Solitary plexiform neurofibroma of the oral cavity A case report

Rare nonsyndromic recurrent solitary gingival neurofibroma in an older adult

BACKGROUND

Neurofibromas are benign peripheral nerve sheath tumors usually featured with neurofibromatosis type 1 syndrome. Recurrent gingival neurofibromas have been rarely reported in the periodontal literature, particularly affecting elderly patients.

METHODS AND RESULTS

A 70-year-old man with a pale, rubbery, and painless thickening along the facial/buccal gingiva of the mandibular right canine and first premolar. Ten years prior, the patient had undergone excision of a neurofibroma within the same region. The patient denied a history of cutaneous disease or neurofibromatosis. Histopathologic and immunostaining of the excised lesion confirmed the diagnosis as a recurrent gingival neurofibroma.

CONCLUSIONS

With cases of suspected recurrent neurofibroma, attending practitioners should consult with an oral pathologist whether the primary lesion had exhibited tumor cells to the surgical specimen margin. Preoperative use of a cone beam computed tomography scan may enhance determination of tumor depth. Clinicians should also carefully weigh the decision for conservative excision of gingival neurofibromas and greater risk of recurrence versus performing a somewhat wider extirpation and possible formation of a mucogingival defect.

KEY POINTS

What are important clinical considerations when performing a gingival biopsy? Gingival neurofibromas may be associated with an increased risk for recurrence owing to decisions for tissue-sparing excision and prevention of a mucogingival defect; supplemental use of cone beam computed tomographic scans may provide greater appreciation of tumor depth. What is a reasonable length of time of postoperative assessment for gingival neurofibromas? Patients who have undergone surgical removal of a gingival neurofibroma should undergo yearly surveillance for at least 10 years. What is a key limitation to this case study? Preoperatively, attending clinicians should consult with an oral pathologist to ascertain whether a primary lesion had manifested tumor cells to the surgical margin. Conservative gingival resection of a neurofibroma may promote recurrence.

Excision of Solitary Non-syndromic Oral Plexiform Neurofibroma Utilizing a Diode Laser: A Case Report

Plexiform neurofibroma is a benign peripheral nerve sheath tumor known to be pathognomonic for neurofibromatosis type 1. However, solitary plexiform neurofibroma in the oral cavity is extremely rare. Herein, we presented a 73-year-old Saudi male with solitary plexiform neurofibroma located on the maxillary alveolar ridge, which was excised successfully using a 940 nm diode laser. Microscopic examination revealed a multinodular arrangement of benign spindle cells in a haphazard pattern. Immunohistochemical analysis showed positive staining for S100 and CD34 in the tumor cells.

Solitary intraosseous neurofibroma in the mandible mimicking a cystic lesion: A case report and review of literature

BACKGROUND

Neurofibromas are benign tumors of a neurogenic origin. If these tumors occur without any other signs of neurofibromatosis, they are classified as isolated neurofibromas. Neurofibromas in the oral cavity mostly occur within soft tissues, indicating that solitary intraosseous neurofibromas in the mandible are rare. Due to the absence of specific clinical manifestations, early diagnosis and treatment of these tumors are difficult to achieve.

CASE SUMMARY

A 37-year-old female patient visited our hospital due to numbness and swelling of the gums in the right lower molar area that had persisted for half a month. The patient's overall condition and intraoral examination revealed no significant abnormalities. She was initially diagnosed with a cystic lesion in the right mandible. However, after a more thorough examination, the final pathological diagnosis was confirmed to be neurofibroma. Complete tumor resection and partial removal of the right inferior alveolar nerve were performed. As of writing this report, there have been no signs of tumor recurrence for nine months following the surgery.

CONCLUSION

This case report discusses the key features that are useful for differentiating solitary intraosseous neurofibromas from other cystic lesions.

