Fibroma pathophysiology: Difference between revisions

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|[[File:Cardiac fibroma.jpg|300px|thumb|none|Fibroblast cells in fascicles with abundant collagen fiber,Heidari A, Sabzi F, Faraji R. Right atrial fibroma in an adult patient. Ann Card Anaesth. 2018;21(1):65–67. doi:10.4103/aca.ACA_121_17,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791493/]]
|[[File:Cardiac fibroma.jpg|300px|thumb|none|Fibroblast cells in fascicles with abundant collagen fiber,Heidari A, Sabzi F, Faraji R. Right atrial fibroma in an adult patient. Ann Card Anaesth. 2018;21(1):65–67. doi:10.4103/aca.ACA_121_17,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791493/]]
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|[[File:Giant cell fibroma.jpg|300px|thumb|none|Pebbly appearance in right retromolar region,Sabarinath B, Sivaramakrishnan M, Sivapathasundharam B. Giant cell fibroma: A clinicopathological study. J Oral Maxillofac Pathol. 2012;16(3):359–362. doi:10.4103/0973-029X.102485,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519210/
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Revision as of 19:49, 29 May 2019

Fibroma Microchapters

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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

On gross pathology, polypoid lesion which is usually small, are characteristic findings of oral fibroma. On microscopic histopathological analysis, fibrous stroma, collagen bundles, prominent vessels, and overlying squamous mucosa with hyperkeratosis and focal ulceration are characteristic findings of oral fibroma. On gross pathology, well circumscribed, metaphyseal lesion, and fragments of white-grey rubbery tissue are characteristic findings of chondromyxoid fibroma. On microscopic histopathological analysis, spindle cells or stellate cells in a myxoid or chondroid stroma, lobules with hypocellular centers and hypercellular peripheries, giant cells in a hypercellular periphery, and scattered calcifications are characteristic findings of chondromyxoid fibroma. On gross pathology, fleshy, fibrous, yellow or tan-brown lesion with variable areas of haemorrhage are characteristic findings of non-ossifying fibroma. On microscopic histopathological analysis, spindle cells without cytologic atypia are arranged in a storiform pattern, scattered chronic inflammatory cells and benign giant cells, foam cells and hemosiderin deposition, and mitoses are characteristic findings of non-ossifying fibroma. On gross pathology, discrete mass that is well delineated from surrounding bone, tan-white, rubbery cut surface, firm to gritty and no encapsulation are characteristic findings of ossifying fibroma. On microscopic histopathological analysis, haphazardly distributed lamellated bony spicules on a background of fibrous stroma, a zonal architecture with a center of immature bone surrounded by more mature lamellar bone, and central spicules of woven bony trabeculae are lined by a layer of osteoblasts are characteristic findings of ossifying fibroma.[1][2]

Pathophysiology

Type of fibroma Location Gross pathology Microscpoic pathology Genetics and Immunohistochemistry Associated conditions
Ovarian Fibroma [3][4][5][6][7][8][9][10]
Oral Fibroma [11][12][13]
  • Buccal mucosa
  • Histologically similar to fibrous papule
  • Fibrous stroma is a key feature
  • Collagen bundles may be present
  • Multiple oral fibromas may be seen in Cowden disease.
Chondromyxoid fibroma [14][15][16][17][18][19][20][21][22]
  • Proximal tibia metaphysis Distal femoral metaphysis.
  • Well circumscribed, metaphyseal lesion, and fragments of white-grey rubbery tissue are noted
  • Spindle cells or stellate cells in a myxoid or chondroid stroma
  • Lobules with hypocellular centers and hypercellular peripheries
  • Giant cells in the hypercellular periphery
  • Scattered calcifications.
  • No true hyaline cartilage formation is seen
  • No mitotic activity is seen
  • GRM1 gene fusion or promoter swapping noted
  • It can be associated with a translocation at t(1;5)(p13;p13)
Uterine fibroma [23][24][25][26][27][28][29][30][31][32][33]
  • Round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and show whorled appearance
  • When multiple fibroids are present they frequently have unrelated genetic defects. Specific mutations of the MED12 protein have been noted in 70% of fibroids.
  • If a mother had fibroids, risk in the daughter is about three times higher than average. Researchers have found that only a few specific genes or cytogenetic deviations are associated with uterine leiomyomas. An association with fatty acid synthase has been reported.
