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Vol. 113 No.

6 June 2012

Central odontogenic fibroma of the jawbone: 2 case reports


describing its imaging features and an analysis of its
DCE-MRI findings
Marina Hara, DDS,a Hidenobu Matsuzaki, DDS,b Naoki Katase, DDS, PhD,c Yoshinobu Yanagi, DDS, PhD,d
Teruhisa Unetsubo, DDS, PhD,e Jun-Ichi Asaumi, DDS, DMSci,f and Hitoshi Nagatsuka, DDS, PhD,g
Okayama, Japan
OKAYAMA UNIVERSITY

Odontogenic fibroma (OF) is a rare nonepithelial benign tumor arising from the odontogenic mesenchymal tissue in
the jawbone. OFs are topographically categorized into 2 types, the central type and peripheral type, and are
histopathologically divided into the epithelium-poor type and epithelium-rich type. The radiological findings of central OF
commonly include a uni- or multilocular radiolucent area with a well-defined margin, which are similar to those of cysts and
other benign tumors of the jawbone. Therefore, it is difficult to distinguish OF from these jawbone lesions on radiographs
because of their noncharacteristic radiological findings. In this article, we report the cases of 2 patients with central OF who
underwent magnetic resonance (MR) examinations and describe the usefulness of dynamic contrast-enhanced MR imaging for
diagnosing OF. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:e51-e58)

Odontogenic fibroma (OF) is a rare benign neoplasm


that is categorized into various types.1-3 The World
Health Organization (WHO) categorized OF into the
following 2 histologic types: the epithelium-poor
type (simple type) and epithelium-rich type (complex
or WHO type).1 Furthermore, according to WHO,
OF are topographically categorized into 2 types: the
intraosseous or central type and the extraosseous or
peripheral type.1 Regarding the most common sites
of OF, Ramer et al.4 reported that 69% and 31% of
OFs are located in the mandible and maxilla, respectively, whereas the WHO reported equivalent figures
of 86.5% and 13.5%, respectively.1 In contrast, Kaffe
and Buchner5 reported that the incidence rate of OF
in the mandible (55%) is similar to that in the maxilla
(45%).
Conventional radiographs of central OF show a
uni- or multilocular radiolucent area with a welldefined margin.1,6-8 In some rare cases, mixed radiolucent/radiopaque areas and undefined margins are
a

Research Fellow, Department of Oral and Maxillofacial Radiology.


Assistant Professor, Department of Oral Diagnosis and Dentomaxillofacial Radiology.
c
Assistant Professor, Department of Oral Pathology and Medicine.
d
Senior Assistant Professor, Department of Oral Diagnosis and Dentomaxillofacial Radiology.
e
Research Fellow, Department of Oral and Maxillofacial Radiology.
f
Professor, Department of Oral and Maxillofacial Radiology.
g
Professor, Department of Oral Pathology and Medicine.
Received for publication Oct 11, 2011; returned for revision Nov 27,
2011; accepted for publication Dec 4, 2011.
2012 Elsevier Inc. All rights reserved.
2212-4403/$ - see front matter
doi:10.1016/j.oooo.2011.12.013
b

observed.1,5,9 More severe, larger lesions show root


resorption and displacement of the neighboring
teeth.1,7,10 Some central OFs are associated with the
crown of an unerupted tooth.1,11 The differential
diagnoses of central OF are ossifying fibroma, odontogenic myxoma, simple bone cyst, fibrous dysplasia,
calcifying cystic odontogenic tumor, dentigerous
cyst, and ameloblastoma.12,13 Thus, the radiological
findings of central OF have been well described in
many articles, but it is difficult to diagnose this
lesion because of its noncharacteristic findings and
varying differential diagnoses.
Magnetic resonance imaging (MRI) is a useful modality for analyzing the internal structures of lesions
because of its superior soft tissue contrast ability. Furthermore, some authors, including us, have reported
that time signal intensity curves (TIC), which are constructed using dynamic contrast-enhanced MRI (DCEMRI) parameters, are useful for diagnosing jawbone
lesions.14-17 To the best of our knowledge, however,
there are no reports about the MR findings of OF. In
this case report, we describe the MRI findings of 2
central OFs and the results of a retrospective analysis of
their DCE-MRI findings.

