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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 10  |  Issue : 2  |  Page : 402-405  

Osteoblastoma of mandible: A unique entity


1 Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, West Bengal University of Health Sciences, Haldia, West Bengal, India
2 Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India

Date of Web Publication13-Feb-2020

Correspondence Address:
Dr. Sucharu Ghosh
Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA 19104, Pennsylvania
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ccd.ccd_676_18

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   Abstract 

Osteoblastoma is an uncommon osteoblastic tumor that rarely involves facial bones. It is an uncommon lesion that accounts for 1% of all bone tumors and about 3% of all benign bone tumors. Here, we present a case of 35-year-old female with benign osteoblastoma on the right side of the mandible which was growing for the past 3 years. Clinical presentation, radiologic and histologic features, and treatment and follow-up of this patient are discussed in this paper. Proper diagnosis of this lesion is very important because of its similarity to others lesions. There are very few reported cases of this rare entity; the primary aim of this article is to add more cases of this rare phenomenon to literature and provide a descriptive review.

Keywords: Mandible, osteoblastoma, tumor


How to cite this article:
Sahu S, Padhiary S, Banerjee R, Ghosh S. Osteoblastoma of mandible: A unique entity. Contemp Clin Dent 2019;10:402-5

How to cite this URL:
Sahu S, Padhiary S, Banerjee R, Ghosh S. Osteoblastoma of mandible: A unique entity. Contemp Clin Dent [serial online] 2019 [cited 2020 Sep 26];10:402-5. Available from: http://www.contempclindent.org/text.asp?2019/10/2/402/278179


   Introduction Top


Benign osteoblastoma is a rare benign tumor of bone, generally affecting the vertebrae and long tubular bones. It is a unique osteoblastic tumor with osteoid and bone deposition, cytologically characterized by the abundant presence of osteoblasts.

This lesion was first reported by Jaffe and Mayer in 1932 as osteoblastic osteoid tissue forming tumor.[1] Jaffe and Lichtenstein named this lesion as “Benign Osteoblastoma” in 1956, which was adopted by the World Health Organization.[2],[3] The review suggests very few amounts of cases have been describetd in the literature.[4]


   Case Report Top


A 35-year-old female reported to our department with a chief complain of intraoral swelling in the right side of her jaw for 3 years [Figure 1].
Figure 1: Patient profile showing facial asymmetry, diffuse swelling involving the left side of the lower jaw

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The swelling which was initially small attained its present size by gradual increment. There were problems with mastication and deglutition, but the pain was never there. There were no significant family and systemic history. The cervical chain of lymph nodes was nonpalpable and nontender.

During intraoral examination, we found that the swelling was originating from the region of the right lower premolar, extending lingually till the midline and continued to the mesial part of a lower right first molar. The swelling was a single, firm, stony hard growth, with well-demarcated borders, displacing the involved tooth [Figure 2].
Figure 2: Buccal and lingual cortical bone expansion along with the displacement of involved teeth

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The overlying mucosa was firm and blanched, although no ulceration or discharge was found. Wide bore needle aspiration was attempted with no success.

An initial clinical diagnosis of benign tumor of bone, with-differential diagnosis of osteoid osteoma, benign osteoblastoma, ossifying fibroma, and fibrous dysplasia was made based on the history, clinical examination, and nature of growth.

A single, well-defined radiopaque area in the premolar region having compact trabecular pattern was found in panoramic radiograph (orthopantomogram). Furthermore, there was displacement of adjacent tooth, but no evidence root resorption was seen. A nonhomogeneous radiopaque mass with flecks of calcification was revealed in the axial computed tomography (CT), which had a predisposition toward the lingual surface [Figure 3].
Figure 3: Orthopantomogram and computed tomography showing non-homogeneous radiopaque mass on the lingual surface at the premolar region along with the displacement of adjacent teeth

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Plump osteoblasts, osteoid tissue with varying degree of mineralization and a highly vascular connective tissue was revealed by an incisional biopsy. Osteoclast, multinucleated cells, and loosely aggregated fibroblast-like cells were found in the collagenous stroma [Figure 4].
Figure 4: Histopathology showing plump osteoblasts, osteoid tissue with varying degree of mineralization

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The final diagnosis of benign osteoblastoma was established based on the clinical, radiographical, and histopathological findings. Considering the massive size of lesion, a multidisciplinary approach was taken for surgical and clinical treatment. Owing to the location and location of lesion excision of the lesion en toto was decided on.

