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Bhatt N, Pan L, Ben-Dov T, Rickert S. Myofibroma of the pinna: a case report and review of the literature. Surg Case Rep 2024; 10:96. [PMID: 38652337 DOI: 10.1186/s40792-024-01879-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Myofibromas are rare mesenchymal tumors with a predilection for the head, neck, and oral cavity. Primarily affecting infants and young children, these tumors typically manifest as superficial painless nodules. Diagnosis is confirmed through histopathological examination of a biopsy, revealing nodules characterized by spindle cell proliferation. To our knowledge, only two cases of pinna myofibroma have been previously reported in the literature. CASE PRESENTATION Here, we present the case of a three-year-old male who developed a myofibroma of the left auricle following trauma to the area one year earlier. The patient underwent surgical resection without any postoperative complications. The patient later returned with a lesion consistent with hypertrophic scar. CONCLUSIONS This study aims to provide a comprehensive review of the clinical presentation, histopathologic and immunohistochemical features, and surgical management of this unique case of myofibroma of the pinna.
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Affiliation(s)
- Nupur Bhatt
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, NYU Langone Health, 240 East 38th Street, Fourteenth Floor, New York, NY, 10016, USA
| | - Lydia Pan
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, NYU Langone Health, 240 East 38th Street, Fourteenth Floor, New York, NY, 10016, USA
| | - Tom Ben-Dov
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, NYU Langone Health, 240 East 38th Street, Fourteenth Floor, New York, NY, 10016, USA
| | - Scott Rickert
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, NYU Langone Health, 240 East 38th Street, Fourteenth Floor, New York, NY, 10016, USA.
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Zhou Y, Sun YW, Liu XY, Shen DH. Misdiagnosis of synovial sarcoma - cellular myofibroma with SRF-RELA gene fusion: A case report. World J Clin Cases 2024; 12:1326-1332. [PMID: 38524524 PMCID: PMC10955539 DOI: 10.12998/wjcc.v12.i7.1326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/06/2024] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Cellular myofibroma is a rare subtype of myofibroma that was first described in 2017. Its diagnosis is often challenging because of its relative rarity, lack of known genetic abnormalities, and expression of muscle markers that can be confused with sarcomas that have myogenic differentiation. Currently, scholars have limited knowledge of this disease, and published cases are few. Further accumulation of diagnostic and treatment experiences is required. CASE SUMMARY A 16-year-old girl experienced left upper limb swelling for 3 years. She sought medical attention at a local hospital 10 months ago, where magnetic resonance imaging revealed a 5-cm soft tissue mass. Needle biopsy performed at a local hospital resulted in the diagnosis of a spindle cell soft tissue sarcoma. The patient was referred to our hospital for limb salvage surgery with endoprosthetic replacement. She was initially diagnosed with a synovial sarcoma. Consequently, clinical management with chemotherapy was continued for the malignant sarcoma. Our pathology department also performed fluorescence in situ hybridization for result validation, which returned negative for SS18 gene breaks, indicating that it was not a synovial sarcoma. Next-generation sequencing was used to identify the SRF-RELA rearrangement. The final pathological diagnosis was a cellular/myofibroblastic neoplasm with an SRF-RELA gene fusion. The patient had initially received two courses of chemotherapy; however, chemotherapy was discontinued after the final diagnosis. CONCLUSION This case was misdiagnosed because of its rare occurrence, benign biological behavior, and pathological similarity to soft tissue sarcoma.
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Affiliation(s)
- Ying Zhou
- Department of Pathology, Peking University People’s Hospital, Beijing 100044, China
| | - Yi-Wen Sun
- Department of Pathology, Peking University People’s Hospital, Beijing 100044, China
| | - Xiao-Yang Liu
- Department of Pathology, Peking University People’s Hospital, Beijing 100044, China
| | - Dan-Hua Shen
- Department of Pathology, Peking University People’s Hospital, Beijing 100044, China
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Liu Y, Housley Smith M, Patel PB, Bilodeau EA. Pediatric Gnathic Bony and Mesenchymal Tumors. Pediatr Dev Pathol 2023; 26:621-641. [PMID: 37232383 DOI: 10.1177/10935266231170744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Evaluation of bone pathology within the head and neck region, particularly the gnathic bonesis is complex, demonstrating unique pathologic processes. In part, this variation is due to odontogenesis and the embryological cells that may be involved, which can contribute to disease development and histologic variability. As with any boney pathosis, the key is to have clinical correlation, particularly with radiographic imaging prior to establishing a definitive diagnosis. This review will cover those entities that have a predilection for the pediatric population, and while it is not all inclusive, it should serve as a foundation for the pathologist who is evaluating bony lesions involving the craniofacial skeleton.
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Affiliation(s)
- Yingci Liu
- Rutgers School of Dental Medicine, Newark, NJ, USA
| | | | - Paras B Patel
- Center for Oral Pathology, Dallas, TX, USA
- Oral and Maxillofacial Pathology ProPath, Dallas, TX, USA
| | - Elizabeth Ann Bilodeau
- Oral & Maxillofacial Pathology, Director, UDHS Oral Pathology Laboratory, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
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El Ouazzani H, Azzam I, Benyahya Z, Chehrastane R, Oujilal A, Zouaidia F, Cherradi N. Solitary infantile myofibromatosis of the petrous bone: a diagnostic pitfall in uncommon location illustrated by a case report. J Surg Case Rep 2023; 2023:rjad237. [PMID: 37192874 PMCID: PMC10182396 DOI: 10.1093/jscr/rjad237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/09/2023] [Indexed: 05/18/2023] Open
Abstract
Infantile myofibromatosis (IM) is the most common fibrous disorder of infancy and early childhood. Solitary intracranial involvement is rare and often unrecognized. This makes its early diagnosis and adequate management difficult. The majority of lesions are localized to the skull or dura with variable intracranial extension. Herein, we report a misdiagnosed and aggressive presentation of a solitary IM of the petrous bone. Our aim is to discuss histopathological differential diagnoses and management difficulties.
