From the Guidelines
The diagnosis and treatment of an atypical fibro-osseous lesion should involve a multidisciplinary approach, with referral to a reference centre for sarcomas, and management should be based on a combination of imaging, biopsy, and pathological diagnosis, with surgical excision being the primary treatment option. The diagnosis of an atypical fibro-osseous lesion typically involves imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, which can help identify the location and extent of the lesion 1. However, a definitive diagnosis can only be made through a biopsy, which should be carried out by a surgeon or a radiologist after multidisciplinary discussion, as needed, within reference centres 1. The biopsy should be planned in such a way that the biopsy pathway and the scar can be safely removed by definitive surgery, and the tumour sample should be fixed in 4% buffered formalin rapidly 1. The pathological diagnosis should be made according to the 2013 World Health Organization (WHO) classification, and a pathological expert validation is required in all cases when the original diagnosis was made outside a reference centre/network 1. The treatment of an atypical fibro-osseous lesion typically involves surgical excision, with complete surgical removal with curettage being recommended for symptomatic lesions or those showing growth. Following excision, regular follow-up with clinical examinations and imaging every 6-12 months for at least 2 years is advised to monitor for recurrence, which occurs in approximately 10-15% of cases. It is essential to note that while these lesions are generally benign, they require proper evaluation to distinguish them from more aggressive conditions like low-grade osteosarcoma or fibrous dysplasia. The key to effective management is a multidisciplinary approach, with referral to a reference centre for sarcomas, and management should be based on a combination of imaging, biopsy, and pathological diagnosis, with surgical excision being the primary treatment option. Some key points to consider in the management of atypical fibro-osseous lesions include:
- Referral to a reference centre for sarcomas
- Imaging studies such as MRI or CT scans
- Biopsy and pathological diagnosis
- Surgical excision as the primary treatment option
- Regular follow-up with clinical examinations and imaging to monitor for recurrence.
From the Research
Diagnosis of Atypical Fibro-Osseous Lesions
- The diagnosis of atypical fibro-osseous lesions can be challenging due to their similar histologic and radiographic features, despite varying biologic behaviors 2, 3.
- A biopsy is often necessary to obtain histopathological confirmation of the diagnosis, as imaging findings can overlap between different sub-types of fibro-osseous lesions 3.
- Radiology plays a central role in the diagnosis of maxillofacial fibro-osseous lesions, as the pathology for all these lesions is similar, but their behavior and management can differ significantly 4.
Treatment of Atypical Fibro-Osseous Lesions
- Treatment of atypical fibro-osseous lesions is varied and depends on the biologic behavior of the tumor, rather than its histologic appearance 2, 5.
- For some lesions, such as cemento-ossifying dysplasia, no treatment may be necessary, while others, like cemento-osseous fibromas, may require surgical treatment 4.
- Fibrous dysplasia, a common entity among fibro-osseous lesions, is treated according to its clinical presentation, which can range from review and follow-up to surgery to address deformity or functional impairment 4, 6.
- The management of fibro-osseous lesions requires a comprehensive approach, taking into account their clinical, radiographic, and histopathological features, as well as their potential for growth and prognosis 5, 6.