Solitary intraosseous myofibroma: a rare case diagnosed from mandibular fracture.

Intraosseous myofibroma is a rare tumor of benign nature, slow growth, and low morbidity. The aim of this article is to report a case of pathologic fracture associated with the incidental diagnosis of myofibroma in the mandible of an adolescent. A 15-year-old girl reported that she experienced a physical assault resulting in facial injuries 1 month previously and had since experienced severe pain, malocclusion, and chewing difficulty. The cone beam computed tomographic examination revealed multiple features suggestive of pathologic fracture associated with a hypodense lesion with lobulated limits, as well as expansion and thinning of the cortical bone in the left mandible. The histopathologic diagnosis of the lesion indicated myofibroma. Treatment consisted of enucleation and curettage of the lesion with reduction and internal fixation of the fracture. After 18 months, the osteosynthesis plates and an impacted mandibular third molar were removed. Curettage of the lesion in association with treatment of the mandibular fracture proved to be effective for both bone consolidation and absence of recurrence while restoring mandibular functionality.

Surgical Management of Myofibroma of the Gengiva.

The purpose of this paper is to report a rare patient of oral myofibroma in a 12-year old patient and to describe its clinical, histopathologic, and immunohistochemical features to establish the correct diagnosis and surgical management.Pathological and immunohistochemical examination is a mandatory method for establishing a definitive diagnosis of this lesion avoiding unnecessary treatment. Surgical excision and careful postoperative observation should be a treatment option.

Rapid growing myofibroma of the gingiva: report of a case and review of the literature.

PURPOSE: Myofibroma is a rare benign tumor of myofibroblasts that rarely exhibits rapid enlargement and is misinterpreted as a malignant lesion. The aim of this study was to investigate its growth potential and to evaluate the usefulness of preoperative immunohistochemical study for an accurate diagnosis. MATERIALS AND METHODS: A case of rapidly growing myofibroma of the lower gingiva was analyzed using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography fused with computed tomography (PET/CT) and immunohistochemical study of Ki-67 and p53. The English-language literature from 1981 to 2012 also was reviewed. RESULTS: An 18F-FDG PET/CT image displayed a high accumulation (maximum standardized uptake value, 14.1) in the lesion. A biopsy specimen showed mitotic activity of spindle-shaped cells, but atypia was not present. The MIB-1 labeling index was 10%, and the p53 test result was negative. The preoperative diagnosis of benign tumor of smooth muscle origin was made from the histopathologic and immunohistochemical features. In a review of 94 cases, tumors involved the mandible (33%), gingiva (23%), tongue (15%), cheek or buccal mucosa (12%), palate (8%), lip (4%), and other areas (5%). Nine cases (9.6%) were described as rapidly enlarging, and 8 cases (8.5%) were suspected of malignancy at initial diagnosis. The preoperative biopsy with immunohistochemical study established an accurate diagnosis in 83% of myofibromas, and no recurrences were reported in these patients. CONCLUSIONS: Careful diagnosis is necessary because these lesions sometimes present clinical and radiologic features that resemble those of malignant tumors. Preoperative immunohistochemical analysis should be performed to avoid misdiagnosis or unnecessary aggressive therapy.

Solitary myofibroma of the mandible in an adult with magnetic resonance imaging and positron emission tomography findings: a case report.

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.

Solitary myofibroma of the mandible: an immunohistochemical and ultrastructural study with a review of the literature.

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.

Gingival Myofibroma. A case report.

AIM: The Myofibroma (MF) is a benign mesenchymal tumor frequently observed in the skin and subcutaneous tissue of the head-neck region. It is described mainly in infants with congenital forms and, in early childhood, with acquired forms. Less often, it can be observed in adolescents and adults. The location of a MF in the oral cavity is occasional and differential diagnosis must be established with other benign and malignant neoplasms, high or low grade, of the oral mucosa. The histology of the myofibroma shows a biphasic growth pattern: elongated spindle cells with eosinophilic cytoplasm, in the borders, polygonal cells arranged in a palisading pattern, with hyperchromatic nuclei, in the central portions. The diagnosis of MF, usually made after excision of the neoformation, is obtained by means of immunohistochemistry, in which there is positivity for vimentin and αactine smooth muscle antibodies and negativity for keratin, S-100, EMA (Epithelial Membrane Antigen) antibodies. The treatment is surgical; the prognosis is generally good with low rates of recurrence after excision. CASE REPORT: The authors describe a case of MF in a 16-year-old male subject, that came to their observation for the growth of a considerable mass attached to the gingival mucosa, describing the therapeutic strategy.