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Affiliation(s)
- Hafsa El Ouazzani
- Correspondence address. Department of Pathology HSR, Ibn Sina University Hospital Center, Rabat 10100, Morocco; Mohammed V University in Rabat, Morocco. Tel: +212674556975; Fax: +21205 37 77 02 28; E-mail:
| | - Imane Azzam
- Mohammed V University in Rabat, Morocco
- Department of Oto-Rhino-Laryngology HSR, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Zainab Benyahya
- Mohammed V University in Rabat, Morocco
- Department of Oto-Rhino-Laryngology HSR, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Rachida Chehrastane
- Mohammed V University in Rabat, Morocco
- Department of Pediatric Radiology, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Abdelilah Oujilal
- Mohammed V University in Rabat, Morocco
- Department of Oto-Rhino-Laryngology HSR, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Fouad Zouaidia
- Mohammed V University in Rabat, Morocco
- Department of Pathology Ibn Sina, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Nadia Cherradi
- Department of Pathology HSR, Ibn Sina University Hospital Center, Rabat, Morocco
- Mohammed V University in Rabat, Morocco
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Muacevic A, Adler JR, El Sayed F. A Recurrent Cheek Mass. Cureus 2022; 14:e31300. [PMID: 36514628 PMCID: PMC9733939 DOI: 10.7759/cureus.31300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Solitary infantile myofibroma is a benign fibrous tumor occurring in early childhood. Although rare, it is the most common benign fibrous tumor of infancy. The clinical course of the disease is almost uniformly good since most tumors regress spontaneously. When indicated, conservative surgical excision is the treatment of choice, with a low recurrence rate. We present a case of solitary infantile myofibroma that recurred after three attempts of surgical excision, questioning the reported recurrence rate and the standard of care in recurrent solitary infantile myofibroma.
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Rodriguez JD, Selleck AM, Abdel Razek AAK, Huang BY. Update on MR Imaging of Soft Tissue Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:151-198. [PMID: 34802577 DOI: 10.1016/j.mric.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.
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Affiliation(s)
- Justin D Rodriguez
- Department of Radiology, Duke University, 2301 Erwin Rd, Durham, NC 27705, USA
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB 7070, Physicians Office Building, Rm G190A, Chapel Hill, NC 27599, USA
| | | | - Benjamin Y Huang
- Department of Radiology, UNC School of Medicine, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA.
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Periorbital Myofibroma in a Child: A Case Report and Review of the Literature. Ophthalmic Plast Reconstr Surg 2021; 36:e127-e128. [PMID: 32251175 DOI: 10.1097/iop.0000000000001632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Infantile myofibroma is a rare benign tumor usually diagnosed before the age of 2 and found in the head and neck but much more rarely in the orbital region. There have only been 7 cases of periorbital myofibromas reported in children in the literature to date. The current case is of an 8-year-old boy with a left upper eyelid myofibroma confirmed on histopathological and immunochemical analysis. A literature review of periorbital myofibromas has been performed to bring the reader up-to-date with the current understanding and management of the disease.
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Manisterski M, Benish M, Levin D, Shiran SI, Sher O, Gortzak Y, Elhasid R. Diverse presentation and tailored treatment of infantile myofibromatosis: A single-center experience. Pediatr Blood Cancer 2021; 68:e28769. [PMID: 33063933 DOI: 10.1002/pbc.28769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Infantile myofibromatosis (IM) is a rare benign fibrous tumor with diverse clinical presentations and treatments, such as watchful waiting, surgical excision, and low-dose chemotherapy. PROCEDURE Clinical presentation and tailored treatment of five infants with solitary and generalized IM are described, together with a review of the literature. RESULTS Three patients underwent total-body magnetic resonance imaging (MRI) at diagnosis and during follow up, which revealed disease extension that aided in designing treatment. Visceral involvement included central nervous system, cardiac, gastrointestinal, muscle, bone, and subcutaneous tissue lesions. The patient with the solitary form of IM was followed up without treatment and had spontaneous improvement. Patients with the multicentric form received intravenous low-dose methotrexate and vinblastine chemotherapy. One patient who received oral methotrexate due to cardiac involvement and unfeasible central line access had excellent results. Recurrence was successfully treated by the same methotrexate and vinblastine regimen as that administered at diagnosis. CONCLUSIONS We suggest screening all patients with one or more IM lesions by means of total body MRI due to its inherent superior soft tissue resolution. Total-body MRI may also be used for routine follow up. Oral methotrexate can be administered successfully in patients that lack central line access, and recurrent lesions can be treated with the same chemotherapeutic combination as that given at diagnosis. Long-term follow up is needed, since recurrence could appear years after initial presentation of the disease.
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Affiliation(s)
- Michal Manisterski
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Marganit Benish
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Dror Levin
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shelly I Shiran
- Pediatric Radiology Unit, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Osnat Sher
- Institute of Pathology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yair Gortzak
- Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ronit Elhasid
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fuchs J, Günther P, Alrajab A, El Damaty A, Antonopoulos W, Volk P. Congenital myofibroma of the pericranium. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ren LZ, Sun R. [Left mandibular infantile myofibromatosis: a case report]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:594-597. [PMID: 33085248 DOI: 10.7518/hxkq.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Infantile myofibromatosis is a rare benign childhood myofibroblastoma. A case of infantile myofibromatosis of the left mandible was reported, and relevant literature was reviewed to discuss the clinical characteristics, pathogenesis, imaging characteristics, pathological characteristics, differential diagnosis, and the treatment of the tumor to improve the understanding of the tumor.
