Ectomesenchymal chondromyxoid tumor of the anterior tongue: a report of three cases

Ectomesenchymal chondromyxoid tumor of the oral cavity: a report of 5 new cases with comprehensive review of the literature and clinicohistopathologic features

OBJECTIVE

An ectomesenchymal chondromyxoid tumor (ECT) is an uncommon soft tissue tumor with an enigmatic histogenesis and striking predilection for the tongue. We present 5 new cases and review the literature.

STUDY DESIGN

We performed a retrospective search for ECTs within the University of Kentucky Oral Pathology Biopsy Service and the published literature.

RESULTS

Five new cases from the biopsy archives and 103 well-documented ECT cases from the literature were compiled and reviewed. Whereas 89.8% of ECT are found on the anterior/dorsal/lateral/unspecified tongue, 4.6% are on the posterior/base of tongue. Six extralingual cases are reported. The age ranges from 2.3 to 78 years with an average of 40. Most ECT react with GFAP (92.8%) and S-100 protein (91.3%). Whereas 21/23 cases demonstrated a RREB1-MKL2 fusion, EWSR1 gene mutations are identified in 4 cases.

CONCLUSIONS

Most ECT are readily diagnosed on routine histopathology in combination with tumor site, immunohistochemical findings, and molecular findings; however, a subset share overlapping features with myoepithelioma of soft parts. As further molecular analysis is performed on this tumor, we may find that a subset of previously diagnosed ECT relate to or represent myoepithelioma or conversely fall under the spectrum of the pluripotent ECT.

Ectomesenchymal Chondromyxoid Tumor: A Rare Association With an Asymmetrical Soft Palate Cleft

Ectomesenchymal chondromyxoid tumor (ECT) is a rare oral lesion first described by Smith et al. in 1995. These tumors are typically painless, slow growing and benign masses occurring predominantly on the anterior tongue dorsum. Prior to this seminal report, many ECTs may have been misdiagnosed due to the histological similarities with other lesions. Immunohistochemical stains aid in definitive diagnosis of an ECT. A total of 39 papers since published have reported 96 patients with ECT. Most lesions involve the anterior aspect of the tongue, with only 6 occurring in the posterior tongue and 2 involving the hard palate. ECTs are considered to develop from ectomesenchymal cells of neural crest cells that have migrated to the tongue during embryological development. This paper is of a rare case of ECT of the posterolateral tongue occurring in association with an unusual asymmetrical soft palate cleft. It is postulated that since the tongue develops before the formation of the soft palate, an ECT lesion occurring on the posterior aspect may have a causal contribution to the development of the soft palate cleft.

Ectomesenchymal chondromyxoid tumour: an uncommon characteristic tumour of the anterior tongue

Ectomesenchymal chondromyxoid tumour (ECMT) is a rare benign tumour which classically presents in the anterior tongue. This tumour is grossly under-reported due to lack of immunohistochemical staining in many centres. We report a 46-year-old man who presented with mass in the anterior tongue and was diagnosed with ECMT. Further management of this lesion is explained with a review of the literature.

Ectomesenchymal chondromyxoid tumor: a comprehensive updated review of the literature and case report

Prompted by a unique case of an ectomesenchymal chondromyxoid tumor (ECT) of the palate in a 54-year-old female, we reviewed the English and German literature on this entity until the end of 2016 using PubMed. The search produced 74 lingual cases with a nearly equal sex distribution and a mean age of 39.3 years, and two extra-lingual cases sharing histological and immunohistological features including nodular growth, round, fusiform or spindle-shaped cellular architecture, and chondromyxoid stroma. Immunophenotyping showed the majority of cases to be positive for glial fibrillary acidic protein (GFAP), S-100 protein, glycoprotein CD57, pancytokeratin (AE1/AE3), and smooth muscle actin (SMA); in isolated cases there was molecular-genetic rearrangement or gain of Ewing sarcoma breakpoint region 1 (EWSR1) but no rearrangement of pleomorphic adenoma gene 1 (PLAG1). At present, ectomesenchymal cells that migrate from the neural crest are considered to play a pivotal role in tumor origin. All cases had a benign course, although there were three recurrences. Because of the rarity of this tumor and the need for differential diagnostic differentiation from myoepithelioma and pleomorphic adenoma, both oral surgeons and pathologists should be aware of this entity.