MATERIAL AND METHODS


Two patients who underwent DCE-MRI were histopathologically diagnosed with central OF at our hospital. This study was approved by our institutional review
board (no. 232).
The MR examinations were performed using a 1.5-T
unit (Magnetom Vision; Siemens, Erlangen, Germany)
with a head coil. T1-weighted images (T1WI) were
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Figure 1. Panoramic and periapical radiographs (case 1). Panoramic and periapical radiographs showing a multilocular radiolucent area with a well-defined margin extending from the upper left lateral incisor to the first premolar region and root resorption
of the first premolar (A, B).

acquired with a spin-echo sequence, and short TI inversion recovery (STIR) images were acquired with a
turbo-spin-echo sequence. We performed DCE-MRI
via 3-dimensional fast imaging using a steady-state
precession sequence. The DCE-MRI series were composed of 14 consecutive scans performed at 1-second
intervals (acquisition time for each scan: 14 seconds).
The total scan time of this series was 210 seconds.
Then, contrast-enhanced T1WIs (CE-T1WIs) with fat
suppression were acquired using the same parameters
as the unenhanced T1WIs after the administration of
contrast medium.
TICs were created using dynamic images, regions of
interest (ROIs) were drawn on a computer monitor, and
the mean signal intensity in the ROI of each lesion was
calculated using a workstation (Synapse Vincent, Fujifilm, Medical Co., Tokyo, Japan).
Case 1
In October 2003, a 24-year-old woman was referred to
our hospital because a radiolucent lesion that extended
from the upper left lateral incisor to the premolar region
had been detected on a periapical radiograph by her
general dental practitioner. She had not noticed any
symptoms and did not have a relevant medical history.
Conventional radiographs showed a multilocular radiolucent area with a well-defined margin extending
from the upper left lateral incisor to the first premolar
region and root resorption of the first premolar (Figure
1, A and B). Computed tomography (CT) images (bone
window) showed similar findings to those of the conventional radiographs, and palatal bony expansion was

seen (Figure 2). It was difficult to decide whether this


lesion was a cystic lesion or benign tumor.
MRIs showed a mass that displayed homogeneous
isointensity on T1WIs (Figure 3, A), heterogeneous isoto hyperintensity on STIR images (Figure 3, B), and
heterogeneous strong enhancement on CE-T1WIs (Figure 3, C). From these MR findings, we diagnosed this
lesion as some kind of benign tumor, such as an odontogenic myxoma or ameloblastoma.
Before surgery, dental treatments for the vital teeth
adjacent to the lesion, from the upper left lateral incisor
to the second premolar, were carried out. First, root
canal treatment of the other teeth except for the first
premolar, of which almost all parts of the root was
included in the lesion, was performed. Then, the lesion
was surgically removed, and the first premolar was
extracted under local anesthesia and intravenous sedation. At the same time, apicoectomy of the second
incisor and the second premolar, of which root apexes
involved the lesion, were performed, whereas the canine was not treated because it remained intact from the
lesion.
The surgical specimen was composed of a fibrous
tissuelike tumor mass. The tumor consisted of minimally cellular, dense fibrous connective tissue with
sparse islands of odontogenic epithelial tissue (Figure
4, A and B). In some areas, lymphocyte infiltration was
observed as part of a secondary inflammatory reaction
(Figure 4, A). Histopathologically, the lesion was diagnosed as odontogenic fibroma, epithelium-poor type
(simple type), according to the revised WHO classification published in 2005.

