Solitary Intra-Osseous Myofibroma of the Jaw: A Case Report and Review of Literature
Abstract
:1. Introduction
2. Patient Description
3. Discussion
Author Contributions
Conflicts of Interest
References
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Pathology | Microscopic Features | Immunohistochemistry |
---|---|---|
Benign Tumors | ||
Intra-osseous myofibroma | Alternating growth pattern show fascicular and cellular areas characterized by polygonal cells at the center and elongated cells at the periphery. Absence of pleomorphism, nuclear atypia and mitosis. | α-SMA and vimentin positive. |
Leiomyoma | Homogenous fascicular pattern made up of spindle cells with cigar shaped nucleus and bright eosinophilic cytoplasm. | Desmin, α-SMA, muscle specific actin (HHF-35), calponin positive. |
Schwannoma | Cellular areas showing palisading growth pattern (Antoni A) intermixed with fibrillar unorganized cellular areas (Antoni B). | Diffuse S-100 podoplanin, calretinin, neurofibromin, CD34, glial fibrillary acidic protein (GFAP), collagen IV positive. Occasionally positive for cytokeratin (CK). |
Neurofibroma | Spindle shaped cells with wavy nuclei showing fascicular or storiform growth pattern, at times myxoid areas are seen. | Expression of markers in descending order of immuno-reactivity S-100, CD34, SRY (sex determining region Y)-box 10 (Sox 10), collagen IV, calretinin, podoplanin, epithelial membrane antigen (EMA) positive. |
Solitary fibrous tumor | No distinct cellular pattern of growth, however staghorn branching of blood vessels and perivascular hyalinization is seen. | CD-34, signal transducer and activator of transcription-6 (STAT-6), CD-99, B-cell CLL/lymphoma 2 (Bcl-2) (>85%) positive. Nuclear reactivity for β-catenin (22–67%). |
Desmoplastic fibroma | Monomorphic fascicles of spindle cells admixed with abundant wavy collagen fibers. Absence of branching vasculature. | Vimentin (92%), β-catenin (50%) and occasional positivity for α-SMA. |
Inflammatory myofibroblastic tumor | Three patterns of plump spindle cell arrangements have been described, along with an infiltrate of chronic inflammatory cells: spindle cells within a myxoid stroma, fascicular or storiform arrangement in a collagenous stroma and hypocellular elongated spindle cell component in a dense collagenous stroma. | Positive markers include: α-SMA, HHF-35, desmin (~50%), anaplastic lymphoma kinase protein (ALK-1) (30–60%), both anti-pan cytokeratin (AE1/AE3) and anticytokeratin for cytokeratin peptide 8 (CAM 5.2) (<35%) respectively. |
Nodular fasciitis | Three patterns have been described: Type 1: Myxomatous vascular and acellular central stroma with plump fibroblasts at the periphery. Type 2: Cellular stroma with slit like vascular spaces. Type 3: Fibromatous stroma which contains interlacing fiber bundles, spindle shaped fibroblasts and capillaries. | Vimentin, HHF-35, α-SMA positive. |
Benign fibrous histiocytoma | Fibroblast and histiocyte proliferation in a storiform pattern, with occasional multinucleated giant cells and foam cells. | Vimentin, CD-68, 1-antitrypsin, 1-antichymotrypsin positive. |
Desmoid tumor | Mature spindle shaped cell proliferation separated by bundles of fibrous tissue. | Focal positivity for α-SMA, desmin and nuclear reactivity for β-catenin. |
Myopericytoma | Oval or spindle shaped cells with a concentric peri-vascular arrangement. | α-SMA, smooth muscle myosin heavy chain, h-caldesmon, and calponin positive. |
Malignant Tumors | ||
Low-grade fibrosarcoma | Malignant fibroblasts show typical herring bone pattern, combined with high mitotic activity and nuclear atypia. | Vimentin positive. Variable positive expression of: α-SMA, HHF35, neuron-specific enolase, desmin, S-100, CD34, and CK. |
Leiomyosarcoma | Palisaded pattern with densely packed spindle cells with fibrillar eosinophilic cytoplasm showing indistinct cell borders. Pleomorphism and high mitotic index is evident. | Diagnosis is based expression of any two of the following markers: α-SMA, desmin, HHF35, calponin. EMA and CK are occasionally positive (10–30%). |
Myofibrosarcoma | Show varied patterns which include fibrosarcoma like areas. Nuclear pleomorphism is ubiquitous. | Vimentin (100%), Fibronectin (100%), α-SMA (~90%), HHF35 (~78%), calponin (67%), and desmin (~20%) positive. |
Rhabdomyosarcoma | Ovoid or elongated rhabdomyoblasts with eosinophilic granular cytoplasm. Few blast cells show cross striations. Multinucleated tumor giant cells and abnormal mitotic figures are occasionally seen in a myxoid stroma. | Nuclear reactivity for myogenin and myogenic differentiation 1 (MyoD1). Diffuse desmin and rare α-SMA positive (~10%). |
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Dhupar, A.; Carvalho, K.; Sawant, P.; Spadigam, A.; Syed, S. Solitary Intra-Osseous Myofibroma of the Jaw: A Case Report and Review of Literature. Children 2017, 4, 91. https://doi.org/10.3390/children4100091
Dhupar A, Carvalho K, Sawant P, Spadigam A, Syed S. Solitary Intra-Osseous Myofibroma of the Jaw: A Case Report and Review of Literature. Children. 2017; 4(10):91. https://doi.org/10.3390/children4100091
Chicago/Turabian StyleDhupar, Anita, Karla Carvalho, Poonam Sawant, Anita Spadigam, and Shaheen Syed. 2017. "Solitary Intra-Osseous Myofibroma of the Jaw: A Case Report and Review of Literature" Children 4, no. 10: 91. https://doi.org/10.3390/children4100091
APA StyleDhupar, A., Carvalho, K., Sawant, P., Spadigam, A., & Syed, S. (2017). Solitary Intra-Osseous Myofibroma of the Jaw: A Case Report and Review of Literature. Children, 4(10), 91. https://doi.org/10.3390/children4100091