Fibroma overview
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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
Fibromas are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchymal tissue. The term "fibroblastic" or "fibromatous" is used to describe tumors of the fibrous connective tissue. There is no classification system established for fibroma. Based on the pathophysiology and location of the tumor, fibroma may be classified into hard fibroma, soft fibroma, angiofibroma, cystic fibroma, chondromyxoid fibroma, desmoplastic fibroma, nonossifying fibroma, ossifying fibroma, nuchal fibroma, collagenous fibroma, fibroma of tendon sheath, perifollicular fibroma, pleomorphic fibroma, uterine fibroma, neurofibroma, and ovarian fibroma.[1] On gross pathology, polypoid lesion which is usually small, is 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.[2][3] Common causes of oral fibroma include trauma or chronic irritation. There are no established causes for chondromyxoid fibroma, non-ossifying fibroma, cemento-ossifying fibroma, and ossifying fibroma.[4][5][6][7] Patients of all age groups may develop fibromas. However, the majority of fibromas are observed in adults. Fibromas usually affects men and women equally, however certain fibromas may show gender predilection. Fibromas are most often observed in adults, but they may occur in individuals of any age and either sex.[3] The majority of patients with fibroma are asymptomatic. The most common symptoms of fibroma include pain and swelling of the affected area.[1][2] Biopsy is the diagnostic study of choice for fibroma.[8]
Historical Perspective
Ossifying fibroma was first described in 1872 by Menzel. In the year 1927 Montgomery coined the term “ossifying fibroma”. Chondromyxoid fibroma was first described in year 1948 by H L Jaffe and L Lichtenstein. The non-ossifying fibroma (NOF) was first recognized in 1941 by Sontag and Pyle. Desmoplastic fibroma was first described in year 1958 by H L Jaffe.[7][9][3]
Classification
There is no classification system established for fibroma. Based on the pathophysiology and location of the tumor, fibroma may be classified into hard fibroma, soft fibroma, angiofibroma, cystic fibroma, chondromyxoid fibroma, desmoplastic fibroma, nonossifying fibroma, ossifying fibroma, nuchal fibroma, collagenous fibroma, fibroma of tendon sheath, perifollicular fibroma, pleomorphic fibroma, uterine fibroma, neurofibroma, and ovarian fibroma.[1]
Pathophysiology
On gross pathology, polypoid lesion which is usually small, is 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.[2][3]
Causes
Common causes of oral fibroma include trauma or chronic irritation. There are no established causes for chondromyxoid fibroma, non-ossifying fibroma, cemento-ossifying fibroma, and ossifying fibroma.[4][5][6][7]
Epidemiology and Demographics
Patients of all age groups may develop fibromas. However, the majority of fibromas are observed in adults. Fibromas usually affects men and women equally, however certain fibromas may show gender predilection. Fibromas are most often observed in adults, but they may occur in individuals of any age and either sex.[3]
Risk Factors
There are no established risk factors for fibroma.
Screening
According to the United States Preventive Services Task Force, screening for fibroma is not recommended among the general population.[10]
Differentiating Fibroma from other Diseases
Oral fibroma must be differentiated from squamous papilloma, giant cell fibroma, neurofibroma, peripheral giant cell granuloma, mucocele, and benign and malignant salivary gland tumors. Non-ossifying fibroma must be differentiated from fibrous cortical defect, aneurysmal bone cyst, chondromyxoid fibroma, fibrous dysplasia, desmoplastic fibroma, giant cell tumour of bone, and spindle cell lesions of bone. Ossifying fibroma must be differentiated from ossifying fibroma, fibrous dysplasia, adamantinoma, and osteoid osteoma. Chondromyxoid fibroma must be differentiated from aneurysmal bone cyst (ABC), giant cell tumour of bone (GCT), non ossifying fibroma, chondroblastoma, chondrosarcoma, and phosphaturic mesenchymal tumor. Desmoplastic fibroma must be differentiated from giant cell tumour of bone (GCT), non ossifying fibroma (NOF), fibrous dysplasia, low grade fibrosarcoma, unicameral bone cyst, chondromyxoid fibroma, periosteal desmoids, eosinophilic granuloma, low-grade intraosseous osteosarcoma, adamantinoma, and distant metastasis.[3][3] [3][3][3][3]
Natural History, Complications and Prognosis
Common complications of 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%.[9][11][12]
Diagnosis
History and Symptoms
The majority of patients with fibroma are asymptomatic. The most common symptoms of fibroma include pain and swelling of the affected area.[1][2]
Physical Examination
