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Psammous desmo-osteoblastoma with concomitant aneurysmal bone cyst of mandible.

Shruthi SK, Kamath VV, Hegde S, Sreevidya B - Ann Maxillofac Surg (2015 Jan-Jun)

Bottom Line: Aneurysmal bone cysts (ABCs) are known to be secondarily associated with primary osseous neoplasms like ossifying fibroma, giant cell granuloma, etc.The histological presentation substantiated by special stains and immunohistochemistry point to the diagnosis of psammous desmo-osteoblastoma with a concomitant ABC.Review of the literature revealed the presentation to be rare with very few cases reported till date.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Pathology, Dr. Syamala Reddy Dental College Hospital and Research Centre, Bengaluru, Karnataka, India.

ABSTRACT
Juvenile psammomatoid ossifying fibroma is a gradually progressive, aggressive extragnathic craniofacial tumor of bone. Due to its complex histogenesis, biological behavior, histology, and classification, its nomenclature has always been the focus of debate among pathologists. Based on the clinical behavior and histology, the term psammous desmo-osteoblastoma (PDO) is an apt expression for this lesion. Immunohistochemical investigation with anti-osteonectin shows positivity for spindle cells whereas psammoma bodies are negative. These results shore up the hypothesis of osteogenic differentiation of the undifferentiated mesenchymal cells of the periodontal ligament that may be responsible for the aggressive behavior of the lesion. Aneurysmal bone cysts (ABCs) are known to be secondarily associated with primary osseous neoplasms like ossifying fibroma, giant cell granuloma, etc. We report a rare case of PDO with concomitant ABC in the mandible of a 30-year-old male patient. The present lesion had recurred at the same site of an osteolytic lesion diagnosed 7 years ago as a benign fibro-osseous lesion and treated by conservative surgical curettage. The histological presentation substantiated by special stains and immunohistochemistry point to the diagnosis of psammous desmo-osteoblastoma with a concomitant ABC. Review of the literature revealed the presentation to be rare with very few cases reported till date.

No MeSH data available.


Related in: MedlinePlus

(a and b) Composite photomicrographs of H and E stained section showing the proliferation of spindles cells in fibrous stroma and psammoma bodies with osteoblastic rimming (c and d) showing blood filled spaces and multinucleated giant cells on the periphery of the blood vessels; features indicative of an aneurysmal bone cyst (H and E stained, magnification ×10)
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Figure 5: (a and b) Composite photomicrographs of H and E stained section showing the proliferation of spindles cells in fibrous stroma and psammoma bodies with osteoblastic rimming (c and d) showing blood filled spaces and multinucleated giant cells on the periphery of the blood vessels; features indicative of an aneurysmal bone cyst (H and E stained, magnification ×10)

Mentions: Microscopic examination of hematoxylin and eosin sections showed various hypercellular fibrous connective tissue stromas consisting of plump hyperchromatic fibroblasts with minimal collagen deposition arranged in the form of sheets and whorls. Numerous psammoma bodies having eosinophilic and fibroblastic rimming were distributed throughout the section [Figure 5a and b]. Pseudocysts of varying sizes filled with erythrocytes were seen, adjacent to which multinucleated giant cells were evident [Figure 5c and d]. This was typical of an ABC and seemed to be present at the distal end of the lesion. To assess the histopathological nature of the collagen stroma and calcified bodies, Picrosirius red and Alizarin Red stains were employed and the sections visualized under polarized microscope. Tissue stained with Picrosirius Red under polarizing microscope showed compact collagen aggregation in the calcifications and loose collagen in the stroma. Tissue stained with Alizarin Red under polarizing microscope showed varying densities of calcification. The origin and nature of the calcified bodies in a fibro-osseous lesion in the jaws is always a matter of debate. To identify the origin of the cells forming the hard tissue, the sections were stained with anti-osteonectin (Clone 15G12, monoclonal antibody, Novocastra™ Lyophilized antibodies, Leica Biosystems Newcastle Ltd., UK) an immunohistochemical antibody specific to osteoblast lineage of cells. Spindle cells in the stroma showed positivity whereas psammoma bodies were negatively stained [Figure 6a–d]. Based on the constellation of histologic, clinical, and radiographic features final diagnosis of PDO concomitant with ABC was given.