Ectomesenchymal chondromyxoid neoplasm. An unusual presentation. A case report

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Ectomesenchymal chondromyxoid tumor (ECMT) is a rare benign intraoral tumor.

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Till date not more than 45 cases have been reported in literature.

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Histopathologically the tumor is characterized by a well circumscribed, lobular proliferation of round, polygonal, ovoid or fusiform cells in a net-like pattern in a myxoid to chondromyxoid background.

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Here, we present a rare case of ECMT occurring in a 17 years old male who presented to us with chief complaint of slow growing painless mass arising from anterior Dorsum of the tongue measuring about 1.5 cms × 1.5 cms. Mass was completely resected as excisional biopsy, it was found un encapsulated with muscle entrapment.

Ectomesenchymal chondromyxoid tumor (ECMT) is a rare benign intraoral tumor. Clinically, it presents as a slow growing, painless, firm, submucosal swelling exclusively occurring on the anterior dorsum of the tongue. Till date not more than 45 cases have been reported in literature. Histopathologically the tumor is characterized by a well circumscribed, lobular proliferation of round, polygonal, ovoid or fusiform cells in a net-like pattern in a myxoid to chondromyxoid background. Here, we present a rare case of ECMT occurring in a 17 years old male who presented to us with chief complaint of slow growing painless mass arising from anterior Dorsum of the tongue measuring about 1.5 cms × 1.5 cms. Mass was completely resected as excisional biopsy, it was found un encapsulated with muscle entrapment.

Cyclin D1 Expression in Ectomesenchymal Chondromyxoid Tumor of the Anterior Tongue

Ectomesenchymal chondromyxoid tumor (ECT) is a rare benign tumor of uncertain lineage, which almost exclusively affects the anterior tongue. Herein, we report 2 cases of ECT occurring in 58- and 56-year-old males on the right and on the left side of the dorsum of the anterior tongue, measuring 18 mm and 10 mm, respectively. Despite positive resection margin in one case, none of the tumors recurred during follow-up of 6 and 5 years. Microscopically, both tumors had lobular architecture with a mixture of solid, microcystic, and chondromyxoid areas. The tumor cells were polygonal or elongated and showed mild atypia in one case. Immunohistochemically, both tumors showed diffuse expression of vimentin and focal positivity of CD10 and of smooth muscle actin. Regarding neural tissue-related markers, there was nearly diffuse expression of CD56 and neuron-specific enolase and focal positivity of PGP 9.5 in both cases and variable expression of CD57, synaptophysin, glial fibrillary acidic protein, and S-100 protein. Interestingly, we observed diffuse expression of SOX10 in one case. In both tumors, diffuse strong nuclear expression of cyclin D1 was present, without CCND1/IGH translocation or CCND1 amplification. The EWSR1 gene rearrangement was not detected. To the best of our knowledge, expression of SOX10, which may support neural crest origin of this peculiar lesion, has not been reported in ECT. The significance of strong cyclin D1 expression remains to be further investigated.

An unusual case of ectomesenchymal chondromyxoid tumour of the left tonsillar bed: imaging and histopathologic features

We describe a case of a rare soft-palatal and parapharyngeal mass in an adult woman. A 71-year-old female presented with a huge mass protruding from the soft palate, complaining about difficulty in swallowing for the past 4 months. After inspection and ear nose and throat fibroscopy, in which the mass appeared regular-shaped and with a regular mucosa, the patient underwent a CT scan and MRI examination. The CT scan showed an oval, not-infiltrating, hypodense mass including a discrete irregular-shaped central calcification, while the MRI examination confirmed the non-infiltrating growth and showed that around the calcified core, the lesion was surrounded by fat. After surgical removal, the histopathologic diagnosis was that of an "ectomesenchymal chondromyxoid tumour". Ectomesenchymal chondromyxoid tumour is a rare benign neoplasm arising from the tongue. Although only 45 cases have been reported in the literature, there are several unique features that define this lesion. Ours is the first case with a complete CT scan and MRI with diffusion imaging description.