Under general anesthesia, intraoral sulcular incision revealed the lesion and the lesion was excised en toto by marginal mandibulectomy, preserving the integrity of mandible [Figure 5] and [Figure 6].
Figure 5: Marginal mandibulectomy of the affected site

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Figure 6: Excised specimen showing 6 mm in length

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The pain was completely relieved after excision of the lesion. The postoperative course was uneventful with no evidence of recurrence at the 1½-year follow-up [Figure 7]a and [Figure 7]b.
Figure 7: (a) 2 months' postoperative follow-up showing satisfactory healing and no recurrence. (b) 1-year postoperative follow-up showing complete healing and no recurrence

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   Discussion Top


Osteoblastoma is a rare bone tumor, among all primary bone tumors, it accounts only for approximately 1%. Males are more commonly affected than females, usually occur during the second decade of life and often arise in the vertebral column and long bones. Little is known about osteoblastoma of the jaws because of its rarity.[5],[6] Barello and Sedano in 1967 described the first case of osteoblastoma in the mandible.[7]

Radiographically, osteoblastomas are well circumscribed, solitary, and expansive lesions which measures 2–12 cm.[8] The lesion may be completely radiolucent, or it may contain flecks of calcification.[8],[9] Smith et al. in 1972 reported that these flecks may be focal and few in number or may be dispersed throughout the lesion with the expansion of the cortical bones.[9] A thin rim of expanded cortical bone may be found encasing the lesion or cortex may appear to be completely absent with an outgrowth of a soft tissue mass. Due to, lack of reactive sclerosis in the mandible the margins appear somewhat indistinct. Although the central radiopaque areas suggest new bone formation, it is less likely to provoke an outstanding bony sclerosis typical of osteoid osteoma. Adjacent teeth may be effected by root resorption, displacement, and tipping.[9] CT has a crucial role in radiographic evaluation of this disease, and it has strongly contributed for the differential diagnosis, management, and surgical planning of osteoblastoma.

Histological features of osteoid osteoma highly resemble benign osteoblastoma. In the year 1954, Dahlin and Johnson suggested a name “giant osteoidosteoma,” based on this histologic similarity.[8] Osteoblastoma occasionally may be mistaken as benign fibro-osseous lesion also, due to its numerous histologic variants.[10] Microscopically, osteoblastomas are composed of long, irregularly shaped, inter-anastomosing trabeculae of osteoid or immature woven bone rimmed by osteoblasts and embedded within a fibrovascular stroma.[8] According to recent studies, neoplastic osteoblasts in osteoblastoma expresses minimal levels of cyclooxygenase-2.[8]

The treatment options of osteoblastoma include conservative surgical excision, excision with vigorous curettage followed by bur ablation and copious irritation or en bloc resection.[11] 14% local recurrence is reported in case of inadequately removed tumors.[12]En bloc resection or resection yielding tumor-free margins exhibit minimal recurrence rate. Primary reconstruction is worthwhile when mandibular integrity can be preserved, despite the chances of recurrence. The long-term follow-up is recommended, to minimize the risk of recurrence also to guarantee the grafts' survival and integration.


   Conclusion Top


In our case, the clinical and histopathologic presentations are in accordance with those reported in literature. Due to the high resemblance of clinical, radiographic, and microscopic similarity to other bone lesions, including malignant tumors, a correct diagnosis of osteoblastoma is very important. Diagnosis is more difficult in smaller lesions especially at their initial stages. A complete surgical resection is shown to eliminate the risk of recurrence.

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.
Jaffe HL. Benign osteoblastoma. Bull Hosp Joint Dis 1956;17:141-51.  Back to cited text no. 2
    
3.
Lichtenstein L. Benign osteoblasma. A category of osteoid and bone forming tumors other than classical osteoid osteoma, which may be mistaken for giant cell tumor or osteogenic sarcoma. Cancer 1956;9:1044-50.  Back to cited text no. 3
    
4.
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. 4
    
5.
Lucas DR, Unni KK, McLeod RA, O'Connor MI, Sim FH. Osteoblastoma: Clinicopathologic study of 306 cases. Hum Pathol 1994;25:117-34.  Back to cited text no. 5
    
6.
Manjunatha BS, Sunit P, Amit M, Sanjiv S. Osteoblastoma of the jaws: Report of a case and review of literature. Clin Pract 2011;1:e118.  Back to cited text no. 6
    
7.
Borello ED, Sedano HO. Giant osteoid osteoma of the maxilla. Report of a case. Oral Surg Oral Med Oral Pathol 1967;23:563–6.  Back to cited text no. 7
    
8.
Alawi F. Benign fibro-osseous diseases of the maxillofacial bones. A review and differential diagnosis. Am J Clin Pathol 2002;118 Suppl 1:S50-70.  Back to cited text no. 8
    
9.
Smith NH. Benign osteoblastoma of the mandible: Report of a case. J Oral Surg 1972;30:288–92.  Back to cited text no. 9
    
10.
Dahlin DC, Johnson EW. Giant osteoid osteoma. The Journal of Bone & Joint Surgery 1954;36:559-72.  Back to cited text no. 10
    
11.
Rawal YB, Angiero F, Allen CM, Kalmar JR, Sedghizadeh PP, Steinhilber AM, et al. Gnathic osteoblastoma: Clinicopathologic review of seven cases with long-term follow-up. Oral Oncol 2006;42:123-30.  Back to cited text no. 11
    
12.
Gordon SC, MacIntosh RB, Wesley RK. A review of osteoblastoma and case report of metachronous osteoblastoma and unicystic ameloblastoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:570-5.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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