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Affiliation(s)
- Li-Zhi Ren
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
| | - Rui Sun
- Dept. of Oral and Maxillofacial Surgery, Shanxi Provincial People's Hospital, Taiyuan 030012, China
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Genetic testing and surveillance in infantile myofibromatosis: a report from the SIOPE Host Genome Working Group. Fam Cancer 2020; 20:327-336. [PMID: 32888134 PMCID: PMC8484085 DOI: 10.1007/s10689-020-00204-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/19/2020] [Indexed: 12/03/2022]
Abstract
Infantile myofibromatosis (IM), which is typically diagnosed in young children, comprises a wide clinical spectrum ranging from inconspicuous solitary soft tissue nodules to multiple disseminated tumors resulting in life-threatening complications. Familial IM follows an autosomal dominant mode of inheritance and is linked to PDGFRB germline variants. Somatic PDGFRB variants were also detected in solitary and multifocal IM lesions. PDGFRB variants associated with IM constitutively activate PDGFRB kinase activity in the absence of its ligand. Germline variants have lower activating capabilities than somatic variants and, thus, require a second cis-acting hit for full receptor activation. Typically, these mutant receptors remain sensitive to tyrosine kinase inhibitors such as imatinib. The SIOPE Host Genome Working Group, consisting of pediatric oncologists, clinical geneticists and scientists, met in January 2020 to discuss recommendations for genetic testing and surveillance for patients who are diagnosed with IM or have a family history of IM/PDGFRB germline variants. This report provides a brief review of the clinical manifestations and genetics of IM and summarizes our interdisciplinary recommendations.
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Amine A, Yassine S, Abi-Akl P, Darwish H. Extended Endonasal Endoscopic Complete Resection of a Solitary Intraorbital Myofibroma: A Case Report and Literature Review. World Neurosurg 2019; 136:283-288. [PMID: 31678317 DOI: 10.1016/j.wneu.2019.10.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infantile myofibromatosis is a rare benign disease of mesenchymal origin. It occurs mostly in infants but can occur in children and adults. It presents in 2 forms: solitary and multicentric. The presence of an orbital component, whether as a solitary lesion or as part of the multicentric disease, is even rarer. Surgery is required when these tumors behave aggressively and grow rapidly or when they are large enough to cause compression symptoms. Several surgical approaches have been described to resect such lesions. CASE DESCRIPTION We present a case of a solitary intraorbital myofibroma extending into the optic canal in a 6-year-old girl that was completely resected via an extended endonasal endoscopic approach. CONCLUSIONS This case report highlights the advantages of the extended endonasal endoscopic approach in terms of intraoperative and postoperative factors.
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Affiliation(s)
- Ali Amine
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salma Yassine
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pierre Abi-Akl
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Darwish
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Srinivasan B, Al- Asaadi Z, Anand R, Brennan P. Rapidly progressing myofibroma of the gingiva - a rare occurrence. Br J Oral Maxillofac Surg 2019; 57:707-708. [DOI: 10.1016/j.bjoms.2019.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 11/30/2022]
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Infantile myofibromatosis treated by mandibulectomy and staged reconstruction with submental flap and free fibula flap: a case report. J Otolaryngol Head Neck Surg 2019; 48:14. [PMID: 30871614 PMCID: PMC6419343 DOI: 10.1186/s40463-019-0333-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infantile myofibromatosis is the most common benign fibrous tumor in infants. Three different types have been reported in the literature. The most commonly affected areas are the head, the neck and the trunk. Our patient showed a very high level of mandibular destruction resistant to all mandibular sparing treatment strategies requiring segmental mandibulectomy and complex reconstruction. CASE PRESENTATION We describe a rare case of multicentric infantile myofibromatosis with mandibular bone destruction. The treatment required a succession of chemotherapy, a subtotal transoral resection and a hemi-mandibulectomy. The mandibular reconstruction was staged with initial bridging titanium plate with a submental flap, followed later by a fibula free flap. CONCLUSION Mandibular involvement by myofibromatosis is rare, and the extend of bone destruction and reconstruction make this case unique. To our knowledge, this is the only reported case of fibula free flap mandibular reconstruction in a patient with infantile myofibromatosis , as well as one of the youngest reported submental island flaps for any pathology. We describe the clinical presentation and management, including relevant imaging, histopathology, medical and surgical treatment as well as a review of relevant literature.