  • CD10 positive
  • SMA positive
  • Desmin positive
  • H-caldesmon positive
  • p16 negative
  • Ki-67 negative
Ossifying Fibroma [34][35][36][37][38][39][40]
  • Tibia: predilection for the cortex of the tibial diaphysis.
  • Femur
  • Discrete mass that is well delineated from surrounding bone, tan-white, rubbery cut surface, firm to gritty and no encapsulation
  • They comprise of haphazardly distributed lamellated bony spicules on a background of fibrous stroma
  • The lesion has a zonal architecture with a center of immature bone surrounded by more mature lamellar bone.
  • The central spicules of woven bony trabeculae are lined by a layer of osteoblasts. The background is a loose and storiform fibrous tissue.
  • Clonal chromosomal abnormalities such as trisomies of chromosomes 7, 8, 12 ,21, and/or 22
Non-ossifying Fibroma [41][42][43]
  • Metaphysis of distal femur or proximal tibia (80%)
  • Cortical
  • Fleshy, fibrous, yellow or tan-brown lesion with variable areas of haemorrhage are noted
  • Spindle cells without cytologic atypia are arranged in a storiform pattern.
  • Scattered chronic inflammatory cells and benign giant cells.
  • Foam cells and hemosiderin deposition are present.
  • Mitoses are seen but cytologic atypia is absent.
  • Clonal rearrangements in chromosomes 1, 3, 4, 11, and 14 are noted in NOFs (non-ossifying fibroma) of bone
Desmoplastic Fibroma [44][45][46][47][48][49][50]
  • Mandible (22%) and the metaphysis of long bones (56%).
  • Pelvis
  • Lamellar bone
  • Fibrotic marrow space has following features:
    • Collagen
    • Low cellularity
    • Spindle cells without significant atypia
  • On histopathology, desmoplastic fibromas are identical to soft tissue desmoid tumors, with abundant collagenous stroma and little cellularity or pleomorphism.
  • The main cell types that are seen include the following:
  • Strong positive for the adhesion protein β-Catenin
  • Weak positive labelling for S-100
  • No positive stain for the proliferation marker Ki67
  • No associated conditions
Pleural Fibroma [51][52][53][54][55][56][57][58][59][60][61][62]
  • 80% of pleural fibromas originate in the visceral pleura, while 20% arise from parietal pleura.
  • Composed of irregularly arranged fascicles comprising of spindle cells with collagen separation.
  • They originate from submesothelial mesenchymal cells.
  • Myxoid or cystic degeneration can occur.
  • Recurrent somatic fusions of the two genes, NGFI-A–binding protein 2 (NAB2) and STAT6, located at chromosomal region 12q13, have been identified in pleural fibromas.
  • Some pleural fibromas are associated with the paraneoplastic Doege–Potter syndrome, which is caused by tumor production of IGF-2.
  • Hypoglycaemia: 2-4% 6, thought to be due to production of IGF-2
  • Hypertrophic pulmonary osteoarthropathy (HPOA): ~20% 6: thought to be due to abnormal production of hyaluronic acid
Cardiac Fibroma [63][64][65][66][67][68][69][70][71][72]
  • Ventricular septum and left ventricular free wall.
  • Well defined, solitary, intramyocardial lesions with smooth margins and usually large, with a mean diameter of ~5 cm
  • Usually have no foci of cystic change, hemorrhage, or necrosis. Calcification is common
Renal Medullary Fibroma [73][74][75]
  • Small, and white well circumscribed nodule in medulla typically less than 3mm are characteristic findings of renal medullary fibroma
  • Small polygonal/stellate cells
  • Abundant loose/myxoid stroma
  • Entrapped renal tubules may be present
  • No associated conditions
Cemento-ossifying Fibroma [76][77][78][79][80][81][82][83][84]
  • Maxillary gingiva is involved more often than the mandibular gingiva
  • Solid, sessile or pedunculated mass, which is often ulcerated, and generally has a diameter of less than 2 cm are characteristic findings of cemento-ossifying fibroma.
  • Cemento -ossifying tumors are composed of fibrous tissue, calcified tissue resembling bone and/or cementum.
  • The bone-like component is predominant reminiscent of woven bone and is found in more 'mature' lesions.
  • In some instances, this entity has been divided into cementifying fibroma and ossifying fibroma depending on the relative amounts of the tumor's constituent tissues. *However, in majority of cases both features are present, warranting the generic term cemento-ossifying fibromas.