[Myofibroma of the mandibule: a case report]. / Myofibrome de la mandibule: à propos d'un cas.

INTRODUCTION: Myofibromatosis is a rare tumor. Two forms are described, solitary and multicentric, the solitary type is more common and is localized mainly on the head and the neck, mandible involvement is rare. The recent observation of a patient with a myofibrome of the mandible has given the opportunity to conduct an analysis and review of the literature of this disease rarely encountered. MATERIALS AND METHODS: We report a case illustrating solitary myofibroma of the mandible in a 16 year old man. RESULTS: The histological diagnosis was done on the identification of the spindle-shaped tumoral proliferation and the positive expression of the anti-vimentine, anti-smooth, muscle actin anti desmin. The treatment was surgical. DISCUSSION: myofibromatosis often presents as a painless, well-circumscribed, solid nodule. Imagery is very useful to assess lesion extension and for the therapeutic followup. The diagnosis is made on anatomopathological findings and immunohistochemical assessment. The treatment of the solitary myofibromatosis is primarily surgical and its prognosis is excellent contrary to the multicentric form.

Atypical Myofibroblastic Tumor of the Oral Cavity in a Child.

A myofibroma is a relatively rare neoplasm characterized by its spindle cell proliferation. This lesion can present as a unifocal mass (myofibroma) or multifocal growths (myofibromatosis) in the skin, soft tissue, bone, or internal organs. In the oral cavity, the tumor is commonly identified on the tongue, mucosa, lips, and mandible. Myofibroma classically occurs in infants and young children. Its fast-growing nature often mimics a sarcoma; however, it is a benign tumor. The purpose of this article is to report the case of an eight-year-old boy who presented with a localized, painless, nodular mass in the palate and gingiva. Through clinical, radiological, and immunohistochemical evaluation, the diagnosis of an atypical myofibroblastic tumor was made after resection of the mass. With interprofessional team management, the patient's quality of life was improved.

Myofibroma of the gingiva: report of a case.

Myofibroma is a benign mesenchymal neoplasm composed of myofibroblasts which has been described with different synonyms since the first report in 1951. It occurs most commonly as a solitary lesion of soft tissue, skin, or bone in infancy. The prognosis of oral myofibromas is excellent, and surgical excision is curative. Recurrence is rare. Awareness and recognition of this benign tumor is important to establish the correct diagnosis and avoid morbidity of unnecessary aggressive therapy. This report describes a myofibroma of the gingiva in a 14 year old girl and is reported together with the conventional histologic, and immunohistochemical findings. The tumor showed rapid increase in size and clinical features suggestive of malignancy. However on histopathologic evaluation it was diagnosed as a benign neoplasm, and this diagnosis was supported by immunohistochemical markers. The spindle cells were immunopositive for smooth muscle actin, and vimentin but were negative for desmin and S-100 protein. The patient was treated with surgical excision, and is followed-up for 33 months without any signs of recurrence.

Masson trichrome stain helps differentiate myofibroma from smooth muscle lesions in the head and neck region.

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.

[Solitary myofibroma of the mandible: a case report]. / Myofibrome solitaire de la mandibule. A propos d'un cas.

OBJECTIVES: Infantile myofibromatosis (IMF) are integrated in the group of fibromatosis juvenile-type which are benign mesenchymal lesions, characterized morphologically by a proliferation of fibroblasts and myofibroblastes, with perivascular pattern. Through a case of solitary myofibroma of the mandible, we will emphasize anatomo-clinical features and differential diagnosis. MATERIALS AND METHODS: We report a case illustrating solitary myofibroma of the mandible in 18 month old infant. RESULTS: The histological diagnosis was done on the identification of two separate components, a fascicular myofibroblastic pattern at the periphery with a hemangiopericytoma like pattern in the centre. Both components positive for alpha-smooth muscle actin and vimentin. DISCUSSION: Solitary IMF is characterised by a single lesion arising from cutaneous, bony or soft tissues. Morphological and immunohistochemical examination allow the diagnosis of the typical form. The differential diagnosis includes other benign spindle cells tumours. The prognosis is excellent with possibility to regress spontaneously.

Clinico-pathological conference 2002.

