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Fu XJ, Xiang L, Liao LS, Xu Y, Li WS. Solitary Myofibroma of the oral and maxillofacial regions in pediatric patients: A clinicopathological analysis of ten patients and review of 75 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:102032. [PMID: 39233053 DOI: 10.1016/j.jormas.2024.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/17/2024] [Accepted: 09/01/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND The imaging manifestations of oral and maxillofacial myofibroma/myofibromatosis can vary among patients. Although many clinical cases have been reported, a consensus on the clinicopathological features of and treatment principles for this disease is lacking. PURPOSE This study aimed to summarize the clinicopathological features of solitary myofibroma of the oral and maxillofacial regions in pediatric patients. METHODS The clinical data, histological features, and immunohistochemical characteristics of ten pediatric patients who underwent surgical removal and subsequent pathological diagnosis of myofibroma were collected and retrospectively and cross-sectionally analyzed. RESULTS Seven patients were male, and 3 were female, with ages ranging from 3 months to 6 years (mean: 2.6 years). The patients presented with solitary lesions involving the mandibular gingiva and adjacent mandible (4 patients), mandible (2 patients), oral floor and submandibular area and adjacent mandible (1 patient), gingiva (1 patient), maxilla (1 patient), and oropharynx (1 patient). Light microscopy revealed spindle-shaped tumor cells organized in bundles or vortex patterns, forming a hemangiopericytoma-like perivascular pattern, whereas immunohistochemical staining revealed diffuse smooth muscle actin (SMA) positivity. All patients underwent surgical resection, and none experienced recurrence over the 12- to 82-month follow-up. CONCLUSIONS Solitary myofibroma in the oral and maxillofacial regions is predominantly observed in infants and young children, with a higher incidence among males. The prognosis is favorable following localized lesion resection or curettage of jawbone lesions. Accurate recognition of the clinical, radiological, and pathological features of the disease will reduce the misdiagnosis rate.
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Affiliation(s)
- Xiao-Juan Fu
- Department of Stomatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Li Xiang
- Department of Stomatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Li-Shu Liao
- Department of Stomatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Ying Xu
- Department of Stomatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Wan-Shan Li
- Department of Stomatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
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Lazim A, Amer SM, Eltawil GM, Laski R, Kuklani R. Solitary Intraosseous Myofibroma of the Mandible in a Nine-Year-Old Child: A Case Report and Literature Review. Cureus 2024; 16:e64232. [PMID: 39130873 PMCID: PMC11312426 DOI: 10.7759/cureus.64232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Myofibroma (MF) is a benign neoplasm derived from myofibroblasts. While they are infrequent, these tumors are predominantly found in the pediatric group and seldom manifest as intraosseous mandibular tumors. Herein, we present a 9-year-old female with a radiolucent lesion in the left mandible associated with malposed left lower canine and 1st premolar teeth. Clinical examination revealed a slightly tender 5×4 cm firm mass resulting in an expansion of the buccal and lingual aspects of the mandible in the canine and first premolar region. An incisional biopsy revealed a benign tumor consisting of spindle cells organized in fascicles, alongside dispersed thin-walled blood vessels. Tumor cells tested positive for α-smooth muscle actin (SMA) and vimentin. Given these findings, a diagnosis of MF was established. To the best of our knowledge, only 45 cases of solitary MF of the mandible have been reported in the pediatric age group in the literature. We describe one additional case and provide a review of the literature.
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Affiliation(s)
- Ahmed Lazim
- Pathology, Temple University Hospital, Philadelphia, USA
| | - Samir M Amer
- Pathology, Temple University Hospital, Philadelphia, USA
| | - Ghadir M Eltawil
- Dentistry, Al Hokail Specialized Digital Polyclinics Academy, Muharraq, BHR
| | - Robert Laski
- Oral Surgery, Valley Oral Surgery, Allentown, USA
| | - Riya Kuklani
- Pathology, Temple University Hospital, Philadelphia, USA
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3
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Savithri V, Suresh R, Janardhanan M, Aravind T. Oral myofibroma presenting as an aggressive gingival lesion. BMJ Case Rep 2021; 14:14/5/e242700. [PMID: 33958368 PMCID: PMC8103945 DOI: 10.1136/bcr-2021-242700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Myofibromas are benign neoplasms of myofibroblastic origin and rarely encountered in the oral cavity. Myofibroma may frequently grow rapidly leading to suspicion of malignancy. This may lead to a tendency for aggressive management. The histopathology of this tumour has similarity with other spindle cell tumours and often requires immunohistochemical staining for diagnosis. Here, we present a case of myofibroma in a 15-year-old female patient who reported with an aggressive gingival swelling and discuss the various histopathological differential diagnosis.