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Volume 113, Number 6

Figure 2. CT image (case 1). An axial image obtained with


the bone window showing a multilocular mass with a welldefined margin with palatal bony expansion in the upper left
canine region.

The patient did not suffer any recurrence during the


1-year follow-up period. Conventional radiographs 1
year after surgery displayed a reduction of the radiolucent region because of marginal bone regeneration.
Case 2
In April 2008, a 12-year-old girl underwent fenestration
of a suspected odontogenic cyst located in the lower
right molar region at another hospital. Her primary
surgeon noticed that the lesion had a solid component
during the operation, however, and stopped the operation, and performed a biopsy. Although the histopathological diagnosis of the lesion was still unknown, she
was referred to our hospital by her primary doctor. She
had not noticed any symptoms until the first operation.
Her medical history revealed tricuspid regurgitation
and premature ventricular contraction.
Conventional radiographs displayed a unilocular
radiolucent lesion with a well-defined margin in the
lower right molar region. Her second molar was
impacted, although not fully, and 2 teeth had been
displaced by the lesion (Figure 5, A and B). On a CT
image (bone window), it was found that the lesion
included the follicular space of the second molar, and
buccal bony expansion was seen (Figure 6, A and B).
Based on these findings, we diagnosed this lesion as
an ameloblastoma or keratocystic odontogenic tumor. Thereafter, we were notified that the biopsy
specimen obtained by her primary surgeon had been
diagnosed as OF.

CASE REPORT
Hara et al. e53

MRI showed a lesion that displayed heterogeneous


isointensity on T1WIs (Figure 7, A), heterogeneous
hypo- to isointensity on STIR images (Figure 7, B), and
heterogeneous strong enhancement on CE-T1WIs (Figure 7, C). Part of the lesion showed differential signal
intensities, i.e., it was hyperintense on T1WIs, hyperintense on STIR images, and displayed weak enhancement on CE-T1WIs. We considered that these MR
findings reflected hemorrhaging caused by the fenestration. These findings were compatible with the diagnosis of OF obtained by biopsy.
The lesion was surgically removed, and the third
molar, together with the remaining portion of the lesion, was extracted under general anesthesia. Because
of the patients age, the second molar was not extracted.
The surgical specimen included the oral epithelium and
submucosal connective tissue. A tumor mass, which
was composed of fibrous tissue with comparatively few
fibroblasts, was observed in the deep area of the connective tissue (Figure 8, A). An admixture of myxoid
tissue and scattered small nests of odontogenic epithelium was observed in some areas (Figure 8, B and C).
These histopathological findings were congruent with a
diagnosis of odontogenic fibroma, epithelium-poor type
(simple type).
Three months after surgery, the second premolar
fully erupted. Two years and 4 months later, there were
no signs of recurrence.
Retrospective dynamic data analysis
The TICs of the 2 cases showed a similar pattern
(Figure 9), i.e., their TIC increased rapidly until 200
seconds and then gradually continued to increase until
about 800 seconds without washout of the contrast
medium.

DISCUSSION
OF is a benign odontogenic neoplasm arising from the
jawbone that is categorized into various types, i.e., it is
histologically divided into 2 types: the epithelium-poor
type (simple type) and the epithelium-rich type (complex or WHO type) and is topographically classified
into 2 types: the intraosseous or central type and the
extraosseous or peripheral type, according to WHO.1 In
this study, both cases involved the central type of OF.
The central and peripheral types of OF represent
approximately 0.1% and 1% to 2% of all odontogenic
tumors, respectively.6 OFs can appear at any age, although they display a predilection for females, and both
of our patients were females (in their first and second
decade, respectively).4,9,10,12 OFs most commonly occur in the anterior region of the maxilla and the posterior region of the mandible.4,5,7,9 In our cases, one OF
was found in the anterior region of the maxilla, and the

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Figure 3. MR images (case 1). The MR images of this case show a tumor (arrows) that displays homogeneous isointensity on
T1WI (A) and heterogeneous iso- to hyperintensity on STIR images (B). On CE-T1WI, the tumor shows strong heterogeneous
enhancement (C).