Ectomesenchymal Chondromyxoid Tumor: A Series of Seven Cases and Review of the Literature

Ectomesenchymal chondromyxoid tumors (ECT) are rare, benign, intraoral mesenchymal soft tissue tumors that can be diagnostically challenging. In this study the demographic, clinical, histopathologic, and immunohistochemical features of seven ECTs are examined. The differential diagnosis of this rare neoplasm is discussed and the literature is reviewed.

Ectomesenchymal chondromyxoid tumor: A rare case report

Ectomesenchymal chondromyxoid tumor (ECMT) is a rare benign neoplasm of uncertain histogenesis, which exclusively involves the oral cavity, particularly the tongue. Clinically, it presents as slow growing, painless, firm, submucosal swelling exclusively occurring on the anterior dorsum of the tongue. Histopathologically, it comprised well circumscribed, unencapsulated lobular proliferation of fusiform and polygonal cells, with varying degree of cellularity, with neoplastic cells often seen in a myxoid, chondroid or hyalinized background. Until date, only 40 cases have been reported in the literature. Most documented lesions involve anterior tongue, however 2 cases in posterior tongue and one palatal tumor has been described. Here, we present a rare case diagnosed clinically and histopathologically as (ECMT) in a 7-year-old girl with the size of the lesion 5.0 cm making this case even rarer and throwing some light on this distinct entity.

Ectomesenchymal chondromyxoid tumor in the anterior tongue: case report of a unique tumor

Ectomesenchymal chondromyxoid tumor (ECMT) is a rare tumor, exclusively arising in the anterior tongue. Thirty-eight cases have been reported in the English literature. It usually presents as a sessile protrusion and shows round to spindle cells embedded in myxoid to chondroid stroma. Tumor cells are almost always positive for polyclonal glial fibrillary acidic protein (GFAP). We report our experience in the recent treatment of a case of ECMT, the third case in 3 years. The mass in the anterior tongue revealed characteristic morphologic features of ECMT and the expression of polyclonal GFAP. Although ECMT should be differentiated from other mesenchymal tumors including myoepithelioma, its clinical, morphological, and immunohistochemical features enable its diagnosis, especially when pathologists are aware of it.

Ectomesenchymal chondromyxoid tumor: Review of literature and a report of a rare case

Ectomesenchymal chondromyxoid tumor (ECMT) is a rare benign intraoral tumor. Clinically, it presents as a slow growing, painless, firm, submucosal sweling exclusively occurring on the anterior dorsum of the tongue. Till date only 40 cases have been reported in literature. Histopathologically the tumor is characterized by a well circumscribed, lobular proliferation of round, polygonal, ovoid or fusiform cells in a net-like pattern in a myxoid to chondromyxoid background. Here, we present a rare case of ECMT occurring in a 7-year-old boy and throw some light on this distinct entity.

Reticulated myxoid tumor of the tongue: 2 cases supporting an expanded clinical and immunophenotypic spectrum of ectomesenchymal chondromyxoid tumor of the tongue

An ectomesenchymal chondromyxoid tumor (ECMT) is a rare neoplasm that exclusively occurs in the anterior dorsum of the tongue. The tumor consists of small round to fusiform or spindle cells with myxoid or chondroid stroma. The tumor consistently shows a positive reaction with glial fibrillary acidic protein antibodies, especially polyclonal antibodies. We report 2 cases of reticulated myxoid tumors arising in the tongue. One tumor occurred in the posterior dorsum of the tongue and another in the anterior. Both tumors showed characteristic morphology of ECMT; however, both were negative for reactions with monoclonal and polyclonal glial fibrillary acidic protein antibodies. On the basis of morphology, they are thought to be belonging to ECMT. Hence, we suggest that ECMT can show broader spectrum of clinical and immunophenotypic feature.

