Perivascular myoid tumors of the oral region: a clinicopathologic re-evaluation of 35 cases

Malignant myopericytoma originating from the colon: A case report

BACKGROUND

Myopericytoma is a benign tumor that typically occurs within subcutaneous tissue and most often involves the distal extremities, followed by the proximal extremities, neck, thoracic vertebrae and oral cavity. Complete resection is often curative. Malignant myopericytoma is extremely rare and has a poor prognosis. Here, we report for the first time a case of malignant myopericytoma originating from the colon.

CASE SUMMARY

A 69-year-old male was admitted to our hospital with right upper quadrant pain for five days. Imaging suggested a liver mass with hemorrhage. A malignant hepatic tumor was the initial diagnosis. Surgical resection was performed after a complete preoperative work up. Initial postoperative pathology suggested that the mass was a malignant myoblastoma unrelated to the liver. Four months after the first surgery, an enhanced computed tomography (CT) scan revealed a recurrence of the tumor. The diagnosis of malignant myopericytoma derived from the colon was confirmed on histopathological examination of the specimen from the second surgery. The patient did not return to the hospital regularly for surveillance. The first postoperative abdominal CT examination six months after the second surgery demonstrated multiple liver metastases. Survival time between the diagnosis of the tumor to death was approximately one year.

CONCLUSION

Malignant myopericytoma is a rare cancer. Preoperative diagnosis may be difficult. Due to a lack of treatment options, prognosis is poor.

Pediatric upper lip myopericytoma: a case report and comprehensive review

BACKGROUND

Myopericytoma is a rare spindle cell tumor of mesenchymal origin, typically benign, characterized by concentric proliferation of tumor cells around blood vessels within subcutaneous tissue. It primarily occurs in middle-aged adults and is often located in distal extremities, although cases have been reported in proximal extremities and head-neck regions. However, occurrences within the oral cavity are exceedingly rare. To date, literature reviews have identified only two cases in children under 10 years old and reported only five cases of myopericytoma occurring in the lip region. We provide a comprehensive review and analysis of all documented cases to better understand this condition.

CASE PRESENTATION

A 7-year-old girl presented to oral and maxillofacial surgery with the discovery of a painless mass on the inner aspect of the upper lip. The diagnosis of myopericytoma was confirmed by histological examination (HE staining), alcian blue staining, and immunohistochemistry.

CONCLUSIONS

Following surgical excision, there were no signs of recurrence at a 3-month follow-up. The pathological diagnosis of myopericytoma is quite challenging, and immunohistochemical testing is necessary.

A Rare Case of Glomus Tumor on the Mucosal Surface of Lower Lip

Glomus tumors are mesenchymal neoplasms derived from glomus bodies with rare presentations in the oral cavity. Glomus tumors present as a purple or pink vascular nodule or papule, sized <1 cm, and imitate vascular neoplasms such as hemangiopericytoma or hemangioma. Glomus tumors represent less than 2% of all benign soft tissue tumors. Only 27 cases of benign glomus tumors with oral cavity involvement have been reported to date. The most-reported oral tumors involved the lips (54.2%), followed by hard palate, gingiva, tongue, and buccal mucosa. The mean age of presentation of the labial glomus tumors is 48.7 years, with no gender predilection, in contrast to the subungual site, which occurs more in females. The etiology of the glomus tumors remains unknown. Subungual glomus tumors present as stabbing pain, cold intolerance, and tenderness of the fingertips, whereas labial glomus tumors mostly present as a painless, small, and slow-growing lesion. Treatment is surgical resection of the tumor. The recurrence rate of labial glomus tumors is unclear. In this article, we present the case of a 62-year-old man with a 2-month history of painless, soft lump on the mucosal surface of the lower left lip. Excisional resection of the tumor was performed in the clinic, and the histopathologic finding was consistent with solid glomus tumor. At 1 year follow-up there was no recurrence.

Leiomyoma and Leiomyosarcoma (Primary and Metastatic) of the Oral and Maxillofacial Region: A Clinicopathological and Immunohistochemical Study of 27 Cases