  • Surface ulceration is common
  • No associated conditions
Desmoplastic Fibroblastoma [85][86][87][88][89][90]
  • Shoulder region
  • Spindle cells or stellate cells without nuclear atypia
  • Acellular stroma with abundant collagen
  • Myxoid areas may be present
  • Mitoses is rare
  • FOSL1 gene is involved in the pathogenesis of desmoplastic fibroblastoma, llq 12 breakpoint described as being characteristic.
  • Beta-catenin -ve
    • Positive in desmoid-type fibromatosis
  • Desmin negative
  • S-100 negative
  • CD34 negative
  • MSA positive
  • Alpha-SMA positive
  • No associated conditions
Elastofibroma [91][92][93][94][95][96][97]
  • Subscapular region.
  • I'll defined, nonencapsulated, rubbery, firm, white lesion with interspersed fat and with moderate demarcation to surrounding tissue are characteristic findings of elastofibroma.
  • The tumors can be quite large (up to 20 cm), although most are around 5 cm.
  • Thick bundles of collagen and elastin fibres are characteristic findings of elastofibroma.
  • Admixture of heavy dense bands of collagenous tissue dissected by fat and abnormal elastic fibers.
  • The elastic fibers are coarse, thick, and darkly eosinophilic, often fragmented into globules, creating a "string of pearls" or "pipe cleaner" appearance. Because of degeneration, the elastic fibers will appear as globules with a serrated or "prickled" edge.
  • There are alterations of short arm of chromosome 1
  • Multifocality may suggest systemic enzymatic defect, resulting in abnormal elastogenesis
  • The elastic fibers will be visible on a Weigert or von Gieson elastic stains.
  • No associated conditions
Sclerotic Fibroma [98][99][100][101][102][103][104][105][106]
  • Skin, may be solitary or multifocal
  • Well-delineated but unencapsulated mass of densely collagenized, hypocellular fibrous tissue with a storiform pattern, and prominent clefts between collagen bundles are characteristic findings of elastofibroma.
Giant cell fibroma [107][108][109][110][111][112][113][114]
  • Mandibular gingiva, followed by the maxillary gingiva, the tongue, and the palate.
  • Sessile or pedunculated nodule that is smaller than 1cm in diameter are characteristic findings of giant cell fibroma. Often, it has a bosselated or somewhat papillary surface.
  • An unencapsulated mass of fibrous connective tissue that contains numerous characteristic large, plump, stellate and spindle-shaped fibroblasts, some of which are multinucleated.
  • The surface epithelium is often atrophic and corrugated.
Peripheral Odontogenic Fibroma [115][116][116]
  • Mandible
 Firm, slowly growing, sessile, and nodular growth of the gingiva are characteristic findings of peripheral odontogenic fibroma.
  • An unencapsulated mass of interwoven cellular fibrous connective tissue that contains scattered nests or strands of odontogenic epithelium
  • It consists of cellular fibrous connective tissue parenchyma with non neoplastic islands, strands of columnar or cuboidal odontogenic epithelium.
  • Myxoid foci, osteoid, cementoid, or dystrophic calcifications are sometimes seen.
  • Generally, the surface is not ulcerated.
