Leiomyomatous hamartoma: report of two cases and review of the literature

Leiomyomatous Hamartoma of Incisive Papilla with High Frenal Attachment: A Case Report

Aim

This case report aims to describe a rare congenital lesion of the incisive papilla with a high labial frenulum attachment, clinically mimicking congenital epulis but histopathologically diagnosed as an oral leiomyomatous hamartoma.

Background

Oral leiomyomatous hamartoma is a very rare congenital lesion, mainly appearing on the median anterior maxilla/incisive papilla and tongue.

Case description

This clinical paper is about a rare lesion in a 6-year-old female child whose parents reported to the department with the complaint of slow-growing soft tissue overgrowth between the front teeth of the upper jaw, present since birth. The soft tissue growth is now causing difficulty in biting food and is visible during smiling and speaking, causing an esthetically unpleasing appearance. The clinical examination also revealed a high labial frenulum attached to the lesion. The lesion was provisionally diagnosed as congenital epulis based on the clinical picture. However, after excisional biopsy and histologic evaluation with special stains, the lesion was finally diagnosed as leiomyomatous hamartoma.

Conclusion

Surgical excision of the lesion followed by frenectomy was performed with no postoperative complications.

Clinical significance

Owing to the rare occurrence and nature of mimicking congenital epulis, it is important for a dental practitioner to have knowledge about these types of lesions. The final diagnosis of such lesions can only be made after histopathological evaluation using special stains. This case report describes the clinical and histopathological features of a rare leiomyomatous hamartoma of the incisive papilla, along with high frenulum attachment and its management.

How to cite this article

Pal SS, Khan SA, Navit S, et al. Leiomyomatous Hamartoma of Incisive Papilla with High Frenal Attachment: A Case Report. Int J Clin Pediatr Dent 2024;17(6):717-722.

Oral leiomyomatous hamartoma: presentation of 3 cases and review of the literature

Oral leiomyomatous hamartoma (OLH) is a rare lesion, with only 40 cases reported in the literature. It typically presents early in life as a nodule on the anterior maxillary alveolar tissues or the tongue. Its growth potential is limited, with few cases reaching dimensions >2.0 cm, and its microscopic composition includes an intact surface mucosa with an underlying fibrovascular stroma possessing an unencapsulated proliferation of smooth muscle fascicles. Excision is considered the definitive treatment. Here we describe the clinical, microscopic, histochemical, and immunohistochemical features and management of 3 cases of OLH and review the literature. The findings we present here can assist in performing differential diagnosis, particularly in discriminating between OLH and similar yet non-hamartomatous processes and in selecting appropriate management.

Tongue hamartomas in pediatric patients: an international case series and literature review

This study reports 9 additional tongue hamartomas in children paired with a literature review. A retrospective analysis was performed from 3 Oral Pathology laboratories. Additionally, a literature review was conducted through 5 electronic databases and gray literature. A total of 9 cases were identified in the retrospective analysis. Females outnumbered males with a ratio of 1.25:1. The age of presentation ranged from 2 weeks to 7 years. The posterior dorsum tongue was the most affected subsite (n = 4). One case was seen in a patient with oro-facial-digital syndrome, 2 cases in patients with cleft palates, and one case with an encephalocele. The most common predominant component was salivary gland tissue (n = 4). A literature search included 79 pediatric patients presenting with 95 tongue hamartomas. A slight female (n = 47) predilection was observed, with ages varying from 15 hours to 19 years. The posterior tongue dorsum (n = 31) was the most affected site. Seven cases were seen in association with syndromes. The most common predominant component was smooth muscle (n = 35). Although hamartomas are rare in the oral cavity, they should be considered in the differential diagnosis of masses involving the posterior tongue dorsum in children.

A Case of an Infantile Lingual Leiomyomatous Hamartoma

Lingual leiomyomatous hamartomas are rare lesions of the tongue with largely unknown mechanisms of formation. These lesions are often asymptomatic, though they may present with symptoms, particularly relating to swallow function. Workup should include imaging of the head and neck, and diagnosis should be made histologically. Treatment is surgical excision. This case is a report of a 4-week-old female who presented for evaluation of an asymptomatic 1 × 1 cm dorsal midline tongue mass discovered at birth. The patient was monitored until the age of 9 months, at which time the mass was surgically excised. The patient had an uncomplicated postoperative course. Pathological analysis yielded a diagnosis of leiomyomatous hamartoma.

