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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 15-17

Benign osteoblastoma of the mandible


1 Department of Orthodontics, SVS Institute of Dental Sciences, Mahabubnagar, Telangana, India
2 Department of Pedodontics and Preventive Dentistry, Senior Lecturer Desh Bhagat Dental College and Hospital, Muktsar, Punjab, India
3 Department of Pedodontics and Preventive Dentistry, Shaheed Kartar Singh Sarabha Dental College, Ludhiana, Punjab, India
4 Department of Endodontics, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India

Date of Web Publication16-Apr-2018

Correspondence Address:
Karanveer Singh Saluja
MIG-315, Phase 1, Dugri, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sidj.sidj_4_18

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  Abstract 


Osteoblastoma, a rare osteoblastic tumor, constitutes approximately 1% of all primary bone tumors. It is characterized by osteoid and bone formation with the presence of numerous osteoblasts. A 24-year-old female presented with a chief complaint of a painless swelling beneath the mandible, which was growing during the past 3 years. Radiological picture disclosed a well-circumscribed lesion with patchy radiopaque internal structure. After complete excision, the histopathological diagnosis was a benign osteoblastoma of the mandible. Differential diagnosis and immunohistochemical features are potentially useful for refining diagnosis of osteoblastoma.

Keywords: Bone tumors, mandible, osteoblastoma


How to cite this article:
Thekiya AH, Saluja KS, Singh B, Bhatia TK, Arora S. Benign osteoblastoma of the mandible. Saint Int Dent J 2017;3:15-7

How to cite this URL:
Thekiya AH, Saluja KS, Singh B, Bhatia TK, Arora S. Benign osteoblastoma of the mandible. Saint Int Dent J [serial online] 2017 [cited 2018 Sep 20];3:15-7. Available from: http://www.sidj.org/text.asp?2017/3/1/15/230205



Osteoblastoma is a benign neoplasm of the bone, accounting for approximately 1% of all primary bone neoplasms. This tumor was first described by Jaffe and Mayer in 1932.[1] Usually, benign osteoblastoma occurs in the second and third decades of life, but the age range is 5–78 years. As to sex incidence, there is male predominance 2–3:1. Benign osteoblastoma in the facial bone is characterized by pain and swelling. However, the lesion can be discovered on routine clinical examination with no signs or symptoms. This tumor may have a different clinical potential because of the propensity for recurrence, locally aggressive behavior, and in rare cases, malignant transformation.[2] Histologically, it shows numerous trabeculae of immature bone and osteoid lined by active osteoblasts, in the background of highly vascularized fibrocellular stroma. In the maxillofacial region, the diagnosis of osteoblastoma is often difficult, and careful clinicopathological correlation may be needed since many jaw lesions may present similar overlapping demographic, clinical, radiographic, and histopathological features.


  Case Report Top


A 24-year-old female reported with the complaint of extraoral swelling, involving mandibular body on the left side for 3 years. Clinical examination revealed the presence of a firm palpable, well-circumscribed tumor mass measuring approximately 1.5 cm in greatest diameter [Figure 1]. Overlying skin was intact and normal in color. Initially, the swelling was small, which had gradually increased in size, attaining the present dimensions. The patient never experienced any pain but had problems in chewing and swallowing. The systemic and family history was noncontributory. All the maxillofacial lymph nodes were normal. No abnormality detected on intraoral examination. Based on the patient history and clinical findings, a provisional diagnosis of cementoblastoma, osteoblastoma, and ossifying fibroma was given. Orthopantomogram showed a round-to-oval radiopaque mass with a radiolucent border at the lower border of mandible [Figure 2]. Computed tomography scan shows a well-defined lobulated homogeneously dense sclerotic lesion arising from the outer cortex of the posterior aspect of the body of mandible on the left side [Figure 3]. It measures approximately 1.5 cm × 1.6 cm. No obvious destruction of the body of mandible is seen. The lesion was excised under general anesthesia and the surgical specimen comprised hard tissue mass [Figure 4].
Figure 1: Extraoral view

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Figure 2: Orthopantomogram

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Figure 3: Computed tomography scan

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Figure 4: Postoperative orthopantomogram

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Histologically, sections revealed interanastomosing trabeculae of woven bone with vascularized stroma surrounded by dense cortical bone. Sections also showed the presence of plump osteoblasts and osteoid tissue with varying degree of mineralization. The collagenous stroma contained osteoclast, multinucleated cells, and loosely aggregated fibroblast-like cells [Figure 5]. Based on the histomorphologic characteristic of the tumor, the clinical facts, and the radiologic findings, the diagnosis of a benign osteoblastoma mandible was established.
Figure 5: Histopathological section

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  Discussion Top


Benign osteoblastoma is a rare osteoblastic tumor of the bone. Jaffe and Lichtenstein stated this lesion to be a true neoplasm of osteoblastic derivation. Trauma, inflammation, abnormal local response of the tissues to injury, and local alteration in bone physiology are few of the other reasons cited in the literature pertaining to the etiology of this tumor. This benign neoplasm of bone is characterized by proliferation of osteoblasts forming trabecular set in a vascularized fibrous connective tissue stroma.[3] Reviewing 67 cases of osteoblastoma of the jaws, Capelozza et al. (2005) showed that 61% of the patients were male and 39% were female, with an average age of 20.97 years at diagnosis. Mandible was more commonly affected than the maxilla. Majority of the lesions (35%) radiographically showed a mixed aspect, with radiolucent areas entangled with radiopaque ones. In this series, 7.2% of cases were noted as recurrent. Osteoblastoma may be classified into cortical, medullary, and periosteal types. Osteoblastomas of the jaws are either medullary or periosteal and not cortical which are common in the extragnathic sites.[4] The differential diagnosis of benign osteoblastoma is osteoid osteoma, central ossifying fibroma, fibrous dysplasia, chondroblastoma, cementoblastoma, and giant cell granuloma.

