Agreement Between Clinical-Radiographic and Histopathological Diagnoses in Maxillofacial Fibro-Osseous Lesions

ABSTRACT Objective: To compare the agreement of clinical and radiographic diagnosis with the histopathological diagnosis in fibro-osseous lesions of the jaws. Material and Methods: An analytical and exploratory study was made based on systematic collected data, carried out in the laboratory of surgical pathology of a public Dental School. There were evaluated cases of fibrous dysplasia (FD), cemento-osseous dysplasia (COD) and ossifyng fibroma (OF), diagnosed by clinical, radiographic (panoramic and periapical radiography), and histopathological analysis, in a period of 12 years (from March 2001 to June 2013). Descriptive and inferential statistics (Fisher's exact test) were obtained. Results: Ninety-six cases of FOLs were evaluated. The radiographic aspects of the FOLs studied did not differ significantly (p=0.09). Radiolucent lesions were the least frequent, corresponding to approximately 13.5% of radiographic findings. Mixed lesions and radiopaques were more present, how they were COD and FD, respectively. The more aggressive variation of OF (Juvenile Ossifying Fibroma - JOF) was less frequent among the pathologies evaluated. In approximately 61.46% of the cases clinical and radiographic diagnosis were confirmed by histopathological diagnosis of FOLs. The highest agreement and the highest disagreement were observed in COD cases (40.7% and 62.2%, respectively). Conclusion: FOLs of the maxillaries represent a group of lesions in which the establishment of the clinical and radiographic diagnosis supported by the histopathological confirmation is critical and challenging.

An Atypical Fibroxanthoma and Intradermal Nevus Collision Tumor-Potential for Misdiagnosis.

Atypical fibroxanthomas (AFX) are rare cutaneous tumors, which typically present as a solitary ulcerated papule or nodule on sun-damaged skin. Despite malignant-appearing features on histology, AFX typically pursue a benign clinical course. In rare instances, AFX can form collision tumors with other lesions. However, to the best of our knowledge, AFX in collision with a nevus has never been previously reported. In this study, we describe such a lesion for its novelty and challenge in diagnosis, as this case was originally considered to be melanoma arising in a nevus. On histologic examination, there were 2 distinct populations of cells; one composed of markedly atypical and pleomorphic epithelioid and oval to spindled cells, consistent with AFX, and the other, a bland-appearing intradermal nevus with congenital features. The AFX population stained positive with smooth muscle actin, CD10, and CD68 and was negative for S100, SOX10, Melan-A, desmin, pancytokeratin, CK5/6, and p63. Deep to this was a second population of small, bland-appearing melanocytes in a broad, band-like distribution. This unusual collision tumor between AFX and an intradermal nevus highlights the important role immunohistochemistry plays in avoiding the misdiagnosis and potential overtreatment of benign or low-grade lesions, and in identifying potential mimickers.

[Pleura's solitary fibrous tumor. Clinical pathology analysis of 17 cases]. / Tumor fibroso solitario de la pleura. Análisis clínico-patológico de 17 casos.

INTRODUCTION: Solitary fibrous tumor of the pleura (SFTP) is a rare neoplasm that usually originates from the visceral pleura, but it can occur in a wide range of tissues. Approximately 12% of pleural cases are malignant tumors and surgical excision usually become curative. The objective of this study is to present 17 new cases of SFTP and analyze the morphological characteristics that help to identify tumors with a malignant behavior. MATERIAL AND METHODS: We did a retrospective review of the patients who had primary pleural tumors from January 1995 to August 2005. RESULTS: Among a total of 94 primary pleural tumors, 17 patients were enrolled in this study, 8 men and 9 women, with a mean age of 63 years. Thirteen cases (76%) were benign and four cases (23%) were malignant. Local recurrences occurred in three cases. There were no metastases found. Recurrences occurred only in malignancy tumors. All malignant tumors were high cellularity and had hemiangiopericitic pattern, more than 4 mitoses per 10 high power fields, and moderate to marked polymorphism. CONCLUSIONS: SFTP shows a benign biologic outcome in most of the cases. There are some histological characteristics that led to distinguish between benign and malign neoplasm.