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Nabavizadeh SA, Zimmerman RA, Mattei P, Liu GT. Infantile Myofibroma of the Carotid Space Presenting as Horner Syndrome. J Neuroophthalmol 2017; 37:459-460. [PMID: 29035908 DOI: 10.1097/wno.0000000000000573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Seyed Ali Nabavizadeh
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Neuro-ophthalmology Service, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Lee SM, Ha DH, Kang H, Shin DE. Solitary myofibroma of the lumbar vertebra in young adult: A case report with 4-year follow-up of postoperative CT or MRI. Medicine (Baltimore) 2017; 96:e8069. [PMID: 28953625 PMCID: PMC5626268 DOI: 10.1097/md.0000000000008069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Solitary myofibroma of the spine is extremely rare, particularly among adults. To the best of our knowledge, only 3 cases affecting lumbar vertebrae have been reported in the English language literature. Of them, only 1 case was an adult case of solitary myofibroma affecting the L1 vertebra. METHODS We report a case of solitary myofibroma affecting the L5 vertebra in an 18-year-old man and the postoperative imaging of solitary myofibroma for the first time. Conventional radiographs demonstrated an expansile osteolytic lesion with thinned cortex and marginal sclerosis. Computed tomography (CT) showed a purely osteolytic expansile lesion with partial disappearance of thinned cortex. MRI of the lesion revealed an isointense signal on T1-weighted images, an inhomogeneous slightly hyperintense signal on T2-weighed images, and homogeneous avid enhancement with gadolinium. RESULTS Surgical excision was performed and the lesion was diagnosed as solitary myofibroma on pathological examination. One-year follow-up postoperative CT demonstrated decreased size of the osteolytic lesion with sclerotic change. Four-year follow-up postoperative MRI revealed complete resolution of the lesion replaced by normal fatty marrow. CONCLUSION If a benign-looking expansile osteolytic lesion reveals a homogeneously isointense signal on T1-weighted image, inhomogeneous slightly hyperintense signal on T2-weighted image, and homogeneous avid enhancement with gadolinium, solitary myofibroma should be considered in the differential diagnosis of spine bone tumors. It can be resolved completely.
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Affiliation(s)
| | | | | | - Dong Eun Shin
- Department of Orthopedics, CHA Bundang Medical Center, CHA University, College of Medicine, Gyeonggi-do, Republic of Korea
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An update on myofibromas and myofibromatosis affecting the oral regions with report of 24 new cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:62-75. [DOI: 10.1016/j.oooo.2017.03.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 01/21/2023]
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Rosello O, Rampal V, Doria C, Bertoncelli C, Clément JL, Solla F. Infantile myofibromatosis of the iliac bone. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2017; 14:241-244. [PMID: 29263742 PMCID: PMC5726218 DOI: 10.11138/ccmbm/2017.14.1.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Solitary infantile myofibromatosis (IM) of bone is a rare benign osseous tumor of childhood with low rate of recurrence. Well documented within the multicenter form, its solitary intraosseous location is less well described. CASE REPORT We present a rare case of intraosseous myofibromatosis arising the iliac bone of a 11-year-old girl, who was operated at 2 months of life for a retroauricular subcutaneous MF with unbalanced translocation t(9;16). She presented with a limping associated to a stiffness of the hip without pain. Imaging disclosed a 4×4×1cm intraosseous, lytic and heterogeneous mass with a soft tissue component on the medial cortical of the left iliac bone. Open biopsy was performed. Histology revealed proliferation of fusiform cells with eosinophil cytoplasm embedded in a myxoid and fibrous stroma without mitotic figures. On immunohistochemistry, cells were positive for actin, PS100, KL1, focally positive for EMA, CD34, P63, rarely CD31, which indicated diagnosis of new localization of IM. Cytogenetic analysis revealed absence of translocation t(9;16), which was found in the first tumor. Subsequent total resection was performed. The patient recovered normal function without recurrence of tumor at 3 years follow-up. CONCLUSION To our knowledge, this is the first case of solitary IM of the iliac bone, occurring 12 years after the first localization. Total resection resulted in excellent outcome. However recurrence can happen even long time after the first resection and new localization is possible, as in our case. This suggests close follow-up and clear information about the risk of recurrence.
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Affiliation(s)
- Olivier Rosello
- Pediatric Orthopaedic Surgery, Lenval University Children’s Hospital, Nice, France
| | - Virginie Rampal
- Pediatric Orthopaedic Surgery, Lenval University Children’s Hospital, Nice, France
| | - Carlo Doria
- Orthopaedic Surgery, University of Sassari, Italy
| | | | - Jean-Luc Clément
- Pediatric Orthopaedic Surgery, Lenval University Children’s Hospital, Nice, France
| | - Federico Solla
- Pediatric Orthopaedic Surgery, Lenval University Children’s Hospital, Nice, France
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Abstract
The nasal cavity and paranasal sinuses occupy the top of the upper respiratory tract and form pneumatic spaces connected with the atmosphere. They are located immediately beneath the base of the cranium, where crucial vital structures are harbored. From this region, very much exposed to airborne agents, arise some of the more complex and rare benign and malignant lesions seen in humans, whose difficulties in interpretation make this remarkable territory one of the most challenging in the practice of surgical pathology. Contents of this chapter cover inflammations and infections, polyps and pseudotumors, fungal and midfacial destructive granulomatous lesions, as well as benign, borderline, and malignant neoplasms. Among the neoplasms, emphasis is made on those entities characteristic or even unique for the sinonasal region, such as Schneiderian papillomas, glomangiopericytoma, intestinal- and non-intestinal-type adenocarcinomas, olfactory neuroblastoma, nasal-type NK-/T-cell lymphoma, and teratocarcinosarcoma. Moreover, recently recognized entities involving this territory, i.e., HPV-related non-keratinizing carcinoma, NUT carcinoma, and SMARCB1-deficient basaloid carcinoma, are also discussed in the light of their specific molecular findings. Furthermore, the text is accompanied by numerous classical and recent references, several tables, and 100 illustrations.
