Benign fibrous histiocytoma in the mandible

Solitary primary intraosseous xanthoma of the mandible in a 15-year-old boy: a case report

BACKGROUND

A xanthoma is a rare bone condition consisting of a predominant collection of lipid-rich, foamy histiocytes. The central xanthoma of the jaws is a unique benign tumor.

CASE REPORT

A 15-year-old Caucasian male has been presented to our department. He had radiological changes in the area of the left mandibular angle, with an area of diffuse osteolysis of 3.0 cm by 2.0 cm. Computed tomography reveals an area of diffuse osteolysis that starts from the distal root of the lower second molar and reaches the ascending process. A bone biopsy was performed, which revealed a benign proliferative process composed of histiocytic cells involving and infiltrating trabecular bone in a background of loose fibrous connective tissue devoid of any other significant inflammatory infiltrate. The size of the formation was 2.9 cm by 2.0 cm. Immunohistochemical staining for CD68 was strongly positive and negative for S-100 and CD1a. From routine blood tests, cholesterol, triglycerides, and blood sugar are within normal values, which excludes systemic metabolic disease. Subsequent to the surgical intervention, the patient underwent postoperative assessments at intervals of 14, 30, 60 days, and a year later, revealing the absence of any discernible complications during the aforementioned observation periods.

CONCLUSION

The diagnosis of primary xanthoma of the mandible is rare and can often be confused with other histiocytic lesions. A differential diagnosis should be made with nonossifying fibroma and Langerhans cell histiocytosis, as in our case. In these cases, immunohistochemistry with CD 68, S-100, and CD1a, as well as blood parameters, are crucial for the diagnosis.

Literature Review, Case Presentation and Management of Non-ossifying Fibroma of Right Angle of Mandible: More Than just a Cortical Defect!

Non-ossifying fibroma (NOF) of jaw bones are rare. While NOF is the most common benign bone tumor of long bones with pathognomonic radiological features and bear a tendency for self-regression, gnathic NOF appears to be comparatively larger in size and behave more aggressively. A 16 years old female patient reported with painless swelling of the right side of the face of 4 months duration. Radiographic analysis showed a unilocular radiolucent lesion of right angle of the mandible with ill-defined margins, cortical perforation and thinning of inferior border. The lesion was provisionally diagnosed as odontogenic keratocyst/unicystic ameloblastoma and incisional biopsy was performed. The histopathological features and immunohistochemical characteristics favored a diagnosis of NOF. The lesion was excised and reconstructed. The excised specimen confirmed the diagnosis. There are no signs of recurrence at 18 months follow-up. NOF should be considered in the differential diagnosis of uni-/multilocular radiolucencies of jaws particularly the posterior mandible.

Benign fibrohistiocytic jaw lesions: a 48-year clinicopathologic analysis and review of the literature

OBJECTIVE

Intra-osseous fibrohistiocytic lesions have long been reported in the literature; evidence suggests they represent a heterogeneous group of reactive and neoplastic processes. This study evaluated a series of gnathic fibrohistiocytic lesions to identify and categorize their clinical, radiographic and morphologic spectrum.

STUDY DESIGN

A retrospective case search over 48 years was conducted for maxillary and mandibular intra-bony fibrohistiocytic lesions. Diagnoses were confirmed and demographic, radiographic, clinical and follow-up data was analyzed.

RESULTS

Fifty cases met the inclusion criteria. Most cases (80%) were found in the second through fourth decades (mean, 29 years). The most common location (86%) was the posterior mandible. Radiographic presentations varied, but a few patterns emerged, including a distinctive mottled, honeycomb type with punctate lucencies. All cases demonstrated fibrous components admixed with variable histiocytes. Eight cases (16%) were histiocyte-rich with dominant sheets of xanthoma cells. Immunohistochemical staining revealed strong CD68 and CD163 expression, along with variable smooth muscle actin staining. The vast majority (92%) of cases were treated conservatively. Available follow-up showed lesional stability in 17 cases (average, 85 months) with 2 recurrences (24 months each) and no evidence of malignant transformation.

CONCLUSIONS

This study is the largest to date of fibrohistiocytic gnathic lesions, revealing distinctive radiographic and histologic findings and characteristic clinical and immunophenotypic features. Available evidence suggests that most of these are indolent, slow-growing lesions amenable to conservative therapy.

