Epithelium Rich Type Central Odontogenic Fibroma in Maxilla a Case Report and Review of Literature

Submit Manuscript | http://medcraveonline.com different conditions were being reported as odontogenic fibroma (OF). Earlier they used to name every enlarged dental follicle as COF but actual cases been reported as the criteria proposed by Gardner in 1980 [3]. It is believed that it arises from true odontogenic mesenchyme influenced by the odontogenic apparatus [4]. As mentioned in literature about the types of COF, being the complex type favoring the mandible with aggressive behavior involving pain, facial asymmetry, teeth displacement and rhizolysis but here in our case showing the same type with the same features but in maxilla [2-5]. The presence of some elements like Myofibroblasts, macrophage, giant cells, as well as the proliferative index can be related to the potential aggressiveness of the tumor; so suggested to do immunohistochemical and electron microscopic studies for better understanding of the biology and eventually the pathogenesis of this unusual odontogenic tumor [3]. Another immunohistochemistry feature supporting the nature of COF is the presence of Langerhans cells positive for CD1a but there pathological significant is still unclear [3]. In order to diagnose a lesion with COF, there must be epithelial remnant present according to the WHO classification of odontogenic tumor. The presence of epithelium can be evaluated either in hemotoxylineosin-stained sections or, recently by immunohistochemistry [3]. Among all the histological variants, granular cells can be detected in numerous tumors such as ameloblastoma, ameloblastic fibroma and COF. With a malignant form that was reported in 40 years old lady ended up with hemiresection of her maxilla with high recurrent rate and such researches concluded that for a lesion, the presence of granular cells increased the risk of the tumor being malignant. Kaffe et al. [5] recommended considering a list of differential diagnosis for all abnormal radiolucency findings in the jaws including odontogenic fibroma due to difficulty to confirm COF diagnosis solely by radiograph [6]. Based on what mentioned above in order to differentiate COF from other lesions, it’s very difficult only by radiographs but collecting data gathered from a combination of history, clinical examination, other radiographic modalities like MRI, macroscopic and microscopic characteristically unique about that lesion [1]. COF may give a picture of an aggressively behaved tumor as it shows infiltrative pattern in the surrounding bone trabeculae in cone beam CT [6]. It responds well to surgical enucleation with rare tendency for recurrence. The reported cases for recurrence to date have shown a higher percentage affecting young females [1]. Hopefully this case will add valuable knowledge to the already existing literature.