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Affiliation(s)
- Vindhya Savithri
- Department of Oral & Maxillofacial Pathology and Microbiology, Amrita Vishwa Vidyapeetham, Amrita School of Dentistry, Kochi, Kerala, India
| | - Rakesh Suresh
- Department of Oral & Maxillofacial Pathology and Microbiology, Amrita Vishwa Vidyapeetham, Amrita School of Dentistry, Kochi, Kerala, India
| | - Mahija Janardhanan
- Department of Oral & Maxillofacial Pathology and Microbiology, Amrita Vishwa Vidyapeetham, Amrita School of Dentistry, Kochi, Kerala, India
| | - Thara Aravind
- Department of Oral & Maxillofacial Pathology and Microbiology, Amrita Vishwa Vidyapeetham, Amrita School of Dentistry, Kochi, Kerala, India
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Rooper LM. Challenges in Minor Salivary Gland Biopsies: A Practical Approach to Problematic Histologic Patterns. Head Neck Pathol 2019; 13:476-484. [PMID: 30887392 PMCID: PMC6684710 DOI: 10.1007/s12105-019-01010-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
Evaluation of minor salivary gland biopsy can be fraught with a wide range of problems, including technical limitations due to the small size and distorted nature of tissue received and interpretive difficulties navigating the considerable morphologic and immunohistochemical overlap between widely disparate entities. As such, common pathologic findings can evoke a perplexing differential diagnosis that encompasses malignant, benign, and non-neoplastic processes. This review will present the diagnostic considerations that arise from four histologic patterns that are frequently encountered on minor salivary gland biopsies: squamous differentiation, tubular and cribriform growth, mucin production, and myxoid stroma. The discussion herein will emphasize practical strategies and priorities for navigating these differential diagnoses in a clinically-relevant and cost-effective manner.
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Affiliation(s)
- Lisa M. Rooper
- Departments of Pathology and Oncology, The Johns Hopkins Hospital, 401 N. Broadway, Weinberg 2242, Baltimore, MD 21231-2410 USA
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5
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Infantile myofibromatosis treated by mandibulectomy and staged reconstruction with submental flap and free fibula flap: a case report. J Otolaryngol Head Neck Surg 2019; 48:14. [PMID: 30871614 PMCID: PMC6419343 DOI: 10.1186/s40463-019-0333-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infantile myofibromatosis is the most common benign fibrous tumor in infants. Three different types have been reported in the literature. The most commonly affected areas are the head, the neck and the trunk. Our patient showed a very high level of mandibular destruction resistant to all mandibular sparing treatment strategies requiring segmental mandibulectomy and complex reconstruction. CASE PRESENTATION We describe a rare case of multicentric infantile myofibromatosis with mandibular bone destruction. The treatment required a succession of chemotherapy, a subtotal transoral resection and a hemi-mandibulectomy. The mandibular reconstruction was staged with initial bridging titanium plate with a submental flap, followed later by a fibula free flap. CONCLUSION Mandibular involvement by myofibromatosis is rare, and the extend of bone destruction and reconstruction make this case unique. To our knowledge, this is the only reported case of fibula free flap mandibular reconstruction in a patient with infantile myofibromatosis , as well as one of the youngest reported submental island flaps for any pathology. We describe the clinical presentation and management, including relevant imaging, histopathology, medical and surgical treatment as well as a review of relevant literature.
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An update on myofibromas and myofibromatosis affecting the oral regions with report of 24 new cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:62-75. [DOI: 10.1016/j.oooo.2017.03.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 01/21/2023]
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Putative Intravascular Myofibroma Mimicking a Vascular Malformation With Phleboliths. Am J Dermatopathol 2017; 39:e79-e81. [PMID: 28525911 DOI: 10.1097/dad.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Myofibroma is a rare, benign myofibroblastic tumor that commonly presents at birth or in early infancy, usually as a painless, slow-growing, solitary, nodular mass. We present a case of a 40-year-old woman with a painful, solitary, myofibroma on the right elbow. The unique features of this case include age and gender of the patient, site, pain on presentation, tumor morphology, and putative intravascular nature of the tumor.
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8
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Abstract
Myofibroma is a rare benign localized or generalized proliferation of myofibroblastic tissue occurring mostly in infants or children. In the oral region, most lesions occur in the mandible, lip, buccal mucosa, and tongue; however, the lesions arising in the maxilla are very rare. Myofibroma has an aggressive clinical presentation and is often treated aggressively because of an inappropriate diagnosis. A unique feature of central myofibroma of the jaws is the potential for teeth and other odontogenic structures to be involved by tumor. We report a case of myofibroma arising in the left side of the maxilla of a 12-year-old girl and describe the differential diagnosis from other spindle cell lesions of neural and smooth muscle origin. We treated the case using surgical excision under general anesthesia. Immunohistochemical staining was done for establishing the diagnosis since histopathological diagnosis with conventional staining could not distinguish myofibroma from spindle cell tumors.