Multiple benign fibrous histiocytomas of the mandible: A case report and review of the literature

Benign fibrous histiocytoma (BFH) mostly occurs on the skin of the extremities, while it is unusual to manifest on the bone and mandibular involvement of BFH is even rarer. The present study reports a case of BFH in a 42-year-old female who had a slowly progressive swelling of the bilateral mandible and slight facial asymmetry over a period of 4 months. However, the outcome of this patient was unsatisfactory, with the first and second recurrence observed 16 and 46 months after surgery, respectively. The present case suggests that BFH has a risk of recurrence after transoral curettage. Regular follow-up is advised to detect tumor recurrence after the surgery of transoral curettage.

Benign fibrous histiocytoma of the oral and maxillofacial region: A systematic review

OBJECTIVE

The aim of the present study was to carry out a systematic review of available data regarding case reports and case series of oral and maxillofacial benign fibrous histiocytoma (BFH).

STUDY DESIGN

A search strategy was performed using the PubMed, Web of Science, Scopus, and EMBASE electronic databases.

RESULTS

Male individuals (56.89%) were more affected, with a mean age of 34.55 ± 20 years. The buccal mucosa (20.33%) represented the most common site, with the clinical presentation of a painless (86.95%) nodule (98.03%). The clinical hypothesis of a fibroma was reported in most cases (31.57%). Radiographic presentation of intraosseous lesions showed multilocular radiolucent images (55.55%). Regarding the histopathologic features, the biphasic population of fibroblastic and histiocytic cells was seen in 21 cases (39.62%), and a spindle-shaped fibroblastic cell population organized into a storiform pattern was observed in 25 cases (47.16%). CD68 (n = 26) and vimentin (n = 25) showed immunoreactivity in all BFH cases in which they were used. All cases were treated with a surgical resection, and 8.10% recurred.

CONCLUSIONS

The current systematic review demonstrated that BFH represents a rare lesion that mainly affects the buccal mucosa of male individuals, and the treatment is mainly surgical with a good prognosis.

Benign fibrous histiocytoma of the maxilla: A rare case report and literature review

Benign fibrous histiocytoma (FH) is a benign soft-tissue tumor that can present as a fibrous tissue mass anywhere in the body. The involvement of the paranasal sinuses is extremely rare, and very few cases have been reported in literature till date. We here report a case of benign FH localized in the maxillary sinus. The clinical and histological features of the lesion are discussed with a brief literature review of this pathology in the paranasal sinuses.

Primary Intraosseous Xanthomas of the Jaws: A Series of Six Cases Including an Example with Formation of Apoptosis-Related Hyaline Globules, So-Called "Thanatosomes"

Primary intraosseous xanthomas of the jaws (PIXJ) are rare and predominantly affect the posterior mandible (86%) of normolipemic patients, with a mean age of 30 years and no gender predilection. Clinically, PIXJ exhibit indolent biologic behavior; curettage is considered treatment of choice. Only 36 PIXJ have been reported. Apoptosis-related hyaline globules (HGs), also known as "thanatosomes", have not been previously reported in PIXJ. Cases diagnosed as xanthoma of bone were retrieved. Six cases fulfilling currently accepted criteria were identified and their clinicopathologic and immunohistochemical properties are presented herein. Mean age for PIXJ was 21.8 years (range = 12-33) and F:M ratio = 2:1. All cases presented as well-demarcated, unilocular or multilocular radiolucencies. Microscopically, PIXJ featured sheets of lipid-laden macrophages with eosinophilic or foamy cytoplasm. A secondary fibroblastic population lacking storiform pattern was evident in two cases. Adipocytes (3/6), peripheral neurovascular bundles (1/6), bone fragments (3/6) and dystrophic calcifications (3/6) were observed enclosed by the xanthoma cells. Notably, one case exhibited numerous, spherical, eosinophilic HGs containing apoptotic nuclei. PIXJ were consistently CD68(+) and negative for CD1α and S100. CD45 decorated lymphocytes and the membrane of foamy histiocytes. Xanthoma cells stained for lysozyme and plasma proteins including alpha-1 antitrypsin (AAT), IgG and IgA in one probed case. HGs were lysozyme(+), AAT(+), IgG(+), IgA(+), PAS(+) and diastase-resistant, and fuchsinophilic with Masson's trichrome. PIXJ represent infrequent, solitary, mandibular lesions with a predilection for the second and third decade of life. Thanatosomes associated with cell injury and death can be present in PIXJ.

