Central and peripheral fibrogenic and neurogenic sarcoma of the oral regions

Neurogenic tumors and tumor-like lesions of the oral and maxillofacial region: A clinicopathological study

Objective

Oral and maxillofacial lesions of neural origin are rare soft tissue neoplasms. The aim of the present study is to review the epidemiological data of oral and maxillofacial neurogenic lesions submitted for diagnosis to our laboratory over a 31-year period (August 1984–March 2015).

Materials and methods

The available formalin-fixed embedded specimens, Hematoxylin and Eosin slides, demographic and clinical data were retrieved.

Results

Thirty-one cases were included in this study, representing 0.6% of the 5161 biopsies submitted. Most of the diagnosed cases 11 (35.5%) were traumatic neuromas. The other cases included 2 (6.5%) solitary circumscribed neuromas, 2 (6.5%) melanotic neuroectodermal tumors of infancy, 2 (6.5%) Schwannomas, 5 (16.1%) granular cell tumors, and 9 (29%) neurofibromas. The patients’ ages ranged from 5 months to 78 years. Among these cases, 16 were males (51.61%) and 15 were females (48.38%).

Conclusion

This analysis showed that neural lesions affecting the oral and maxillofacial region were rare and mostly benign in nature. Such lesions should be carefully diagnosed because of their association with life-threatening syndromes and the possibility of malignant transformation.

Intra Oral Fibrosarcoma with Various Histopathological Patterns: A Rare Case Report

Fibrosarcoma has been defined as a malignant mesenchymal tumour, the cells of which recapitulate the appearance of the normal fibroblast, with variable collagen production. Fibrosarcoma is a very uncommon tumour in the head and neck regions constituting only 0.05% of all the fibrosarcomas presenting in humans. They cause no characteristic symptoms and pose difficulty in clinical diagnosis. They have been classified histologically based on their distinct features into myxoid fibrosarcoma, low grade fibromyxoid fibrosarcoma and sclerosing epitheloid sarcoma. Here we present a rare case report of a 45-year-old male patient presenting with a maxillary fibrosarcoma, which histologically presented with different patterns.

Malignant peripheral nerve cell tumour

Malignant Peripheral Nerve Sheath Tumour (MPNST) also termed as spindle cell malignancy of the peripheral nerve schwann cell or neurogenic sarcoma represents 10% of all soft tissue sarcomas. The tumour is usually found in lower extremities and only 10% to 20% of all lesions occur in head and neck region thus making it a rare entity. Central involvement, particularly in the jaw bones is quite unusual. Neurofibroma is one of the common nerve sheath tumours occurring in the soft tissues and generally appears in neurofibromatosis I (NF-I or von recklinghausen's disease). MPNST are uncommon sarcomas that almost always arise in the soft tissues. Here we report a case of intraosseous peripheral nerve sheath tumour occurring in the mandible and discuss the surgical management with adjuvant and neoadjuvant treatment plan.

Malignant peripheral nerve sheath tumour in the maxilla associated with von Recklinghausen's disease

Malignant transformation of neurofibromatosis is one of the most serious complications of von Recklinghausen's disease (VRD). The most common associated malignancy is the malignant peripheral nerve sheath tumour (MPNST). Few cases of MPNST associated with VRD in the maxillary region have been reported. This report describes a rare case of MPNST in the maxilla and the aggressive nature of MPNST associated with VRD.

A rare case of fibrosarcoma of the jaws in a 4-year-old male

A case of fibrosarcoma in a 4-year-old male child is reported. Primary fibrosarcomas of bone in the head and neck region are rare. The histological appearance of the tumour is related to its grade of differentiation. It could present a high level of cellularity and the amount of collagen is variable. The accepted treatment is radical surgery; however, metastases could occur in the lungs. This article is presented to highlight the rarity of fibrosarcomas in the jaws of children.

Maxillary fibrosarcoma with extracellular immuno-characterization

Maxillary fibrosarcoma of a 31-year-old female is described with special reference to immunofluorescent characterization of the extracellular matrix. Following extractions, endodontic treatment and occlusal adjustment the tumour was operated on. The spindle-shaped tumour cells displayed a herring-bone pattern. The tumour was diagnosed as a fibrosarcoma and graded as poorly differentiated. Immunostaining for the specific type I collagen was positive throughout the tumour matrix, whereas staining for type III collagen was faint and occasional, and did not definitely codistribute with reticulin. Staining for type IV collagen and fibronectin in the tumour matrix was negative.