Figure 4. Histopathological findings (case 1). The surgical specimen was composed of dense fibrous connective tissue, which
showed a minimal cellular appearance accompanied by a partial inflammatory reaction (A; hematoxylin-eosin stain, 100). In the
connective tissue, scattered islands or chords of odontogenic epithelium were observed (B; hematoxylin-eosin stain, 200).

other was located in the posterior region of the mandible.18


Clinically, central OFs show asymptomatic slow
growth, which results in cortical expansion.5-7,12,19-21
In our cases, neither patient had noticed any symptoms
before their primary doctor detected a radiolucent lesion during a radiographic examination.
Radiologically, conventional radiographs and CT
images of central OF display uni- or multilocular radiolucent areas with well-defined margins1,6-8; however,
these radiological findings are not specific to central
OF.12,13 Both of our cases showed uni- or multilocular
radiolucent areas with well-defined margins. Because
of the effects of the lesion on the neighboring teeth,
root resorption was seen in case 1, although it was not

observed in case 2. One lesion (case 2) was associated


with the crown of an unerupted tooth. Bony expansion
was not seen in case 1, but was present in case 2. These
radiological findings agreed with those described in
previous reports of central OF, and it was difficult to
distinguish these lesions from cystic lesions and benign
tumors, such as dentigerous cyst, simple bone cyst,
ossifying fibroma, ameloblastoma, odontogenic myxoma, calcifying cystic odontogenic tumor, and fibrous
dysplasia.
To the best of our knowledge, there are no reports
about the MR findings of OF in the literature. In our
cases, MRI of the lesion in case 1 found that it displayed homogeneous isointensity on T1WIs and heterogeneous iso- to hyperintensity on STIR images. In

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CASE REPORT
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Figure 5. Panoramic radiograph and posterior-anterior projection (case 2). A panoramic radiograph and posterior-anterior
projection showing a unilocular radiolucent lesion with a well-defined margin together with second molar impaction and third
molar displacement in the lower right molar region (A, B).

Figure 6. CT images (case 2). The axial (bone-window) image shows a unilocular mass with a well-defined margin together with
bony expansion in the lower right molar region (A). A reconstructed sagittal image obtained with the bone window showing a
lesion involving the second molar crown that has displaced the third molar tooth germ (B).

addition, case 2 demonstrated an area of varying signal


intensity in the lesion, which was assumed to reflect
hemorrhaging caused by fenestration of the lesion, on
T1WIs and STIR images. In case 2, most of the lesion,
excluding the hemorrhagic area, showed similar signal
intensities to those seen in case 1 on T1WIs and STIR
images. On CE-T1WIs, both lesions displayed heterogeneous strong enhancement, although that in case 2
had a low enhancement area owing to fenestration. As
we mentioned previously, the conventional radiographs
of central OF and cystic lesions, such as keratocystic

odontogenic tumors, dentigerous cyst, and so forth,


display similar findings, i.e., a uni- or multilocular
radiolucent area with a well-defined margin. On the
other hand, MRIs of fluid-containing cystic lesions in
the jawbone show a mass that displays homogeneous
hypointensity on T1WIs and homogeneous hyperintensity on T2WIs (STIR images).22 Therefore, MRI is
useful for distinguishing central OF from these cystic
lesions of the jawbone. Otherwise, MRIs of benign
tumors of the jawbone, such as ameloblastoma, myxoma, adenomatoid odontogenic tumor, and so forth,

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Figure 7. MR images (case 2). The MR images show a tumor displaying heterogeneous isointensity on T1WI (A) and heterogeneous
hypoisointensity on STIR images (B). Part of the tumor appeared hyperintense on T1WI and STIR images (A, B). On CE-T1WI, the
tumor showed strong heterogeneous enhancement outside of the area that appeared hyperintense on T1WI and STIR images (C).