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Affiliation(s)
- Paramjeet Kaur
- Department of Oral and Maxillofacial Surgery, Punjab Government Dental College and Hospital, Amritsar, Punjab, India
| | - Rajat Chowalta
- Department of Oral and Maxillofacial Surgery, Punjab Government Dental College and Hospital, Amritsar, Punjab, India
| | - Jeevan Lata
- Department of Oral and Maxillofacial Surgery, Punjab Government Dental College and Hospital, Amritsar, Punjab, India
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9
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A rapidly enlarging gingival mass in an 11-year-old boy. J Am Dent Assoc 2015; 147:58-63. [PMID: 26562734 DOI: 10.1016/j.adaj.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 06/09/2015] [Accepted: 07/01/2015] [Indexed: 11/21/2022]
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10
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Infantile Myofibromatosis of the Soft Palate. J Craniofac Surg 2015; 26:1427-8. [DOI: 10.1097/scs.0000000000001598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Saleh RR, Rodic S, Musharrafieh U, Jabbour MN, Sabri A. Myofibroma of the tongue: A case report of a rapidly growing tumor and review of characteristics. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Fushimi K, Shiiba M, Kouzu Y, Kasama H, Higo M, Koike H, Kasamatsu A, Sakamoto Y, Ogawara K, Uzawa K, Tanzawa H. Central myofibroma of the maxilla: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2013.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Satomi T, Kohno M, Enomoto A, Abukawa H, Fujikawa K, Koizumi T, Chikazu D, Matsubayashi J, Nagao T. Solitary myofibroma of the mandible: an immunohistochemical and ultrastructural study with a review of the literature. Med Mol Morphol 2014; 47:176-83. [PMID: 24213519 DOI: 10.1007/s00795-013-0062-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/18/2013] [Indexed: 12/01/2022]
Abstract
A solitary myofibroma (MF) is an unusual spindle cell neoplasm that usually arises in the soft tissue, skin, or bone of the head and neck region in infancy. We report an extremely rare case of MF of the mandible in an 18-year-old Japanese woman together with the conventional histologic, immunohistochemical, and electron microscopic findings. The tumor was well circumscribed and composed of fibroblast-like or myofibroblast-like spindle cells. On immunohistochemical evaluation the tumor cells were positive for vimentin, α-smooth muscle actin, HHF-35, and calponin, but negative for neurogenic antigens and markers for vascular endothelial cells. The Ki-67 labeling index was 10 % and the p53 labeling index was 10 %. Ultrastructural examination revealed smooth muscle cell differentiation. The patient was treated by surgical resection and underwent follow-up without any signs of recurrence. MF presents a wide range of differential diagnosis, including benign and malignant neoplasms. Therefore, accurate diagnosis may avoid an unnecessarily aggressive therapy.
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Affiliation(s)
- Takafumi Satomi
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan,
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14
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Tanaka Y, Yamada H, Saito T, Nakaoka K, Kumagai K, Fujihara H, Mishima K, Hamada Y. Solitary myofibroma of the mandible in an adult with magnetic resonance imaging and positron emission tomography findings: a case report. World J Surg Oncol 2014; 12:69. [PMID: 24678877 PMCID: PMC4230239 DOI: 10.1186/1477-7819-12-69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 03/15/2014] [Indexed: 11/29/2022] Open
Abstract
Myofibroma is a benign tumor composed of myoid spindle cells. The prevalence of myofibroma in the oral cavity is very low, with the mandible being the most common site. This report describes an adult case of myofibroma that arose on the mandible and includes magnetic resonance imaging (MRI) and positron emission tomography (PET) findings. On the MRI T1-weighted images, the tumor appeared with signal iso-intensity and was highly and heterogeneously enhanced with contrast material. On the T2-weighted images, it appeared with increased signal intensity. 18 F-fluorodeoxyglucose (FDG)-PET imaging showed abnormal strong accumulation of FDG in the left mandibular region. The tumor was removed by marginal resection of the left mandible under general anesthesia. Histopathological findings revealed that the tumor stroma contained abundant thin-walled vessels. The postoperative course was uneventful, and we found no evidence of recurrence at the postoperative 34-month follow-up.
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Affiliation(s)
| | - Hiroyuki Yamada
- Department of Oral and Maxillofacial Surgery, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, Japan.
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15
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16
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Eley KA, Fisher C, Gould S, Watt-Smith SR. A rapidly enlarging mandibular swelling. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:431-5. [PMID: 23522644 DOI: 10.1016/j.oooo.2011.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 12/18/2011] [Accepted: 12/21/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Karen A Eley
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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Arya AN, Saravanan B, Subalakshmi K, Appadurai R, Ponniah I. Aggressive fibromatosis of the mandible in a two-month old infant. J Maxillofac Oral Surg 2012; 14:235-9. [PMID: 25861188 DOI: 10.1007/s12663-012-0460-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/16/2012] [Indexed: 01/03/2023] Open
Abstract
Aggressive fibromatosis is a benign spindle cell tumor with locally infiltrative behavior and tendency to recur. It has overlapping features with other spindle cell lesions and hence it is pertinent to be distinguished from them as they have different treatment modalities. We report a rare case involving the mandible of a two-month old infant with histopathological, immunohistochemical and imaging features.