Smooth muscle neoplasms represent an important group of lesions which is rare in the oral cavity. Leiomyoma (LM) is benign smooth muscle/pericytic tumor usually presenting as non-aggressive neoplasm, while leiomyosarcoma (LMS) represents its malignant counterpart. The rarity of these lesions, together with its unspecific clinical presentation and a variable histopathological appearance, lead to a broad list of differential diagnoses, hampering their diagnoses. Therefore, in this study we describe the clinical and microscopic features of a series of oral and maxillofacial LMs and LMSs. A retrospective search from 2000 to 2019 was performed and all cases diagnosed as LM and LMS affecting the oral cavity and gnathic bones were retrieved. Clinical and demographic data were obtained from the patients' pathology records, while microscopic features and immunohistochemistry were reviewed and completed when necessary to confirm the diagnoses. Twenty-two LMs and five LMSs were obtained. In the LM group, males predominated, with a mean age of 45.7 years. The upper lip was the most affected site, and 18 cases were classified as angioleiomyomas and four as solid LM. In the LMS group, females predominated, with a mean age of 47.6 years. The mandible was the most affected site. Diffuse proliferation of spindle cells, with necrosis and mitotic figures, were frequent microscopic findings. LMs and LMSs were positive for α-smooth muscle actin, HHF-35 and h-caldesmon. In conclusion, oral LM/LMS are uncommon neoplasms with the latter usually presenting as metastatic disease. H&E evaluation may be very suggestive of oral LMs, but h-caldesmon staining is strongly recommended to confirm LMS diagnosis.

Glomangiopericytoma-type glomus tumour/myopericytoma of the lip

We describe the case of a 46-year-old man who presented with a four-month history of a reddish, otherwise asymptomatic, nodular lesion that involved the mucosal side of the upper lip. The lesion consisted of myoid glomus-like cells arranged around branching and thin-walled haemangiopericytoma-like vascular structures, and was classified as glomangiopericytoma. No recurrences occurred during an eight-month follow-up. To the best of our knowledge, this tumour has never previously been described in the mucosa of the lip.

Clinical and pathologic analysis of myopericytoma in the oral and maxillofacial region

OBJECTIVE

The aim of this study was to analyze myopericytoma in the oral and maxillofacial region in terms of clinical appearance, diagnosis, treatment, and outcomes.

STUDY DESIGN

Data on 5 new patients with myopericytoma in the oral and maxillofacial region treated at our department were collected and analyzed.

RESULTS

There were 2 males and 3 females (age range 10-62 years; mean age 43.8 years). All of the 5 patients presented with masses showing benign biologic behavior. Imaging examinations with use of computed tomography or magnetic resonance imaging showed heterogeneous regions with internal contrast-enhancement or cystic change in 3 cases. All of the patients underwent surgery. Histologic examination showed a broad morphologic spectrum characterized by concentric and perivascular growth of ovoid, plump spindled, and/or round myoid tumor cells. Immunohistochemical examination showed positive staining for vimentin and smooth muscle actin, and negative for CD34 and desmin. During the follow-up period (8-56 months), there was no tumor recurrence.

CONCLUSIONS

Myopericytoma in the oral and maxillofacial region always exhibits benign biologic behavior and a heterogeneous region with internal contrast-enhancement or cystic change on imaging examinations. Surgery is the first choice of treatment and results in good clinical outcomes.

Glomus Tumor of the Oral Cavity: Report of a Rare Case and Literature Review

Glomus tumor is a benign neoplasm composed of a perivascular proliferation of glomic cells that resembles the normal glomus body. Usually, it appears as a solitary, symptomatic small blue-red nodule, located in the deep dermis or subcutis of upper or lower extremities of young to middle-aged adults. Cases affecting the oral cavity are very rare, with only 23 well-documented cases reported in the English-language literature. Herein, we present a rare case of glomus tumor of the upper lip, and review the literature of cases involving the mouth.

Glomus tumor in the floor of the mouth: a case report and review of the literature

Background

Glomus tumors are rare benign neoplasms that usually occur in the upper and lower extremities. Oral cavity involvement is exceptionally rare, with only a few cases reported to date.

Case presentation

A 24-year-old woman with complaints of swelling in the left floor of her mouth for 6 months was referred to our institution. Her swallowing function was slightly affected; however, she did not have pain or tongue paralysis. Enhanced computed tomography revealed a 2.8 × 1.8 × 2.1 cm-sized well-defined, solid, heterogeneous nodule above the mylohyoid muscle. The mandible appeared to be uninvolved. The patient underwent surgery via an intraoral approach; histopathological examination revealed a glomus tumor. The patient has had no evidence of recurrence over 4 years of follow-up.

Conclusions

Glomus tumors should be considered when patients present with painless nodules in the floor of the mouth.

The glomus tumor resorbed bone and teeth in the mandible: a case report

BACKGROUND

A glomus tumor is a rare neoplasm usually found in the dermis or subcutaneous tissue of the extremities. It is rare for the glomus tumor to occur on the head and face. Only 26 glomus tumors of the oral region and affected bone have been reported in the English-language literature (Table 1). We report a case of a glomus tumor at the mandible. As a new point, the glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible.