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Affiliation(s)
- Antonio Cardesa
- University of Barcelona, Anatomic Pathology Hospital Clínic University of Barcelona, Barcelona, Spain
| | - Pieter J. Slootweg
- Radboud Univ Nijmegen Medical Center, Pathology Radboud Univ Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nina Gale
- University of Ljubljana,, Institute of Pathology, Faculty of Medic University of Ljubljana,, Ljublijana, Slovenia
| | - Alessandro Franchi
- University of Florence, Dept of Surg & Translational Medicine University of Florence, Florence, Italy
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A rapidly enlarging gingival mass in an 11-year-old boy. J Am Dent Assoc 2015; 147:58-63. [PMID: 26562734 DOI: 10.1016/j.adaj.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 06/09/2015] [Accepted: 07/01/2015] [Indexed: 11/21/2022]
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22
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Ruptured Infantile Myofibroma of the Head Presenting in a Neonate: Case Report and Review of the Literature. World Neurosurg 2015; 98:884.e13-884.e18. [PMID: 26459706 DOI: 10.1016/j.wneu.2015.09.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Infantile myofibroma/myofibromatosis (IM/M) is a myofibroblastic proliferative disorder often seen in infants and children. IM/M can result in congenital tumors of the head and neck and may occasionally present to the neurosurgeon. CASE DESCRIPTION We report a case of a solitary ruptured myofibroma of the head in a newborn patient. The lesion was initially suggestive of encephalocele. We describe the presentation and management of this patient, including relevant imaging, histopathologic evaluation, and surgical technique. We subsequently review the literature of IM/M of the head and neck, highlighting the 3 forms of the condition, each requiring a distinct management strategy. CONCLUSIONS Although this tumor rarely presents to the neurosurgeon, it may do so in the process of ruling out other more dangerous conditions. It is therefore important to consider this diagnosis in masses that occur in the head and neck of newborns.
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Infantile Myofibromatosis of the Soft Palate. J Craniofac Surg 2015; 26:1427-8. [DOI: 10.1097/scs.0000000000001598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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24
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Lopes RN, Alves FDA, Rocha AC, Suassuna TM, Kowalski LP, de Castro JFL, Perez DEDC. Head and neck solitary infantile myofibroma: Clinicopathological and immunohistochemical features of a case series. Acta Histochem 2015; 117:431-6. [PMID: 25744090 DOI: 10.1016/j.acthis.2015.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 01/22/2015] [Accepted: 02/01/2015] [Indexed: 10/23/2022]
Abstract
Infantile myofibroma is a rare mesenchymal benign tumor mostly found in the head and neck region. The aim of this study was to describe a small case series of head and neck solitary infantile myofibroma, emphasizing the importance of the histopathological and immunohistochemical features, and the potential diagnostic challenges. For the study, clinical and imaging data were obtained from the medical records. All cases were histologically reviewed, and immunohistochemical analyses were performed to confirm the diagnosis. Four cases of head and neck solitary infantile myofibroma were identified. All patients were females and presented a mean age of 3 years old (ranging from 2 to 6 years). The site of the tumors were the mandible, right cheek, subcutaneous tissue adjacent to basal cortical of the mandible and upper anterior gingiva. No symptoms, such as pain or paresthesia, were reported. Computerized tomography revealed well-delimited tumors. All tumors were positive for vimentin and alpha-smooth muscle actin. All patients underwent surgical excision and no signs of recurrence were observed after long-term follow-up. In summary, head and neck solitary infantile myofibromas are rare and present excellent prognosis. The correlation between clinical, histopathological and immunohistochemical features are essential for a correct diagnosis.
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Abstract
Although solitary presentations of infantile myofibromatosis tend toward spontaneous regression, multicentric forms fare worse. Previous case reports have depicted observation, surgical resection, and systemic therapies as treatment options. This paper reports well-tolerated, successful outcomes in a series of patients with high-risk infantile myofibromatosis in need of life-sustaining interventions treated with a combination of vincristine and dactinomycin. The clinical presentation, pathology, and radiographic findings are described.
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Myofibroma of the gingiva: a rare case report and literature review. Case Rep Dent 2015; 2015:243894. [PMID: 25918649 PMCID: PMC4397003 DOI: 10.1155/2015/243894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/18/2015] [Indexed: 11/29/2022] Open
Abstract
Myofibromas are benign uncommon fibroblastic tumors of the soft tissue, bone, or internal organs affecting all ages. These lesions histopathologically may mimic many other soft tissue tumors of the oral cavity such as spindle cell tumors of neurogenic and smooth muscle cell origin, thus leading to misdiagnosis and mistreatment. This case report describes a rare benign tumor, which presented as a soft tissue swelling on posterior gingiva. Surgical excision of the lesion was carried out under local anaesthesia. Histopathologic and immunohistochemical examination confirmed the diagnosis of myofibroma. Myofibroma should be included in the clinical differential diagnosis of masses of the oral soft tissues; however immunohistochemical examination is essential to establish an accurate diagnosis.
