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
Common complications of chondromyxoid, ossifying and non-ossifying fibroma include pathological fractures. Depending on the type of the fibroma, the prognosis may vary. However, the prognosis is generally regarded as excellent for nonossifying fibroma. Ossifying fibromas tend to regress over time. Ossifying fibroma is noninvasive tumor. It will recur if it is excised before skeletal maturity. Excision after skeletal maturity is usually successful. Oral fibromas are benign tumors. Recurrence of oral fibromas is possible, however, if the offending irritant persists. Desmoplastic fibromas are benign and locally aggressive tumors. Desmoplastic fibroma is a rare benign intraosseous tumor neoplasm. Desmoplastic fibroma has a recurrence rate of approximately 37% to 72%. The average rate of recurrence after curettage has been reported to be approximately 55%.[1][2][3]
Natural History
Cemento-ossifying fibroma
Clinically, cemento-ossifying fibroma 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.[4] 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.[5][6][7]
Chondromyxoid Fibroma
Chondromyxoid fibroma (CMF) is a rare, slow-growing, benign bone tumor of chondroblastic derivation. Approximately 70% of patients with chondromyxoid fibroma have symptoms at the time of diagnosis; the remaining lesions are found incidentally. Chondromyxoid fibroma (CMF) represents less than 1% of all benign bone neoplasms. It is a slow-growing, locally destructive tumor.[8] 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 stiffness and swelling. As a consequence of slow growth of the tumor, pathologic fractures have been rarely reported. Chondromyxoid fibroma is an unusual benign tumor of cartilaginous tissues.[9][10][11][12][13]
Oral Fibroma
A history of chronic irritation to the area or trauma followed by the development of a sessile, firm mass is characteristic of oral fibroma. The majority of fibromas represent reactive focal fibrous hyperplasia due to local irritation or trauma. The fibroma may occur in any area, although the areas most frequently affected include the areas most easily traumatized, such as the tongue, buccal mucosa, and labial mucosa. They are benign lesions and they do not have malignant potential and recurrence is mostly as a result of failure to eliminate the irritation. Oral fibroma generally presents as a painless, sessile, ovoid or round, broad based growth. Oral fibromas develop over weeks or months to reach a maximum size which is approximately 1cm in diameter, but can sometimes be larger.[14][15][16][17]
Desmoplastic Fibroma
Desmoplastic fibroma (DF) is an extremely rare benign intraosseous tumor with locally aggressive and infiltrative characteristics. The clinical presentation of desmoplastic fibroma is nonspecific and usually presents as pain over the affected area and occasionally as a palpable mass, although pathologic fracture has been described previously as a common reason for seeking treatment. Desmoplastic fibroma has also been presented as an incidental finding. The most common sites of involvement are the mandible and the metaphysis of long bones. Biologically and histologically, desmoplastic fibroma mimics extra-abdominal desmoid tumor of soft tissue. Morphologically a distinction between desmoplastic fibroma and aggressive fibromatosis (desmoid tumor) is not possible.[1]
Non-ossifying Fibroma
Nonossifying fibroma (NOF) is a common type of benign fibrous lesion that occurs in the metaphysis of the long bones of the lower extremities. While the NOF occurs with relative frequency in the long bones, NOF of the mandible and other areas of the skeleton are rare. The majority of NOFs are asymptomatic; however, those that are particularly large may cause chronic pain and/or pathologic fracture in the long bones. Diagnosis of NOF in the long bones is usually based upon the characteristic clinical and radiographic appearance. Typically the NOF appears as an asymptomatic multiloculated lesion often identified incidentally during radiographic evaluation indicated for another reason. Mandibular lesions of the NOF may be asymptomatic or may present with expansion. Non-ossifying fibromas are typically self-limiting and spontaneous resolution at skeletal maturity is usually seen. This spontaneous regression, usually starting at the end of adolescence, has been observed to occur over periods of 29–52 months. Recurrence is rare. The clinical behavior of mandibular NOF appears to be that of a benign lesion with no reports of recurrence, as seen in the long bones.[18][19][20][21]
Complications
Ovarian Fibroma
- Adnexal / ovarian torsion[22]
Ossifying- Fibroma
- Pathological fracture(s)
- Limb bowing
Non-ossifying Fibroma
- Pathological fractures
Chondromyxoid fibromas
- Pathological fractures
Uterine Fibromas
- Rarely invasion of adjacent venous channels leading to intravenous leiomyomatosis
- Rarely (0.1-0.5%), they undergo malignant degeneration into leiomyosarcomas
- In extremely rare instances, lesions capable of metastasising without malignant transformation: benign metastasising leiomyoma
- Fibroids may torse, leading to acute pelvic pain
- Pregnancy may cause fibroid growth in 30%
Prognosis
Non-ossifying Fibroma
Generally, the prognosis for nonossifying fibroma is excellent. They usually fill in during adolescence. The risk of recurrence is usually lower than for other benign tumors.[2]
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. Ossifying fibroma is noninvasive tumor. It will recur if it is excised before skeletal maturity. Excision after skeletal maturity is usually successful.[23][24]
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 tumors and are histologically identical. [3] Desmoplastic fibroma has a recurrence rate of approximately 37% to 72%. The average rate of recurrence after curettage has been reported to be approximately 55%.[1]
Sclerotic Fibroma
Sclerotic fibroma is an uncommon benign fibrous neoplasm and may be solitary or multifocal.