Type of fibroma Gross image Microscopic image
Ovarian fibroma
Ed Uthman, MD [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)],https://upload.wikimedia.org/wikipedia/commons/0/04/Fibroma_of_the_Ovary.jpg,https://commons.wikimedia.org/wiki/File:Fibroma_of_the_Ovary.jpg
Histopathology of ovarian fibroma showing benignspindle cellproliferation,Boujoual M, Hakimi I, Kouach J, Oukabli M, Moussaoui DR, Dehayni M. Large twisted ovarian fibroma in menopausal women: a case report. Pan Afr Med J. 2015;20:322. Published 2015 Apr 6. doi:10.11604/pamj.2015.20.322.5998,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491469/
Oral fibroma
Fibroma of oral mucosa,Klaus D. Peter, Gummersbach, Germany [CC BY 3.0 de (https://creativecommons.org/licenses/by/3.0/de/deed.en)],https://upload.wikimedia.org/wikipedia/commons/c/c5/Fibroma.jpg,https://commons.wikimedia.org/wiki/File:Fibroma.jpg
Librepath [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)],https://upload.wikimedia.org/wikipedia/commons/d/db/Oral_fibroma_--_low_mag.jpg,https://commons.wikimedia.org/wiki/File:Oral_fibroma_--_low_mag.jpg
Chondromyxoid fibroma
arahkayb [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)],https://upload.wikimedia.org/wikipedia/commons/a/a6/Bone_ChondromyxoidFibroma_Calcium_MP_PA.JPG,https://commons.wikimedia.org/wiki/File:Bone_ChondromyxoidFibroma_Calcium_MP_PA.JPG
Uterine fibroma
Hic et nunc [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)],https://upload.wikimedia.org/wikipedia/commons/f/f7/Uterine_fibroids.jpg,https://commons.wikimedia.org/wiki/File:Uterine_fibroids.jpg
Calicut Medical College [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)],https://upload.wikimedia.org/wikipedia/commons/e/ea/Leiomyoma_Uterus_40x.jpg,https://commons.wikimedia.org/wiki/File:Leiomyoma_Uterus_40x.jpg
Ossifying Fibroma
Histopathologicaly, this lesion is characterized by spindle cell proliferation packed with globular cementum droplets and round/ovoid fragments of woven bone. These spindle cells appear benign and associated with psammomatoid cementum droplets and some woven bone and consistent with aggressive ossifying fibroma, psammomatous type IV,Alghonaim Y, ALRashed ALHumaid S, Arafat A. Aggressive ossifying fibroma of right ethmoidal sinus: A case report. Int J Surg Case Rep. ;53:513–516. doi:10.1016/j.ijscr.2017.12.026,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290393/
Cardiac fibroma
Jha NK, Kiraly L, Tamas C, et al. Large cardiac fibroma and teratoma in children- case reports. J Cardiothorac Surg. 2015;10:38. Published 2015 Mar 22. doi:10.1186/s13019-015-0242-9,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373309/
Fibroblast cells in fascicles with abundant collagen fiber,Heidari A, Sabzi F, Faraji R. Right atrial fibroma in an adult patient. Ann Card Anaesth. 2018;21(1):65–67. doi:10.4103/aca.ACA_121_17,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791493/
Giant cell fibroma [[File:Giant cell fibroma.jpg|300px|thumb|none|Pebbly appearance in right retromolar region,Sabarinath B, Sivaramakrishnan M, Sivapathasundharam B. Giant cell fibroma: A clinicopathological study. J Oral Maxillofac Pathol. 2012;16(3):359–362. doi:10.4103/0973-029X.102485,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519210/

References

  1. ↑ Fibroma. Libre pathology(2015) http://librepathology.org/wiki/Fibroma Accessed on March 12, 2016
  2. ↑ Fibroma. Radiopedia(2015) http://radiopaedia.org/search?utf8=%E2%9C%93&q=fibroma&scope=all Accessed on March 12, 2016
  3. ↑ Boujoual M, Hakimi I, Kouach J, Oukabli M, Moussaoui DR, Dehayni M (2015). "Large twisted ovarian fibroma in menopausal women: a case report". Pan Afr Med J. 20: 322. doi:10.11604/pamj.2015.20.322.5998. PMC 4491469. PMID 26175813.
  4. ↑ Chen H, Liu Y, Shen LF, Jiang MJ, Yang ZF, Fang GP (November 2016). "Ovarian thecoma-fibroma groups: clinical and sonographic features with pathological comparison". J Ovarian Res. 9 (1): 81. doi:10.1186/s13048-016-0291-2. PMC 5120502. PMID 27876070.
  5. ↑ Matsuda K, Tateishi S, Akazawa Y, Kinoshita A, Yoshida S, Morisaki S, Fukushima A, Matsuwaki T, Yoshiura KI, Nakashima M (October 2016). "Rapid growth of mitotically active cellular fibroma of the ovary: a case report and review of the literature". Diagn Pathol. 11 (1): 101. doi:10.1186/s13000-016-0554-7. PMID 27770806.
  6. ↑ Yamada T, Hattori K, Satomi H, Hirose Y, Nakai G, Daimon A, Hayashi A, Terai Y, Ohmichi M, Fukunaga M (October 2015). "Mitotically active cellular fibroma of the ovary: a case report and literature review". J Ovarian Res. 8: 65. doi:10.1186/s13048-015-0191-x. PMC 4595272. PMID 26437718.