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27
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Fushimi K, Shiiba M, Kouzu Y, Kasama H, Higo M, Koike H, Kasamatsu A, Sakamoto Y, Ogawara K, Uzawa K, Tanzawa H. Central myofibroma of the maxilla: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2013.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Rai B, Ludusan E, McGovern B, Sharif F. Mandibular swelling in a 5-year-old child--mandibular myofibroma. BMJ Case Rep 2014; 2014:bcr-2014-203977. [PMID: 25178888 DOI: 10.1136/bcr-2014-203977] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Birendra Rai
- Department of Pediatrics, Midland Regional Hospital, Westmeath, Ireland
| | - Evodia Ludusan
- Department of Pediatrics, Midland Regional Hospital, Westmeath, Ireland
| | - Brianán McGovern
- Department of Histopathology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Farhana Sharif
- Department of Pediatrics, Midland Regional Hospital, Westmeath, Ireland Royal College of Surgeons, Ireland
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29
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Satomi T, Kohno M, Enomoto A, Abukawa H, Fujikawa K, Koizumi T, Chikazu D, Matsubayashi J, Nagao T. Solitary myofibroma of the mandible: an immunohistochemical and ultrastructural study with a review of the literature. Med Mol Morphol 2014; 47:176-83. [PMID: 24213519 DOI: 10.1007/s00795-013-0062-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/18/2013] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Takafumi Satomi
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan,
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30
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Infantile myofibromatosis: A series of 28 cases. J Am Acad Dermatol 2014; 71:264-70. [DOI: 10.1016/j.jaad.2014.03.035] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 11/17/2022]
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31
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Myofibroma of the tongue: a case suggesting autosomal dominant inheritance. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:e92-6. [DOI: 10.1016/j.oooo.2013.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 11/17/2022]
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32
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Infantile myofibroma eroding into the frontal bone: a case report and review of its histopathologic differential diagnosis. Case Rep Pediatr 2012; 2012:630804. [PMID: 22966474 PMCID: PMC3433120 DOI: 10.1155/2012/630804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 07/30/2012] [Indexed: 01/19/2023] Open
Abstract
Infantile myofibroma is a rare and benign tumour of children presenting in the head and neck region. Rendering a final diagnosis of infantile myofibroma can be challenging in the light of nonspecific clinical, radiological findings and its histopathological similarities with a number of neoplasms especially spindle cell tumours. In this paper we discuss a case of infantile myofibroma in a 2-month-old infant, enumerating the various differential entities that have to be eliminated in reaching its specific diagnosis and highlighting the importance of immunopositivity to vimentin and smooth muscle actin (SMA) in establishing its myofibroblastic differentiation.
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33
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Myofibromas of the Jaws in Children. J Oral Maxillofac Surg 2012; 70:1880-4. [DOI: 10.1016/j.joms.2011.09.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 09/22/2011] [Accepted: 09/23/2011] [Indexed: 11/24/2022]
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34
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Garcia-Perla A, Belmonte-Caro R, Infante-Cossio P, Muñoz-Ramos M, Esteban-Ortega F. Upper airway distress due to an oropharyngeal infantile myofibroma. J Craniomaxillofac Surg 2012; 40:e112-4. [DOI: 10.1016/j.jcms.2011.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 05/30/2011] [Accepted: 05/31/2011] [Indexed: 01/19/2023] Open
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35
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Woo SB. Fibrous, Gingival, Lipocytic, and Miscellaneous Tumors. ORAL PATHOLOGY 2012:63-105. [DOI: 10.1016/b978-1-4377-2226-0.00005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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36
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Green MC, Dorfman HD, Villanueva-Siles E, Gorlick RG, Thornhill BA, Weber RV, Geller DS. Aggressively recurrent infantile myofibroma of the axilla and shoulder girdle. Skeletal Radiol 2011; 40:357-61. [PMID: 20978757 DOI: 10.1007/s00256-010-1056-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 10/06/2010] [Accepted: 10/08/2010] [Indexed: 02/02/2023]
Abstract
Infantile myofibroma is the most common fibrous tumor of infancy, typically affecting neonates and children under 2 years of age. Though the multicentric variant portends a grave prognosis, solitary lesions have an excellent prognosis and frequently undergo spontaneous regression. Surgical excision of solitary lesions is usually curative. In this report, we describe a pediatric patient with an unusually aggressive solitary myofibroma of the axilla who ultimately required a forequarter amputation as a lifesaving measure following multiple tumor recurrences and progressive tumor growth. The clinical course, radiographic findings, histology, and management rationale are presented.
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Affiliation(s)
- Matthew C Green
- Montefiore Medical Center, 429 Third Avenue, Pelham, NY 10803, USA.
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37
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Infantile myofibroma of the nasal cavity; a case report and review of the literature. Int J Pediatr Otorhinolaryngol 2010; 74:1452-4. [PMID: 20950870 DOI: 10.1016/j.ijporl.2010.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/09/2010] [Accepted: 09/12/2010] [Indexed: 11/22/2022]
Abstract
Infantile myofibroma is the most common fibrous tumor of infancy. Although the etiology is unknown, some cases are associated with a genetic inheritance of variable penetrance. With a myriad of possible locations, the presenting symptoms and findings are highly variable making its diagnosis difficult. Worldwide, there have been close to three hundred reported cases. Approximately 90% of these cases presented before age 2 with over half present at birth. The incidence is likely to be greater as many asymptomatic or hidden lesions will regress prior to discovery. The following is a report on a 7 month old male diagnosed with an infantile myofibroma within his right nasal cavity originating from the anterior skull base. This case is unusual in both its symptom presentation as well as location of origin of this tumor.
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38
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Weaver CH, Merritt BG, Groben PA, Morrell DS. A partially regressed, atrophic plaque on a 17-year-old girl: an unusual presentation of myofibromatosis. Pediatr Dermatol 2010; 27:481-4. [PMID: 20807358 DOI: 10.1111/j.1525-1470.2010.01265.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Solitary cutaneous myofibromas have been reported in patients of all ages. Infantile and adult forms are distinguished by age of onset, location of lesions, and the potential for infantile myofibromas to regress. We report a case of a 17-year-old girl with a solitary myofibroma on the right leg that presented as a partially regressed, atrophic plaque with multiple surrounding papules. Unusual features of this case include the tumor size, simultaneous regression and proliferation, patient age, and gender.
