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Fibroma

Fibroma Durum


Presentation

Fibromas present as hard swellings or lumps that are typically painless. The tumors are well circumscribed and usually immobile.

Associated symptoms depend upon the type of tumor. For example, a fibroma of the oral cavity may also present with dysphagia, slurring of words and impaired speech, etc.

Dysphagia
  • For example, a fibroma of the oral cavity may also present with dysphagia, slurring of words and impaired speech, etc. Workup consists of a detailed history and physical examination.[symptoma.com]
Diplopia
  • The case concerns a 34 year-old man, who presented with pain in the medial canthus in his left eye, with proptosis and diplopia. The examination showed exophthalmus and a palpable mass at the inner canthus.[ncbi.nlm.nih.gov]
Skull Mass
  • Although JPOF is a rare pathological entity, neurosurgeons must consider this odontogenic lesion in the differential diagnosis of skull masses given the lesion's aggressive behavior and locally invasive growth.[ncbi.nlm.nih.gov]
Cutaneous Manifestation
  • The initial evaluation of the patient was complicated by the strong histologic resemblance of multiple lesions to sclerotic fibroma, a cutaneous manifestation of Cowden disease.[ncbi.nlm.nih.gov]
Splinter Hemorrhage
  • Clinically, it presents with yellow discoloration along the entire nail plate, proximal splinter hemorrhages, and a tendency toward transverse overcurvature of the nail plate with prominent longitudinal ridging.[ncbi.nlm.nih.gov]
Facial Scar
Distractibility
  • We report on a case in which trifocal distraction osteogenesis was applied in a patient with a mandibular defect caused by resection of an ossifying fibroma.[ncbi.nlm.nih.gov]

Workup

Workup consists of a detailed history and physical examination.

Laboratory Tests

  • Complete blood count
  • Tumor growth factors

Imaging Studies

  • CT scan to see the extent of growth
  • Fine needle aspiration
  • Biopsy

Test Results

A detailed physical examination along with imaging studies is sufficient to come to a diagnosis.

Treatment

Treatment depends upon thy subtype of the fibroma. Intralesional curettage and cementation is an effective treatment strategy for chondromyxoid fibromas, providing satisfactory functional results with a low recurrence rate [9].

Gingival fibromas and plantar fibromas are recommended to be surgically excised. Angiosarcomas are also treated by surgical removal, etc. Aggressive treatment of ameloblastic fibrosarcoma (AFS) including resection with negative margins is the treatment of choice [10].

Prognosis

Fibromas are benign tumors so they have an excellent prognosis. With appropriate treatment, all symptoms can be successfully relieved.

Complications

Complications of fibromas depend on the location and type of tumor. For instance, a gingival fibroma such as POF or giant cell fibroma may obstruct the oral and nasal cavity. Surface ulceration is common [8]. A plantar fibroma may cause chronic heel pain. And like any other benign tumor, there is a chance, no matter how slight, that it may become premalignant or in some extremely rare cases, malignant.

Etiology

Fibromas are majorly idiopathic. Some, however, are drug induced. For example, some fibromas arising in the gingiva can be the result of chronic use of some drugs. Drug induced gingival overgrowth has been associated with systemic use of phenytoin, cyclosporin and calcium channel blockers [2]. Other causes include familial inheritance and benign overgrowth due to irritants.

Epidemiology

Incidence

The exact incidence of fibromas is unknown.

Age

Fibromas can occur at any age. However, they are more common in adults.

Sex distribution
Age distribution

Pathophysiology

Fibromas are connective tissue tumors so they can occur anywhere in the body. They arise from the mesenchyme either due to mutation in the cells or due to irritants, such as plaque in the case of oral cavity fibromas. Histologically, they are unencapsulated, hard, nodular masses of hyalinized connective tissue fibres arranged haphazardly.

Types

The following are the most common type of fibromas:

  • Oral cavity fibromas
  • Angiofibromas

Oral cavity fibromas

Some subtypes of oral cavity fibromas include:

  •  Peripheral ossifying fibroma

Peripheral ossifying fibroma (POF) is a reactive lesion of the gingival tissues that predominantly affects women and is usually located in the maxilla anterior to the molars [3]. Surgical excision is the treatment of choice.