Clinical, histological and immunohistochemical features of ectomesenchymal chondromyxoid tumor

OBJECTIVE

Ectomesenchymal chondromyxoid tumor is a rare oral soft tissue neoplasm that should be differentiated from other neural and chondromyxoid entities. The aim of this study was to report the clinical, histological, and immunohistochemical features of 3 additional cases of this condition.

METHODS

Clinical data were obtained from the clinical records and all cases were evaluated through light microscopy and immunohistochemistry to cytokeratins, vimentin, S100 protein, desmin, smooth muscle actin, and glial fibrilary acidic protein.

RESULTS

All 3 cases affected the tongue as a long-lasting submucosal swelling and were managed through conservative surgery. They all showed myxoid and chondroid histological patterns, and vimentin, S100, and glial fibrilary acidic protein immunoexpression.

CONCLUSIONS

These findings reinforce the typical features of ectomesenchymal chondromyxoid tumor previously described, helping to confirm and establish the clinical, histopathological, and immunohistochemical profile of this uncommon lesion.

Oral ectomesenchymal chondromyxoid tumor: case report and literature review

Ectomesenchymal chondromyxoid tumor (ECMT) of the oral cavity is a rare lesion. We describe the 33rd reported case in the current English-language literature. This patient had originally presented 5 years earlier with a tongue neoplasm with biopsy results consistent with nerve sheath myxoma. A general surgical pathologist gave the patient's current lesion a preliminary diagnosis of low-grade sarcoma. After further evaluation by an oral and maxillofacial pathologist, the diagnosis of ectomesenchymal chondromyxoid tumor was established. It is important for clinicians to have a better understanding of ECMT, so as to avoid future misdiagnosis of this entity.

The ectomesenchymal chondromyxoid tumor: a review

The ectomesenchymal chondromyxoid tumor is a relatively recently described neoplasm that appears to involve uniquely the oral cavity, particularly the tongue. Thirty well-accepted cases have been reported since the initial description of this lesion in 1995. While a wide age range (9-78 years) has been documented, most of these tumors are diagnosed from the third to sixth decades of life. No sex predilection is seen. The size of the neoplasm is typically <2 cm, and most affect the anterior dorsal tongue. The duration of the lesion was difficult to gauge, probably due to the asymptomatic nature of the process. Some tumors, however, were well documented to have been present for as long as 10-20 years. Histopathologically, the ectomesenchymal chondromyxoid tumor is characterized by a well circumscribed, but unencapsulated, lobular growth pattern. Varying degrees of cellularity are noted, with the lesional cells often set in a myxoid, chondroid or hyalinized background. Immunohistochemical studies reveal positivity of the lesional cells for antibodies directed against glial fibrillary acidic protein, cytokeratins, S-100 protein and CD-57 in the majority of tumors. Treatment consists of conservative surgical excision, and while recurrence is possible, it has been noted in <10% of reported cases.

Ectomesenchymal chondromyxoid tumour of the tongue: Unlikely to originate from myoepithelial cells

Ectomesenchymal chondromyxoid tumour is a recently described rare entity found almost exclusively in the anterior dorsum of the tongue. We report an additional case, review the pertinent literature and explore the histogenesis of the lesion. The lesion has no discriminating clinical features and diagnosis is only established following histopathological examination including immunohistochemical assessment. The histogenesis of the lesion remains speculative and our study seems to discount myoepithelial cells as a potential source.

Myoepithelioma of the tongue

Soft tissue myoepitheliomas, in contrast to salivary gland myoepitheliomas, are benign neoplasms that typically occur in the soft tissues of the extremities. Both are characterized by a multilobular proliferation of polygonal to fusiform cells embedded in a variably myxoid to chondromyxoid matrix. A histologically similar lesion that has a marked predilection for the anterior dorsum of the tongue has been referred to as ectomesenchymal chondromyxoid tumor. The morphological and immunohistochemical resemblance of soft tissue myoepitheliomas to ectomesenchymal chondromyxoid tumors has led to the use of these designations interchangeably. We present a case of myoepithelioma of the tongue and review the literature, with emphasis on the differential diagnosis and histogenesis of this lesion and pertinent nosologic considerations.