Abrams et al. reported that the histologic similarities of cementoblastoma, osteoid osteoma, and benign osteoblastoma suggest a close relationship among these three conditions.[5] The attachment of the tumor to the roots of teeth should not be used as a hallmark for the diagnosis of cementoblastoma as osteoblastoma in the tooth-bearing area may envelop the roots of the involved teeth. However, the broad trabecular regions with limited cellularity seem to be a prominent feature, possibly unique to cementoblastoma. Furthermore, reversal lines that may impart a mosaic pattern to the calcified portion are a feature of cementoblastoma. At microscopic examination, the bony trabeculae of osteoblastoma are slightly wider than those of osteoid osteoma, and there is less irregularity in their arrangement; the number of osteoblasts is much greater in osteoblastoma, but osteoma lacks giant cells and is not as well vascularized as osteoblastoma.[6] Radiographic picture of osteoblastoma is not very consistent and varies from case to case depending on the duration.[7] A combination of radiopaque and radiolucent patterns, depending on the degree of calcification and absence of perilesional sclerotic border, is a general radiographic finding for benign osteoblastomas.

Surgical excision is the only treatment. The lesion can be removed with intralesional curettage or wide resection, depending on the clinical situation, location within the bone, and suspicion of malignancy. A more conservative approach of surgical curettage has been suggested in the literature. Nowparast et al. stated that benign osteoblastoma has a good prognosis and is best treated by curettage or conservative surgical excision.[8] Recurrence rates vary with the surgical approach, and wide resection is associated with lower recurrence rates. Radiation therapy or chemotherapy to treat osteoblastoma is controversial. Marsh et al. stated that radiotherapy should be employed only in cases of incomplete surgical excision or if there is any evidence of continual growth or recurrence of the lesion.[9] Long-term follow-up is required due to the possibility of recurrence and malignant transformation. Long-term follow-up is recommended, of at least 2 years, not only to minimize the risk of undiagnosed recurrence but also to guarantee the grafts' survival and integration.


  Conclusion Top


Benign osteoblastoma involving jaw bones is a rare tumor. A correct diagnosis is very important as osteoblastoma presents a clinical, radiographic, and microscopic similarity to other bone lesions, including malignant tumors. Complete surgical excision is only treatment available for osteoblastoma with an overall good prognosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jaffe HL, Mayer L. An osteoblastic-osteoidtissue-forming tumor of a metacarpal bone. Arch Surg 1932;24:550-64.  Back to cited text no. 1
    
2.
Alvares Capelozza AL, Gião Dezotti MS, Casati Alvares L, Negrão Fleury R, Sant'Ana E. Osteoblastoma of the mandible: Systematic review of the literature and report of a case. Dentomaxillofac Radiol 2005;34:1-8.  Back to cited text no. 2
    
3.
Jones AC, Prihoda TJ, Kacher JE, Odingo NA, Freedman PD. Osteoblastoma of the maxilla and mandible: A report of 24 cases, review of the literature, and discussion of its relationship to osteoid osteoma of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:639-50.  Back to cited text no. 3
    
4.
Farman AG, Nortjé CJ, Grotepass F. Periosteal benign osteoblastoma of the mandible. Report of a case and review of the literature pertaining to benign osteoblastic neoplasms of the jaws. Br J Oral Surg 1976;14:12-22.  Back to cited text no. 4
    
5.
Abrams AM, Kirby JW, Melrose RJ. Cementoblastoma. A clinical-pathologic study of seven new cases. Oral Surg Oral Med Oral Pathol 1974;38:394-403.  Back to cited text no. 5
    
6.
Haug HR, Hauer C, De Camillo JA, Araneta M. Benign osteoblasoma of the mandible: Report of a case. J Oral Maxillofac Surg 1990;48:743-8.  Back to cited text no. 6
    
7.
Saikhedkar R, Wanjari S, Nirwan A, Prasad H. Osteoblastoma involving maxilla: An unusual report with review of literature. J Orofac Sci 2010;2:53-7.  Back to cited text no. 7
  [Full text]  
8.
Nowparast B, Mesgarzadeh A, Lassemi I. Benign osteoblastoma of the mandible. A clinical-pathologic review and report of a case. Int J Oral Surg 1979;8:386-90.  Back to cited text no. 8
    
9.
Marsh BW, Bonfiglio M, Brady LP, Enneking WF. Benign osteoblastoma: Range of manifestations. J Bone Joint Surg Am 1975;57:1-9.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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