Cemento-osseous dysplasia versus cemento-ossifying fibroma

Cemento-osseous dysplasia (COD)

COD is a fibro-osseous lesion occurring exclusively in the tooth bearing areas of the jaws. It is characterized by the presence of calcifications in the form of spherical masses of cementum-like material and immature woven bone (osteoid) (hence cemento-osseous dysplasia) in a loose fibro-vascular stroma.

• The 4th edition of WHO classification (2017) recognizes three variants of COD --> a) Periapical COD (PCOD), b) Focal COD (FCOD), c) Florid COD (FLCOD).

• PCOD and FCOD, are the most common fibro-osseous lesions encountered in clinical practice.

• All 3 variants of COD have the same histopathology features and are differentiated based on clinical and radiology features.

Cemento-ossifying fibroma (COF)

COF is a tumor where there is proliferation of cellular (fibroblasts) fibrous tissue along with calcifications in the form of basophilic spherical masses (cementum-like material) & immature bone (osteoid) (hence cemento-ossifying fibroma). It is a true neoplasm, in that, it has a proliferative (growth) potential and can cause expansion of bone.

The most recent (2017) WHO classification considers ossifying fibroma (OF) in general to have three variants

• COF, considered to be odontogenic in origin, and

• Non-odontogenic variants called

  • Juvenile trabecular OF (JTOF),

  • Juvenile psammamatoid OF(JPOF).

The overwhelm!

Fibro-osseous lesions, especially cemento-osseous dysplasia (COD) and cemento-ossifying fibroma (COF) can be confusing topics for students, since there are so many overlapping/similar features as well as differences between the two. 

To add fuel, COD has three variants called 1) Periapical cemento-osseous dysplasia (PCOD), 2) Focal cemento-osseous dysplasia (FCOD) and 3) Florid cemento-osseous dysplasia (FLCOD) which may have subtle differences between themselves. Knowing key differences and similarities between COD and COF is not just academic, but of clinical importance too.

Knowing this, I have curated a table enumerating key features of COD (its 3 variants) and COF. The table highlights both similar features and differences of all these lesions. This could come in handy for your written exams as well as your practical viva-voce tests!

You could download the excel sheet here 👉

Cod Versus Cof

12KB ∙ XLSX file

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📖REFERENCES AND FURTHER READING

1. Speight PM, Takata T. New tumour entities in the 4th edition of the World Health Organization Classification of Head and Neck tumours: odontogenic and maxillofacial bone tumours. Virchows Arch. 2018 Mar;472(3):331-339.

2. El-Mofty SK. Fibro-osseous lesions of the craniofacial skeleton: an update. Head Neck Pathol.2014 ;8(4):432–444.

3. Brannon RB, Fowler CB. Benign fibro-osseous lesions: a review of current concepts. Adv Anat Pathol. 2001;8(3):126-43.

4. Eversole R, Su L, ElMofty S. Benign Fibro-Osseous Lesions of the Craniofacial Complex A Review. Head Neck Pathol. 2008; 2(3): 177–202.

5. Neville BW, Damm DD, Allen CM, Chi A. Oral and Maxillofacial Pathology. South Asian ed. Elsevier; 2016.

6. Regezzi JA, Sciubba JJ, Jordan RCK. Oral Pathology: Clinical Pathologic Correlations. 5 th ed. Elsevier; 2007.

7. Wood NK, Goaz PW. Differential Diagnosis of Oral and Maxillofacial Lesions. 5 th ed. Mosby; 1997.