Oral leiomyomas

Central angioleiomyoma of the mandible: A rare entity

The leiomyoma is a benign smooth-muscle neoplasm commonly found in the female genital tract, gastrointestinal tract, or skin. Leiomyomas of the oral cavity are unusual. Oral leiomyomas are uncommon due to the paucity of the smooth muscle in the mouth (except in blood vessels) and thus the involvement of jaw bones is extremely rare. Leiomyomas have been classified as solid angiomyoma, angioleiomyoma (vascular leiomyoma), and epithelioid variants. Angioleiomyomas are benign mesenchymal tumors derived from smooth muscle, which rarely occur in the oral cavity. Malignant transformation probably does not occur but careful histopathologic examination is still necessary to differentiate these benign lesions from their malignant counterparts due to different prognosis. Although uncommon in the maxilla and mandible, they should be included in the differential diagnosis of radiolucent lesions of jaw bones. An extensive search of literature was carried out on the Medline-PubMed and Google Scholar database using the keywords such as leiomyoma, angioleiomyoma, jaw bones, maxilla, mandible, intra-osseous to thoroughly search and collect all the reported cases of intraosseous leiomyoma (but our search was not limited to these terms only). To the best of our knowledge, only 23 cases of intraosseous leiomyomas have been reported so far in the jaw bones, among which only 8 belonged to angioleiomyomas. Herein, we report the 9^th case of intraosseous angioleiomyoma, one of the variants of leiomyoma and overall 24^th intraosseous leiomyoma in a 6-year-old female child, together with conventional histopathologic and immunohistochemical findings.

Oral Leiomyoma in an Adult Male: A Case Report

Introduction:

Oral leiomyomas are rare, benign neoplasms of smooth muscle origin, presenting as a solitary, asymptomatic, nodular mass.

Case Presentation:

Here we present the case of a 54-year-old male with a lesion in the midline of his hard palate, which was diagnosed as a localized benign leiomyoma, along with a review of the recent literature.

Discussion:

Diagnosis of a leiomyoma must be based on the histopathological assessment of tissue as the clinical appearance is non-specific. The peak prevalence of head and neck leiomyoma is observed in the 4^th and 5^th decade of life with uncertain gender predilection. Histological features include interlacing fascicles of smooth muscle small cells with eosinophilic cytoplasm. Complete excision is usually curative and recurrence is rare.

Conclusion:

Due to their rare nature, it is important that cases of oral leiomyoma can be reported in the literature to improve our understanding of this entity.

Intraosseous Leiomyoma of the Mandible: A Case Report of the Rare Entity and Review of Literature

INTRODUCTION

Leiomyoma is a rare tumor of smooth muscle origin with a very low incidence in the maxillofacial region. Intraosseous occurrence of oral leiomyoma is even rare with involvement of mandible followed by maxilla.

AIM

The purpose of this paper is to present a case of intraosseous leiomyoma of the left mandibular angle region with the review of literature describing this rare entity. The paper also highlights the need to include this entity in differential diagnoses of jaw lesions.

MATERIAL AND METHOD

An extensive search of literature was carried out on the Medline-Pubmed and Google Scholar database using the keywords leiomyoma, maxilla, mandible, oral and palate to thoroughly search and collect all the reported cases of intraosseous leiomyoma.

RESULT

To the best of our knowledge till date only 22 cases of intraosseous leiomyoma have been reported in the maxillomandibular region we represent the 23rd case of the intraosseous leiomyoma in a 36 year old male patient.

CONCLUSION

Though uncommon but it is known to occur in the jaws therefore intraosseous leiomyoma should be included in the list of differential diagnoses of radiolucent lesion of mandible and maxilla.

Unusual benign smooth muscle lesions of the tongue: review and report of two cases

Benign smooth muscle proliferations are relatively rare in the oral cavity. Most are classified as angioleiomyomas, some as hamartomatous growths and a few as cutaneous-type leiomyomas. We present two cases of benign smooth muscle proliferations in the tongue, provide a review, briefly discuss histogenesis and offer a clinico-pathological differential diagnosis.

Common Presentation of Uncommon Lesion

Angioleiomyomas are rarely seen in the oral cavity. We present here an asymptomatic swelling discovered during routine intraoral examination. On excision and further histological examination it was diagnosed as an angioleiomyoma. There was no recurrence following excision.

Angioleiomyoma: an unusual diagnosis for a lump in the cheek

Buccal swellings such as fibroepithelial polyps and granulomas are commonly seen in any oral diagnostic clinic, but occasionally an unusual mass presents. We describe a rare case of a man with a four-year history of a slowly enlarging, painless buccal mass that was confirmed histologically as an angioleiomyoma. Deep dissection to excise the mass completely caused no damage to nerves and there has been no recurrence.

Clinico-pathologic correlations of myofibroblastic tumors of the oral cavity. II. Myofibroma and myofibromatosis of the oral soft tissues

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.