Periodontal Manifestation in a Patient with Kindler Syndrome

Kindler syndrome is a rare subtype of inherited epidermolysis bullosa. A 42-year-old female patient was admitted to our clinic with a complaint of tooth mobility. Multiple hypo- and hyperpigmented macules dissipated all over her body, prominent poikilodermatous changes, xerosis of the skin, and atrophy were seen in the clinical extraoral examination. Intraoral examination showed atrophy of the buccal mucosa, limited oral opening, epidermal tissue easily separated from the connective tissue, painful ulcers of the hard palate, severe periodontitis, and keratosis of the lips. All of the teeth showed mobility. After dermatologist consultation, the diagnosis of the patient was clinically identified as “Kindler syndrome.” All of her teeth were extracted due to her progressive periodontal disease and late admission to our clinic. Periodontal treatment might be effective in treating and controlling oral symptoms related to the syndrome and in improving the patient's quality of life.

Lingual Hamartomas: Clinical Characteristics, Diagnostic Evaluation, Treatment, and Outcomes

OBJECTIVES/HYPOTHESIS

To further clinically characterize lingual hamartomas, and to consolidate literature by analyzing clinical presentation, diagnostic evaluation, treatment, and outcomes.

STUDY DESIGN

Retrospective chart review and literature review.

METHODS

Case series from 1989 to 2020 at a tertiary pediatric center; follow-up ranging from 2 months to 12 years. Patient demographics, clinical presentations, physical examination findings, surgical pathology, operative methods, pre-operative imaging, and follow-up. A review of English-language literature from 1945 to 2020 was conducted.

RESULTS

Seven patients (four male, three female) with nine lingual hamartomas were identified. Average age at surgical excision was 7.9 months (SD 3.5 months, range 3 to 14 months). Follow-up ranged from 2 months to 12 years, with all patients having no recurrence. Physical examination identified five pedunculated hamartomas and two sessile hamartomas. One patient had a neck CT, one had neck ultrasound, and two had facial MRIs. CT and ultrasounds confirmed presence of cervical thyroid. MRI suggested no muscular invasion for one patient, whereas motion artifact obscured findings for the other patient. Most patients who presented with dysphagia or poor weight gain achieved post-surgical improvement. The present cases combined with the literature review identified 57 patients with 63 lingual hamartomas.

CONCLUSIONS

Lingual hamartomas appear as hypovascular pedunculated masses near the foramen cecum. There is no demographic predisposition, and most are identified during infancy. Imaging is not necessary, unless there is concern for lingual thyroid, in which case thyroid ultrasound should be performed. Surgical excision is curative, with dysphagia resolution and low likelihood for recurrence.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E2080-E2088, 2021.

An unusual case report of multiple pulmonary leiomyomatous hamartoma

RATIONALE

Multiple pulmonary leiomyomatous hamartoma (MPLH) is an extremely rare benign disease that mostly occurs in women of reproductive age.

PATIENT CONCERNS

A 32-year-old female patient recently diagnosed with multiple bilateral pulmonary nodules. She has the symptoms of dry cough, chest tightness, dyspnea on exertion. Chest X-ray identified multiple bilateral pulmonary nodules in the lung, and the diameter of the largest nodule was about 3.1 cm.

DIAGNOSES

Pathology confirmed the diagnosis of MPLH based on morphology and immunohistochemical staining.

INTERVENTIONS

The patient presented with multiple well-defined nodular shadows in chest computed tomography (CT), atypical image and symptoms were detected. Positron emission tomography/CT scan showed mild fluorine-18 fluorodeoxyglucose uptake in the lesions and no abnormal foci in any other parts of her body. She subsequently underwent a video-assisted thoracoscopic surgery with wedge resection of the biggest one of the nodules. Then the patient given symptomatic treatment, without hormone, no further treatment was prescribed.

OUTCOMES

The patient is in the good general condition and without obvious pulmonary symptoms after the follow-up of 1 year, chest CT scan showed no significant changes in the sizes and locations of her bilateral pulmonary nodules.

LESSONS

Due to its rare presentation, the primary MPLH may be undiagnosed. Awareness of main morphologic and immunohistochemical features of MPLH is critical for the recognition of this uncommon disease.

