Mandibular leiomyoma in an infant. Report of a case

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.

Solitary cutaneous leiomyoma in an infant

This report describes a case of leiomyoma of the ankle occurring at an unusual age. A 5-month-old girl presented with an asymptomatic nodule on her left ankle.

Intraosseous oral leiomyoma: systematic review and report of one case

OBJECTIVES

The objectives of this study were to report one case of intraosseous oral leiomyoma and to systematically review the English literature.

METHODS

The clinical and radiographic findings of a patient who presented with intraosseous oral leiomyoma were recorded. In addition, 11 references from the English literature that reported 12 patients were reviewed.

RESULTS

Thirteen patients (age range 8 months to 71 years; mean 36 years, median 25 years) were reported to present with intraosseous oral leiomyoma. After excluding one patient whose sex was not reported, there were five female patients (42%) and seven males (58%). The majority of patients presented with either no symptoms or with an asymptomatic swelling. Eleven of 13 lesions occurred in the mandible; the most common site was the posterior of the jaw. Radiographically, intraosseous oral leiomyoma was found to present as either a unilocular or multilocular radiolucency with either well defined or ill defined borders and frequent cortical involvement.

CONCLUSIONS

Intraosseous oral leiomyoma was found to occur in the mandibular posterior region of relatively young patients, with cortical involvement and a slight male gender preference. Surgical excision was the treatment of choice and no recurrence has been encountered.

Mandibular intraosseous leiomyoma in a child: report of a case

Leiomyoma is a benign tumor of smooth muscle origin that rarely occurs in the oral cavity. Of the 118 cases occurring in the oral cavity described since 1884, only five involved the mandible. This is a case of an intraosseous leiomyoma in a 9-year old child, who presented to our attention with a firm intraoral mass, involving the angle and the posterior portion of the left mandibular body. The patient was treated with local incision alone, preserving the permanent dental germs and the left inferior alveolar nerve. He remained disease free with regular follow-up for 40 months.

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.

Myofibromas presenting in the oral cavity: a series of 9 cases

OBJECTIVES

Solitary myofibromas are well described in the head and neck, but oral examples are less well known, and jaw lesions are rare. We studied the clinicopathologic features of a series of such lesions.

DESIGN

Nine cases of oral myofibromas were retrieved from archives and studied.

RESULTS

Two cases involved the mandible (intraosseous), 3 involved the gingiva, 2 involved the tongue, and 2, the hard palate. There were 4 men and 5 women, aged 9 months to 50 years (mean, 24 years; median, 27 years). Deep lesions showed typical histology, with paucicellular lobules and intervening hemangiopericytoma-like zones. In ulcerated submucosal lesions, these features blended superficially with cellular fascicles. The tumors expressed smooth muscle actin but lacked desmin and S100 protein. None of the tumors recurred or metastasized.

CONCLUSION

Myofibromas appear in osseous, intramuscular, and submucosal aspects of the oral cavity. Ulceration imparts a fascicular appearance that makes superficial biopsy specimens difficult to interpret.

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.

Leiomyoma of the mandible: a rapid growing case with immunohistochemical and electron microscopic observations

A rare case of leiomyoma of the mandible is reported together with the conventional histologic, immunohistochemical, and electron microscopic findings. On immunohistochemical evaluation the tumor cells were positive for vimentin, desmin, and alpha-smooth muscle actin but negative for neurogenic antigens and markers for vascular endothelial cells. Ultrastructural examination revealed smooth muscle cell differentiation. The Ki-67 labeling index was 4.7%. The tumor showed rapid increase in size and clinical features suggestive of malignancy. However, on histopathologic evaluation it was diagnosed as a benign neoplasm, and this diagnosis was supported by the results for mitotic rate, Ki-67 labeling index, and p53 immunostaining.

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.

Intraosseous leiomyoma of the mandible: report of a case

A rare case of intraosseous leiomyoma of the mandible is reported. This is the fourth recorded case involving the mandible. The literature is reviewed and the amenability of the lesion to simple local excision is highlighted.