MINI-SYMPOSIUM: HEAD AND NECK PATHOLOGYMaxillofacial fibro-osseous lesions
Introduction
Fibro-osseous lesions are a poorly defined group of lesions affecting the jaws and craniofacial bones. All are characterized by the replacement of bone by cellular fibrous tissue containing foci of mineralization that vary in amount and appearance. Classification and, therefore, diagnosis of these lesions is problematical, partly because of a lack of agreement about terminology, but also because of a significant overlap in histological features. The group includes developmental and reactive or dysplastic lesions as well as neoplasms. A number of workers have tried to clarify the classification of these lesions1, 2, 3, 4, 5, 6, 7 and although they may not have agreed on an exact terminology, a concept has emerged which has culminated in the latest WHO classification.8 The core of this classification is the concept of a spectrum of clinicopathological entities in which the diagnosis can only be made on the basis of a full consideration of clinical, histological and radiological features. Although the terminology is still problematic, this review will use this new classification (Table 1) and will concentrate on the histopathological features that may guide the working surgical pathologist towards a diagnosis. It is emphasized again that diagnosis must take account of radiological features and for these the reader is referred to more expert reviews.9, 10
Section snippets
Fibrous dysplasia
Fibrous dysplasia is a developmental or possibly hamartomatous condition of unknown aetiology. In over 80% of cases it affects only one bone (monostotic) but it may also be polyostotic and affect multiple bones. The polyostotic type may also be associated with café-au-lait skin pigmentation and precocious puberty in the McCune Albright syndrome, which almost exclusively affects young females. The jaws and skull are often affected by monostotic fibrous dysplasia and may be involved in the
Osseous dysplasias
In previous versions of the WHO classification12 these lesions were referred to as cemento-osseous lesions and were clearly divided into three entities. It is now appreciated that they represent a spectrum of lesions, probably reactive in nature, which only differ by their clinical presentation and radiological appearances. All types affect the tooth-bearing areas of the jaws and appear to arise from the periodontal ligament and form cementum, or cementum-like tissue. For unknown reasons they
Ossifying fibroma
Ossifying fibroma is a true benign neoplasm of the bone-forming tissues. In many respects it may be regarded as a type of osteoblastoma and in some cases the histological distinction from osteoblastoma may be difficult. Terminology has been problematic and confusing, but in recent years the classification of ossifying fibroma of the head and neck has evolved into a spectrum of three overlapping clinicopathological entities.1, 3, 6, 7, 8, 14 These are summarized in Table 2. One of the most
Diagnostic problems and other relevant lesions
The lesions so far described are those regarded as fibro-osseous by most authorities, but the term is not well defined and other lesions may show some features (fibrous stroma and bone) that could justifiably put them into this category. These will not be discussed since they are well described elsewhere and in standard texts,16, 17 but they include giant cell granuloma and cherubism, both of which may contain trabeculae of woven bone. Giant cells may also be seen in ossifying fibromas, but the
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