Ectomesenchymal chondromyxoid tumor of the hard palate - a case report

Ectomesenchymal chondromyxoid tumor (ECMT) is a rare tumor. Only 26 cases of ECMT have been reported, all occurred in the anterior tongue. We present a case of a 30-year-old male with a nodule in the hard palate, which was reported as ECMT on histopathology. The differential diagnosis considered included are extraskeletal myxoid chondroma, ECMT, pleomorphic adenoma, oral focal mucinosis, chondroid choristoma, and ossifying fibromyxoid tumor. After serial sections no other component was observed and a diagnosis of ECMT was made by exclusion. The patient is asymptomatic on follow up. A review of existing literature is also presented here.

Ectomesenchymal chondromyxoid tumour of the anterior tongue

Ectomesenchymal chondromyxoid tumour (ECT) of the anterior tongue was first described in 1995. To date, only 23 cases have been reported in the literature. Two new cases of ECT have been described, with immunohistochemical analysis including cytokeratin (CK) profile, GFAP, S-100 protein, SMA, CD-57, EMA, desmin and Ki67. Tumour cells showed intense and diffuse staining for GFAP and diffuse staining for S-100 protein. Pan-keratin, high- and low-molecular-weight CK, CK 7, 8, 18, 19 and 20 were negative. Tumour cells were also negative for desmin, SMA, CD-57 and EMA. Ki67 was positive in only scattered cells. The findings of the present study support the suggested ectomesenchymal origin for ECT, rather than myoepithelial salivary gland origin. The low Ki67 expression is in agreement with the low growth rate, small size and lack of mitotic activity in the present cases, as well as in those previously described.

Nerve sheath myxoma (neurothekeoma) in the tongue of a newborn

Nerve sheath myxoma is a benign peripheral nerve sheath tumor that rarely occurs in the oral cavity; experience with these lesions is therefore limited. The lesion described in this report appeared clinically as a gradually enlarging, painless growth arising on the tongue of a newborn girl. Microscopically, the lesion was characterized by nodules of spindle-shaped cells with abundant myxoid stroma. Immunohistochemical studies were consistent with a nerve sheath neoplasm.

Cribriform adenocarcinoma of the tongue: a hitherto unrecognized type of adenocarcinoma characteristically occurring in the tongue

AIMS

We report a review of our institutional and consultation files in order to select cases of hitherto unrecognized type of adenocarcinoma occurring in the tongue.

MATERIALS AND RESULTS

Eight cases of a characteristic adenocarcinoma of the tongue resembled solid and follicular variants of the papillary carcinoma of the thyroid. All the tumours were unencapsulated and were divided by fibrous septa into lobules. Major parts of the lesions were composed of areas with solid and microcystic growth patterns. The most striking cytological feature was that the tumour nuclei were pale-staining with a 'ground glass' quality, and they often appeared to overlap. Immunohistochemically, the tumours expressed cytokeratin and S100 protein and, focally, actin; thyroglobulin was negative. Ultrastructurally the cells had clefted nuclei, and the cytoplasm contained a few mitochondria, lysosomes and Golgi apparatus. Many tumour cells had combined features of both myoepithelial and secretory differentiation-well formed microvilli on their apical borders and bundles of microfilaments. At first presentation, all eight patients had metastases in the regional neck lymph nodes, but all are alive 2-6 years after the initial excision and irradiation.

CONCLUSION

We describe a distinctive type of adenocarcinoma of the tongue, for which we propose the name cribriform adenocarcinoma of the tongue (CAT). CAT usually presents with metastases in the neck lymph nodes at the time of presentation. We hypothesize that the tumour might arise from the thyroglossal duct anlage.