Figure 8. Histopathological findings (case 2). A tumor mass was observed in the deep areas of connective tissue (A; hematoxylin-eosin
stain, 20). The tumor mass consisted of comparatively acellular fibrous connective tissue, which was admixed with myxomatous tissue
(B; hematoxylin-eosin stain, 100). The odontogenic epithelium in the tumor mass formed small islandlike nests (C; hematoxylin-eosin
stain, 200).

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Volume 113, Number 6

Figure 9. TIC of odontogenic fibromas (Case 1 and Case 2).


The TIC of both cases (case 1: blue line; case 2: green line)
increased rapidly until 200 s and then gradually continued to
increase until about 800 s without washout of the contrast
medium.

display various features depending on the sequence


being used.14,16,17,22-25 Furthermore, ameloblastoma
and adenomatoid odontogenic tumors are divided into
several types, such as the cystic and solid types, and
display various MR findings because of the different
components of each type.22 Because our OF cases did
not display a liquid component, it might be possible to
differentiate OF from lesions with liquid components;
however, it is difficult to differentiate OFs from lesions
without a liquid component.
The TIC of our 2 cases showed the same pattern, i.e.,
the curve increased rapidly until 200 seconds and then
continued to gradually increase until about 800 seconds
without washout of the contrast medium. We previously reported the contrast index (CI), which was calculated from DCE-MRI parameters, curves of ameloblastomas and odontogenic myxomas.16,17 The CI
curves of ameloblastomas showed various patterns, but
could be broadly divided into 2 patterns. In the first
pattern, the CI curve increases, reaches a plateau at 100
to 300 seconds, and then continues to plateau or decreases gradually from 600 to 900 seconds, whereas in
the second pattern, the curve increases relatively rapidly, reaches a plateau at 90 to 120 seconds, decreases
relatively rapidly to 300 seconds, and then decreases
gradually thereafter.16 The histopathological type of the
lesion, e.g., whether it was a plexiform, follicular,
mixed, desmoplastic, or unicystic ameloblastoma, did
not affect the CI curve pattern.16 The CI curves of our
central OF could be differentiated from those of ameloblastomas, except for a few cases that showed the
former CI curve pattern. Most ameloblastomas had
cystic components, however, and could be differentiated from central OF on MRI. We considered that MRI,
including DCE-MRI is useful for differentiating central
OF from ameloblastomas. The CI curves of the odon-

CASE REPORT
Hara et al. e57

togenic myxomas described in our previous article displayed a pattern involving gradually increasing enhancement without washout of the contrast medium
until 500 to 600 seconds, which was different from that
of OF, which involved rapidly increasing enhancement
until 200 seconds.17 We consider that DCE-MRI makes
it possible to differentiate central OF from odontogenic
myxomas.
The TIC of our OF showed increasing signal intensities until 800 seconds, indicating that the inflow of
contrast medium was greater than its washout during
this period. Various authors have reported that the rich
fibrous tissues in the extracellular spaces of some tumors reduce the washout of contrast medium.26,27 OFs
are nonepithelial benign tumors arising from odontogenic mesenchymal tissue; however, our OFs were of
the simple type, and lesions of this type contain small
amounts of epithelial tissue.1,5,7,9,28,29 The histopathological findings of our OFs, which contained more rich
fibrous tissue than epithelial tissue, agreed with the
results of previous articles. Therefore, we consider that
a TIC that increases for a long time after the administration of contrast medium is a characteristic finding of
OF arising from odontogenic mesenchymal tissue.
Ossifying fibromas also arise from mesenchymal tissue and are one of the differential diagnoses of central
OF. Ossifying fibromas display various histopathological and radiographic features depending on the contributions of their soft and hard tissue components.1,30 In
ossifying fibromas with hard tissue components, it is
possible to differentiate between ossifying fibromas and
central OF on conventional radiographs and CT images. On the other hand, when the lesion is composed
of mesenchymal soft tissue, it is difficult to distinguish
ossifying fibromas from OF, not only on conventional
radiographs and CT images, but also on MRI, including
DCE-MRI. Therefore, we had to compare the TIC of
our cases with those of ossifying fibromas, but there are
no reports about the DCE-MRI characteristics of OF.