Oral spindle cell neoplasms: a review of 307 cases

The infrequent exposure of pathologists to soft tissue spindle cell neoplasms coupled with overlapping histologic patterns can often make diagnosis challenging. We reviewed all nonodontogenic spindle cell neoplasms seen between 1982 and 2002 (86,162 total accessions). Diagnoses were reclassified according to current standards supplemented with immunohistochemistry. Of the 307 neoplasms reviewed (0.36% of total accessions), neural tumors were the most common benign entities, accounting for 21% of total cases. Kaposi's sarcoma was the most common malignancy, accounting for 67% of all cases. Diagnoses were revised for 57 cases. Schwannoma and neurofibroma were most commonly revised to palisaded encapsulated neuroma. There were 8 myofibromas and 1 inflammatory myofibroblastic tumor. There were no oral leiomyomas; that is, all 4 originally reported cases were reclassified as myofibroma, palisaded encapsulated neuroma, and solitary fibrous tumor. With the exception of Kaposi's sarcoma, oral soft tissue sarcomas were rare; most benign lesions were neural in origin. The relatively high prevalence of some tumors, such as myofibroma, likely reflects the use of immunohistochemistry in the diagnosis of spindle cell tumors.

Congenital leiomyomatous epulis: a case report with immunohistochemical study

The histologic and immunohistochemical findings of an extremely rare case of congenital soft tissue mass on the alveolar ridge in an infant are reported. The lesion clinically mimicked an ordinary congenital epulis (congenital granular cell epulis, granular cell tumor of the newborn); however, histologically it consisted of a conglomerate of spindle-shaped cells, akin to smooth muscle cells, which formed interlacing and whorled fasciculi. Nerve fibers with myxoid degeneration, capillaries and muscle walled small vessels intermingled with fasciculi of spindle-shaped cells. The border between the conglomerate of spindle-shaped cells and the surrounding connective tissue was not evident. Immunohistochemically, most of the spindle-shaped cells were intensely positive for antibodies to alpha-smooth muscle actin, HHF-35 and desmin. These findings suggest that the lesion was composed of mature smooth muscle cells that were of hamartomatous or choristomatous nature. The term 'congenital leiomyomatous epulis' is proposed.

Intraosseous leiomyoma of the mandible

An intraosseous leiomyoma arising within the mandible was diagnosed in a 24-year-old woman. Clinically, a nodular swelling of the lower border of the mandible was noted. Radiographically, a unilocular ellipsoid radiolucency, loss of the lower border of the mandible, and tooth resorption were observed. The mitotic count was 0.4 per 10 high-power fields, which supported the benign nature of the tumor. The clinical and histologic parameters for distinguishing between benign and malignant smooth muscle neoplasms are discussed.

Unusual leiomyomatous hamartoma of the hard palate: a case report

Harmartomas of the head and neck are common lesions, often taking the form of melanocytic nevi or vascular malformations such as hemangiomas and lymphangiomas. Hamartomas composed of other tissue types are much rarer and within the oral cavity are usually located on the tongue near the foramen cecum or on the anterior hard palate near the incisive papilla. Although most occur as isolated phenomena, a small number may be associated with other local developmental defects or with a syndrome complex. A normal 5-year-old girl had a 1 cm soft sessile swelling in the vault of the hard palate on the left side. Histopathologic examination showed bundles of smooth muscle embedded in fibrovascular stroma and accompanied by abundant mature fat and a small amount of salivary tissue. The features were regarded as those of a leiomyomatous hamartoma and could be distinguished from a smooth-muscle tumor, teratoma, and benign mesenchymoma by virtue of the clinical and histopathologic features. No recurrence has been seen after excision.

Leiomyoma of the oral cavity: a light microscopic and immunohistochemical study with review of the literature from 1884 to 1992

Leiomyoma is the most common benign neoplasm in the uterus and stomach but is rare in the oral cavity. There were only 5 oral cases in a series of 7748 leiomyomas of all sites. Benign smooth muscle neoplasms are classified into leiomyoma (solid leiomyoma), angiomyoma (vascular leiomyoma) and epithelioid leiomyoma (leiomyoblastoma). 6 cases diagnosed as leiomyoma were retrieved from the files of two oral biopsy services over the past 25 years. A light microscopic study including trichrome and phosphotungstic acid haematoxylin (PTAH) stains, and an immunohistochemical study with the following markers: desmin, muscle specific actin, myoglobin, vimentin, S-100 protein, neuron-specific enolase, factor VIII and Ulex europeus were done with suitable controls. The haematoxylin and eosin and Masson's trichrome stains supported a diagnosis of leiomyoma in all 6 cases but PTAH was positive in only 3 of them. The immunohistochemical study confirmed the diagnosis of leiomyoma in 3 cases. The other 3 were identified as granular cell tumour, myofibroma and neurofibroma, respectively. The review of the literature contributed the following data: mean age was 41 and median age 39 in 134/142 patients. A male sex prevalence 72/137 patients (54.0%) was noted. The lips were the most common site with 39 cases (27.46%) followed by the tongue 26 (18.30%), cheeks and palate 22 (15.49%), gingiva 12 (8.45%), and mandible 8 (5.63%). Prognosis of oral leiomyomas is excellent. Immunohistochemistry is a precise and reliable method for definitive diagnosis of oral leiomyoma.