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Affiliation(s)
- Achamangalam Nandakumar Arya
- Department of Oral and Maxillofacial Pathology, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
| | - Balasubramaniam Saravanan
- Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
| | - Krishnamurthi Subalakshmi
- Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
| | - Rajendiran Appadurai
- Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
| | - Irulandy Ponniah
- Department of Oral and Maxillofacial Pathology, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
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18
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Palaskar S, Koshti S, Maralingannavar M, Bartake A. Inflammatory myofibroblastic tumor. Contemp Clin Dent 2012; 2:274-7. [PMID: 22346151 PMCID: PMC3276851 DOI: 10.4103/0976-237x.91787] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Inflammatory myofibroblastic tumor is an uncommon lesion of unknown cause. It encompasses a spectrum of myofibroblastic proliferation along with varying amount of inflammatory infiltrate. A number of terms have been applied to the lesion, namely, inflammatory pseudotumor, fibrous xanthoma, plasma cell granuloma, pseudosarcoma, lymphoid hamartoma, myxoid hamartoma, inflammatory myofibrohistiocytic proliferation, benign myofibroblatoma, and most recently, inflammatory myofibroblastic tumor. The diverse nomenclature is mostly descriptive and reflects the uncertainty regarding true biologic nature of these lesions. Recently, the concept of this lesion being reactive has been challenged based on the clinical demonstration of recurrences and metastasis and cytogenetic evidence of acquired clonal chromosomal abnormalities. We hereby report a case of inflammatory pseudotumor and review its inflammatory versus neoplastic behavior.
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Affiliation(s)
- Sangeeta Palaskar
- Department of Oral Pathology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
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Infantile myofibroma eroding into the frontal bone: a case report and review of its histopathologic differential diagnosis. Case Rep Pediatr 2012; 2012:630804. [PMID: 22966474 PMCID: PMC3433120 DOI: 10.1155/2012/630804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 07/30/2012] [Indexed: 01/19/2023] Open
Abstract
Infantile myofibroma is a rare and benign tumour of children presenting in the head and neck region. Rendering a final diagnosis of infantile myofibroma can be challenging in the light of nonspecific clinical, radiological findings and its histopathological similarities with a number of neoplasms especially spindle cell tumours. In this paper we discuss a case of infantile myofibroma in a 2-month-old infant, enumerating the various differential entities that have to be eliminated in reaching its specific diagnosis and highlighting the importance of immunopositivity to vimentin and smooth muscle actin (SMA) in establishing its myofibroblastic differentiation.
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20
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Myofibromas of the Jaws in Children. J Oral Maxillofac Surg 2012; 70:1880-4. [DOI: 10.1016/j.joms.2011.09.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 09/22/2011] [Accepted: 09/23/2011] [Indexed: 11/24/2022]
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21
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Hamada T, Hirano M, Semba I, Kamikawa Y, Sugihara K. Myofibroblastoma of the tongue: A case report with immunohistochemical findings. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2012. [DOI: 10.1016/j.ajoms.2012.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Garcia-Perla A, Belmonte-Caro R, Infante-Cossio P, Muñoz-Ramos M, Esteban-Ortega F. Upper airway distress due to an oropharyngeal infantile myofibroma. J Craniomaxillofac Surg 2012; 40:e112-4. [DOI: 10.1016/j.jcms.2011.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 05/30/2011] [Accepted: 05/31/2011] [Indexed: 01/19/2023] Open
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Gouvêa AF, Díaz KP, Léon JE, Vargas PA, de Almeida OP, Lopes MA. Nodular lesion in the anterior hard palate. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:154-9. [PMID: 22769404 DOI: 10.1016/j.oooo.2011.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 10/26/2011] [Accepted: 11/03/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Adriele Ferreira Gouvêa
- Department of Oral Diagnosis, Oral Semiology and Oral Pathology Sections, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Sun Q, Sattayakhom A, Backs J, Stremmel W, Chamulitrat W. Role of myocyte enhancing factor 2B in epithelial myofibroblast transition of human gingival keratinocytes. Exp Biol Med (Maywood) 2012; 237:178-85. [DOI: 10.1258/ebm.2011.011261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
It has recently emerged that the myogenic contribution of the epithelial mesenchymal transition plays a role in neoplastic invasion and metastasis. Myocyte enhancing factor 2B (MEF2B) is the only MEF2 isoform expressed during early embryonic development, and is herein proposed to transactivate the downstream target proteins of the epithelial myofibroblast transition (EMyT). We have previously generated eight preneoplastic cell lines with spindle and cobblestone morphology from human gingival mucosal keratinocytes immortalized by E6/E7 of human papillomavirus type 16. Spindle cells formed tubulogenic morphogenesis on Matrigel and exhibited contractility, anchorage-independent growth and invasiveness to a greater extent than cobblestone cells. Expression of MEF2B mRNA and myofibroblast proteins was higher in spindle cells compared with cobblestone cells. Epidermal growth factor (EGF) treatment of cobblestone cells also induced expression of these genes. Knockdown of MEF2B in a cobblestone cell line abolished EGF-induced upregulation of MEF2, vimentin and non-muscle caldesmon proteins, but enhanced basal expression of mesenchymal vimentin and fibronectin. Differential regulation of intermediate filaments revealed an unrecognized role of MEF2B in myogenic transformation of the epithelial to a myofibroblast phenotype, which occurs as epithelioid variants in some soft tissue sarcomas.
