Fibroma natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Natural History
Cemento-ossifying fibroma
Clinically, cemento-ossifying fibromas manifest as a slow-growing intrabony mass that is normally well delimited and asymptomatic, although over time the lesion may become large enough to cause facial deformation. Cemento-ossifying fibroma is a benign fibro-osseous maxillary tumor. It is a slow-growing lesion. Approximately one-half of all cases are asymptomatic, the growth of the tumor over time may lead to facial asymmetry, with the appearance of a mass causing facial discomfort or mandibular expansion, and the possible displacement of dental roots. Juvenile aggressive cemento-ossifying fibroma presents in children and is clinically more aggressive and pathologically more vascular.[1] Central cemeto-ossifying fibromas are a distinct form of benign fibro-osseous lesions of the maxilla and mandible. Central cemento-ossifying fibromas are asymptomatic if they are not expanded. Therefore, they are generally not diagnosed until the tumor has had time to produce calcifications. Central cemento-ossifying fibromas are typically well-circumscribed, they maintain a round shape, expand the surrounding cortical bone without cortical expansion, and may cause tooth divergence. The expanded tumors may involve the nasal septum, orbital floor, and infraorbital foramen. At the time of diagnosis, maxillary central cemento-ossifying fibromas are large; indicating the ability of the tumor to expand freely within the maxillary sinus.[2]
Chondromyxoid Fibroma
Chondromyxoid fibroma (CMF) is a rare, slow-growing, benign bone tumor of chondroblastic derivation. Approximately 70% of patients have symptoms at the time of diagnosis; the remaining lesions are discovered incidentally. Pain is the most common symptom and may be present for years. While typically mild, the pain may become severe with time, and night symptoms may be present. Patients may also report swelling and stiffness. Pathologic fractures have been rarely reported, probably as a consequence of the slow growth of this tumor.
Complications
Ovarian Fibroma
- Adnexal / ovarian torsion[3]
Ossifying- Fibroma
- Pathological fracture(s)
- Limb bowing
Prognosis
Oral Fibromas
Oral fibromas are benign tumors. Recurrence of oral fibromas is possible, however, if the offending irritant persists.
Ovarian Fibromas
Ovarian fibromas are almost always benign.
Ossifying Fibroma
Ossifying fibromas tend to regress over time. For locally aggressive lesions, surgical resection is often curative although recurrence has been reported.
Pleural Fibroma
- The majority of pleural fibromas tend to be benign and slow growing. Approximately 78% to 88% of SFT's are benign and 12% to 22% are malignant. In approximately 10 to 25 percent of cases recurrence of the tumor can occur. Late relapse, even for benign tumors, is common.
- Approximately 63% of patients with malignant pleural fibromas will have a recurrence of their tumor, of which more than half will succumb to disease progression within 2 years.
- Among tumors classified as malignant, approximately 10 to 40 percent of those destined to metastasize will do so after five years, and they may recur up to 20 years after initial presentation . Prolonged survival after pleural fibroma recurrence is possible, particularly for those who are amenable to re-resection. Patients with multiple synchronous metastases that are not amenable to surgical intervention, usually have a poor prognosis.
- Recurrence in pleural fibromas may be due to following causes:
- Incomplete resection
- Tumor seeding within the pleura, peritoneum or meninges, or distant hematogenous spread.
- The most common sites of distant metastasis in SFT at all sites are lung, liver, bone, and brain
Chondromyxoid-Fibroma
Chondromyxoid-fibroma are benign lesions and malignant degeneration is rare. Chondromyxoid-fibromas have a high recurrence rate of approximately 25%.
Cemento-ossifying Fibroma
Recurrence following complete excision of cemento-ossifying fibroma is generally considered to be uncommon. However, in some series, it has been reported to be approximately 16%.
Desmoplastic Fibroma
Desmoplastic fibromas are benign and locally aggressive tumors. Desmoplastic fibroma is a rare benign intraosseous tumor neoplasm. It is usually a localized lesion with propensity for cortical bone perforation and recurrence. They are considered to be a bony counterpart of soft tissue desmoid tumours and are histologically identical. [4]
Sclerotic Fibroma
Sclerotic fibroma is an uncommon benign fibrous neoplasm and may be solitary or multifocal.
Uterine Fibromas
About 1 out of 1000 lesions are or become malignant, typically as a leiomyosarcoma on histology. A sign that a lesion may be malignant is growth after menopause. There are a number of rare conditions in which fibroids metastasize. They still grow in a benign fashion, but can be dangerous depending on their location.
Peripheral odontogenic fibroma
Recurrence is rare
Giant cell fibroma
Giant cell fibroma is a benign non-neoplastic lesion. Recurrence is rare.
References
- ↑ Silvestre-Rangil, J.; Silvestre, FJ.; Requeni-Bernal, J. (2011). "Cemento-ossifying fibroma of the mandible: Presentation of a case and review of the literature". Journal of Clinical and Experimental Dentistry: e66–e69. doi:10.4317/jced.3.e66. ISSN 1989-5488.
- ↑ Hekmatnia A, Ghazavi A, Saboori M, Mahzouni P, Tayari N, Hekmatnia F (2011). "A case report of cemento-ossifying fibroma presenting as a mass of the ethmoid sinus". J Res Med Sci. 16 (2): 224–8. PMC 3214308. PMID 22091236.
- ↑ "Ovarian fibroma [Dr Ahmed Abd Rabou and Radswiki]".
- ↑ Cheng, A.; Ji, S.; Pogrel, M.A. (2012). "Poster 55: A Natural History of Desmoplastic Fibroma: Over 20 Years of Experience". Journal of Oral and Maxillofacial Surgery. 70 (9): e74. doi:10.1016/j.joms.2012.06.111. ISSN 0278-2391.