Common physical examination findings of oral fibroma include sessile, dome-shaped mass, 1-2 cm in diameter, pale pink in color, and firm, non-tender on palpation. Common physical examination findings of non-ossifying fibromas include localized tenderness or swelling over a lesion. Common physical examination findings of cemento-ossifying fibromas include a sessile or pedunculated mass, mass may be ulcerated and generally has a diameter of less than 2 cm, and diffuse expansion of jaw on right maxillary posterior area, extending anteroposteriorly from distal of upper right second premolar to tuberosity region. Common physical examination findings of desmoplastic fibroma include tenderness over the affected area and palpable mass may be present[9]
Chest X Ray
X-ray may be helpful in the diagnosis of fibroma. Findings on x-ray suggestive of a particular fibroma depends on the type of the fibroma. Findings on x-ray suggestive of non-ossifying fibromas include sharply demarcated, asymmetrical, and cortically based lucencies with a thin sclerotic rim. Findings on x-ray suggestive of ossifying fibromas include well-circumscribed lesion, intracortical osteolysis with a characteristic sclerotic band, cortical expansion, and a lytic thinning of the diaphyseal cortical bone with interspersed sclerosis. Findings on x-ray suggestive of chondromyxoid fibroma include a lobulated, eccentric radiolucent lesion. Findings on x-ray suggestive of desmoplastic fibroma include a lytic bone lesions with a geographic pattern of bone destruction and a narrow zone of transition and non-sclerotic margins.[13][3]
CT
CT scan may be helpful in the diagnosis of fibroma. Findings on x-ray suggestive of a particular fibroma depends on the type of the fibroma. Findings on CT scan of ossifying fibroma include a well-circumscribed lesion, intracortical osteolysis with a characteristic sclerotic band, and moderate cortical expansion. Findings on CT scan of non- ossifying fibroma include sharply demarcated, asymmetrical, cortically based lucencies with a thin sclerotic rim. Findings on CT scan of chondromyxoid fibroma include a mild cortical expansion and characteristic lack of mineralization within chondromyxoid fibromas. Findings on CT scan of cemento-ossifying fibroma include a well circumscribed masses which expand the underlying bone.[3][3][3][3]
MRI
MRI may be helpful in the diagnosis of fibroma. On MRI, fibromas appear isointense or hypointense on T1 sequences and hyperintense on T2 sequences.[3]
Ultrasound
Ultrasound may be helpful in the diagnosis of fibroma. Findings on ultrasound suggestive of fibroma include solid, hypoechoic masses with ultrasound beam attenuation.[3][3]
Other Imaging Findings
Other imaging studies for ossifying fibroma include bone scan, which demonstrates mild hyperemia and moderate bone uptake during healing. However, in general they are negative.[3][3]
Other Diagnostic Studies
Biopsy is the diagnostic study of choice for fibroma.[8]
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ 1.0 1.1 1.2 1.3 fibroma. Wikipedia(2015) https://en.wikipedia.org/wiki/Fibroma Accessed on February 25, 2016
- ↑ 2.0 2.1 2.2 2.3 Fibroma. Libre pathology(2015) http://librepathology.org/wiki/Fibroma Accessed on March 12, 2016
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 Fibroma. Radiopedia(2015) http://radiopaedia.org/search?utf8=%E2%9C%93&q=fibroma&scope=all Accessed on March 12, 2016
- ↑ 4.0 4.1 Granter SR, Renshaw AA, Kozakewich HP, Fletcher JA (1998). "The pericentromeric inversion, inv (6)(p25q13), is a novel diagnostic marker in chondromyxoid fibroma". Mod Pathol. 11 (11): 1071–4. PMID 9831204.
- ↑ 5.0 5.1 Yasuda T, Nishio J, Sumegi J, Kapels KM, Althof PA, Sawyer JR; et al. (2009). "Aberrations of 6q13 mapped to the COL12A1 locus in chondromyxoid fibroma". Mod Pathol. 22 (11): 1499–506. doi:10.1038/modpathol.2009.101. PMC 2784180. PMID 19648885.
- ↑ 6.0 6.1 Nord KH, Lilljebjörn H, Vezzi F, Nilsson J, Magnusson L, Tayebwa J; et al. (2014). "GRM1 is upregulated through gene fusion and promoter swapping in chondromyxoid fibroma". Nat Genet. 46 (5): 474–7. doi:10.1038/ng.2927. PMID 24658000.
- ↑ 7.0 7.1 7.2 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.
- ↑ 8.0 8.1 Nielsen GP, Keel SB, Dickersin GR, Selig MK, Bhan AK, Rosenberg AE (1999). "Chondromyxoid fibroma: a tumor showing myofibroblastic, myochondroblastic, and chondrocytic differentiation". Mod Pathol. 12 (5): 514–7. PMID 10349990.
- ↑ 9.0 9.1 9.2 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.
- ↑ http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=fibroma Accessed on March 10, 2016.
- ↑ Biermann JS (2002). "Common benign lesions of bone in children and adolescents". J Pediatr Orthop. 22 (2): 268–73. PMID 11856945.
- ↑ 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.
- ↑ Copley L, Dormans JP (1996). "Benign pediatric bone tumors. Evaluation and treatment". Pediatr Clin North Am. 43 (4): 949–66. PMID 8692589.