Solitary Neurofibroma of Mandible in a 2-Year-Old Child: A Rare Case Report and Review of Literature

Solitary intraosseous neurofibromas of mandible are very rare and only 40 cases are documented. This case report presents one of the youngest documented case of solitary neurofibroma of mandible, in a 2-years old male child. The tumour was symptomatic and presented as a swelling over right posterior region of mandible. The patient underwent conservative excision under general anaesthesia. The inferior alveolar nerve was preserved. Histopathology was suggestive of benign nerve sheath tumour. Immunohistochemistry showed moderate S-100 and strong CD34 positivity. Postoperative healing was uneventful. This report also reviews forty previously reported cases of solitary intraosseous neurofibromas of the mandible.

Endoscopic Endonasal Surgery to Resect a Solitary Trigeminal Neurofibroma Involving the Infratemporal Fossa: A Case Report

Trigeminal neurofibromas are rarely reported, and even rarer when involving the infratemporal fossa. We describe the case of a 58-year-old man incidentally found through magnetic resonance imaging to have a tumor situated mainly in the infratemporal fossa. The tumor derived from the third branch of the trigeminal nerve and was totally removed by endoscopic endonasal surgery. Final pathology confirmed a diagnosis of neurofibroma. The patient had no intraoperative or postoperative complications except for numbness of the face. During the 6 years of follow-up, there has been no tumor progress or recurrence. We consider that endoscopic endonasal surgery is feasible in treating trigeminal neurofibromas involving the infratemporal fossa.

Solitary intraosseous neurofibroma of the mandible: Report of an extremely rare histopathologic feature

Neurofibroma (NF) is a benign tumor derived from the peripheral nerve sheath. Neurofibromas may present either as solitary lesions or as part of the generalized syndrome of neurofibromatosis or von Recklinghausen's disease of the skin. The intraosseous variant of NF is very rare. We report a case of a 32-year-old female who was diagnosed with a solitary intraosseous neurofibroma of the mandible. The present case is rare with respect to its unique histopathologic feature.

LASER Assisted Excision of Solitary Neurofibroma in the Gingiva

Neurofibromatosis (NF) is a genetic disorder that presents as benign tumours of the nervous system originating from the nerve sheath. It is of three types: Type I, Type II and Schwannomatosis. Type I Neurofibromatosis or von Recklinghausen's disease is the most common type of neurofibromatosis seen and it accounts for 90% of all cases seen. It can be seen as light brown pigmentation spots (Café-au-lait) on the skin and multiple small tumours among the nerves. Oral manifestations of NF are very rare and can be seen as sessile lesion in the tongue or the gingiva. The major complaints of the oral manifestations include difficulty in speech and mastication which it results in progression of periodontal disease. Here, we present a case report of Type I NF which presented as a sessile lesion in the right maxillary gingiva, for which we performed an excisional biopsy using LASER.

Solitary Neurofibroma of the Soft Palate: A Rare Entity

The solitary neurofibroma is a benign tumor of neuronal origin uncommonly reported in the oral cavity. The possible association of this neoplasia with systemic pathologies, such as von Recklinghausen's disease and multiple endocrine neoplasia, makes its diagnosis fundamental. Solitary isolated neurofibroma of the soft palate not associated with von Recklinghausen's disease is an unusual tumor and probably only four cases have been reported in English literature previously. To the best of our knowledge, our case of soft palate neurofibroma in 17-year-old male represents the fifth reported in English literature, for which complete surgical excision was achieved with uneventful healing.

Solitary neurofibroma of the floor of the mouth: rare localization at lingual nerve with intraoral excision

Background

Neurofibromas (NF) are benign tumors of the peripheral nerves that are composed of Schwann cells, perineural-like cells and fibroblasts. The differential diagnosis for a solitary intraneural variant of neurofibroma arising in the floor of the mouth is broad and includes a submandibular gland neoplasm and adenopathy, among others. The intraoral approach is the best choice for a medium-sized lesion.