  7. ↑ Zong L, Lin M, Fan X (2014). "Mitotically active cellular fibroma of ovary should be differentiated from fibrosarcoma: a case report and review of literature". Int J Clin Exp Pathol. 7 (11): 7578–82. PMC 4270577. PMID 25550794.
  8. ↑ Parwate NS, Patel SM, Arora R, Gupta M (December 2016). "Ovarian Fibroma: A Clinico-pathological Study of 23 Cases with Review of Literature". J Obstet Gynaecol India. 66 (6): 460–465. doi:10.1007/s13224-015-0717-6. PMC 5080219. PMID 27821988.
  9. ↑ Finch T, Pushpanathan C, Brown K, El-Gohary Y (June 2012). "Gorlin syndrome presenting with a unilateral ovarian fibroma in a 22-year-old woman: a case report". J Med Case Rep. 6: 148. doi:10.1186/1752-1947-6-148. PMID 22691621.
  10. ↑ Yazdani S, Alijanpoor A, Sharbatdaran M, Bouzari Z, Abedisamakoosh M, Lakaieandi F, Mohammadpour M (2014). "Meigs' syndrome with elevated serum CA125 in a case of ovarian fibroma /thecoma". Caspian J Intern Med. 5 (1): 43–5. PMC 3894471. PMID 24490014.
  11. ↑ Panta P (2015). "Traumatic fibroma". Pan Afr Med J. 21: 220. doi:10.11604/pamj.2015.21.220.7498. PMC 4587079. PMID 26448815.
  12. ↑ Christopoulos P, Sklavounou A, Patrikiou A (April 1994). "True fibroma of the oral mucosa: a case report". Int J Oral Maxillofac Surg. 23 (2): 98–9. PMID 8035060.
  13. ↑ Krishnan V, Shunmugavelu K (2015). "A clinical challenging situation of intra oral fibroma mimicking pyogenic granuloma". Pan Afr Med J. 22: 263. doi:10.11604/pamj.2015.22.263.8080. PMC 4765330. PMID 26958126.
  14. ↑ Takenaga RK, Frassica FJ, McCarthy EF (2007). "Subperiosteal chondromyxoid fibroma: a report of two cases". Iowa Orthop J. 27: 104–7. PMC 2150655. PMID 17907440.
  15. ↑ Sharma H, Jane MJ, Reid R (June 2006). "Chondromyxoid fibroma of the foot and ankle: 40 years' Scottish bone tumour registry experience". Int Orthop. 30 (3): 205–9. doi:10.1007/s00264-005-0046-y. PMC 2532097. PMID 16547720.
  16. ↑ Yasuda T, Nishio J, Sumegi J, Kapels KM, Althof PA, Sawyer JR, Reith JD, Bridge JA (November 2009). "Aberrations of 6q13 mapped to the COL12A1 locus in chondromyxoid fibroma". Mod. Pathol. 22 (11): 1499–506. doi:10.1038/modpathol.2009.101. PMID 19648885.
  17. ↑ Choi YS, Kim BS, Joo JE, Park YK, Lee SH, Song BY (2011). "A rare case of epiphyseal chondromyxoid fibroma of the proximal tibia". Korean J Radiol. 12 (6): 761–4. doi:10.3348/kjr.2011.12.6.761. PMC 3194784. PMID 22043162.
  18. ↑ Gutiérrez-González R, De Reina L, Saab A, Jiménez-Heffernan J, García-Uría J (June 2012). "Chondromyxoid fibroma of the lumbar spine: case report and literature review". Eur Spine J. 21 Suppl 4: S458–62. doi:10.1007/s00586-011-2078-x. PMID 22094389.
  19. ↑ Morris LG, Rihani J, Lebowitz RA, Wang BY (June 2009). "Chondromyxoid fibroma of sphenoid sinus with unusual calcifications: case report with literature review". Head Neck Pathol. 3 (2): 169–73. doi:10.1007/s12105-009-0121-6. PMID 19644549.
  20. ↑ Minasian T, Claus C, Hariri OR, Piao Z, Quadri SA, Yuhan R, Leong D, Tashjian V (2016). "Chondromyxoid fibroma of the sacrum: A case report and literature review". Surg Neurol Int. 7 (Suppl 13): S370–4. doi:10.4103/2152-7806.182547. PMC 4879845. PMID 27274412.
