Abbas Zafar, Abbas Zafar

Muhammad Shafi, Muhammad Shafi

Pervez, Shahid

Shaukat Malik, Shaukat Malik

eCommons@AKU

eCommons@AKUDepartment of Pathology and Laboratory Medicine Medical College, PakistanDecember 1997Ossifying Fibroma of Nasal cavityAbbas Zafar Abbas ZafarKarachi Medical and Dental CollegeMuhammad Shafi Muhammad ShafiKarachi Medical and Dental CollegeShaukat Malik Shaukat MalikKarachi Medical and Dental CollegeShahid PervezAga Khan University, shahid.pervez@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiolPart of the Oncology Commons, Otolaryngology Commons, Otorhinolaryngologic DiseasesCommons, and the Pathology CommonsRecommended CitationAbbas Zafar, A., Muhammad Shafi, M., Shaukat Malik, S., Pervez, S. (1997). Ossifying Fibroma of Nasal cavity. Journal of PakistanMedical Association, 47(12), 312-313.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol/305Ossifying Fibroma of Nasal CavityPages with reference to book, From 312 To 313 Abbas Zafar, Muhammad Shafi, Shaukat Malik ( Department of ENT and Head and Neck Surgery, Karachi Medical andDental College and Abbasi Shaheed Hospital. ) Shahid Pervaiz ( Department of Pathology, Aga Khan University Hospital, Karachi. ) Introduction Ossifying fibroma is a mre slow-growing benign tumour of fibro osseous tissue which can behave in anunpredictable aggressive fashion1. Pathologically, it is the process of replacement of normal osseousstructures by fibrous connective tissue, containing calcification of various types and amounts2. In thehead and neck regions it can arise anywhere within the facial skeleton and skull3. The most commonsites are mandible and maxilla4 with other sites having been reported sporadically such as parietal5,occipital6, tempoml7 and sçthenoid bones8, nasopharynx9. sella turcica10 and nasalcavity11. The nasalcavity is one of the rarest sites for this lesion. On reviewing the literature, we could find only one caseof ossifying fibroma in the nasal cavity reported so far11.Case Report A 15 years old girl presented with a 6 months history of nasal obstruction, nasal deformity andheadache. Examination revealed mild nasal deformity with grossly deviated nasal septum to the right.The left nasal cavity was completely occupied by a firm, pink coloured mass, whichbecanie pale onpressure. CT scan showed a predominantly non-enhancing, expansile mass in the left nasal caviw withexpansion and scaHoping of bony septum and lateral nasal wall (Figure 1).No bony destruction or extension into adjacent sinuses was noted. Biopsy of the mass showedfibrocellular lesion with deposition of osteoid and ossification consistent with ossifying fibroma. Thetumour was completely removed via a lateral rhinotomy approach (Figure 2).Histopathology of the specimen confirmed the diagnosis of ossifying fibroma after immunochernicalstaining with monoclonal antibodies. Three years follow-up showed no recurrence.Discussion The term ossifying Fibroma was first described by Menzel in 18723. Being a lesion with fibrous andosseous components, it shares the histological picture with other lesions like fibrous dysplasia,cemento-ossifying fibroma and cernentifying fibroma. However, ossifying fibroma is made of cellularfibrous connective tissue stroma with varying degress of cellularity and no initotic activity. One mayfind trabeculac of lamellar bone, rimmed by osteoblasts. There are also numerous small roundedpsanmoma-like bodies present in the cellulartissue in 60% of cases12. The histopathology of the massfrom nasal cavity in our case, revealed a cellular lesion comprising of spindle cells with elongatednuclei, exhibiting minimal degree of nuclear pleomorphism and hyperchromasia. Focally, laminatedand granular calcification was seen with deposition of osteoid (Figure 3).Differential diagnosis included ossifying fibroma and inira-nasal meningioma. To ascertain the tumourtype, the sections werc stained imntuno-histochemically with monoclonal antibodies against Vimentin,Alpha smooth muscle Actin (ASMA), Epithelial membrane Antigen (EMA) and cytokeratin. Thislesion only showcd reactivity to vimentin and no reactivity to other markers13. This is consistent with afibrous lesion as most meningiomas show reactivity to EMA also.References 1. Marvel, LB., Marsh, M.A, and Catlin, FL. Ossifying fibroma ofthemidfaceand paranasal sinuses:Diagnostic and therapeutic considerations. Otolaryngol.Head Neck Surg., 1991;104:803-8.2. Huchner, G.R., Brenneise, CV. and Etallenger, 3. Central ossifying fibrotna of the anterior maxills:Report of case. J. Am. Dent. Assoc., 1988; 116:507-510.3. Mitrani, M., Remsen, K., Lawson, W. et al. Giant ossifying fibroma of the psrsnasal sinuses. EarNose and Throat J., 1988 ;67: 186-192.4. Berger, A. and Jaffe, H.L. Fibrous (fibro-osseous) dysplasia of Jaw bones. J. Oral. Surg., 1953;11:3-17.5. Kobsyashi, S., Sugits, V. and Kalaysma, M. A ease of ossifying aroma of the psrietal bone. KurumeMed. 3., 1986;33 :43-9.6. Binstli, C., Ersahin, V., Coskun, S. et sl. Ossifying fibroma of the occipital bone. Clin NeurolNeurosurg., 1995;97:47-9.7. Ssitoh, S., Suzui, H., Miznbuchi, H eta!. Ossifying fibroma in the cranial vault. Case report. NeurolMed. Chit. Tokyo, 1991 ,31:1035-9.8. Sterling, KM., Stollman, A., Sacher, M. et al. Ossifying fibroms of sphenoid hone with coexistentmucocele: CT and MRI 3. Comput. Assist. Tomogr, 1993 ; 17:492-494.9. Cskir, B and Karadsyi, N. Ossifying fibroms in the nssophatynx. A case report. Clin Imaging, 1991 ;15:290-2.10. Shsrma, V. and Newton, G. Ossifying fibroms of the sells tureics 3. Korean Med. Sci., 1992;7:58-61.11. Dehner, L.P. Tumours of the mandible and msxills in children: Clinieopathologic study of46histologically benign lesions. Cancer, 1973;31:364-384.12. Bertrand, B., Buoy, Ph., Comelis, 3. Ph. et al. Juvenile aggressive cemento-ossifying aroma: Casereport and review of the literature. Laryngoscope, 1993,103:1385-90.13. Fukunaga, M., Ushigome, S. and Ishikaws, E. Ossifying subeutsneoua tumour with myofibroblastiedifferentiation: A variant of ossifying fibromyxoid tumour of soft parts. Pathol. Int., 1994;44:727-34.

Ossifying Fibroma of Nasal cavity

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Ossifying Fibroma of Nasal cavity

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