Primary Xanthoma of the Mandible-A Case Report

Xanthomas are common cutaneous and subcutaneous lesions that occur due to altered metabolic or endocrinal function. They are found on skin and around tendon sheaths in individuals with dyslipidemias. In extremely rare cases, they can present as isolated intrabony lesions in otherwise healthy individuals. The isolated intrabony lesions are referred to as primary xanthomas. This report describes a case of an incidentally found primary xanthoma, its management, and follow-up in an otherwise healthy patient.

Central Xanthoma of the Jaw Bones: A Benign Tumor

Extragnathic xanthomas are seen in the bones or as soft tissue masses. They are often associated with hyperlipidemia and are considered as reactive or metabolic lesions. Only 19 cases of xanthomas of the jaws have been reported so far in the English literature. A total of ten cases of central xanthoma of the jaw bones were identified from the Oral and Maxillofacial Pathology biopsy services of the University of Washington and the Tufts University School of Dental Medicine, between the years 2000-2016. The demographic and clinical information on these cases was tabulated logically on the basis of age, gender, location and presence or absence of symptoms, extragnathic lesions and serum hyperlipidemia. Radiographic and histopathological features were also examined. The findings in these cases were correlated with those available from the previously reported cases. Majority of cases are seen in the second and third decades of life. There is no gender predilection. Jaw lesions presented as solitary radiolucencies with a predilection for the posterior mandible. Unlike maxillary lesions, pain and expansion are inconsistent findings in mandibular lesions. Jaw lesions are not associated with extragnathic bone or soft tissue involvement or a hyperlipidemia. The central xanthoma of the jaws is a unique benign tumor. Histopathologically, many other jaw lesions contain variable numbers of foamy histiocytes. Therefore, a diagnosis of a central xanthoma of the jaws must be made after excluding all other such histiocyte containing lesions. This requires correlation of histopathological findings with clinical and radiographic features.

Fibrous Histiocytoma-like Spindle-Cell Proliferation in the Nipple After Body-Piercing

We report the case of a 19-year-old pregnant woman who presented with a nipple tumor. The lesion consisted in a spindle-cell proliferation with histologic features similar to those of fibrous histiocytoma, with a highly vascularized stroma. Although it showed low mitotic activity, scattered marked atypical cells with prominent nucleoli were identified, thus raising concern about the benign nature of the tumor. Immunohistochemical evaluation revealed that the spindle cells were diffusely positive for vimentin, focally positive for CD68, and negative for all the other tested antibodies. The patient had a total excision of the lesion and she is free of disease after 30 months. To our knowledge this is the first reported case of a lesion of this type in the nipple after body-piercing.

Benign Spindle Cell Tumour of Mandible and Points of Modification in Reconstruction with Nonvascularised Iliac Crest Graft

Benign fibrous histiocytoma (BFH) is a rare spindle cell tumor occurring in the jaw. It is a benign lesion composed of spindle shaped fibroblasts arranged in a storiform pattern. Literature shows that there are less than hundred reported cases of BFH worldwide and only six reported cases in the mandible. In this article, we are reporting a rare case of BFH in mandible and novel points of modification in reconstruction with nonvascularised iliac crest graft .

Benign Fibrous Histiocytoma of Mandible: A Case Report and Updated Review

Benign Fibrous Histiocytoma (BFH) is a well recognised tumour of the soft tissue, developing entirely within the subcutaneous tissue, the deep soft tissues or in the parenchymal organs. However, BFH of bones is poorly defined. It has been rarely reported in the bones with femur, tibia and pelvic bone being the most commonly affected bones. Involvement of the jawbones is rare. Their clinical and radiographic features often simulate the common odontogenic and non-odontogenic lesions of the jaws. Hence, it is imperative for a dentist to have proper knowledge of various conditions affecting the jaws. Here we report a case of BFH which presented as an indolent swelling of the right mandibular posterior region for 15 years. The case emphasizes the need for considering BFH in the differential diagnosis of swellings of the jaws.