Psammous desmo-osteoblastoma with concomitant aneurysmal bone cyst of mandible.

Shruthi SK, Kamath VV, Hegde S, Sreevidya B - Ann Maxillofac Surg (2015 Jan-Jun)

(a and b) Composite photomicrographs of H and E stained section showing the proliferation of spindles cells in fibrous stroma and psammoma bodies with osteoblastic rimming (c and d) showing blood filled spaces and multinucleated giant cells on the periphery of the blood vessels; features indicative of an aneurysmal bone cyst (H and E stained, magnification ×10)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555939&req=5

Figure 5: (a and b) Composite photomicrographs of H and E stained section showing the proliferation of spindles cells in fibrous stroma and psammoma bodies with osteoblastic rimming (c and d) showing blood filled spaces and multinucleated giant cells on the periphery of the blood vessels; features indicative of an aneurysmal bone cyst (H and E stained, magnification ×10)
Mentions: Microscopic examination of hematoxylin and eosin sections showed various hypercellular fibrous connective tissue stromas consisting of plump hyperchromatic fibroblasts with minimal collagen deposition arranged in the form of sheets and whorls. Numerous psammoma bodies having eosinophilic and fibroblastic rimming were distributed throughout the section [Figure 5a and b]. Pseudocysts of varying sizes filled with erythrocytes were seen, adjacent to which multinucleated giant cells were evident [Figure 5c and d]. This was typical of an ABC and seemed to be present at the distal end of the lesion. To assess the histopathological nature of the collagen stroma and calcified bodies, Picrosirius red and Alizarin Red stains were employed and the sections visualized under polarized microscope. Tissue stained with Picrosirius Red under polarizing microscope showed compact collagen aggregation in the calcifications and loose collagen in the stroma. Tissue stained with Alizarin Red under polarizing microscope showed varying densities of calcification. The origin and nature of the calcified bodies in a fibro-osseous lesion in the jaws is always a matter of debate. To identify the origin of the cells forming the hard tissue, the sections were stained with anti-osteonectin (Clone 15G12, monoclonal antibody, Novocastra™ Lyophilized antibodies, Leica Biosystems Newcastle Ltd., UK) an immunohistochemical antibody specific to osteoblast lineage of cells. Spindle cells in the stroma showed positivity whereas psammoma bodies were negatively stained [Figure 6a–d]. Based on the constellation of histologic, clinical, and radiographic features final diagnosis of PDO concomitant with ABC was given.

Bottom Line: Aneurysmal bone cysts (ABCs) are known to be secondarily associated with primary osseous neoplasms like ossifying fibroma, giant cell granuloma, etc.The histological presentation substantiated by special stains and immunohistochemistry point to the diagnosis of psammous desmo-osteoblastoma with a concomitant ABC.Review of the literature revealed the presentation to be rare with very few cases reported till date.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Pathology, Dr. Syamala Reddy Dental College Hospital and Research Centre, Bengaluru, Karnataka, India.

ABSTRACT
Juvenile psammomatoid ossifying fibroma is a gradually progressive, aggressive extragnathic craniofacial tumor of bone. Due to its complex histogenesis, biological behavior, histology, and classification, its nomenclature has always been the focus of debate among pathologists. Based on the clinical behavior and histology, the term psammous desmo-osteoblastoma (PDO) is an apt expression for this lesion. Immunohistochemical investigation with anti-osteonectin shows positivity for spindle cells whereas psammoma bodies are negative. These results shore up the hypothesis of osteogenic differentiation of the undifferentiated mesenchymal cells of the periodontal ligament that may be responsible for the aggressive behavior of the lesion. Aneurysmal bone cysts (ABCs) are known to be secondarily associated with primary osseous neoplasms like ossifying fibroma, giant cell granuloma, etc. We report a rare case of PDO with concomitant ABC in the mandible of a 30-year-old male patient. The present lesion had recurred at the same site of an osteolytic lesion diagnosed 7 years ago as a benign fibro-osseous lesion and treated by conservative surgical curettage. The histological presentation substantiated by special stains and immunohistochemistry point to the diagnosis of psammous desmo-osteoblastoma with a concomitant ABC. Review of the literature revealed the presentation to be rare with very few cases reported till date.

No MeSH data available.


Related in: MedlinePlus