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Jot K, Nayyar V, Surya V, Mishra D, Sowmya SV, Augustine D, Indu M, Haragannavar VC. A multicentric case study of fibroblastic and myofibroblastic oral spindle cell lesions. J Oral Maxillofac Pathol 2023; 27:629-641. [PMID: 38304501 PMCID: PMC10829460 DOI: 10.4103/jomfp.jomfp_282_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024] Open
Abstract
Context Spindle cell lesions comprise a vast plethora of benign and malignant lesions with similar clinical and radiographic features. Their overlapping histopathologic features ensure a diagnostic dilemma. Aim The current multicentric study aims to delineate fibroblastic and myofibroblastic oral spindle cell lesions based on cytomorphology and comprehensive immunohistochemical analysis. Settings and Design The experimental study was conducted at MS Ramaiah University of Applied Sciences, Bangalore, and All India Institute of Applied Sciences, Delhi. Methods and Material A comprehensive histological scoring criteria and panel of immunohistochemical makers (STAT6, CD31, CD34, S100, SMA, vimentin, pan-CK, HHF-35, Ki67, ALK, desmin, HMB-45, SATB2, ERG, EMA and CD99) were employed concurrently for the first time for fibroblastic and myofibroblastic oral spindle cell lesions. The data obtained was tabulated and studied. Statistical Analysis Used NA. Results: Using cytological scoring criteria and panel of immunohistochemical makers, the cases analysed and characterized were desmoplastic fibroma, fibrosarcoma, leiomyosarcoma, nodular fasciitis, neurofibroma and epithelioid inflammatory myofibroblastic sarcoma (EIMS). Conclusions The diagnostic strategies need to be upgraded for the diagnosis of spindle cell lesions. Emphasis must be placed on cytomorphology, an immunohistochemistry (IHC) panel of markers is imperative for the accurate diagnosis of fibroblastic and myofibroblastic oral spindle cell lesions.
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Affiliation(s)
- Kiran Jot
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vivek Nayyar
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Varun Surya
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Fifth Floor, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - SV Sowmya
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru, Karnataka, India
| | - Dominic Augustine
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru, Karnataka, India
| | - M Indu
- Department of Oral Pathology, Government Dental College, Kottayam, Kerala, India
| | - Vanishri C. Haragannavar
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, MSR Nagar, Bengaluru, Karnataka, India
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Yadav V, Kaur H, Gupta V, Mishra D. Fibrosarcoma: Origin, differential diagnosis, and report of a case in the mandible. J Indian Soc Periodontol 2022; 26:169-177. [PMID: 35321293 PMCID: PMC8936010 DOI: 10.4103/jisp.jisp_188_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/19/2021] [Accepted: 09/05/2021] [Indexed: 11/24/2022] Open
Abstract
Fibrosarcoma (FS) is a malignant neoplasm of mesenchymal cells with no specific line of differentiation. Histologically, it mimics the wide spectrum of benign and malignant spindle cell neoplasms creating diagnostic conundrum. Immunohistochemistry plays a crucial role in the diagnosis which relies on various antibodies reacting with different antigens expressed by heterogeneous cells. Thus, there is a need to study the origin of the spindle cells to better comprehend their immunophenotypes that forms cornerstone for final confirmatory diagnosis. This case report describes the case of a 42-year-old male with soft-tissue mass in the mandible. Initial biopsy revealed it a reactive fibrous lesion; however, deeper biopsy confirmed spindle cell malignancy which exhibited immunonegativity to all other markers except vimentin. In addition, this case highlights the origin of various spindle cells with markers expressed during their development. The differential diagnosis of FS from other benign and malignant spindle cell lesions on the basis of clinical, histopathology, and immunohistochemistry is also elaborated.
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Solitary Intra-Osseous Myofibroma of the Jaw: A Case Report and Review of Literature. CHILDREN-BASEL 2017; 4:children4100091. [PMID: 29064415 PMCID: PMC5664021 DOI: 10.3390/children4100091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 11/26/2022]
Abstract
Myofibroma is a rare benign spindle cell neoplasm in children that usually affects both soft tissue and bone in the head and neck region. Approximately one third of these cases are seen within jaw bones as solitary lesions. Solitary intra-osseous myofibroma of the jaw bone shares its clinical, radiographic and histological features with other spindle cell tumors. The rarity of this lesion can make diagnosis difficult for clinicians and pathologists. We report a case of a solitary intra-osseous myofibroma in the mandible of a nine-year-old child.
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Akhtar K, Hasan SA, Sherwani RK, Ahmad M. Fibrosarcoma of the Gingiva: An Unusual Presentation. Oman Med J 2016; 31:312-4. [PMID: 27403246 DOI: 10.5001/omj.2016.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Fibrosarcoma is a malignant tumor of the fibroblasts, which is liable to recur and metastasize, most frequently in the lungs. Although fibrosarcomas are rare, they can occur anywhere in the body. The most common sites are in the retroperitoneum, thigh, knee, and distal extremities. It is very uncommon in the head and neck region and comprises only about 1% of all the malignancies in humans. Almost 23% are seen in the oral cavity. The prognosis for fibrosarcomas is poor with a five-year survival rate of 20-35%. The common modality of treatment is radical surgery. We report a rare presentation of gingival fibrosarcoma in a young female, who presented with a painless lump.