Benign fibrous histiocytoma: A rare case involving jaw bone

Benign fibrous histiocytoma (BFH) is a soft tissue neoplasm which occurs mostly on the skin of extremities. BFH rarely occurs in bone and may affect femur, tibia, and pelvic bone. Jaw bone involvement is very unusual with only 11 cases reported till date. This report describes a case of BFH occurring in a 30-year-old female patient affecting left mandibular posterior region. Computed tomography revealed a well-defined expansile lytic lesion in the posterior mandible. Gross examination of the tumor revealed an admixture of fibroblasts and histiocytes in a fascicular and storiform pattern. Immunohistochemical staining was positive for CD68.

Benign Fibrous Histiocytoma: A Rare Case Report and Literature Review

Fibrous histiocytoma is a benign soft tissue tumour that may present as a fibrous mass anywhere in the human body. The involvement of the oral cavity is extremely rare and very few cases have been reported in literature till date. We here report a case of benign fibrous histiocytoma localized in the oral cavity. The clinical and histological features of the lesion are discussed precisely in the light of a literature review of this pathology in oral cavity.

The non-ossifying fibroma: a case report and review of the literature

The non-ossifying fibroma (NOF) is a benign, non-neoplastic lesion most commonly seen in the metaphyses of the long bones in children. While rare, the NOF has been reported in the mandible. The NOF in the extra-gnathic skeleton has a characteristic radiographic appearance, is typically asymptomatic and has a variable histologic make-up. Correlation of the radiographic appearance, clinical presentation and histopathology allows for differentiation of the NOF from odontogenic and non-odontogenic cysts and tumors. We report a new case of this interesting entity and review the radiographic, clinical and histologic features of the gnathic NOF reported in the literature. A thorough search of the English language literature returned a total of 19 cases of NOF involving the gnathic bones.

Benign fibrous histiocytoma of the cheek

Benign fibrous histiocytoma (FH) is a benign neoplasm of a mixture of fibroblastic and histiocytic cells. The tumor occurs most frequently on the skin of the extremities but rarely in deep soft tissues of the head and neck. The diagnosis of benign FH may be clinically difficult, and is frequently confirmed after excision. The most important diagnostic distinction is the separation of this tumor from malignant FH. A 22-year-old male presented with a painless swelling mass on the left cheek. Detailed clinical and laboratory examinations were performed. The patient received angiography with embolization and underwent an intraoral excision of the mass under general anesthesia with primary closure. The histopathology revealed a benign FH. The complete image survey and appropriate treatment of benign FH of the cheek are emphasized.

Treatment of intracapsular femoral neck lesions: aggressive or conservative surgery?

Benign fibrous histiocytomas (BFHs) and non-ossifying fibromas (NOFs) are benign bone tumors that are clinically different, but histologically similar. Most benign lesions are treated with curettage and grafting; however, some misdiagnosed cases are treated with more aggressive procedures, including arthroplasty. Herein, we present a 21-year-old patient that presented with a 1-year history of right hip pain. Anteroposterior X-ray showed a centrally located lesion in the femoral neck that was intracapsular and localized subcortically. To the best of our knowledge, the literature does not include any reposts of BFH or NOF localized at the intracapsular hip. In addition, localization of and treatment options for intracapsular hip lesions are clarified.

Piezoelectric-assisted removal of a benign fibrous histiocytoma of the mandible: an innovative technique for prevention of dentoalveolar nerve injury

In this article, we present our experience with a piezoelectric-assisted surgical device by resection of a benign fibrous histiocytoma of the mandible.

A 41 year-old male was admitted to our hospital because of slowly progressive right buccal swelling. After further radiographic diagnosis surgical removal of the yellowish-white mass was performed. Histologic analysis showed proliferating histiocytic cells with foamy, granular cytoplasm and no signs of malignancy. The tumor was positive for CD68 and vimentin in immunohistochemical staining. Therefore the tumor was diagnosed as primary benign fibrous histiocytoma. This work provides a new treatment device for benign mandibular tumour disease. By using a novel piezoelectric-assisted cutting device, protection of the dentoalveolar nerve could be achieved.

Benign fibroxanthoma of the mandible

Histiocytomas constitute a large group of tumors, the classification of which created a lot of confusion in the past. For this reason, various attempts were carried out during the last years so that a widely accepted classification system could be defined. Fibroxanthomas, according to contemporary data, are classified into benign histiocytomas and they are mostly located at the skin of extremities. They are rarely localized in the area of the head and neck, where they are found commonly in soft tissue. Fibroxanthomas located at the bones of oral and maxillofacial region are extremely rare. The purpose of this paper is to present a case of a fibroxanthoma located at the mandible as well as to analyze the histological findings of the lesion on which the diagnosis and differential diagnosis were based.