Angiomyoma of the upper lip: report of a case with electron microscopic and immunohistochemical observation

Immunohistochemical and electron microscopic observations of a vascular leiomyoma of the upper lip are presented. Tumour cells were positive for desmin, vimentin and neuron specific enolase but not for S-100 protein. Factor VIII was detected in the endothelium of blood vessels. Ultramicroscopically, the spindle-shaped tumour cells had elongated nuclei and cytoplasm containing abundant myofilaments and pinocytotic vesicles. Emphasis is placed on the fact that an immunohistochemical approach using appropriate antibodies can be used in identifying this tumour.

Nonpainful, smooth-surfaced, bluish nodule on the upper lip

A case of a vascular leiomyoma of the upper lip has been presented. A review of the literature was completed, and the findings reported. Leiomyomas are rare intraoral neoplasms. When affecting the mouth, they are most likely to occur on the tongue, palate, buccal tissues, and lips. Conservative local excision is the recommended treatment.

Tonsillar leiomyoma

Tumors of smooth muscle origin are rare in the oral cavity. To date, only eighty-three cases of oral leiomyomas have been reported. A first case of tonsillar leiomyoma in a 73-year-old male is presented. The theories of origin and the various histologic types of oral leiomyomas are discussed. Leiomyoma can easily be confused with other spindle-cell tumours. Special stains are necessary to reach a correct diagnosis. It is sometimes difficult to differentiate benign leiomyoma from malignant leiomyosarcoma. The use of mitotic figure count to indicate malignant behaviour is not always reliable. The need for wide surgical excision of the tumour, complete sectioning and examination of the specimen and meticulous follow-up of the patient for evidence of recurrence are emphasized.

A transmission electron microscopic study of two cases of oral smooth muscle neoplasm

Two cases of smooth muscle tumors that had appeared in the oral regions were examined by means of histopathology and electron microscopy. One was a case of angiomyoma that appeared in the lip of a 33-year-old man, and the other was a case of leiomyosarcoma in the maxilla of a 63-year-old woman. The results of the examination of both cases were as follows: the benign tumor (angiomyoma) was composed of mainly mature smooth muscle cells having dark cytoplasm, and the malignant tumor (leiomyosarcoma) consisted mainly of two types of cells, undifferentiated mesenchymal cells or fibroblast-like cells (type I) and myofibroblast-like cells (type II). Based upon these results, the relationship between the myogenous differentiation and the component cell types, and biological behavior of these smooth muscle tumors was discussed.

Mandibular vascular leiomyoma

A 54-year-old man had a symptomless swelling on the buccal aspect of the right mandibular molar area, this was associated with a multilocular radiolucency. Histologic and ultrastructural examination of the lesion revealed a vascular leiomyoma. This is only the fourth intrabony leiomyoma of the jaws to be reported.

Oral leiomyomas. Review of the literature and report of a case of palatal angioleiomyoma

A rare case of angioleiomyoma of the palate is reported. A review of the literature shows that of a total of 116 previously reported cases of oral leiomyomas, only 19 were palatal angioleiomyomas.

Leiomyoma of the palate

Leiomyoma, a benign neoplasm of smooth muscle cell origin, has been documented infrequently in the oral cavity. It may arise wherever unstriated muscle is present including the arterial wall (Cherrick et al., 1973). The most common site is the uterus, followed by the wall of the alimentary canal and in subcutaneous tissue (McCaffrey et al., 1978). A search of the literature revealed 51 cases of oral leiomyomas. Cherrick et al. (1973) reviewed 35 cases, including seven of their own. Galili and Shteyer (1974) summarized the clinical data of 42 cases of oral leiomyomas reported since 1884. We can find only nine more reported cases of leiomyoma in the oral cavity: one each by Rhatigan and Kim (1976), Shirota et al. (1976), Kelly and Harrigan (1977), Schweigel (1980), Davis (1980) and Mechlin et al. (1980); and three cases by Damm and Neville (1979). The common sites in the oral cavity are the tongue and cheek but its occurrence on the palate is rare for out of the 51 cases of oral leiomyomas, only 10 involved the palate (one case each was reported by Fein, 1905; Kist and Bhaskar, 1964; Garrett, 1969; Galili and Shteyer, 1974; Rhatigan and Kim, 1976; and Davis, 1980; and four cases by Cherrick et al., 1973). Its rarity and large size make the tumour worth reporting.