CONCLUSIONS
We have reported 2 cases of central OF of the jawbone.
It was difficult to diagnose these lesions as OF because
they did not display characteristic radiological features.
MRIs of OF show a mass that displays homogeneous
isointensity on T1WIs, heterogeneous iso- to hyperintensity on STIR images, and heterogeneous strong enhancement on CE-T1WIs. The MRI findings of these
cases were different from those of jawbone cysts, although they were similar to those of odontogenic tumors. The TIC of OF rapidly increased in the early
phase and gradually increased without contrast medium
washout in the late phase. The TIC pattern of OF is
different from those of other odontogenic tumors of the

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e58 Hara et al.

jawbone, which allowed us to distinguish our OFs from


these tumors. Therefore, we consider that dynamic MRI
is useful for diagnosing central OF.

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June 2012

16.

REFERENCES
1. Barnes L, Eveson JW, Reichart P, Sidransky D. International
Agency for Research on Cancer. Pathology and genetics of head
and neck tumours. Lyon: IARC; 2005. p. 315.
2. Skinner RL, Davenport WD Jr, Weir JC, Carr RF. A survey of
biopsied oral lesions in pediatric dental patients. Pediatr Dent
1986;8:163-7.
3. Das S, Das AK. A review of pediatric oral biopsies from a
surgical pathology service in a dental school. Pediatr Dent
1993;15:208-11.
4. Ramer M, Buonocore P, Krost B. Central odontogenic fibroma
report of a case and review of the literature. Periodontal Clin
Investig 2002;24:27-30.
5. Kaffe I, Buchner A. Radiologic features of central odontogenic
fibroma. Oral Surg Oral Med Oral Pathol 1994;78:811-8.
6. Daskala I, Kalyvas D, Kolokoudias M, Vlachodimitropoulos D,
Alexandridis C. Central odontogenic fibroma of the mandible: a
case report. J Oral Sci 2009;51:457-61.
7. Covani U, Crespi R, Perrini N, Barone A. Central odontogenic
fibroma: a case report. Med Oral Patol Oral Cir Bucal 2005;
10(Suppl 2):E154-7.
8. Regezi JA. Odontogenic cysts, odontogenic tumors, fibroosseous, and giant cell lesions of the jaws. Mod Pathol 2002;
15:331-41.
9. Raubenheimer EJ, Noffke CE. Central odontogenic fibroma-like
tumors, hypodontia, and enamel dysplasia: review of the literature and report of a case. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2002;94:74-7.
10. Cercadillo-Ibarguren I, Berini-Ayts L, Marco-Molina V, GayEscoda C. Locally aggressive central odontogenic fibroma associated to an inflammatory cyst: a clinical, histological and immunohistochemical study. J Oral Pathol Med 2006;35:513-6.
11. Bonetti GA, Marini I, Zucchelli G, Checchi L. Obstruction of the
eruption pathway by peripheral odontogenic fibroma: report of a
patient. Am J Orthod Dentofacial Orthop 2008;133:303-7.
12. Daniels JS. Central odontogenic fibroma of mandible: a case
report and review of the literature. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2004;98:295-300.
13. MacDonald-Jankowski DS. Fibro-osseous lesions of the face and
jaws. Clin Radiol 2004;59:11-25.
14. Hisatomi M, Yanagi Y, Konouchi H, Matsuzaki H, Takenobu T,
Unetsubo T, Asaumi J. Diagnostic value of dynamic contrastenhanced MRI for unilocular cystic-type ameloblastomas with
homogeneously bright high signal intensity on T2-weighted or
STIR MR images. Oral Oncol 2011;47:147-52.
15. Yanagi Y, Asaumi J, Unetsubo T, Ashida M, Takenobu T,
Hisatomi M, et al. Usefulness of MRI and dynamic contrast-

17.