Uterine Fibroma
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
- ↑ 1.0 1.1 1.2 Nedopil A, Raab P, Rudert M (2013). "Desmoplastic fibroma: a case report with three years of clinical and radiographic observation and review of the literature". Open Orthop J. 8: 40–6. doi:10.2174/1874325001307010040. PMC 3583030. PMID 23459513.
- ↑ 2.0 2.1 Biermann JS (2002). "Common benign lesions of bone in children and adolescents". J Pediatr Orthop. 22 (2): 268–73. PMID 11856945.
- ↑ 3.0 3.1 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.
- ↑ 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.
- ↑ Naik RM, Guruprasad Y, Sujatha D, Gurudath S, Pai A, Suresh K (January 2014). "Giant cemento-ossifying fibroma of the mandible". J Nat Sci Biol Med. 5 (1): 190–4. doi:10.4103/0976-9668.127326. PMC 3961933. PMID 24678226.
- ↑ Jayachandran S, Meenakshi R (2004). "Cemento ossifying fibroma". Indian J Dent Res. 15 (1): 35–9. PMID 15682795.
- ↑ Khalatbari, Mahmoud; Hamidi, Mehrdokht; Moharamzad, Yashar (2012). "Chondromyxoid Fibroma of the Anterior Skull Base Invading the Orbit in a Pediatric Patient: Case Report and Review of the Literature". Neuropediatrics. 43 (03): 140–145. doi:10.1055/s-0032-1307460. ISSN 0174-304X.
- ↑ E., Estrada-Villaseñor; E., Delgado Cedillo; G., Rico Martínez; R., Delgado Chávez (2005). "Periosteal chondromyxoid fibroma: A case study using imprint cytology". Diagnostic Cytopathology. 33 (6): 402–406. doi:10.1002/dc.20357. ISSN 8755-1039.
- ↑ McGrory BJ, Inwards CY, McLeod RA, Sim FH (1995). "Chondromyxoid fibroma". Orthopedics. 18 (3): 307–10. PMID 7761324.
- ↑ White PG, Saunders L, Orr W, Friedman L (1996). "Chondromyxoid fibroma". Skeletal Radiol. 25 (1): 79–81. PMID 8717127.
- ↑ Schutt PG, Frost HM (1971). "Chondromyxoid fibroma". Clin Orthop Relat Res. 78: 323–9. PMID 5110934.
- ↑ RALPH LL (1962). "Chondromyxoid fibroma of bone". J Bone Joint Surg Br. 44-B: 7–24. PMID 14038586.
- ↑ Regezi, Joseph A., James J. Sciubba, and Richard C. Jordan. Oral Pathology Clinical Pathologic Correlations. City: Elsevier Health Sciences, 2015. Print.
- ↑ Rangeeth, B. N., Joyson Moses, and Veera Kishore Kumar Reddy. "A rare presentation of mucocele and irritation fibroma of the lower lip." Contemporary clinical dentistry 1.2 (2010): 111.
- ↑ Vilmann, A., P. Vilmann, and H. Vilmann. "Pyogenic granuloma: evaluation of oral conditions." British journal of oral and Maxillofacial surgery 24.5 (1986): 376-382.
- ↑ Kolte, Abhay P., Rajshri A. Kolte, and Tushar S. Shrirao. "Focal fibrous overgrowths: A case series and review of literature." Contemporary clinical dentistry 1.4 (2010): 271.
- ↑ Bowers LM, Cohen DM, Bhattacharyya I, Pettigrew JC, Stavropoulos MF (2013). "The non-ossifying fibroma: a case report and review of the literature". Head Neck Pathol. 7 (2): 203–10. doi:10.1007/s12105-012-0399-7. PMC 3642261. PMID 23008139.
- ↑ Sakamoto, Akio; Ishii, Takeaki; Oda, Yoshinao; Iwamoto, Yukihide (2012). "Nonossifying fibroma presenting as an aneurysmal bone cyst: a case report". Journal of Medical Case Reports. 6 (1): 407. doi:10.1186/1752-1947-6-407. ISSN 1752-1947.
- ↑ Bowers, Leah M.; Cohen, Donald M.; Bhattacharyya, Indraneel; Pettigrew, James C.; Stavropoulos, Mary F. (2012). "The Non-ossifying Fibroma: A Case Report and Review of the Literature". Head and Neck Pathology. 7 (2): 203–210. doi:10.1007/s12105-012-0399-7. ISSN 1936-055X.
- ↑ Herget GW, Mauer D, Krauß T, El Tayeh A, Uhl M, Südkamp NP, Hauschild O (April 2016). "Non-ossifying fibroma: natural history with an emphasis on a stage-related growth, fracture risk and the need for follow-up". BMC Musculoskelet Disord. 17: 147. doi:10.1186/s12891-016-1004-0. PMC 4820930. PMID 27044378.
- ↑ "Ovarian fibroma [Dr Ahmed Abd Rabou and Radswiki]".
- ↑ McCaffrey M, Letts M, Carpenter B, Kabir A, Davidson D, Seip J (2003). "Osteofibrous dysplasia: a review of the literature and presentation of an additional 3 cases". Am J Orthop (Belle Mead NJ). 32 (10): 479–86. PMID 14620087.
- ↑ Wang JW, Shih CH, Chen WJ (1992). "Osteofibrous dysplasia (ossifying fibroma of long bones). A report of four cases and review of the literature". Clin Orthop Relat Res (278): 235–43. PMID 1563159.