Leiomyomatous Hamartomas of the Oral Cavity: Clinicopathological and Immunohistochemical Features of 4 Cases and Literature Review

Objective. To present 4 new cases of oral leiomyomatous hamartomas (OLH), describing its clinical, microscopical, and immunohistochemical features, and a literature review. Methods. The OLH cases were retrieved from the files of 2 Brazilian and 1 Peruvian oral pathology services. Clinical data were obtained from the pathology reports. Microscopical features were reviewed, and immunohistochemical reactions were performed. A review of the English-language literature about OLH was done. Results. The sample was composed of 3 females (4-, 10-, and 15-year-old) and 1 male (3-year-old). Three cases affected the dorsum of the tongue and one the incisive papilla, and all presented sessile or pedunculated smooth nodules. Microscopically, the lesions were composed of varying-size fascicles of smooth muscle fibers in a fibrous connective tissue background. Immunohistochemistry revealed positivity of the smooth muscle bundles for myogenic markers. The English-language literature review revealed 38 OLH cases reported, most were congenital or diagnosed up to 5 years old. The main locations were tongue and anterior maxilla. Conclusions. Although OLH is a rare lesion, it must be considered in the differential diagnosis of midline tongue or maxillary masses in newborns, infants, and youngsters.

Oral Leiomyomatous Hamartoma of the Anterior Maxillary Gingiva

INTRODUCTION

Oral leiomyomatous hamartoma (OLH) is a rare developmental tumor-like anomaly of the oral cavity.

CASE PRESENTATION

This report documents a 4-year-old female who was diagnosed with an OLH of the palatal gingiva between the maxillary central incisors. This lesion was treated successfully by local surgical excision.

CONCLUSION

Because many of the reported cases of this lesion have developed on the anterior maxillary gingiva, it is important for the periodontist to be aware of this entity.

Congenital Midline Tongue Base Mass in An Infant: Lingual Hamartoma

Lingual hamartoma is a rare finding of congenital midline posterior tongue mass. The lesion may be seen as a single anomaly or maybe associated with syndrome especially the Oral Facial Digital Syndrome (OFDS). Here, we report an otherwise normal and healthy two-month-old boy with a congenital midline base of tongue mass presented with snoring and episodic vomiting since the age of 1 month. Tumour excision from the area of foramen of caecum recovered a pinkish pedunculated tumour. Histopathology examination confirmed the diagnosis of leiomyomatous lingual hamartoma. Differential diagnosis, especially for midline tongue mass and other paediatric tongue lesions are discussed. We also discuss the epidemiology, histopathologic features, treatment and prognosis of lingual hamartoma based on the literature review.

Gingival leiomyomatous hamartoma of the maxilla: a rare entity

Hamartoma is a tumour-like malformation appearing as a focal overgrowth of normal cells. Leiomyomatous hamartomas (LHs) are rare in the oral cavity and commonly seen in the Japanese and less than 40 cases have been reported in the Japanese and English literature. The clinical differential diagnoses are irritational (traumatic) fibroma and congenital epulis. It has to be differentiated histopathologically from its neoplastic counterparts and mesenchymomas. Hence, we report such a case of LHs, which presented as a sessile gingival growth occurring in the midline in a 15-year-old girl. The final diagnosis was based on the histopathological appearance which was confirmed by immunohistochemical staining of various markers. A review of the literature of previous cases was also carried out.

Gingival leiomyomatous hamartoma of the maxilla: a rare entity

Hamartoma is a tumour-like malformation appearing as a focal overgrowth of normal cells. Leiomyomatous hamartomas (LHs) are rare in the oral cavity and commonly seen in the Japanese and less than 40 cases have been reported in the Japanese and English literature. The clinical differential diagnoses are irritational (traumatic) fibroma and congenital epulis. It has to be differentiated histopathologically from its neoplastic counterparts and mesenchymomas. Hence, we report such a case of LHs, which presented as a sessile gingival growth occurring in the midline in a 15-year-old girl. The final diagnosis was based on the histopathological appearance which was confirmed by immunohistochemical staining of various markers. A review of the literature of previous cases was also carried out.

Hamartomas of the oral cavity

The majority of oral diseases present as growths and masses of varied cellular origin. Such masses may include simple hyperplasia, hamartoma, choristoma, teratoma, benign or malignant neoplasms. The distinguishing features of hamartomatous lesions are not certain, and often these non-neoplastic masses are indiscreetly denoted as neoplasms without weighing their pathology or biological behaviour. Essentially, understanding the dynamics of each of these disease processes forms an integral part of the appropriate treatment planning.

