central odontogenic fibroma ( cof ) is a very rare proliferation of mature odontogenic mesenchyme and hence that locations and sex and age distributions can not be accurately determined . in general the lesion may evolve from a dental germ ( dental papilla or follicle ) or from the periodontal membrane , and , therefore , is invariably related to the coronal or radicular portion of teeth . radiographically the tumor sometimes produces an expansile multilocular radiolucency similar to that of the ameloblastoma . the rarity of this tumor excludes it from most differential lists , and when diagnosed , it is an unexpected finding that usually requires expert second opinions for confirmation . most presentations will suggest the more common radiolucent odontogenic cysts and tumors such as an odontogenic keratocyst , an ameloblastoma or an odontogenic myxoma , as well as an ameloblastic fibroma in children and teenagers . in younger individuals a 15-year - old female patient presented with a painless swelling on the left side of the upper jaw . the parents patient first noticed the swelling when she was still a child , and it was increasing slowly . as she was growing up , the patient started having aesthetic discomfort . extraoral examination revealed facial asymmetry with a hard swelling on the left buccal side of the upper jaw , extending from temporal area to the cheek [ figure 1 ] . on intraoral examination , a swelling extending from distal of left mandibular canine back to tuberosity was noticed . the lesion had a firm consistency . facial asymmetry with a hard swelling on the left buccal side of upper jaw , extending from temporal area to the cheek intraoral examination revealing a swelling extending from distal of left mandibular canine back to tuberosity was noticed with normal appearance of the overlying mucosa orthopantomogram showed a large maxillary multilocular radiolucent lesion , extending from left second premolar to the maxillary tuberosity region . axial computed tomography scan demonstrated a mass of the maxilla , which expanded the buccal cortical plate and perforated bone cortex in some places [ figure 4 ] . orthopantomogram showing a large maxillary multilocular radiolucent lesion , extending from left second premolar to the maxillary tuberosity region axial computed tomography scan showing the expansion of the tumor mass to the maxillary sinus , as well as the bone perforation three - dimensional view showed the large bone destruction and the impacted teeth differential diagnosis of the lesion included ameloblastoma , odontogenic myxoma . the tumor was treated by enucleation under general anesthesia and was found to be a well circumscribed , solid mass that was separated easily from surrounding bone and was enucleated one piece [ figure 6 ] . the histopathological examination revealed a tumor consisting of fibrous tissue with myxoid areas along with islands and strands of the inactive odontogenic epithelium . the tumor was treated by enucleation under general anesthesia and was found to be a well circumscribed , solid mass that was separated easily from surrounding bone and was enucleated one piece based on clinical , radiographic and histological findings , a diagnosis of cof was made , and the patient was advised a long - term follow - up . cof is a rarely encountered and benign neoplasm that could appear very similar to the other odontogenic tumors . however , odontogenic fibroma is considered as a distinct neoplasm with its own histopathologic and clinical features separating it from other odontogenic tumors . there is no gender predilection in some reports and some others present mild female dominant . the age of the patients varies from 4 to 80 , and it is more frequent in the third or fourth decades of life . clinically , cof is expansible and slow - progressing , and it is usually asymptomatic intraosseous neoplasm , similar to our case . radiographically , cof tends to be unilocular radiolucent lesion with well - defined borders similar to odontogenic cysts , central giant cell granuloma , traumatic bone cyst , as well as ameloblastoma . radiographic findings may show a multilocular radiolucent lesion with ill - defined borders , the differential diagnosis consists of benign lesions such as ameloblastic fibroma , odontogenic myxoma and aggressive lesions such as desmoplastic fibroma , juvenile aggressive fibromatosis or fibrosarcoma . sometimes , the small radiolucent lesions of the codf may resemble as dentigerous or apical cysts . however , the large ones are possessed of the potential to cause tooth divergence , tooth displacement or extensive external resorption of the associated roots . histopathologically , the codf is featured by one or more of the following characteristics : fibrous or myxoid stroma , odontogenic epithelium and calcifications . scattered fibroblasts within a collagen - rich background are often seen . recently the codf is classified into two types : the epithelium - rich type ( formerly termed the who - type ) and the epitheliuml - poor type ( formerly termed the simple type ) . the epithelium - poor type lesions are less cellular , and the epithelial tissue is not necessarily presented . it is generally agreed that the odontogenic epithelium is not always presented in the codf . when presented , epithelial nests or epithelial cords are probably distributed throughout the tumor . if the epithelium is absent , the histological feature mimics desmoplastic fibroma which is more malignant potential than the codf . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s)has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s)has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .
central odontogenic fibroma ( cof ) is an uncommon tumor that accounts for 0.1% of all odontogenic tumors ; it has been defined as a benign neoplasm of the jaw . 
 clinically , the lesion grows slowly and leads to cortical expansion . 
 radiologically , the most common finding is multilocular radiolucency . 
 the lesions are associated with the crown of an unerupted molar , premolar , or incisor tooth and in some cases , with root resorption or displacement . 
 histologically , the lesion is characterized by mature collagen fibers and numerous fibroblasts . 
 cof responds well to surgical enucleation with no tendency for malignancy or recurrence . 
 we report a case of a 15-year - old female patient presented with painless swelling of the left side of the maxilla since her childhood . 
 radiographs revealed an expanding ill - defined radiolucency with a displacement of the adjacent tooth . 
 the impacted tooth was pushed posteriorly . 
 the lesion was removed surgically . 
 there were no postoperative complications .