Multiple leiomyomatous hamartoma in the oral cavity

A systematic review of the clinicopathological characteristics of oral leiomyomatous hamartoma

BACKGROUND

Oral leiomyomatous hamartoma (OLH) corresponds to an abnormal, benign and disorganized overgrowth of mature smooth muscle tissue, which can develop in any site where this tissue is found in healthy conditions. The present systematic review aimed to analyze the clinicopathological characteristics of OLH.

MATERIALS AND METHODS

The protocol of this study was constructed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was registered in the Open Science Framework (OSF): OSF.IO/BMPUX. Five electronic databases were used to identify studies for this systematic review: PubMed, Web of Science, Dentistry & Oral Science Source, Scopus and ScienceDirect, from January 15th, 1945 to January 10th, 2024. The Joanna Briggs Institute (JBI) tool was used to assess the risk of bias and the quality of the included reports and case series.

RESULTS

A comprehensive search yielded 5,562 articles, of which 55 met the inclusion criteria. The total number of subjects studied in the included investigations was sixty-six. The subjects' ages varied from newborns to 61 years, with a mean age ± standard deviation of 71.23 ± 123.01 months. 50.7% were males and 49.3% were females. Most lesions presented normochromic color (24.24%), pedunculated base (31.81%), firm consistency (22.72%), with an average size of 1.20 cm, present on the dorsum of the tongue (31.81%) or anterior part of the alveolar border of the maxilla (30.30%). Treatment was carried out by surgical excision (78.46%) and half of the studies report that there were no recurrences.

CONCLUSIONS

The cases described in the medical-dental literature provide valuable information to date on the clinicopathologic and immunohistochemical profile of OLH. Although it is a rare lesion, it should be considered as part of the differential diagnosis in newborns, infants, children and young adults with lingual and/or maxillary masses present in the midline.

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.

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.

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.

Hamartoma of the Oral Cavity with Ectopic Meningothelial Elements in Infants: A Rare Entity with Report of Two Cases

Choristomas and hamartomas within the oral cavity are relatively uncommon lesions and may present with diverse clinical and histopathological appearances. In this report, we describe two infant patients with hamartoma with ectopic meningothelial elements involving tongue and maxillary alveolar ridge. To the best of our knowledge, these are the first two cases in which a meningothelial proliferation has been identified in the oral cavity. Hamartoma with ectopic meningothelial elements is a rare condition that has been classically described occurring in the scalp. These lesions are characterized by bland round to spindle-shape cells that interdigitate through collagen bundles and express progesterone receptor and epithelial membrane antigen by immunohistochemistry supporting a meningothelial origin.

Oral Subcutaneous Midline Leiomyomatous Hamartoma Presenting as Congenital Incisive Papilla Overgrowth in a Toddler

Congenital soft-tissue tumors of oral cavity are mostly hyperplastic and benign in nature. This article presents an unusual case of congenital subcutaneous hamartoma of incisive papilla in a 2-year-old female child causing feeding and breathing difficulty. Total excisional biopsy was done under local anesthesia. Histopathology of tissue in reticulin-stained slide showed the presence of immature muscle fibers whereas Masson's trichrome stain revealed collagen fibers and smooth muscles confirming the diagnosis of oral midline subcutaneous smooth muscle (leiomyomatous) hamartoma of incisive papilla. It is important for dental professionals to be aware of this oral lesion present from birth mimicking overgrowth of incisive papilla, by its presentation, differential diagnosis, histopathology, and management.

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.

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.

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.

Leiomyomatous hamartoma of the midline maxillary gingival presenting as a congenital epulis: a case report with an immunohistochemical study

An otherwise-healthy 2-year-old Japanese female presented with a polyp-like lesion on the palatal surface at the incisive papilla. The appearance of the lesion was similar to that of a congenital epulis. The histological findings showed proliferating mesenchymal components that contained mainly smooth muscle admixed with collagen fibres, nerve fibres, small vessels and mucous salivary glands. The immunohistochemical staining findings for α-smooth-muscle actin, desmin and S-100 protein were all positive. The histological diagnosis was therefore leiomyomatous hamartoma, based on clinical microscopic observations.