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Affiliation(s)
- Chad H Weaver
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC 27576, USA
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40
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Chtourou I, Krichen Makni S, Dhouib M, Khabir A, Fakhfakh I, Ayadi L, Mnif H, Abdelmoula M, Sellami Boudawara T. [Pediatric mandibular myofibromatosis]. ACTA ACUST UNITED AC 2007; 108:461-4. [PMID: 17632191 DOI: 10.1016/j.stomax.2006.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 11/06/2006] [Accepted: 11/06/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pediatric myofibromatosis is a rare tumor in neonates and children. 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 aim of this article was to report the anatomoclinical and therapeutic features of this pediatric tumor in a case as well as its follow-up. CASE REPORT A 10-year-old girl was brought to consultation for a lower left gingival swelling 5 cm in diameter, forming a unit with the mandibular bone. The volume had gradually increased over the last 12 months. Imagery revealed the presence of an osteolytic tumor benign in aspect, but locally aggressive. Conservative surgery was performed. The diagnosis of pediatric myofibromatosis was confirmed. Evolution was excellent and after three years of follow-up, there was no evidence of relapse. DISCUSSION Pediatric myofibromatosis often presents as a painless, well-circumscribed, solid nodule. Imagery is very useful to assess lesion extension and for the therapeutic follow-up. 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.
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Affiliation(s)
- I Chtourou
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib-Bourguiba, 3029 Sfax, Tunisie
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41
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Vered M, Allon I, Buchner A, Dayan D. Clinico-pathologic correlations of myofibroblastic tumors of the oral cavity. II. Myofibroma and myofibromatosis of the oral soft tissues. J Oral Pathol Med 2007; 36:304-14. [PMID: 17448141 DOI: 10.1111/j.1600-0714.2007.00528.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Myofibroma is a solitary benign tumor of myofibroblasts. Myofibromatosis describes multiple, simultaneous myofibromas at different sites in various organs. The clinico-pathologic correlations of myofibroma/myofibromatosis confined only to oral soft tissues were analyzed. METHODS In the English language literature, 41 myofibroma and 12 myofibromatosis cases involving the oral soft tissues were found. From our files, three new myofibroma cases were added. RESULTS Age at time of diagnosis of oral mucosa myofibroma ranged from birth to 70 years (mean 21.7 years), considerably higher than myofibroma in other parts of the body. Lesions occurred during the first decade (44%) and in the first year of life (17%). Male:female ratio was 1:1.6, contrary to the male predominance in other parts of the body. Common sites were the tongue (32%) and buccal mucosa (18%). Treatment was local excision, either complete (n = 13) or partial (n = 3), wide excision (n = 4), surgery, and chemotherapy (n = 1). Myofibromatosis involving oral soft tissues was diagnosed at birth in nine (75%) patients, within the first year in two, and as a young adult in one. Male:female ratio was 2:1. The tongue was the most common site (50%). Half the patients died of disseminated disease within a few days from birth, three were cured by partial or complete excision, and three experienced spontaneous regression. Histologically, oral mucosa myofibroma/myofibromatosis appearance agreed with findings in the literature. CONCLUSIONS Myofibroma should be included in the clinical differential diagnosis of masses of the oral soft tissues, especially in the tongue and buccal mucosa of children and adolescents. Histological differential diagnosis includes benign and malignant spindle-shaped lesions. Treatment of choice is local excision.
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Affiliation(s)
- Marilena Vered
- Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
PURPOSE To report a novel case of solitary myofibroma involving the sclera. METHODS Case report and review of the literature. RESULTS A 19-year-old woman had an expanding and painful epibulbar mass clinically diagnosed as nodular scleritis that did not respond to anti-inflammatory therapy. A biopsy showed a proliferation of spindle-shaped cells that reacted strongly positively with immunoperoxidase stains for vimentin and smooth-muscle actin. The diagnosis of solitary myofibroma was made. Six months postoperatively, the patient was well, and the lesion had not recurred. CONCLUSIONS Myofibroma should be considered in the differential diagnosis of an epibulbar mass, especially in the setting that would mimic nodular scleritis.
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Affiliation(s)
- Pitipol Choopong
- Cogan Eye Pathology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary (MEEI), Boston, MA, USA
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Abstract
Infantile myofibroma of the orbit is an extremely rare condition. Only a few instances of this condition have ever been reported. A 3-year-old boy visited our clinic with lateral lower eyelid swelling and a palpable mass in the left eye, which had apparently persisted for 2 months. A computed tomography scan revealed a well-circumscribed mass in the inferolateral orbital portion of the zygomatic bone, coupled with erosion of bone and orbital extension with reactive hyperostosis. Immunohistochemical stains proved positive for smooth muscle actin, supporting the diagnosis of solitary infantile myofibroma of the orbital bone (zygoma). Although rarely found in the orbit, solitary infantile myofibroma can display more aggressive or malignant neoplasm. Immunohistochemistry is integral to the differential diagnosis and a systemic evaluation for multicentric myofibroma is essential.
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Abstract
There are many developmental abnormalities that may appear in the neonate and in infants when critical steps in embryogenesis fail. These steps are often not fatal but can lead to significant morbidity for those patients affected. A logical approach is needed in addressing both the diagnostic and therapeutic issues that arise when caring for these patients, as various lesions will warrant an observational approach, and others may require imaging studies or definitive surgical intervention. Additionally, there are other "lumps and bumps" that are seen in the neonatal and infantile age groups that include malignancies and cutaneous neoplasms with associated systemic sequelae.
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Affiliation(s)
- Davis Farvolden
- University of Massachusetts Medical School, Worcester, MA, USA
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45
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Franzese CB, Carron J. Infantile myofibromatosis: unusual diagnosis in an older child. Int J Pediatr Otorhinolaryngol 2005; 69:865-8. [PMID: 15885344 DOI: 10.1016/j.ijporl.2005.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Revised: 12/21/2004] [Accepted: 01/06/2005] [Indexed: 11/18/2022]
Abstract
This manuscript describes the unusual presentation of infantile myofibromatosis (IM) in an older child with its diagnosis and management. An 8-year-old girl presented with a painless, rapidly expanding malar mass. CT demonstrated an erosive soft tissue lesion and needle biopsy was nondiagnostic. Complete excision returned the pathologic diagnosis of IM. The patient had no complications and no evidence of recurrence at 1 year. Almost 90% of IM cases present by age two and IM in older children is highly unusual. The solitary form of IM is most common and its treatment is complete excision with an excellent prognosis.