  21. ↑ Kilic D, Findikcioglu A, Tepeoglu M, Vural C (August 2015). "Chondromyxoid Fibroma of the Sternum in a 63-Year-Old Woman". Tex Heart Inst J. 42 (4): 400–2. doi:10.14503/THIJ-14-4381. PMC 4567104. PMID 26413029.
  22. ↑ Fomete B, Adeosun OO, Awelimobor DI, Olayemi L (January 2014). "Chondromyxoid fibroma of the mandible: Case report and review of the literature". Ann Maxillofac Surg. 4 (1): 78–80. doi:10.4103/2231-0746.133072. PMC 4073468. PMID 24987604.
  23. ↑ Manta L, Suciu N, Toader O, Purcărea RM, Constantin A, Popa F (2016). "The etiopathogenesis of uterine fibromatosis". J Med Life. 9 (1): 39–45. PMC 5152611. PMID 27974911.
  24. ↑ Borahay MA, Al-Hendy A, Kilic GS, Boehning D (April 2015). "Signaling Pathways in Leiomyoma: Understanding Pathobiology and Implications for Therapy". Mol. Med. 21: 242–56. doi:10.2119/molmed.2014.00053. PMC 4503645. PMID 25879625.
  25. ↑ Miettinen M, Felisiak-Golabek A, Wasag B, Chmara M, Wang Z, Butzow R, Lasota J (December 2016). "Fumarase-deficient Uterine Leiomyomas: An Immunohistochemical, Molecular Genetic, and Clinicopathologic Study of 86 Cases". Am. J. Surg. Pathol. 40 (12): 1661–1669. doi:10.1097/PAS.0000000000000703. PMC 5106328. PMID 27454940.
  26. ↑ Commandeur AE, Styer AK, Teixeira JM (2015). "Epidemiological and genetic clues for molecular mechanisms involved in uterine leiomyoma development and growth". Hum. Reprod. Update. 21 (5): 593–615. doi:10.1093/humupd/dmv030. PMC 4533663. PMID 26141720.
  27. ↑ Flake GP, Andersen J, Dixon D (June 2003). "Etiology and pathogenesis of uterine leiomyomas: a review". Environ. Health Perspect. 111 (8): 1037–54. doi:10.1289/ehp.5787. PMC 1241553. PMID 12826476.
  28. ↑ Lobel MK, Somasundaram P, Morton CC (March 2006). "The genetic heterogeneity of uterine leiomyomata". Obstet. Gynecol. Clin. North Am. 33 (1): 13–39. doi:10.1016/j.ogc.2005.12.006. PMID 16504804.
  29. ↑ Wolańska M, Bańkowski E (February 2007). "Transforming growth factor beta and platelet-derived growth factor in human myometrium and in uterine leiomyomas at various stages of tumour growth". Eur. J. Obstet. Gynecol. Reprod. Biol. 130 (2): 238–44. doi:10.1016/j.ejogrb.2006.01.034. PMID 16564125.
  30. ↑ Baird DD, Kesner JS, Dunson DB (February 2006). "Luteinizing hormone in premenopausal women may stimulate uterine leiomyomata development". J. Soc. Gynecol. Investig. 13 (2): 130–5. doi:10.1016/j.jsgi.2005.12.001. PMID 16443507.
  31. ↑ Andersen J (August 1996). "Growth factors and cytokines in uterine leiomyomas". Semin. Reprod. Endocrinol. 14 (3): 269–82. doi:10.1055/s-2007-1016336. PMID 8885057.
  32. ↑ Laganà AS, Vergara D, Favilli A, La Rosa VL, Tinelli A, Gerli S, Noventa M, Vitagliano A, Triolo O, Rapisarda A, Vitale SG (November 2017). "Epigenetic and genetic landscape of uterine leiomyomas: a current view over a common gynecological disease". Arch. Gynecol. Obstet. 296 (5): 855–867. doi:10.1007/s00404-017-4515-5. PMID 28875276. Vancouver style error: initials (help)
  33. ↑ Koutsilieris M (May 1992). "Pathophysiology of uterine leiomyomas". Biochem. Cell Biol. 70 (5): 273–8. PMID 1323302.
  34. ↑ Wang TT, Zhang R, Wang L, Chen Y, Dong Q, Li TJ (March 2014). "Two cases of multiple ossifying fibromas in the jaws". Diagn Pathol. 9: 75. doi:10.1186/1746-1596-9-75. PMC 3974450. PMID 24678936.
