The Roentgen Appearance of Ossifying Fibroma of Bone

Abstract

According to Eden (2), the disease generally known as ossifying fibroma was first described in 1872 by Menzel, who considered it to be a form of osteoma. At least two early textbooks on the jaw, that of Heath in 1894 (5) and of Scudder in 1912 (12), contain accounts of tumors consistent with the lesion under discussion here. Montgomery (8) in 1927 probably introduced the term ossifying fibroma. At this time he described 3 cases and in a review of the literature was able to uncover 14 similar ones. Geschickter's paper (4) on jaw tumors in 1935 contained a section on ossifying fibroma. Two years later Phemister and Grimson (9) in a significant study presented 13 cases, reviewed 2 of Montgomery's, and noted 30 more from the literature. These authors, employing the term fibrous osteoma for ossifying fibroma, suggested that this process bore a relationship to membranous bone similar to that which osteochondroma bears to cartilaginous bone. In 1939 Eden presented a study of 5 cases primarily from the pathological point of view and concluded that ossifying fibroma represents an immature form of the benign “fibro-osseous” tumors of membranous bone. Following the presentation of fibrous dysplasia of bone as an entity, several writers have suggested an intimate relationship between this disease and ossifying fibroma. In fact, Lichtenstein (6) felt that several of the cases of Phemister and Grimson were indistinguishable from fibrous dysplasia. Four years later, in 1942, Mallory (7) seemed ready to accept the possibility of these diseases being one and the same. Schlumberger (11), writing in 1946 and basing his opinion largely upon pathological grounds, concluded that ossifying fibroma was at the most a variant of fibrous dysplasia. It is the feeling of the Department of Pathology at Memorial Hospital that ossifying fibroma of the jaw presents little of a specific nature histologically. Consequently the department refrains from making an unequivocal diagnosis upon microscopic study alone. In material seen at this hospital, however, there are a few tumors in the group under discussion which are outstanding microscopically in that they show relatively extensive calcific spherulation. This has not been observed in sections of any of our cases having the clinical, radiographic, and pathologic attributes of fibrous dysplasia of bone. Although this cannot be considered an absolute differential criterion, it can scarcely be entirely ignored (3). Generally speaking, when histologic material is adequate, one readily places ossifying fibroma in a small group having certain similar microscopic features. This group includes fibrous dysplasia of bone as well as fibrosing epulis and osteitis fibrosa-cystica.