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Affiliation(s)
- Christine B Franzese
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39110, USA.
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Scheper MA, Difabio VE, Sauk JJ, Nikitakis NG. Myofibromatosis: A case report with a unique clinical presentation. ACTA ACUST UNITED AC 2005; 99:325-30. [PMID: 15716840 DOI: 10.1016/j.tripleo.2004.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Myofibroma and myofibromatosis have been described under different names since 1951. These lesions are a benign fibroblastic and myofibroblastic proliferation containing a biphasic presentation of spindle-shaped cells surrounding a central zone of less differentiated cells focally arranged in a hemangiopericytoma-like pattern. Classically, these lesions are described in children younger than 2, with two thirds present at birth, and rarely in adults. The typical clinical presentation shows variable growth pattern of a painless purple to pink soft tissue mass, often showing secondary ulceration. Controversy exists as to an autosomal dominant or recessive inheritance versus sporadic occurrence. Presented here is a unique case of myofibromatosis presenting first as a superficial scalp lesion at age 2, followed by other primary lesions of the right mandibular vestibule, right temple, and left mandibular vestibule at ages 9, 12, and 23, respectively. All were treated with excision, without recurrence at the primary site.
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Affiliation(s)
- Mark A Scheper
- Department of Diagnostic Sciences and Pathology, University of Maryland, Baltimore, MD 21201, USA.
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47
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Abstract
Myofibromas are benign mesenchymal tumors that are commonly found in the dermis and subcutaneous tissues of the head and neck. Although most lesions are recognized daring infancy and early childhood, several cases have been reported in older children and adults. We describe the case of a 9-year-old girl who presented with a solitary nodule in the left cheek and a history of minor trauma. Preoperative imaging detected the presence of a subcutaneous soft-tissue mass consistent with a soft-tissue neoplasm rather than a hematoma. Analysis of fine-needle aspiration material was nondiagnostic. Incisional biopsy revealed that the lesion was a myofibroma.
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Affiliation(s)
- Tali L. Kassenoff
- From the Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York City
| | - Abtin Tabaee
- From the Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York City
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48
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Westfall AC, Mansoor A, Sullivan SA, Wilson DJ, Dailey RA. Orbital and periorbital myofibromas in childhood. Ophthalmology 2003; 110:2000-5. [PMID: 14522779 DOI: 10.1016/s0161-6420(03)00622-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Infantile myofibromatosis is an uncommon tumor that occurs rarely in the periorbit and orbit. This article reports two cases of infantile myofibromatosis of the orbital adnexa and describes the associated clinical, histopathologic, and immunohistochemical findings. DESIGN Two retrospective, interventional case reports with clinicopathologic correlation. INTERVENTION Treatment consisted of excision of the tumors. MAIN OUTCOME MEASURES Histologic and immunohistochemical evaluation and clinical evaluation for tumor recurrence. RESULTS The first patient was a newborn male with a large tumor extending from his eyelid that was excised at day 2 of life. Histologic and immunohistochemistry analyses were used to make a diagnosis of infantile myofibromatosis. He remains disease free at age 7 years. The second case was a 6-year-old boy with a 1-month history of proptosis resulting from an orbital mass. Incisional biopsy revealed a tumor consistent with infantile myofibromatosis. He remains tumor free 12 months after complete gross surgical resection. CONCLUSIONS Infantile myofibromatosis is an uncommon tumor that is rare in the orbit. Differential diagnosis can be difficult based solely on histologic analysis. Immunohistochemistry evaluation demonstrating cytoplasmic actin filaments within neoplastic spindle cells confirms the diagnosis. As soon as the diagnosis is made, chest and abdominal imaging is of value to define the prognosis and to direct further treatment. After the diagnosis of nonvisceral infantile myofibromatosis, complete gross resection, if possible, is the treatment of choice.
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Affiliation(s)
- Andrew C Westfall
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Sciences University, 3375 SW Terwilliger Boulevard, Portland, OR 97201, USA
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Klein AM, Schoem SR, Altman A, Eisenfeld L. Inflammatory myofibroblastic tumor in the neonate: a case report. Otolaryngol Head Neck Surg 2003; 128:145-7. [PMID: 12574774 DOI: 10.1067/mhn.2003.45] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Adam M Klein
- Department of Otolaryngology, Connecticut Children's Medical Center, Hartford 06106, USA
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Williams W, Craver RD, Correa H, Velez M, Gardner RV. Use of 2-chlorodeoxyadenosine to treat infantile myofibromatosis. J Pediatr Hematol Oncol 2002; 24:59-63. [PMID: 11902743 DOI: 10.1097/00043426-200201000-00016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 3-year-old boy had fever and bone pain. Magnetic resonance imaging of his femurs showed marrow replacement; iliac crest marrow biopsy revealed myelofibrosis. Although the pathologic criteria for Langerhans cell histiocytosis were not met, the clinical picture led to treatment with etoposide and methylprednisolone, without clinical improvement. One month after presentation, generalized tonic-clonic seizures occurred, and magnetic resonance imaging revealed parenchymal brain lesions. 2-chlorodeoxyadenosine was used. Because of the unexpected lack of response to etoposide and methylprednisolone, a second bone biopsy was performed. The diagnosis was revised to infantile myofibromatosis. After six courses of 2-chlorodeoxyadenosine, brain and bone lesions regressed, with resolution of the clinical symptoms.
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