INTRODUCTION: Six cases are reported, each presented at the 11th Biennial Congress of the International Association of Oral Pathologists as an instructive case for differential diagnosis on the basis of clinical, imaging or histological features. CLINICAL PICTURE: Case diagnoses included a large, possibly intraosseous, myofibroma presenting with an oral mass; Langerhans cell histiocytosis with facial skin lesions; an intraosseous vascular hamartoma of the maxilla with worrying radiological features; an unusual mixed radiolucency of the jaw caused by cemento-ossifying fibroma; an osteosarcoma of the posterior mandible causing a well-defined radiolucency and an intraoral squamous cell carcinoma in a child.

Pediatric solitary intraosseous infantile myofibroma of the mandible.

Myofibroma is a rare benign tumor of myofibroblastic origin that presents as solitary or multiple, and as an intraosseous and/or soft tissue lesion. It most commonly occurs in infants and children, although adult myofibromas have also been reported. Solitary central infantile myofibroma of the jaws is very rare and should be considered in the differential diagnosis of central jaw lesions involving the mandible in children. Its etiology is unknown. The purpose of this manuscript is to report a case of solitary intraosseous infantile myofibroma of the mandible wherein trauma may have been a contributory factor to the development of the tumor. The importance of immunohistochemistry in diagnosing this entity has also been emphasized. Resection should be preferred over enucleation when the lesion infiltrates the surrounding bone.

Mandibular swelling in a 5-year-old child--mandibular myofibroma.

A 5-year-old girl of African descent presented with a history of progressive painless swelling on the right side of the jaw since the past 2-3 months. Orthopantomogram showed a radiolucent lesion near the angle of the mandible. Subsequent CT scan revealed a 2 cm×2 cm radiolucent lesion with intense periosteal reaction surrounding the lesion and destruction of the overlying cortex. Radiological perplexity aroused regarding the possibility of eosinophilic granuloma or some other malignant lesion. Incisional biopsy performed and microscopy showed spindle cell tumor. Immunohistochemistry confirmed it as myofibroma. Myofibroma is a rare benign tumour involving mesenchyme. Involvement of the mandible is rare. Radiological presentation with strong periosteal reaction is a rarity and has rarely been reported in the medical literature. We conclude that intraosseous myofibroma can sometimes have strong periosteal reaction and careful radiological evaluation is a prerequisite for accurate diagnosis and to avoid unnecessary aggressive therapy.

Specificity of paediatric jawbone lesions: tumours and pseudotumours.

INTRODUCTION: Characteristics and epidemiology of jaw tumours have been described mostly in adults. Compared with their adult counterparts, childhood jaw tumours show considerable differences. The aim of this study was to describe the different jaw tumours in children, define diagnostic tools to determine their specificity and describe optimal treatment. METHODS: All children patients with jaw lesions, excluding cysts, apical granuloma and osteitis were included in our study between 1999 and 2009. The medical records were analyzed for clinical, radiological, and pathological findings, treatments and recurrences. RESULTS: Mean patient age was 10.9 years old, ranging from 2 months to 18 years old. Of the 63 lesions, 18 were odontogenic and 45 non-odontogenic lesions. 6% of all cases were malignant tumours; the mean age of presentation was 7.25 years old, [ranging from 0.2 to 18 years old]. Approximately 80% of the tumours developed after 6 years of age. Odontogenic tumours occurred more often after the age of 6. CONCLUSION: Compared with their adult counterpart, childhood jaw tumours show considerable differences in their clinical behaviour and radiological and pathological characteristics. Clinical features of some tumours can be specific to children. Tumourigenesis is related to dental development and facial growth. Conservative treatment should be considered.

Solitary myofibroma of the adult mandible: a case report.

A 43-year-old woman presented with a swelling in the anterior mandible appearing radiographically as a well-defined radiolucency causing mobility of the anterior teeth. A clinical diagnosis of a radicular cyst led to removal of the lesion and the associated mobile teeth. Postoperative histopathology led to a diagnosis of intraosseous solitary myofibroma of the mandible. Solitary lesions of myofibroma are exceedingly rare in adult jaws, with only 3 previously documented cases.

Myofibroma of the mandible: a case report.

This report describes the case of a male aged 28 years who presented with a chief complaint of discomfort and swelling in the mandibular right molar area. An incisional biopsy was performed with a preliminary differential diagnosis of periodontal abscess, fibrotic lesion, or odontogenic tumor. Subsequent excision of the lesion was performed and histologic analysis confirmed the diagnosis of myofibroma.