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Affiliation(s)
- Qiang Sun
- Department of Internal Medicine IV (Gastroenterology and Infectious Disease), Forschungsgruppen, Im Neuenheimer Feld 345, EG, Heidelberg 69120
- Division of Experimental Cardiology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Apsorn Sattayakhom
- Department of Internal Medicine IV (Gastroenterology and Infectious Disease), Forschungsgruppen, Im Neuenheimer Feld 345, EG, Heidelberg 69120
- Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand
| | - Johannes Backs
- Department of Internal Medicine III (Cardiology), Im Neuenheimer Feld 345, Heidelberg 69120, Germany
| | - Wolfgang Stremmel
- Department of Internal Medicine IV (Gastroenterology and Infectious Disease), Forschungsgruppen, Im Neuenheimer Feld 345, EG, Heidelberg 69120
| | - Walee Chamulitrat
- Department of Internal Medicine IV (Gastroenterology and Infectious Disease), Forschungsgruppen, Im Neuenheimer Feld 345, EG, Heidelberg 69120
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25
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Woo SB. Fibrous, Gingival, Lipocytic, and Miscellaneous Tumors. ORAL PATHOLOGY 2012:63-105. [DOI: 10.1016/b978-1-4377-2226-0.00005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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LeBlanc RE, Taube J. Myofibroma, Myopericytoma, Myoepithelioma, and Myofibroblastoma of Skin and Soft Tissue. Surg Pathol Clin 2011; 4:745-759. [PMID: 26837646 DOI: 10.1016/j.path.2011.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The authors address a group of loosely associated, characteristically benign soft tissue neoplasms that exhibit partial myoid differentiation. The entities share similarities in morphology and in nomenclature that have historically created confusion. The authors attempt to clarify the distinct architectural patterns and the corresponding immunophenotypic and ultrastructural features that distinguish myofibroma, myopericytoma, myoepithelioma, and myofibroblastoma.
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Affiliation(s)
- Robert E LeBlanc
- Department of Pathology, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Janis Taube
- Departments of Dermatology and Pathology, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Abstract
The myofibroma, especially the intraosseous variety, is an uncommon benign tumor that occurs primarily in children younger than 3 years of age. Since 1966, less than 40 cases of solitary myofibromas of the mandible have been reported in the literature. Myofibroblasts and spindle cells are predominantly found in this benign lesion. These cells are also commonly found in many lesions due to which great difficulty can be encountered in the diagnosis. A rare case of the intraosseous variety of an infantile myofibroma of the mandible diagnosed in a 10-month-old child has been reported. The tumor was completely excised via an intraoral approach and no recurrence has been noted 15 months postoperatively. A brief review of the differential diagnosis of this lesion in terms of its clinicopathologic, histologic, and immunohistochemical features is also discussed.
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Affiliation(s)
- Natarajan Nirvikalpa
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India
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29
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Unusual benign smooth muscle lesions of the tongue: review and report of two cases. Head Neck Pathol 2010; 6:121-4. [PMID: 21116881 PMCID: PMC3311941 DOI: 10.1007/s12105-010-0229-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/12/2010] [Indexed: 10/18/2022]
Abstract
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.
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30
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Ramadorai A, Rajsekaran A, Narayanan V. A case report of solitary, intraosseous, adult-onset myofibroma of the mandible. J Maxillofac Oral Surg 2010; 9:280-3. [PMID: 22190806 DOI: 10.1007/s12663-010-0073-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/10/2010] [Indexed: 11/27/2022] Open
Abstract
Myofibroma is a benign proliferation of myofibroblasts in the connective tissue. Solitary intraosseous myofibromas are a rare finding especially in an adult. Myofibroma is a benign lesion and its treatment is similar to any other benign lesion.This article reports a rare case of a 32 year old lady presenting with a complaint of a painful swelling in the lower third molar region, on examination the tender swelling had expansion of the buccal cortex. The diagnostic work up included OPG radiograph, CT Scan, and a deep incisional biopsy of the mass under L.A. The final diagnosis of myofibroma was made only after the histopathological diagnosis and Immunohistochemistry (IHC). The patient was treated with wide local excision of the lesion in the mandible under GA.