  35. ↑ Chen Y, Hu DY, Wang TT, Zhang R, Dong Q, Xu ZX, Wang L, Li TJ (September 2016). "CDC73 gene mutations in sporadic ossifying fibroma of the jaws". Diagn Pathol. 11 (1): 91. doi:10.1186/s13000-016-0532-0. PMC 5034632. PMID 27658992.
  36. ↑ Maria A, Sharma Y, Malik M (December 2013). "Juvenile ossifying fibroma of mandible: a case report". J Maxillofac Oral Surg. 12 (4): 447–50. doi:10.1007/s12663-010-0122-8. PMID 24431886.
  37. ↑ Alghonaim Y, ALRashed ALHumaid S, Arafat A (2018). "Aggressive ossifying fibroma of right ethmoidal sinus: A case report". Int J Surg Case Rep. 53: 513–516. doi:10.1016/j.ijscr.2017.12.026. PMC 6290393. PMID 29373206.
  38. ↑ Liu Y, Shan XF, Guo XS, Xie S, Cai ZG (2017). "Clinicopathological Characteristics and Prognosis of Ossifying Fibroma in the Jaws of Children: A Retrospective Study". J Cancer. 8 (17): 3592–3597. doi:10.7150/jca.21556. PMC 5687175. PMID 29151945.
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  44. ↑ Schneider M, Zimmermann AC, Depprich RA, Kübler NR, Engers R, Naujoks CD, Handschel J (November 2009). "Desmoplastic fibroma of the mandible--review of the literature and presentation of a rare case". Head Face Med. 5: 25. doi:10.1186/1746-160X-5-25. PMID 19930688.
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  81. ↑ Katti G, Khan MM, Chaubey SS, Amena M (May 2016). "Cemento-ossifying fibroma of the jaw". BMJ Case Rep. 2016. doi:10.1136/bcr-2015-214327. PMC 4885328. PMID 27174452.
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  85. ↑ de Sousa SF, Caldeira PC, Grossmann Sde M, de Aguiar MC, Mesquita RA (June 2011). "Desmoplastic fibroblastoma (collagenous fibroma): a case identified in the buccal mucosa". Head Neck Pathol. 5 (2): 175–9. doi:10.1007/s12105-010-0239-6. PMID 21221866.
  86. ↑ Pereira TD, de Lacerda JC, Porto-Matias MD, de Jesus AO, Gomez RS, Mesquita RA (February 2016). "Desmoplastic fibroblastoma (collagenous fibroma) of the oral cavity". J Clin Exp Dent. 8 (1): e89–92. doi:10.4317/jced.52605. PMID 26855713.
  87. ↑ Grewal R, Natter P, Makary R, Silliman J (January 2018). "Desmoplastic fibroblastoma of the left upper arm". BMJ Case Rep. 2018. doi:10.1136/bcr-2017-221738. PMID 29374633.
  88. ↑ Osipov V, Carrera GF (2009). "Collagenous fibroma (desmoplastic fibroblastoma) with vertebral body erosion". Sarcoma. 2009: 682687. doi:10.1155/2009/682687. PMID 19503798.
  89. ↑ Nagaraja V, Coleman HG, Morgan GJ (September 2013). "Desmoplastic fibroblastoma presenting as a parotid tumour: a case report and review of the literature". Head Neck Pathol. 7 (3): 285–90. doi:10.1007/s12105-013-0435-2. PMC 3738752. PMID 23504494.
  90. ↑ Kim JH, Oh DY, Kim SW, Lee JH, Ahn ST, Rhie JW (January 2012). "Desmoplastic fibroblastoma of the finger tip in an adult". Arch Plast Surg. 39 (1): 84–6. doi:10.5999/aps.2012.39.1.84. PMC 3385291. PMID 22783503.
  91. ↑ Darling MR, Kutalowski M, MacPherson DG, Jackson-Boeters L, Wysocki GP (September 2011). "Oral elastofibromatous lesions: a review and case series". Head Neck Pathol. 5 (3): 254–8. doi:10.1007/s12105-011-0274-y. PMC 3173539. PMID 21681661.
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  116. ↑ 116.0 116.1 Shah M, Rathod CV, Shah V (April 2012). "Peripheral giant cell fibroma: A rare type of gingival overgrowth". J Indian Soc Periodontol. 16 (2): 275–7. doi:10.4103/0972-124X.99276. PMC 3459513. PMID 23055599.

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