CASE PRESENTATION

The patient was a 44-year-old Japanese man who complained swelling of the right mandible. Radiographic examination showed a multilocular radiolucency area in the left mandible. Radiographic findings on our case resembled those of a common benign tumor. The lesion occupied to the premolar and molar area and revealed that the tumor resorbed the roots of the teeth. The lesion was removed surgically with the buccal cortical bone and buccal mucosa in contact with the mass of the tumor. The mass fully excised intraorally under general anesthesia, and the inferior alveolar nerve in contact with the mass was preserved. The specimen was pathologically diagnosed as a glomus tumor. Immunohistochemical staining was positive for vimentin, muscle-specific actin/HHF35, and calponin. A hairline-shaped area of positive staining for type IV collagen surrounding the tumor cells was also observed. In contrast, staining for alpha-SMA, cytokeratin (AE1/AE3), cytokeratin (CAM5.2), CK19, CD31, CD34, CD68, p63, S-100, Factor VIII, and desmin was all negative. The Ki-67 labeling index was almost 1%. A recurrent tumor was again detected in the site below the primary tumor at an 8-year follow-up, and it was surgically removed. The patient has had no symptoms of recurrence in 2 years after the second operation.

CONCLUSION

The glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible. The immunohistochemical features of the tumor were consistent with those described in previous reports. It is important to completely remove the Glomus tumor.

Glomus tumor: a comprehensive review of the clinical and histopathologic features with report of two intraoral cases

BACKGROUND

Glomus tumors are benign neoplasms that most commonly present in the subungual region. Their occurrence in the oral cavity is exceedingly rare. Here, we present 2 cases from the oral cavity, detail their clinical and histopathologic features, and review the literature for solitary cases involving the oral regions.

STUDY DESIGN

The English language literature was queried for cases of benign glomus tumors in/around the oral cavity. Additional citations were cross-referenced from the identified sources.

RESULTS

Thirty-one cases of solitary glomus tumor in the oral and paraoral regions have been described, including the present cases. Patient age ranged from 10 to 85 years, with an average age of 47 years. In 12 of the 31 cases, the tumors occurred in the lips, 5 in the palate, 4 in the tongue, 4 in the buccal mucosa, 3 in the gingiva, and 1 each in the parotid, pterygoid fossa, and oropharynx. Only 18 of these cases had accompanying immunohistochemical stains, with 14 expressing positivity for muscle cell markers.

CONCLUSIONS

Although glomus tumors have distinct histopathologic features, diagnostic confusion may exist with regard to extradigital locations. Detailed documentation and discussion of the clinical and histopathologic features of rare tumors like these are vital to understanding them.

Myopericytoma of the Lip: A Case Report of This Rare Lesion

Myopericytomas are rare benign tumors that show a distinctive, concentric perivascular proliferation of oval to spindle-shaped myoid-appearing cells that are predominantly arranged concentrically around thin-walled vascular channels. These lesions are similar in histologic appearance to hemangiopericytomas, myofibromas, and glomus tumors. The myopericytoma is usually found in the distal extremities, but a handful of reports have shown the lesion to be present in the oral cavity. A review of the literature to date shows only 4 other reported cases of myopericytomas occurring in the lips. We describe a case of myopericytoma in the lower lip of a 42-year-old woman.

Myopericytoma arising adjacent to the common carotid artery: Case report and systematic review of deep located neck myopericytomas

BACKGROUND

Myopericytoma is a perivascular tumor of the skin and subcutaneous tissue of the extremities, it is a rare finding in the head and neck, and even rarer is its deep location.

METHODS

A 38-year-old woman presented with a slowly growing mass at the right carotid triangle. Contrast-enhanced CT scan revealed a moderately enhancing mass. At surgery, the tumor was firmly attached to the common carotid artery, making it necessary to excise a small portion of the vessel wall.

RESULTS

The histopathologic report was myopericytoma. The postoperative course was uneventful, without tumor recurrence.

CONCLUSION

The very few deep located myopericytomas at the head and neck region show a predilection to appear near the great neck vessels with a possibility to require vascular repair, or at the parotid space where they can be multicentric. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2479-E2482, 2016.

Myopericytoma of the tongue: a case report

Myopericytoma is a rare benign tumour composed of pericytic cells that show myoid differentiation and have a tendency for concentric perivascular growth. It belongs to a spectrum ofperivascular myoid cell neoplasms. To date, only a small number of cases of myopericytoma involving the oral cavity have been reported. We describe a case of myopericytoma presenting as a slowly growing tongue nodule in a 61-year-old woman. A diagnosis of myopericytoma was established with the histopathological findings combined with immunohistochemical staining. Myopericytoma should be included in the differential diagnosis of well-circumscribed, slow-growing lesions of the oral cavity.