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Affiliation(s)
- Ashok Ramadorai
- Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha University, 162, Poonamallee High Road, Chennai, 600 077 India
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31
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Demarosi F, Bay A, Moneghini L, Carrassi A. Low-grade myofibroblastic sarcoma of the oral cavity. ACTA ACUST UNITED AC 2009; 108:248-54. [PMID: 19615664 DOI: 10.1016/j.tripleo.2009.03.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 03/04/2009] [Accepted: 03/16/2009] [Indexed: 12/30/2022]
Abstract
Two cases of low-grade myofibroblastic sarcoma (LGMS) are presented: one of lateral tongue, the other of lower buccal vestibule. LGMS represents a distinct atypical myofibroblastic tumor that occurs in several sites, primarily within the head and neck regions. A painless, enlarging mass is the most common clinical presentation, but a definitive diagnosis requires both histopathological and immunohistochemical analyses. Histologically, LGMS commonly presents as a cellular lesion composed of spindle-shaped tumor cells arranged primarily in fascicles with a diffusely infiltrative pattern. Immunohistochemically, LGMS shows positive staining for at least one myogenic marker, such as desmin, and muscle actin.
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Affiliation(s)
- Frederica Demarosi
- Unit of Oral Pathology and Medicine, Department of Medicine, Surgery and Dentistry, University of Milan, Milano, Italy.
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32
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Chang JYF, Kessler HP. Masson trichrome stain helps differentiate myofibroma from smooth muscle lesions in the head and neck region. J Formos Med Assoc 2009; 107:767-73. [PMID: 18926943 DOI: 10.1016/s0929-6646(08)60189-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/PURPOSE Myofibromas are well described in the head and neck region, but differentiating them from smooth muscle lesions is still difficult using smooth muscle immunohistochemical stains. This study evaluated the usefulness of the Masson trichrome stain in differentiating myofibromas from smooth muscle lesions in the head and neck region. METHODS Samples of 11 oral myofibromas, two leiomyomas, one angioleiomyoma, and one smooth muscle hamartoma were retrieved from our archives. Immunohistochemistry and Masson trichrome stains were performed on tissue sections of these lesions. RESULTS All 11 oral myofibromas, seven from male patients and four from female patients, were solitary myofibromas. The patients' mean age at diagnosis was 32.8 years. Oral myofibromas occurred most commonly on the gingiva (four cases) and in the mandible (three cases). With the Masson trichrome stain, the smooth muscle cell cytoplasm was stained red, while the collagenous fibrous tissue was stained blue. Myofibromas and smooth muscle lesions demonstrated different characteristic patterns with the Masson trichrome stain. Myofibromas were composed of a much more collagenous stroma intermixed with the spindle cells. Thick fibrous bundles with random, irregularly intersecting angles were prominent in myofibromas. Smooth muscle lesions showed only minimal delicate fibrous tissue surrounding the smooth muscle cells and in the septa between the smooth muscle masses. On low-power view, red masses of smooth muscle tumor surrounded by blue fibrous tissue were observed. CONCLUSION The Masson trichrome stain can be a useful tool to differentiate myofibromas from smooth muscle lesions, but immunohistochemical methods to rule out other spindle cell lesions are still needed.
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Affiliation(s)
- Julia Yu Fong Chang
- Department of Diagnostic Sciences, Oral Pathology, Baylor College of Dentistry, Texas A&M University System Health Science Center, Dallas, Texas, USA.
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33
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Souza DP, Loureiro CCS, Rejas RAG, Sousa SOM, Raitz R. Intraosseous myofibroma simulating an odontogenic lesion. J Oral Sci 2009; 51:307-11. [DOI: 10.2334/josnusd.51.307] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Oral myofibromas: report of two cases and review of clinical and histopathologic differential diagnosis. ACTA ACUST UNITED AC 2008; 105:e35-40. [PMID: 18417385 DOI: 10.1016/j.tripleo.2008.02.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/17/2008] [Accepted: 02/18/2008] [Indexed: 11/22/2022]
Abstract
Myofibroma is a benign mesenchymal neoplasm composed of myofibroblasts which has been described with different synonyms since the first report in 1951. It may show clinical and histologic features that may be misinterpreted as a malignancy. We describe 2 cases of oral myofibromas affecting infants; the first one showed a rapid growth with teeth displacement and ulceration; the second one presented a relatively slow growth with an indolent course. Differential diagnosis included benign and malignant mesenchymal neoplasms, salivary gland tumors, and reactive processes. Microscopic analysis of both lesions revealed a spindle cell tumor with immunoreactivity for vimentin, muscle-specific actin, and specific smooth muscle isoform alpha-actin, rendering the diagnoses of myofibroma. The patients were treated with surgical excision, and both are in follow-up without any signs of recurrence. Myofibroma presents a wide range of differential diagnosis, including benign and malignant neoplasms. Therefore, accurate diagnosis may avoid an unnecessary aggressive therapy.