Malignant schwannoma of the gingiva

A case of malignant schwannoma on the buccal-attached gingiva in the right mandible is described. There was no evidence of multiple neurofibromatosis and the tumor was totally excised. Numerous closely-packed spindle-shaped cells showing marked mitotic activity were seen. The recognizable pattern of neurilemmoma could be observed focally in a small area of the tumor. At two years follow-up, the patient has remained symptom-free with no signs of metastasis.

Malignant schwannoma of the mandible

A case of malignant schwannoma occurring in the mandible of a 76-year-old Japanese woman is presented. Results of the gross examination are described as well as the surgical procedure. Details of the staining techniques for examination of the biopsy specimen are given. The histopathological findings are mentioned including those obtained from radiographic, microscopic, and electron microscopic examination. A discussion of the disease and of its difficulty of diagnosis follows.

Malignant fibrous histiocytoma of jaws. A clinicopathologic study of 11 cases

Malignant fibrous histiocytoma (MFH) of the jaws is a highly malignant tumor that recurs, metastasizes, and usually causes death despite aggressive surgical therapy. This clinicopathologic review looks at five patients with MFH of the maxilla and six with MFH of the mandible. Five male and six female patients ranged in age from 12 to 75 years (mean, 35.4 years). All patients had large lytic areas of bone destruction, often with soft tissue extension. Two cases were postirradiation sarcomas, one of the maxilla and the other of the mandible. All patients underwent surgery and eight patients received chemotherapy when disease recurred locally or metastasized. Seven patients had local recurrences 3 to 13 months following surgery, and six patients had distant metastases. Of the 11 patients, 7 died of their disease, 1 died of unknown causes, and another with extensive local disease was lost to follow-up after 1.7 years. Two patients with recurrent disease are alive at 18 and 27 months postoperatively.

Fibrosarcoma of the mandible

Fibrosarcoma is a rare malignancy in the oral cavity. Tumours of fibrous connective tissue are sometimes difficult to classify as benign or malignant. The literature is reviewed and three cases of oral fibrosarcoma are presented.

Benign fibroblastic tumor-like lesion simulating malignancy in the maxilla

A benign fibroblastic lesion simulating malignancy is reported. The lesion occurred in the right maxilla of an 11-year-old girl and perforated the outer cortical plate, suggesting malignancy. The biopsy, however, revealed proliferation of fibroblasts and fibrocytes with neither prominent atypia nor mitosis in a myxoid matrix. Electron microscopy showed that some fibroblastic cells were indeed myofibroblasts. As the lesion did not belong to any established entities, the final pathological diagnosis of benign fibroblastic lesion was made, leading to conservative surgery. The patient is well without recurrence 18 months after surgery.

Fibrosarcoma of the jaws. A study of 7 cases

Seven cases of fibrosarcoma of the jaws are presented. Five cases were in the mandible and 2 involved the maxilla. There were 3 males and 4 females and ages varied from 11 to 59 years. Four patients were in their third decade. All patients died of their tumour. Reason for death was local extension (2 patients); metastatic spread (2 patients); both local extension and metastatic spread (2 patients); and post-operative complications (1 patient). Factors causing this unfavourable clinical course are discussed. Chemotherapy and irradiation were of no therapeutic benefit. Some notes on histogenesis are made with respect to an odontogenic origin of jaw fibrosarcoma. This possibility exists but contributory evidence is equivocal unless a secondary fibrosarcoma has arisen in a benign odontogenic tumour.

[Neurogenic sarcoma of the head and neck with contact to the skull base (author's transl)]

The neurogenic sarcoma is a neoplasm found seldom. It descends from the sheaths of peripheric nerves. If this tumor develops from a solitary or multiple neurofibroma, it might also be called a neurofibrosarcoma. All other synonyms, especially that of the malignant schwannoma, should better be abandoned for histogenetic reasons. Today the classification of all tumors of the peripheral nervous system is based on a suggestion of the WHO from 1969. The tabular summary of the literature shows that only a little more than a hundred cases of neurogenic sarcoma of the head and neck were reported during the last 50 years. Differential diagnosis of this malignant tumor includes nearly all other malignant neoplasms of soft tissue, sometimes even anaplastic carcinoma. Histopathology, including electron microscopy, is described in general and also in detail with regard to three cases. Three forms of micro-morphological variants are dealt with, too. For diagnosis histological examination will be absolutely successful only in cases of neurofibromatosis or in cases where the nerve from which the tumor originates may be identified. Otherwise, conventional and computerized X-ray tomography may be helpful. Finally, some therapeutic and prognostic principles are discussed.