  • Other gingival fibromas

Localised overgrowths of the gingiva such as peripheral fibroma, peripheral ossifying/cementifying fibroma, pyogenic granuloma and peripheral giant cell granuloma belong to a common group of lesions designated as focal reactive overgrowths (FROG) [4]. They occur in response to chronic low-grade irritation of the oral mucosa.

Angiofibroma

Soft tissue angiofibroma is a recently described neoplasm that typically presents as a slowly growing, painless mass in the soft tissues of the lower extremities [5]. A t(5;8) translocation has been found associated with it.

Others

  • Elastofibroma

Histologically, the elastofibroma consists of collagen fibres and coarse elastic fibres that can be demonstrated by elastin stain [6]. This subtype is fairly uncommon. 

  • Sclerotic fibroma

This type is an uncommon benign growth occurring most commonly in the skin either singly or it can be multifocal. The tumor cells are CD34 and vimentin positive [7].

Prevention

A healthy life style and avoiding use of potentially harmful drugs as well as protection from external irritants may possibly prevent occurrence or recurrence of the tumors.

Summary

Fibromas are benign overgrowths of the connective tissue that occur in response to a mutation in the cells. As they are non cancerous, they do not pose serious health risks and can be surgically removed when needed. Recurrence is possible, however, if the offending irritant persists [1].

Patient Information

Definition

Fibromas are non cancerous overgrowths of connective tissues like bone, soft tissues, skin, blood, etc.

Cause

Fibromas are generally idiopathic. Some, like oral cavity fibromas however, may be due to irritants such as chewing beetle nuts, a common practise in many South Asian countries. Others may be due to drug associated growth, familial inheritance predisposing to the condition and genetic mutations.

Symptoms

Patients generally complain of single or multiple painless swelling, associated with regional (area-wise) symptoms.

Treatment

Treatment is surgical excision of the tumor.

Prevention

Fibromas have no definite preventive measures. However, they can be avoided by safe guarding against external irritants and harmful drugs.

References

Article

  1. Esmeili T, Lozada-Nur F, Epstein J. Common benign oral soft tissue masses. Dent Clin North Am. Jan 2005;49(1):223-40, x [Medline]
  2. Dongari-Bagtzoglou A. Drug-associated gingival enlargement. J Periodontol. Oct 2004;75(10):1424-31. [Medline]
  3. Kale L, Khambete N, Sodhi S, Sonawane S. Peripheral Ossifying Fibroma: series of 5 cases. J Indian Soc Periodontol. 2014 July;18(4):527-30 doi: 10.4103/0972-124X.138762.
  4. Parwani S, Parwani RN. Diagnosis and management of focal reactive overgrowths of gingival-a case series. H Mich Dent Assoc. 2014 July;96(7):36-47. PMID 25163184 [PubMed]
  5. Lee JJ, Bredella MA, Springfield DS, Neilson GP. Soft tissue angiofibroma: a case report. Skeletal Radiol 2014 March;43(3):403-7. doi: 10.1007/s00256-013-1742-0 PMID 24113908 [PubMed]
  6. Lee JH, An JS, Lee ES, Kwon SY, Kim YS. Comparison of sporadic sclerotic fibroma and solitary fibrous tumor in the oral cavity. Yonsei Med J. June 30 2007;48(3):535-9 [Medline].
  7. Manchandu R, Foote J, Alawi F. Elastofibroma presenting as an oral soft tissue mass. J Oral Pathol Med. Feb 2008;37(2):125-6. [Medline]
  8. Buchner A, Hansen LS. The histomorphologic spectrum of peripheral ossifying fibroma. Oral Surg Oral Med Oral Pathol. Apr 1987;63(4):452-61
  9. Bhamra JS, Al-Khateeb H, Dhinsa BS, Gikas PD, Tirabosco T, Pollock RC, Skinner JA, Aston WJ, Saifuddin A, Briggs TW. Chondromyxoid fibroma Management: a single institution experience of 22 cases. World J Surg Oncol. 2014 Sep 12;12(1):283.
  10. Wang BY. Head and Neck Pathology:SS13-1 Ameloblastic Fibrosarcoma of Mandible. Pathology. 2014 Oct;46 Suppl 2:S18. doi 10.1097/01.PAT.0000454111.11437.36. PMID 25188081. 

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Last updated: 2017-08-09 18:19