A rare case of fibrous histiocytic tumor of the tongue

Fibrous histiocytoma is a benign soft tissue tumor composed of a mixture of fibroblastic and histiocytic cells arising as a fibrous mass everywhere in the human body. Based on location it is divided into cutaneous type and those involving the deeper tissues. Involvement of the oral cavity is rare. It is important to distinguish this tumor from the more aggressive forms of fibrohistiocytic neoplasm including dermatofibrosarcoma protuberans and malignant fibrous histiocytoma (FH) (7).The clinical and histiological diagnosis, treatment, and prognosis of FH have been discussed.

Benign fibrous histiocytoma of the lower lip

Benign fibrous histiocytoma (BFH) is one of the most common tumors of the superficial and deep soft tissues; it is commonly localized on the skin of the extremities and presents as a slow growing solitary nodule, made up of a mixture of fibroblastic and histiocytic cells. To our knowledge, involvement of the soft tissue of the oral cavity is rare. We present a case of BFH of the lower lip in a 61-year-old white woman who presented with a painless, slow-growing lump inside the lower lip. The lesion was surgically removed. Histologically, it was characterized by uniform spindle-shaped cells arranged in a prominent whorled or storiform pattern. Scattered xanthomatous cells, multinucleated giants cells, lymphocytes, and deposits of hemosiderin were noted throughout the lesion. This rare tumor should be considered in the differential diagnosis of the oral soft-tissue neoplasms.

Benign fibrous histiocytoma of the buccal mucosa: case report and literature review

Benign fibrous histiocytoma is an interesting and challenging entity even in its most usual, cutaneous presentation. Noncutaneous presentation is extremely limited, even more so for the mucosa of the head and neck area. We herein report such a case, describing the clinical characteristics of the lesion, complete diagnostic evaluation, management, and follow-up. Diagnostic histopathological challenges are specifically illustrated. A complete review of the relevant literature is also included.

Oral benign fibrous histiocytoma: two case reports

Fibrous histiocytoma is a benign soft tissue tumour arising as a fibrous mass everywhere in the human body. The involvement of the oral cavity is rare. We report two cases of benign fibrous histiocytoma that localized in the oral cavity. The clinical and histological features of the lesion are reported. Finally, a literature revision of this pathology at the level of the oral cavity is reported.

Benign fibrous histiocytoma of the skull with increased intracranial pressure caused by cerebral venous sinus occlusion

The authors present a very rare case of benign fibrous histiocytoma of the skull with increased intracranial pressure caused by sinus occlusion. A 33-year-old woman was referred for investigation of a right occipital protrusion with tenderness and double vision. She had only mild divergence insufficiency and bilateral papilledema neurologically. Imaging findings showed that the skull tumor was located at the right occipital bone with bone disruption and a compressed right sigmoid sinus. When planning the resection, caution was required to spare the collateral flow so as to manage the intracranial pressure. Immunohistochemical analysis showed that the tumor was positive for CD68, α1-antichymotrypsin, and α1-antitrypsin. From these findings, the tumor was diagnosed as a primary benign fibrous histiocytoma of the skull.

Benign fibrous histiocytoma in the condylar process of the mandible: Case report

A 48-year-old man was referred for investigation of an asymptomatic radiolucent lesion in the mandible. The margin was partly irregular, and there was no peripheral sclerosis. The tumour was composed of histiocytic cells, spindle cells, and fibrous tissue. Immunohistochemical analysis showed that the tumour cells stained for CD68 and vimentin, and not for cytokeratin, smooth muscle actin, S-100 protein, or CD34. The tumour was therefore diagnosed as a benign fibrous histiocytoma.

Benign fibrous histiocytoma of the skull base. Case report

The authors report the case of benign fibrous histiocytoma (BFH) of the skull base in an 11-month-old girl. During draining for a middle ear infection, the child was noted to have an anomalous mass in the skull base. On magnetic resonance imaging studies a soft-tissue mass of the skull base primarily involving the regions of the temporal and occipital bones was discovered. Results of a surgical biopsy were consistent with BFH. At the most recent follow-up examination--18 months postoperatively--the child was noted to be asymptomatic with no gross increase in tumor size.