-tender and hard in consistency.\nIntraorally lower labial and buccal cortical expansion was present extending from midline until 48 region and minimal lingual cortical expansion was present []. Hard-tissue examination revealed 41 was rotated, 43 was labially erupted and deciduous canine and molars were retained. 44 and 45 were clinically missing. Provisional diagnosis of Dentigerous cyst with 15 was made. Differential diagnosis given was unicystic ameloblastoma, ameloblastic fibroma, calcifying epithelial odontogenic tumor, ossifying fibroma and odontogenic myxoma.\nOn fine needle aspiration cytology no fluid was aspirated. Orthopantomograph (OPG) revealed mixed radiolucent radiopaque lesion extending from 34 until distal aspect of 47 regions with a radiopaque dense mass near the apical aspect of 84 and 85. Borders were well-defined and thinning of lower border of mandible was present. Root resorption of 85, 86 and 46 was present. Inferior alveolar canal was displaced to lower border of mandible [].\nAxial, coronal and sagittal sections of computed tomography scan showed multilocular lesion with multiple internal septa []. It revealed intact lower border of mandible and the lesion crossing the midline. 3D reconstruction showed formation of internal septa and areas of homogenous calcification [].\nHistopathological examination showed small spherical hematoxyphillic ossicles i.e., psammoma such as bodies, cellular connective tissue stroma and bony trabeculae []. The final diagnosis was JPOF. The patient was referred to Oral surgery department for surgical removal of the tumor. 6 months post-operative OPG of patient [] and intraoral [] examination showed no recurrence.