Navigating the Convoluted Diagnosis of Fibro-osseous Lesions of Jaws – A Case Series and Review of Literature

Fibro-osseous lesions (FOLs) have been characterized by replacement of normal bone with cellular fibrous tissue, with ossification/cementum formation or calcification of fibrous tissue by metaplasia in due course of time. Due to significant overlapping features and variations in treatment protocol for each lesion, correlation of the clinical presentation, radiography and histopathology with surgical findings is necessary. In this article, four case reports of different FOLs have been discussed along with an extensive review of the literature. First case is of a 36-year-old female, presenting with a swelling over right side of face. Despite previous attempts at bone contouring, the lesion recurred, leading to the disfigurement of the face. Hence, bone recontouring was done, and histopathology showed characteristic features of Fibrous dysplasia. The second case is of a young male patient in which swelling occurred suddenly with increasing size. Under histopathology, psammoma-like ossicles with brush border were noted in the background of hypercellular stroma, along with nonspecific areas of cystic degeneration, depicting Psammomatoid ossifying fibroma. It is a rare entity caused by HRPT2 gene deficiency or alterations in MDM2 and RASAL1. The third case elaborated a Focal cemento-osseous dysplasia (COD) in a 35-year-old female patient, with a previous history of extraction. Fourth case details a 35-year-old female patient with swelling and pus discharge from the edentulous posterior mandible with a known history of Neurofibromatosis. Histopathology revealed osseous tissue and globular masses of cementum, confirming the diagnosis as florid COD. These cases elaborated the convoluted diagnosis of FOL and the need for expertise in oral pathology for accurate diagnosis and precise treatment plan.