Lyoubi Mouna, Beghdad Mohamed, Hammouda Yassir, Oukessou Youssef, Rouadi Sami, Mahtar Mohamed
ENT Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, 20000, Casablanca, Morocco.
Int J Surg Case Rep. 2021 Apr;81:105754. doi: 10.1016/j.ijscr.2021.105754. Epub 2021 Mar 13.
Juvenile ossifying fibroma (OF) is a benign fibro-osseous tumor, affecting the bones of the face. It's locally very aggressive, with a strong tendency to recur. We report a case of a juvenile psammomatoid ossifying fibroma (JPOF) complicated with exophthalmos undergoing an entirely endoscopic resection.
A 14-years-old, young woman presented with a 7 months history of headache and right chronic tearing complicated with exophthalmos. Nasal endoscopy revealed a polylobed mass filling the right nasal cavity, the ophthalmic examination showed an isolated exophthalmos. CT scan revealed a well-limited benign mass covered by a thick shell of bone, pushing out the orbital lamina papyracea responsible for a grade 1 exophthalmos. On the facial MRI, we excluded intracranial or intraorbital involvement. A biopsy of the mass describes a psammomatoid juvenile ossifying fibroma. The patient underwent endoscopic transnasal approach with image-guided neuro-navigation system.
JPOF is an aggressive variant of ossifying fibroma occurring predominantly in children with a predilection for the paranasal sinuses. CT scan images show a characteristic well-limited benign expansile mass covered by a thick shell of bone, but sometimes it's mistaken for a mucocele. MRI helps with excluding intracranial or intraorbital involvement. Endonasal endoscopic approaches have been increasingly used and it tends to become the new standard of care.
Treatment consists of complete surgical removal; incomplete resection is associated with a high local recurrence rate. Clinician should keep in mind the need for clinical and radiological follow-up for many years.
青少年骨化性纤维瘤（OF）是一种良性纤维骨性肿瘤，累及面部骨骼。它在局部具有很强的侵袭性，复发倾向明显。我们报告一例青少年砂粒体性骨化性纤维瘤（JPOF）合并眼球突出并接受完全内镜下切除术的病例。
一名14岁年轻女性，有7个月头痛病史，伴有右侧慢性流泪并合并眼球突出。鼻内镜检查发现一个多叶状肿物充满右侧鼻腔，眼科检查显示单纯性眼球突出。CT扫描显示一个边界清晰的良性肿物，被一层厚厚的骨壳包裹，推移眶纸板导致1级眼球突出。面部MRI检查排除了颅内或眶内受累。肿物活检显示为砂粒体性青少年骨化性纤维瘤。患者在图像引导神经导航系统辅助下接受了内镜经鼻入路手术。
JPOF是骨化性纤维瘤的一种侵袭性变异型，主要发生于儿童，好发于鼻窦。CT扫描图像显示一个特征性的边界清晰的良性膨胀性肿物，被一层厚厚的骨壳包裹，但有时会被误诊为黏液囊肿。MRI有助于排除颅内或眶内受累。鼻内镜入路已越来越多地被使用，并逐渐成为新的标准治疗方法。
治疗方法为完整手术切除；切除不完整与局部高复发率相关。临床医生应牢记需要进行多年的临床和影像学随访。