Case presentation

We report a rare case of a solitary neurofibroma of the floor of the mouth in a 31-year-old male. The patient consulted the dental emergency department for acute pain of the left mandible. Systematic clinical examination revealed the presence of a mass in the left mouth floor. The panoramic x-ray was not conclusive and the magnetic resonance imaging (MRI) revealed a well-defined soft tissue lesion with homogenous isosignal intensity on the T1-weighted image, high intensity signal on the T2-weighted image and heterogeneous enhancement following contrast-enhancement on the T1-weighted Fast Sat image. The surgical excision of the soft-tissue neoplasm was accomplished by an intraoral approach. The specimen was sent for histopathologic analysis and Immunohistochemical studies which confirmed the diagnosis of a myxoid predominant intraneural solitary neurofibroma.

Conclusion

The diagnosis of neurofibroma was confirmed by histopathological evaluation and immunohistochemical studies which also excluded other entities in the histopathologic differential diagnosis including schwannoma and a malignant peripheral nerve sheath tumor among other. Localized (solitary) neurofibromas most often occur as sporadic lesions, however; diagnosis of a solitary neurofibroma prompts clinical evaluation to exclude the remote possibility of neurofibromatosis. The purpose of this case report is to raise awareness of the uncommon presentation of neurofibroma and to document the successful management of such a lesion using an intraoral approach.

Isolated plexiform neurofibroma of the tongue

Neurofibromas (NF) are benign tumors of neural origin, of which roughly 90% appear as solitary lesions. They are classified into cutaneous, subcutaneous, and plexiform subtypes. Plexiform neurofibromas are the least common variant and usually are pathognomonic for NF I. Here, we present a very rare case of isolated plexiform neurofibroma with a painless enlarging mass of the tongue of an 11-year-old girl. This rare benign tumor has the potential for malignant transformation, and the diagnosis was difficult owing to the patient's age and to the insidious clinical presentation. The present case is a diffuse isolated plexiform neurofibroma of the tongue that was not associated with neurofibromatosis that was treated with intraoral surgery.

Neurofibroma of sinus maxillae

Neurofibroma is a benign tumour composed from Schwann cells. Localization in sinus maxillea is very rare. Authors presenting case which was treatment in Maxillo-Facial Surgery Clinic in Wrocław.

Solitary plexiform neurofibroma of the gingiva: unique presentation in the oral cavity

Neurofibromas are benign tumours originating from the nerve sheath. Amongst the histological variants, plexiform types are considered exclusive. These are poorly circumscribed, locally invasive and may exhibit sarcomatous potential. Plexiform neurofibromas are key features of Neurofibromatosis - 1 and their solitary intra-oral presentation is uncommon. The following case report describes a unique case of an isolated solitary plexiform neurofibroma of the maxillary anterior gingival region in a middle aged female patient.

Solitary oral plexiform neurofibroma: review of literature and report of a case

Plexiform neurofibroma (PN) is a rare, benign tumor of nerve sheath origin, which frequently manifests as part of neurofibromatosis type 1. The article presents a case of solitary PN in a 4-year-old girl, which manifested as a double lip and without systemic or familial involvement. A review of the literature on solitary PN in the oral soft tissue demonstrates the scarcity of such cases.

Solitary submucous neurofibroma of the mandible: review of the literature and report of a rare case

Solitary neurofibroma is a rare benign non-odontogenic tumor. Particularly in the oral cavity, neurogenic tumors are rare, especially if they are malignant. Neurofibromas may present either as solitary lesions or as part of the generalised syndrome of neurofibromatosis or von Recklinghausen's disease of the skin. Clinically, oral neurofibromas usually appear as pediculated or sessile nodules, with slow growth and mostly without pain. The diagnosis can be confirmed by histological examination. Neurofibromas are immunopositive for the S-100 protein, indicating its neural origin. Treatment is surgical and the prognosis is excellent. For illustration a rare case of a solitary neurofibroma in the mandible is presented.