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35
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Ide F, Mishima K, Yamada H, Saito I, Horie N, Shimoyama T, Kusama K. Perivascular myoid tumors of the oral region: a clinicopathologic re-evaluation of 35 cases. J Oral Pathol Med 2007; 37:43-9. [DOI: 10.1111/j.1600-0714.2007.00594.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Vered M, Allon I, Buchner A, Dayan D. Clinico-pathologic correlations of myofibroblastic tumors of the oral cavity. II. Myofibroma and myofibromatosis of the oral soft tissues. J Oral Pathol Med 2007; 36:304-14. [PMID: 17448141 DOI: 10.1111/j.1600-0714.2007.00528.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Myofibroma is a solitary benign tumor of myofibroblasts. Myofibromatosis describes multiple, simultaneous myofibromas at different sites in various organs. The clinico-pathologic correlations of myofibroma/myofibromatosis confined only to oral soft tissues were analyzed. METHODS In the English language literature, 41 myofibroma and 12 myofibromatosis cases involving the oral soft tissues were found. From our files, three new myofibroma cases were added. RESULTS Age at time of diagnosis of oral mucosa myofibroma ranged from birth to 70 years (mean 21.7 years), considerably higher than myofibroma in other parts of the body. Lesions occurred during the first decade (44%) and in the first year of life (17%). Male:female ratio was 1:1.6, contrary to the male predominance in other parts of the body. Common sites were the tongue (32%) and buccal mucosa (18%). Treatment was local excision, either complete (n = 13) or partial (n = 3), wide excision (n = 4), surgery, and chemotherapy (n = 1). Myofibromatosis involving oral soft tissues was diagnosed at birth in nine (75%) patients, within the first year in two, and as a young adult in one. Male:female ratio was 2:1. The tongue was the most common site (50%). Half the patients died of disseminated disease within a few days from birth, three were cured by partial or complete excision, and three experienced spontaneous regression. Histologically, oral mucosa myofibroma/myofibromatosis appearance agreed with findings in the literature. CONCLUSIONS Myofibroma should be included in the clinical differential diagnosis of masses of the oral soft tissues, especially in the tongue and buccal mucosa of children and adolescents. Histological differential diagnosis includes benign and malignant spindle-shaped lesions. Treatment of choice is local excision.
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Affiliation(s)
- Marilena Vered
- Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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37
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Allon I, Vered M, Buchner A, Dayan D. Central (intraosseous) myofibroma of the mandible: clinical, radiologic, and histopathologic features of a rare lesion. ACTA ACUST UNITED AC 2007; 103:e45-53. [PMID: 17150381 DOI: 10.1016/j.tripleo.2006.08.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 08/17/2006] [Accepted: 08/28/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Myofibroma frequently manifests as a solitary soft tissue tumor and less as simultaneous multiple tumors in both soft tissues and bones. The present study evaluated clinical, radiological, and histopathologic features of myofibroma of the jaws. STUDY DESIGN Nineteen cases from the literature and 4 new cases were analyzed. RESULTS At initial diagnosis, age ranged from birth to 34 years (mean 7.2 years, median 6 years). Male/female ratio was 2.3:1. Myofibromas were radiolucent solitary lesions located solely in the mandible: 70% unilocular, 30% multilocular; 67% with well-defined borders. Conservative treatment was performed on 75% of the patients; 25% underwent partial jaw resection. Where information was provided, no lesion recurred during 6-month to 17-year follow-up. CONCLUSION Although rare, myofibroma of the mandible should be considered in the differential diagnosis of radiolucent lesions (particularly unilocular), especially in children. Treatment of choice is conservative surgery to minimize potential functional and/or esthetic damage.
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Affiliation(s)
- Irit Allon
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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38
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Abstract
BACKGROUND Myopericytoma is a rare mesenchymal neoplasm of pericytic cells demonstrating myoid differentiation. The lesion typically arises within the subcutaneous tissue of the extremities. We report a case that, to the best of our knowledge, is the first case of myopericytoma involving the soft tissue of the oral cavity. METHODS A 36-year-old woman had a 5-mm sessile, whitish-pink, firm tongue nodule. The patient underwent excisional biopsy, and histopathologic examination as well as immunohistochemical analysis were performed. RESULTS The differential diagnosis by histologic analysis included solitary fibrous tumor, myofibroma, glomus tumor, and myopericytoma. The results of immunohistochemical analysis, when combined with the histologic features, led to a diagnosis of myopericytoma. CONCLUSIONS Applying strict morphologic criteria and appropriately selective immunohistochemical markers will help to distinguish myopericytoma in the oral cavity.