Intracellular collagen and fibronexus in fibromatosis and other fibroblastic tumors.

Myofibroblasts are mesenchymal cells with combined function and structure for contraction and collagen synthesis. They are found in reparative responses, nodular fasciitis, fibromatosis, and myofibroblastic sarcoma. Ultrastructurally, myofibroblasts are characterized by a specialized cell surface structure called the fibronexus (FNX). In addition, intracellular collagen fibers (ICF) have been described in nodular fasciitis and fibromatosis, but their origin and nature are still controversial. The aim of the present work was, first, to assess the frequency of FNX and ICF in proliferative myofibroblastic conditions compared to diverse mesenchymal tumors with spindle-shaped cells, and, second, to determine what kind of organelles contain ICF and if they are related to phagocytosis or cell synthesis. Forty-two cases of aggressive fibromatosis and 11 of nodular fasciitis (group A) were compared to 82 spindle-cell mesenchymal tumors of diverse nature (group B) by electron microscopy study. The presence and frequency of FNX and ICF was compared in both groups, and the organelles containing ICF were recorded. FNX and ICF were constantly found in group A (69.8 and 84.9%, respectively), and rarely in group B (0 and 5.12%, respectively). Most frequently ICF were contained in tunnels and phagolysosomes, but also were found in Golgi vesicles and cisternae of rough endoplasmic reticulum. In the majority of cases (75%), ICF were similar to collagen fibers of the extracellular space, but in some cases (22.5%), they were in dissimilar stages of fibrogenesis. Fibromatosis and nodular fasciitis are characterized by proliferation of myofibroblasts and constantly show FNX and ICF. These structures are rarely found in other mesenchymal tumors. The ICF are found in organelles of digestion and also in others related to synthesis and transport.

[Solitary fibrous tumor of the meninges: case report]. / Tumor fibroso solitário da meninge: relato de caso.

The solitary fibrous tumor (SFT) is a rare mesenquimal neoplasm, found originally in association with the pleura. Recently, SFT was reported in others sites. The extension into adjacent structures is not uncommon. The meningeal involvement by SFT is rare and there has only twenty-six cases been reported previously in the literature. We report a case of a 25 years-old female patient with generalized tonic clonic seizures in the last six years. During the neurologic investigation, a tumor in the left occipital region of the brain was found. The patient underwent an occipital craniotomy with total resection of the tumor. The histopathological and immunohistochemical diagnosis was STF. After three years of follow-up, the patient remains stable, with a normal neurological exam. There is no sign of tumor recidive in the postoperative cranial tomography. We will briefly review the literature about STF.

Solitary fibrous tumour of the mouth: report of two cases involving the tongue and cheek.

We describe two additional cases of solitary fibrous tumour (SFT) affecting the mouth. SFT is very uncommon in the oral cavity and we found only 14 cases reported in the literature. Our two cases were well circumscribed, slow growing tumours that, after surgical removal, did not recur. Case 1 was a 3 cm nodule on the right cheek. Hypo and hypercellular adjacent areas were mainly patternless, and the stroma was formed by thin collagen fibrils. Case 2 was a 4.8 cm mass in the anterior portion of the tongue. Microscopically it was formed by spindle cells embedded in a vascularized sclerotic collagen matrix. Some areas were hypercellular with scarce collagen fibrils. The immunohistochemical findings were similar in both cases, with strong immunoreactivity for vimentin, CD34, bcl-2, focal positivity for Ki-67 and negativity for other immunomarkers. Based on these clinical, microscopical and immunohistochemical features the final diagnosis of these two cases was SFT. Diagnosis of SFT is difficult and, although uncommon, it should be considered in the differential diagnosis of oral soft tissue tumours.