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Affiliation(s)
- Kafil Akhtar
- The Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Syed Abrar Hasan
- ENT Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Rana K Sherwani
- The Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Murad Ahmad
- The Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
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Recurrent adult-type fibrosarcoma of the frontal bone in a child. Childs Nerv Syst 2016; 32:1169-73. [PMID: 26743922 DOI: 10.1007/s00381-015-2998-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/22/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Primary, adult-type bone fibrosarcoma is an uncommon, malignant spindle-cell tumor of fibroblastic origin, rarely affecting children. Most frequently diagnosed among bone malignancies in the past, improved diagnostic techniques and further restrictive classification criteria have currently made the diagnosis of fibrosarcoma very unusual. CASE REPORT We hereby report the case of a 7-year-old child with a right frontal swelling mass. A computed tomography scan showed an osteolytic lesion of the right frontal bone, involving the diploe and the outer table of the skull. An en bloc surgical excision, followed by a thorough immunohistological evaluation, led to the diagnosis of fibroblastic proliferation, with low cellularity and minimal atypias. The patient had four recurrences during the 4-year follow-up. With an increasing histological grade at recurrences, a diagnosis of adult-type fibrosarcoma was made. CONCLUSION To the best of the authors' knowledge, this is the first reported case of an adult-type fibrosarcoma arising in the frontal bone of a child.
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Dauda MA, Yakubu D, Mandong BM, Ojo EO. Sarcomas in Nigerian Children in Jos North Central Nigeria. AFRICAN JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2014; 43:37-44. [PMID: 26689374 PMCID: PMC4682882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND There is a growing concern about childhood sarcomas, with recent studies suggesting an increase in the frequency of childhood sarcomas in sub-Saharan Africa. This study was carried out to determine the pattern of childhood sarcomas in Jos, North Central Nigeria and to compare the data obtained with other previous related studies. METHODS Review of the Jos University Teaching Hospital cancer registry from January 2001 to December 2010. Data of all children (0-15 years) in the data base were retrieved for analysis. RESULTS Two hundred and ten histological diagnosis of malignancies were made in children over the period, with 81 cases (39%) being childhood Sarcomas. The sarcomas occurred predominantly in males (54%) with male/female ratio of 2:1. The minimum age was 2 months and the maximum age was 15 years. Soft tissue sarcoma (STS) was the most predominant group which accounted for 73 cases (90%) of all sarcomas seen. Rhabdomyosarcoma (RMS) was the most common STS, it accounted for 65 cases (89%) of the STS and 80% of all the sarcomas. This is followed by Kaposi Sarcoma (KS) accounting for 6.9% of STS. There were 8 cases of Osteosarcoma which accounted for 10% of all the sarcomas. Embryonal RMS predominated in the very young children while all other sarcomas affected the older children. Extremities were the sites of predilection for most of the sarcomas (36%). Seventeen (17) cases of the RMS were of superior prognostic group, 34 (54%) were of intermediate prognostic group while 24 cases (37%) were of poor prognostic group. CONCLUSION Childhood sarcomas are common in our environment and RMS is the single most common sarcoma while the non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) are rare.
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Swain N, Kumar SV, Dhariwal R, Routray S. Primary fibrosarcoma of maxilla in an 8-year-old child: A rare entity. J Oral Maxillofac Pathol 2014; 17:478. [PMID: 24574679 PMCID: PMC3927362 DOI: 10.4103/0973-029x.125226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fibrosarcoma (FS) is a malignant mesenchymal neoplasm of the fibroblasts that is uncommon in the head and neck and constitutes less than 1% of malignancies and approximately 6% of the soft tissue sarcomas. FSs rarely occur before the third decade except infantile type. This condition primarily affects long bones, and its occurrence in the cranium is rare (15%), with the mandible being the most commonly involved cranial site. Here a case of primary FS in anterior maxilla of an 8-year-old male child is reported. This article is presented to document the rarity of FSs in the jaws of children with review of literature.
