|Year : 2015 | Volume
| Issue : 2 | Page : 139-140
Psammomatous ossifying fibroma: A case report
Sreedhar Bora, Chaganti Padmavathi Devi, Kakumanu Nageswara Rao, Aparna Chinnam
Department of Pathology, Guntur Medical College, Guntur, Andhra Pradesh - 522 002, India
|Date of Web Publication||12-Jun-2015|
Department of Pathology, Guntur Medical College, Guntur, Andhra Pradesh - 522 002
Source of Support: None, Conflict of Interest: None
Psammomatous ossifying fibroma is a rare lesion representing a unique subtype of fibro-osseous lesions of bone. We report a case of psammomatous ossifying fibroma involving the sinonasal tract in a 26-year-old female who presented with nasal obstruction.
Keywords: Juvenile, ossifying fibroma, psammomatous, trabecular
|How to cite this article:|
Bora S, Devi CP, Rao KN, Chinnam A. Psammomatous ossifying fibroma: A case report. J NTR Univ Health Sci 2015;4:139-40
| Introduction|| |
Ossifying fibromas are well-demarcated benign tumors of craniofascial skeleton. The lesion contains fibrous tissue, osteoid, and mineralized material compressing the bone.  Psammomatous ossifying fibroma represents a rare type of ossifying fibroma. It is a slowly progressive lesion. Complete excision by endoscopic nasal surgery is the treatment of choice.
| Case report|| |
A female aged about 26 years came to the ENT clinic with nasal obstruction since 6 months. On speculum examination, a polypoidal growth of 3 × 2 cm was found in the left nostril. Computed tomographic scan of the paranasal sinuses showed a well-circumscribed radiolucent mass surrounded by a thick bony wall invading the adjacent structures. Complete excision of the tumor was done.
Histopathological examination showed a tumor composed of fibroblastic stroma admixed with small ossicles resembling psammoma bodies. The stroma is cellular with minimal collagen. The diagnosis of Psammomatous ossifying fibroma is made [Figure 1].
|Figure 1: (a) 10 × 10 view showing respiratory lining epithelium with underlying lesion. (b, c) 40 × 10 view showing psammoma bodies. (d) 40 × 10 view showing psammoma bodies with interlacing osteoid|
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| Discussion|| |
Ossifying fibroma is a well-demarcated benign tumor of craniofascial skeleton. It is characterized by fibrous tissue and mineralized material that does not fuse with its surroundings. Thus, the lesion is demarcated or encapsulated (rhinology). Ossifying fibromas show variable amounts of woven and lamellar bone trabeculae and osteoblasts may rim the trabeculae. Psammomatoid variant is a subtype of ossifying fibroma with distinctive histomorphological and clinical features.  Histologically, spherical ossicles with irregular seams of osteoid in a highly cellular fibrous tissue, separated by fibrous tissue were observed.  It is a slowly progressive lesion with the potential to create a sizeable defect in the orbit and the sinonasal tract. In the WHO classification of jaw tumors, juvenile aggressive ossifying fibroma is divided into two types: Juvenile psammomatoid ossifying fibroma and juvenile trabecular ossifying fibroma.  Juvenile psammomatoid ossifying fibroma mainly involves the orbit and paranasal sinuses seen in older people. Juvenile trabecular ossifying fibroma mainly affects the jaw bones in children and adolescents. 
Psammomatoid ossifying fibroma was initially described by Gogl as early as in 1949.  In 1985, Margo described psammomatoid juvenile ossifying fibroma as a distinctive solitary fibrous osseous lesion of young adults. Psammomatoid juvenile ossifying fibroma is not classified under osseous tumors of the jaw in the Armed Forces Institute of Pathology book.
Afflicted individuals tend to be young. In general, patients with psammomatoid ossifying fibroma are a few years older than those with trabecular psammomatoid ossifying fibroma. But as in the case of trabecular juvenile ossifying fibroma, there is no sex predilection. The majority of psammomatoid ossifying fibromas originate in the paranasal sinuses and about 10% have been reported to originate in the calvarium. In the present study, the tumor was in the paranasal sinuses. Clinically, it presents as proptosis, visual complaints, nasal obstruction, ptosis, and papilledema. In the present case, the patient presented with nasal obstruction only.
Confusion between trabecular juvenile ossifying fibroma and psammomatoid ossifying fibroma is due to the use of term juvenile ossifying fibroma to describe these two entities. Trabecular juvenile ossifying fibroma is trabecular, i.e. favors gnathic bones, whereas psammomatoid juvenile ossifying fibroma is psammomatoid, i.e. involves periorbital bones. The present case fits into the criteria. Patient came with a recurrent lesion after 6 months.
| Conclusion|| |
Psammomatoid ossifying fibromas are rare lesions. They need to be recognized and managed appropriately because they tend to recur.
| References|| |
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