Juvenile ossifying fibroma: Psammamatoid variant
A 28-year-old female patient reported to an oral and maxillo-facial surgeon in a private dental clinic with a complaint of swelling on the left side of face over a 5-year period. The main concern of the patient was esthetic rehabilitation. Past history revealed a small painless swelling, which first appeared at the age of 12 years at the same site. Incisional biopsy was done; it was then diagnosed as cementifying fibroma. She underwent surgery for that and remained asymptomatic for 10 years. After that, swelling recurred at the same site, and it was excised. A diagnosis of fibrous dysplasia was given. After a period of 5 years, it recurred again at the same site, which gradually increased in size to attain the present size.\nExtra-oral examination revealed gross facial asymmetry on the left side of the face with obliteration of thenasolabial fold. This was also visible in the left nasal cavity. On palpation, swelling was non-tender, hard in consistency with no bony crepitus present. []\nIntra-oral examination revealed solitary well-defined swelling in the left upper vestibule in the canine-molar region, measuring approximately 5 × 3.5 cm in size. Slight mobility was present in relation to 23 and 25, and 24 was missing. There was gross expansion of the left maxillary process extending to the hard palate. [] There was no history of pain, toothache, discharge of pus, and paresthesia. The overlying mucosa was smooth and intact and was of normal color.\nCT scan was carried out. Under coronal view, mixed radioopaque-radiolucent lesion was seen on the antero-lateral and medial wall of the maxilla, involving the entire maxillary antrum on the left side and extending into the lateral wall of the nose.\nUnder axial view, destruction of buccal and palatal cortical plate was seen in the anterior maxilla. More extension of the lesion was seen on the buccal side, extending into the nasal cavity with complete obliteration of the antrum on the left side.\nUnder 3D view, nasolabial fold and vestibular obliteration was noticed. []\nAll routine blood examination was conducted before the surgical procedure. Excisional biopsy of the mass was performed under general anesthesia. Gross examination of tissue specimen revealed single tissue bit measuring 5 × 3.5 cm in size, brownish-white in color, gritty in consistency.\nMicroscopic examination revealed a highly cellular fibrous stroma exhibiting a whorled pattern. The connective tissue stroma consists of proliferating plump cells having hyperchromatic nuclei intermingled with psammoma-like bodies or psammamatoid ossicles without any osteoblastic rimming. The intervening fibrous connective tissue stroma consists mainly of spindle-shaped fibroblasts and areas of chronic inflammatory cells. []\nImmunohistochemical analysis was conducted to check out the aggressiveness and origin of tumor. Ki 67 [] and vimentin [] positivity was noticed.\nThus, the final diagnosis of juvenile ossifying fibroma was given.\nThe patient was subjected to clinical and radiological follow-up after excision of the lesion to discard any possible relapses or recurrences.