Sporadic and multiple neurofibromas in the head and neck region: a retrospective study of 33 years

The neurofibroma occurs as isolated or multiple lesions frequently associated with neurofibromatosis type 1 (NF-1). The aim of this study was to analyze the clinical and histopathological features of neurofibromas, particularly the plexiform variant, in the skin and oral mucosa, discussing their pathogenesis as well as clinical management of isolated lesion unassociated with NF1. The clinicopathologic features of 66 neurofibromas in the head and neck region diagnosed at the pathology laboratories of the Bauru Dentistry School and Lauro de Souza Lima Research Institute from 1970 to 2003 were reviewed. The clinical data, therapy, and follow-up information were obtained from the medical records. The results showed a high frequency of cutaneous lesions (81.8%) occurring mainly in females older than 40 years. Isolated neurofibromas were found in 51.2% of patients, and multiple lesions were often associated with the NF-1. The histopathological analysis demonstrated that diffused neurofibromas occur more frequently than the plexiform type. However, one case of plexiform neurofibroma was detected in the oral mucosa as an isolated lesion non-associated with the NF-1. The indolent clinical behavior of isolated neurofibromas in the head and neck region and the absence of NF-1 association reinforce that sporadic lesion could be hyperplastic or hamartomatous rather than neoplastic in nature.

Oral plexiform neurofibroma not associated with neurofibromatosis type I: case report

An unusual case of isolated plexiform neurofibroma arising in the oral cavity without other clinical manifestations or family history of neuro-fibromatosis-1 (NF-1) is described. The tumor was histopathologically analyzed and an immunohistochemical panel comprising S-100 protein, epithelial membrane antigen (EMA), collagen IV, and CD34 was performed. Typical features of plexiform neurofibroma characterized by enlarged nerve fascicles composed of elongated nuclei and scant cytoplasm cells were identified. Subjacent to the oral epithelium, tactile-like bodies were also detected. On the basis of this report, we would like to emphasize that plexiform neurofibroma can occur in the oral cavity as a benign isolated tumor in patients without other stigmata of NF-1.

Isolated Plexiform Neurofibroma: Treatment with Three-Dimensional Conformal Radiotherapy

OBJECTIVES

To present a case of an unusual benign tumor of the tongue treated successfully with radiotherapy.

STUDY DESIGN

Case report.

METHODS

Retrospective chart review.

RESULTS

A 60-year-old man presented with a painful submucosal lesion of the tongue base. Computed tomography showed an infiltrative soft-tissue mass involving the left base of the tongue. Operative biopsy revealed plexiform neurofibroma. Because of the patient's operative risk and the potential morbidity of surgical resection, he was treated with three-dimensional conformal radiotherapy (3DCRT). His treatment was accomplished using a five-field arrangement treating exclusively the mass lesion to a total tumor dose of 60 Gy. After treatment, the patient's tongue pain resolved, and he noted minimal transient xerostomia. Serial follow-up radiographic examinations showed the base of tongue mass to be slightly smaller 4 months after treatment. The most recent follow-up magnetic resonance image reveals a further decrease in size of the mass. The patient is now over 3 years out from treatment.

CONCLUSIONS

Solitary plexiform neurofibroma of the tongue base is a rare tumor. These benign neoplasms are usually treated with either observation or surgical excision. This case demonstrates that, when significant symptoms necessitate active management, these lesions may be successfully treated with minimal morbidity using 3DCRT. The ability of this technique to deliver a conformal radiation dose to the tumor volume while sparing the surrounding normal tissues may expand the application of radiotherapy in the treatment of these benign lesions of the head and neck.

Massive plexiform neurofibroma of the sympathetic trunk

A case report of a massive plexiform neurofibroma of the sympathetic trunk is reported. Symptoms included dysphagia, shortness of breath and paraesthesia of the right hand. The nerve of origin and extent of the tumour were unusual. The tumour mass partially filled the right hemithorax, surrounded the right brachial plexus, extended to the base of skull and invaded the cervical vertebrae threatening to compromise the spinal cord. Surgical resection required combined cardiothoracic, neurosurgical and plastic and reconstructive surgical teams. Early outcome following surgery was excellent. This case illustrates the need for a combined surgical approach for such a lesion and we believe it is the first reported case of plexiform neurofibroma of the sympathetic trunk.