Back
This study reports a case of atypical ossifying fibroma, located in the hard palate/maxilla, in a 20-year-old patient, being followed up for chronic kidney disease (CKD) and dialysis, secondary hyperparathyroidism and HIV positive. The complaint was occasional odynophagia, without weight loss and dysphagia caused by the growth of the palate mass, which had been growing progressively for 1 year. On physical examination, a palatal lesion was found (>4cm), extending to the anterior gingival margin, with palatal bone remodeling and dental diastemas. Neck tomography showed diffuse changes in the bones of the skull, face and spine located in the hard palate. The main diagnostic hypothesis was a brown tumor caused by hyperparathyroidism.
The information contained in this work was obtained through a medical record review and literature review. This study was submitted and approved by the human research ethics committee. The proposed methodology was descriptive and observational of data indexed to the clinical care record and anatomopathological results.
Ossifying fibroma (OF) is a benign fibro-osseous neoplastic mass in which calcifications are found, formed by metaplastic bone fibrocellular tissue. There is a predilection for females, in the fourth decade of life, more common in the posterior region of the jaw and characterized by slow and painless growth. In this report, the patient developed OF in the anteroinferior region of the maxilla, the second region most commonly affected by this neoplasm, and later in the recurrence it affected the left mandibular region.
In this study, the initial imaging examination showed an expansive lesion in the hard palate measuring 40x36x28mm, and after 3 months in a new tomography, the lesion measured 65x51x37mm and extended to the inferior meatuses of the nasal cavity, and to the oral cavity. There was a triple increase in the initial volume, contradicting the main literature found, which demonstrates slower growth. An incisional biopsy was performed, which resulted in ossifying fibroma, confirmed through immunohistochemistry.
Surgical treatment of this pathology is determined according to its size. In this patient, we opted for surgical resection for reduction in recurrence rates. During follow-up, less than 2 years after tumor resection, there was a recurrence of the lesion in the left anterior mandible region, which was painless and firm on palpation. Visualized by tomography, an expansive osteolytic lesion with heterogeneous density involving the left ramus of the mandible, and dental roots measuring approximately 33x17mm in the largest diameters. Afterwards, the recurrence of ossifying fibroma was confirmed by biopsy, now in the mandibular region.
It was concluded that after clinical, radiographic and histopathological examinations, the lesion was an atypical case of ossifying fibroma, contradicting the main diagnostic suspicion of being a case of brown tumor, given that the patient has hyperparathyroidism secondary to CKD. Adopting the standard proposed by the main literature, the proposed treatment was partial lower maxillectomy, to completely remove the lesion. Less than 2 years later, it developed a recurrence in the jaw, involving the tongue and dental arch, confirmed by biopsy. It was decided to refer the patient to a specialized service for microsurgery and reduction of postoperative sequelae.