18.
19.
20.

21.

22.

23.

24.

25.

26.

27.

28.
29.

30.

enhanced MRI for differential diagnosis of simple bone cysts


from true cysts in the jaw. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2010;110:364-9.
Asaumi J, Hisatomi M, Yanagi Y, Matsuzaki H, Choi YS, Kawai
N, et al. Assessment of ameloblastomas using MRI and dynamic
contrast-enhanced MRI. Eur J Radiol 2005;56:25-30.
Asaumi J, Matsuzaki H, Hisatomi M, Konouchi H, Shigehara H,
Kishi K. Application of dynamic MRI to differentiating odontogenic myxomas from ameloblastomas. Eur J Radiol 2002;
43:37-41.
Gardner DG. The peripheral odontogenic fibroma: an attempt at
clarification. Oral Surg Oral Med Oral Pathol 1982;54:40-8.
Dunlap CL. Odontogenic fibroma. Semin Diagn Pathol 1999;16:
293-6.
Huey MW, Bramwell JD, Hutter JW, Kratochvil FJ. Central
odontogenic fibroma mimicking a lesion of endodontic origin. J
Endod 1995;21:625-7.
Ikeshima A, Utsunomiya T. Case report of intra-osseous fibroma:
a study on odontogenic and desmoplastic fibromas with a review
of the literature. J Oral Sci 2005;47:149-57.
Hisatomi M, Asaumi J, Konouchi H, Yanagi Y, Matsuzaki H,
Kishi K. Comparison of radiographic and MRI features of a
root-diverging odontogenic myxoma, with discussion of the differential diagnosis of lesions likely to move roots. Oral Dis
2003;9:152-7.
Konouchi H, Asaumi J, Yanagi Y, Hisatomi M, Kishi K. Adenomatoid odontogenic tumor: correlation of MRI with histopathological findings. Eur J Radiol 2002;44:19-23.
Konouchi H, Asaumi J, Yanagi Y, Hisatomi M, Kawai N, Matsuzaki H, Kishi K. Usefulness of contrast enhanced-MRI in the diagnosis of unicystic ameloblastoma. Oral Oncol 2006;42:481-6.
Minami M, Kaneda T, Ozawa K, Yamamoto H, Itai Y, Ozawa
M, et al. Cystic lesions of the maxillomandibular region: MR
imaging distinction of odontogenic keratocysts and ameloblastomas from other cysts. AJR Am J Roentgenol 1996;166:943-9.
Yabuuchi H, Fukuya T, Tajima T, Hachitanda Y, Tomita K,
Koga M. Salivary gland tumors: diagnostic value of gadoliniumenhanced dynamic MR imaging with histopathologic correlation.
Radiology 2003;226:345-54.
Murakami T, Nakamura H, Tsuda K, Ishida T, Tomoda K, Hori
S, et al. Contrast-enhanced MR imaging of intrahepatic cholangiocarcinoma: pathologic correlation study. J Magn Reson Imaging 1995;5:165-70.
Lucas RB. Pathology of tumours of the oral tissues. 4th ed.
Edinburgh: Churchill Livingstone; 1984. p. 162-5.
Jones GM, Eveson JW, Shepherd JP. Central odontogenic fibroma. A report of two controversial cases illustrating diagnostic
dilemmas. Br J Oral Maxillofac Surg 1989;27:406-11.
Mishra AK, Bhusari P, Kanteshwari K. Peripheral cementoossifying fibromaa case report. Int J Dent Hyg 2011;9:234-7.

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