Nasopharyngeal leiomyomatous hamartoma: case report

Background

Fibroma, neurofibroma, and papilloma are the most commonly encountered benign lesions in the nasopharynx. Hamartomas are non-neoplastic overgrowth of mature/differentiated tissue indigenous to the specific part of the body in which they develop. Most hamartomas are located in the liver, spleen, lungs, and pancreas. However, nasopharyngeal hamartoma is rare.

Case presentation

We describe here a 77-year-old Japanese woman who presented with a mass arising from the left lateral wall of the nasopharynx. Computed tomography (CT) revealed a soft tissue mass without bony erosion, suggesting that the mass was a benign tumor such as a fibroma. Pathological examination showed that the mass was a leiomyomatous hamartoma.

Conclusion

To our knowledge, this is the first report of a leiomyomatous hamartoma in the nasopharynx. Although leiomyomatous hamartoma in the nasopharynx is extremely rare, it should be kept in mind during differential diagnosis.

Lingual leiomyomatous hamartoma with bifid tip and ankyloglossia in a patient without oral-facial-digital syndrome: a case report and literature review

Here is a rare case of lingual leiomyomatous hamartoma (LLH) with bifid tongue tip and tongue-tie in a patient with non-oral-facial-digital syndrome (OFDS). A 29-year-old male consulted for a painless tumor over the midline of the tongue dorsum measuring 2 × 1.5 cm. The tumor was excised and the tongue-tie was corrected. Diagnosis of LLH was based on histo-pathologic and immuno-histochemical studies. The epidemiologic data and differential diagnosis of LLH, as well as related literature, are discussed. To date, only 14 cases of LLH have been reported in English literature. This may be the first reported case of LLH with bifid tip and ankyloglossia in a non-OFDS patient.

Oral leiomyomatous hamartoma of the median maxillary gingiva: a case report and review of the literature

Oral leiomyomatous hamartoma (OLH) is a rare lesion seen in the oral cavity. It mainly presents on the median maxilla and tongue. In the literature in English, there are only 10 reported cases of OLH of the median maxilla. Most of the cases were found in patients of Japanese and Latin American origin. We report a case of OLH in an 18-month-old boy of Middle Eastern ancestry. The lesion presented as a pedunculated, light pink, soft swelling that was located on the labial gingiva of tooth number 21. Microscopically, it showed proliferative smooth-muscle fascicles dispersed in loose fibrous stroma and multiple small vessels. The lesional cells looked mature and elongated and were deeply eosinophilic spindle cells with basophilic, central "cigar-shaped" nuclei. The diagnosis of OLH was supported by positive immunohistochemical reactivity of smooth-muscle actin and desmin. To our knowledge, this is the first reported case of OLH in a Middle Eastern patient.

Case report of a congenital lingual leiomyomatous hamartoma: new epidemiologic findings and a review of the literature

We present an unusual case of a lingual leiomyomatous hamartoma, along with a current literature review of this previously under reported lesion. Described is a case of a 5 month-old male presenting with a posterior midline tongue mass and surgical excision yielded pathology consistent with a leiomyomatous hamartoma. A comprehensive literature review revealed thirty-nine cases of leiomyomatous hamartomas, a number much greater than previously reported. We conclude that these rare lesions are notably twice as common as previously reported and have equal gender predilection.

Unusual benign smooth muscle lesions of the tongue: review and report of two cases

Benign smooth muscle proliferations are relatively rare in the oral cavity. Most are classified as angioleiomyomas, some as hamartomatous growths and a few as cutaneous-type leiomyomas. We present two cases of benign smooth muscle proliferations in the tongue, provide a review, briefly discuss histogenesis and offer a clinico-pathological differential diagnosis.

Angiomyolipomatous hamartoma of the upper lip: a rare case in an 8-month-old child and differential diagnosis

Hamartoma is a proliferation of normal tissues that are considered endogenous to the site of occurrence. In the head and neck region, hamartomas composed of other tissues different from blood and lymphatic vessels (hemangiomas and lymphangiomas) are very uncommon. We report an unusual case of upper lip angiomyolipomatous hamartoma in an 8-month-old patient. The patient underwent surgical treatment and the 1-year follow-up revealed no signs of recurrence. Angiomyolipomatous hamartoma is a very rare condition in the paediatric population group, especially in the head and neck region. It should be considered in the differential diagnosis of congenital lesions in childhood.