Intraosseous angioleiomyoma the tibia: a case report

Angioleiomyoma (vascular leiomyoma/angiomyoma) is a morphologically distinctive tumor characterized by proliferating smooth muscle cells admixed with prominent vascular elements. The majority of angioleiomyomas involve the superficial soft tissues. Examples of this lesion originating in bone, particularly in the appendicular skeleton, are extremely rare. The present report details the clinicopathologic features of an unusual case of an intraosseous angioleiomyoma arising in the distal tibia. The skeletal tumor exhibited the typical histologic appearance and immunophenotypic features of this entity. Due to its rarity, angioleiomyoma of bone can pose problems in diagnosis. Awareness that angioleiomyoma can present as a primary intraosseous lesion is important so as not to confuse this neoplasm with more commonly encountered bone tumors.

Management of multicentric myopericytoma in the maxillofacial region: a case report

Myopericytoma (MPC) is a rare kind of benign neoplasm, showing derivation from perivascular myoid cells. About 115 cases have been reported in the English literature; however, most of the literature focuses on the description and classification of pathology. The case presented here is that of a 42-year-old woman with a surgical management experience of multicentric MPC in the maxillofacial region. Although small MPC can be completely and easily excised, large MPC, especially in certain anatomic sites, necessitates careful preoperative preparation.

Myopericytoma of low grade malignancy in the oral cavity

Myopericytoma (MPC) of the oral cavity is extremely rare. Herein reported is a case of MPC of low grade malignancy in the oral cavity. A 61-year-old man noticed a tumor of the cheek mucosa, and admitted to our hospital. Oral examination revealed a reddish elevated tumor of the cheek mucosa. Tumorectomy with wide margins was performed. The clinical diagnosis was pyogenic granuloma. Grossly, the tumor was reddish, and measured 1×1×1 cm. Microscopically, oval to spindle tumor cells with hyperchromatic vesicular nuclei and many vasculatures were seen. The tumor cells were contiguous and mixed with endothelial cells in many blood vessels, thus resembling pericytes. Mitotic figures were scattered. The surgical margins were negative for tumor cells. Immunohistochemically, the tumor cells were positive for vimentin, α-smooth muscle actin and p53. The Ki67 labeling was 40%. The tumor cells were negative for cytokeratins (AE1/3 and CAM5.2), CD31, CD34, S100 protein, HMB45, CD10, vimentin, desmin, and factor VIII-related antigen. The endothelium of the vessels were positive for vimentin, CD31, CD34 and factor VIII-related antigen, but negative for α-smooth muscle actin, p53, cytokeratins (AE1/3 and CAM5.2), S100 protein, HMB45, CD10, vimentin, and desmin. The Ki67 labeling was 5%. Because the pericytoid tumor cells showed α-smooth muscle actin and negative for endothelial markers, MPC was diagnosed. In addition, because there was some atypia and mitotic figures were scatters and also because the tumor cells were positive for p53 and Ki67 labeling was high, a pathological diagnosis of MPC with low grade malignancy was made. No recurrence was observed, and the patient is now free from tumor 6 months after the operation.

Glomangiopericytoma of the nasal cavity

Glomangiopericytoma is a rare tumor arising from the pericytes surrounding capillaries, and accounts for less than 0.5% of all sinonasal tumors. A 60-year-old male patient presented with a glomangiopericytoma of the nasal cavity manifesting as nasal obstruction and epistaxis, which was treated successfully with endoscopic excision. Histological examination showed multiplication of spindle-shaped to oval cells which reacted strongly to immunostaining for α-smooth muscle actin. Glomangiopericytoma is categorized as a borderline low malignancy tumor, which tends to recurrence. Strict follow-up is required, especially if complete resection is not achieved.

Myopericytoma of the kidney

Myopericytoma is a rare, histologically distinctive tumor that shows evidence of differentiation toward perivascular myoid cells. Myopericytoma is largely considered a neoplasm of skin and soft tissues, with examples of this lesion involving visceral sites being extremely limited. We present the clinical and pathologic details of an unusual case of myopericytoma occurring in the kidney. Histologically, the tumor was richly vascularized and composed of a perivascular proliferation of oval to spindle-shaped cells with bland cytologic features. The neoplastic cells were arranged in a concentric fashion around vascular lumina and also surrounded dilated, branching vessels, with a glomangiopericytomatous appearance. Mitotic figures were inconspicuous, and necrosis was absent. Perivascular myoid differentiation was supported by positive immunoreactivity for muscle-specific and smooth muscle actins, and absence of reactivity for desmin. The present case serves to expand the anatomical distribution of myopericytoma and also broadens the spectrum of primary mesenchymal neoplasms that may be encountered in the kidney.

Common Presentation of Uncommon Lesion

Angioleiomyomas are rarely seen in the oral cavity. We present here an asymptomatic swelling discovered during routine intraoral examination. On excision and further histological examination it was diagnosed as an angioleiomyoma. There was no recurrence following excision.

Low-grade myofibroblastic sarcoma of the oral cavity

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.