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Affiliation(s)
- Niharika Swain
- Department of Oral Pathology, Mahatma Gandhi Mission Dental College and Hospital, Kamothe, Navi, Mumbai, Maharashtra, India
| | - Shwetha V Kumar
- Department of Oral Pathology, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Richa Dhariwal
- Department of Oral Pathology, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Samapika Routray
- Department of Oral Pathology, Institute of Dental Sciences, Bhubaneswar, Odisha, India
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Basavaraj KF, Madihalli AU, Mujeeb A, Mansuri S, Hussain MA. Advancing mandibular swelling: a diagnostic dilemma. J Contemp Dent Pract 2013; 14:754-8. [PMID: 24309361 DOI: 10.5005/jp-journals-10024-1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Asymmetrical swelling of the mandible in adolescence may pose a significant diagnostic dilemma. The differential diagnosis ranges from traumatic, infectious, and metabolic processes to benign and malignant tumors. Also may present with similar clinical and radiological features, making an accurate diagnosis quite difficult. This is an illustrative case involving a 30-year-old female who initially presented with complaint of pain and swelling in the lower left side of the face for 2 months. Multiple investigations and several biopsies were required to arrive at a diagnosis. This paper deals with a case report of a fibrosarcoma involving the mandible highlighting the importance of early diagnosis and treatment planning.
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Affiliation(s)
- K F Basavaraj
- Lecturer, Department of Oral Pathology and Oral Biology, Faculty of Dentistry, Al-Jabal Al-Gharbi University, Gharian, Libya, e-mail:
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Hashemi A, Tefagh S, Seifadini A, Moghimi M. Infantile fibrosarcoma in a child: a case report. IRANIAN JOURNAL OF PEDIATRIC HEMATOLOGY AND ONCOLOGY 2013; 3:135-7. [PMID: 24575285 PMCID: PMC3921878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/08/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infantile Fibrosarcoma is a rare soft tissue tumor in infants and children mostly located in extremities. An infantile and adult form has similar histopathological patterns but survival prognosis is much better in infantile form. Recurrence of infantile fibrosarcoma is common but the rates of metastasis are less than 10 percent in children younger than five Years and 50 percent in children more than 10 years old. CASE PRESENTATION In this case report, we presented a nine years girl with a relapsing mass in her left hand. The pathologic findings showed sheets of spindle-shaped cells with suggested diagnose of infantile fibrosarcoma. She was successfully treated with combination of surgery and chemotherapy with a good outcome. CONCLUSION Infantile fibrosarcoma is a differential diagnose of soft tissue mass in infants and children. It has a good prognosis and distant metastasis is uncommon. Choice of treatment is surgery but chemotherapy and radiotherapy were useful in decrease metastasis.
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Affiliation(s)
- A Hashemi
- Department of Pediatrics, Hematology, Oncology and Genetic Research Center, Shahid Sadoughi University of Medical Sciences Health Services, Yazd, Iran
| | - S Tefagh
- MD, Hematology, Oncology and Genetics Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
| | - A Seifadini
- Medical Student, Islamic Azad University branch Yazd, Yazd, Iran
| | - M Moghimi
- Department of Pathology, Shahid Sadoughi University of Medical Sciences Health Services, Yazd, Iran
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Abstract
Fibroblastic and myofibroblastic tumors in children and adolescents are a relatively common group of soft tissue proliferations that range from reactive to hamartomatous to neoplastic, with a full spectrum of benign, intermediate, and malignant neoplasms. These lesions are diagnostically challenging because of morphologic and immunohistochemical overlap, despite significant clinical, genetic, and prognostic differences. The fibromatoses are a major subgroup, and all types of fibromatoses can occur in the 1st 2 decades of life. Intermediate and malignant fibroblastic-myofibroblastic tumors are an important group that includes variants of fibrosarcoma and other tumors with recurrent cytogenetic or molecular genetic abnormalities and low metastatic potential. Pathologic examination is enhanced by adjunct techniques, such as immunohistochemistry, cytogenetics, and molecular genetics, although morphology provides the ultimate criteria for a specific diagnosis. This article reviews the clinicopathologic features of fibroblastic and myofibroblastic tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents, the use of diagnostic adjuncts, and differential diagnoses.
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Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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Yuwanati MB, Tupkari JV. Fibrosarcoma of mandible: a case report. Case Rep Dent 2011; 2011:536086. [PMID: 22567441 PMCID: PMC3335480 DOI: 10.1155/2011/536086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 05/17/2011] [Indexed: 12/05/2022] Open
Abstract
Fibrosarcoma is a malignant mesenchymal neoplasm of fibroblasts that rarely affects the oral cavity and can cause local recurrences or metastasis. In this paper, a case of fibrosarcoma in the posterior area of mandible in a 44-year-old woman is described. Clinical examination revealed a growth on right mandibular third molar region extending on the buccal and the lingual side. There was history of extraction of posterior teeth. Radiologically, there was a diffuse bone loss. Microscopically, the tumor showed an intense proliferation of fibroblasts of variable size and shape. These cells were arranged in parallel bands and partly crossing each other. The cells exhibited increased mitotic activity and nuclear pleomorphism. Immunohistochemically the cells showed immunoreactivity only for vimentin while they exhibited negativity towards S-100 protein, cytokeratin cocktail, HMB-45, desmin, smooth muscle actin, and epithelial membrane antigen (EMA). Based on findings the final diagnosis of fibrosarcoma was made.
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Affiliation(s)
- Monal B. Yuwanati
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Mumbai, India
| | - J. V. Tupkari
- Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Mumbai, India
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