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Affiliation(s)
- Vivekanand Datta
- Department of Pathology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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39
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Valo I, Josselin N, Chouet-Girard F, Laccourreye L, Croue A. [A tumor of the mandible]. Ann Pathol 2005; 24:457-9. [PMID: 15738877 DOI: 10.1016/s0242-6498(04)94007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Sedghizadeh PP, Allen CM, Kalmar JR, Miloro M, Suster S. Solitary central myofibroma presenting in the gnathic region. Ann Diagn Pathol 2004; 8:284-9. [PMID: 15494935 DOI: 10.1016/j.anndiagpath.2004.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Solitary myofibroma of adults is an uncommon neoplasm that typically arises in soft tissue and subcutaneous sites in the head and neck, but rarely within bone. When encountered in the jaws, the lesions exhibit clinical and radiographic features suggestive of an odontogenic tumor or cyst as well as several other neoplastic conditions. Tooth mobility, displacement of teeth, and dramatic jaw expansion may be observed. Analogous to other sites of involvement, gnathic myofibromas are biologically indolent and show little or no recurrence following excision. In rare instances, however, the ability to obtain adequate surgical margins by conservative measures may be limited; thus, issues of local control may supercede the importance of biologic potential. We present the radiologic and histopathologic findings in a case of central myofibroma presenting as a large lytic lesion of the mandible. Myofibroma involving the jaw bones represents a unique diagnostic and therapeutic challenge, and accurate diagnosis and management is predicated on careful correlation of radiographic and pathologic findings.
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Affiliation(s)
- Parish P Sedghizadeh
- Department of Oral and Maxillofacial Surgery, Oral and Maxillofacial Pathology and Dental Anesthesiology; College of Dentistry, The Ohio State University, Columbus, OH 43218-2357, USA.
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41
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Oliver RJ, Coulthard P, Carre C, Sloan P. Solitary adult myofibroma of the mandible simulating an odontogenic cyst. Oral Oncol 2003; 39:626-9. [PMID: 12798407 DOI: 10.1016/s1368-8375(03)00042-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The solitary adult myofibroma is a rare lesion but has a predilection for the head and neck. Intraosseous lesions are common in childhood but uncommon in adults. The lesion is considered to be completely benign but there is the potential for it being confused with more aggressive spindle cell tumours. Histologically it is characterised by two cell types arranged in a biphasic pattern; namely centrally positioned small rounded cells with pale staining nuclei and eosinophilic cytoplasm and peripherally elongated spindle cells. A case is reported of a 34-year-old female patient who presented with a solitary myofibroma in the lower third molar region of the mandible which clinically and radiographically simulated an odontogenic cyst.
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Affiliation(s)
- R J Oliver
- University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK.
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42
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Jordan RCK, Regezi JA. Oral spindle cell neoplasms: a review of 307 cases. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:717-24. [PMID: 12789154 DOI: 10.1067/moe.2003.1400] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The infrequent exposure of pathologists to soft tissue spindle cell neoplasms coupled with overlapping histologic patterns can often make diagnosis challenging. We reviewed all nonodontogenic spindle cell neoplasms seen between 1982 and 2002 (86,162 total accessions). Diagnoses were reclassified according to current standards supplemented with immunohistochemistry. Of the 307 neoplasms reviewed (0.36% of total accessions), neural tumors were the most common benign entities, accounting for 21% of total cases. Kaposi's sarcoma was the most common malignancy, accounting for 67% of all cases. Diagnoses were revised for 57 cases. Schwannoma and neurofibroma were most commonly revised to palisaded encapsulated neuroma. There were 8 myofibromas and 1 inflammatory myofibroblastic tumor. There were no oral leiomyomas; that is, all 4 originally reported cases were reclassified as myofibroma, palisaded encapsulated neuroma, and solitary fibrous tumor. With the exception of Kaposi's sarcoma, oral soft tissue sarcomas were rare; most benign lesions were neural in origin. The relatively high prevalence of some tumors, such as myofibroma, likely reflects the use of immunohistochemistry in the diagnosis of spindle cell tumors.
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Abstract
AIMS The behaviour of leiomyosarcoma is site-related and there are few data on such tumours located in the head and neck. We studied the clinicopathological features of these lesions. METHODS AND RESULTS Cases diagnosed as leiomyosarcoma of the head and neck were retrieved from the archives of three institutions. Immunohistochemistry was performed and follow-up information was obtained. There were seven men and six women, aged 21-73 years, and lesions involved the neck (n=3), maxilla (n=4), buccal area (n=3), and maxillary sinus, nose, and pharynx (n=1 each). Tumours ranged from 10 to 80 mm. All tumours showed at least focally typical histological features of leiomyosarcoma with perpendicularly arranged fascicles of smooth muscle cells with blunt-ended nuclei, eosinophilic cytoplasm and paranuclear vacuoles. They expressed muscle-specific actin (8/9), smooth muscle actin (7/9), and desmin (10/12). Follow-up information was available on nine patients. All had surgery, with radiation and/or chemotherapy in seven. Three (27%) recurred at 6-24 months; in one case twice. Five (56%) had metastases, including the three with prior recurrences at 1-128 months. Five (including two who received adjuvant therapy) were disease-free at a median of 47 months, one was alive with metastatic disease at 24 months), and three were dead of disease (median 13 months). CONCLUSIONS Head and neck leiomyosarcomas are rare and aggressive neoplasms which metastasize. Adjuvant therapy has limited effect.
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Affiliation(s)
- E Montgomery
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA
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