Intraosseous leiomyoma of the mandible

A Case of Vascular Leiomyoma Causing Osseous Malformations in the Foot

A vascular leiomyoma is a vascular soft tissue tumor that is relatively rare and benign. They usually occur as solitary lesions and are well encapsulated. The present study describes a unique case of vascular leiomyoma causing erosions of a metatarsal secondary to compression from the tumor. We present a female in her fourth decade of life with osseous malformations of the third metatarsal that became painful after an acute trauma to the foot.

Atypical localization of intraosseous angioleiomyoma in the rib of a pediatric patient: a case report

BACKGROUND

This is the first reported case of a primary intraosseous angioleiomyoma and the second case of a primary leiomyoma of the rib, irrespective of age. Angioleiomyomas mostly occur in patients of advanced age, in any part of the body, particularly the lower extremities and present as painful, slow-growing nodules in the dermis, subcutaneous fat or deep fascia. Other localizations, especially bone, are considered extremely rare, as well as their occurrence in paediatric patients.

CASE PRESENTATION

A 10-year-old girl was admitted to the orthopaedic surgery department for further assessment of a pain localized in the posterior part of the right hemithorax. After magnetic resonance imaging (MRI) and surgical biopsy, intraosseus angioleiomyoma of the fourth rib was diagnosed by histopathology examination. Atypical costal localization of this type of a benign tumour presents diagnostic difficulty, especially in children. The differential diagnoses included cartilaginous tumours, Ewing sarcoma, fibrous dysplasia, Langerhans cell histiocytosis, intraosseous haemangioma and metastatic tumours. We report a detailed diagnostic procedure including MRI, selective angiography and histopathologic examination.

CONCLUSION

Diagnosis of intraosseous angioleiomyoma is difficult due to the extreme rarity of this tumour and absence of pathognomonic radiological signs. Although very rarely identified in bones and young age group, radiographers and reporting doctors should be aware of this possible angioleiomyoma presentation and supported by the provided detailed diagnostic information.

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.

Intraosseous Leiomyoma of the Tibia. A Case Report

Introduction:

Leiomyoma is benign smooth-muscle tumor most commonly arising in the uterus, the gastrointestinal tract, and the skin. Leiomyomata are infrequently seen in the extremities and rarely seen in the bone. It is usually presented by a gradually increasing pain with nonspecific radiological findings, and could be a differential diagnosis for wide range of bone tumors.

Case presentation:

We report a case of a 73-year-old Japanese female patient with a painful intraosseous leiomyoma involving the proximal tibia. The patient had undergone tumor excision with wide margin, immediate weight bearing was allowed, pain had been relieved and the patient was satisfied with no recurrence, malignant change, distant metastases or functional impairment. We reviewed all published cases of intraosseous leiomyomata in English literature.

Conclusion:

Diagnosis of Intraosseous leiomyoma of the extremities is difficult due to extreme rarity of the tumor and absence of pathognomonic radiological sign in X-ray, CAT, or even MRI. While the exact diagnosis is only achieved by histopathological examination and with immunohistochemistry stains, which can differentiate it from malignancy, especially from the much less rare leiomyosarcoma. Orthopedic oncologists have to include this rare benign tumor in the differential diagnosis of any intraosseous lesion with gradually worsening and long-standing pain, despite of benign imaging characters. Different histological patterns of leiomyoma do exist, however there is no difference in prognosis or treatment options. Treatment standard includes wide excision with autologous bone graft whenever possible. Internal fixation may be necessary if the bone defect is large or there is thinning out of the cortex that may lead to pathological fracture.

Intraosseous leiomyoma of the distal femur: a case report and review of literatures

BACKGROUND

Leiomyoma is a benign tumor of smooth-muscle origin. They most commonly derived from the uterus. Besides, they were also usually diagnosed in the gastrointestinal tract, skin, and mucous membranes. However, it rarely occurs in the bone.

CASE PRESENTATION

The authors reported one case of 56-year-old male with intraosseous leiomyoma of the distal femur. Initially, the patient felt left knee pain for 1 year. Radiographs film disclosed an ill-defined osteolytic lesion with thinning cortex over left distal femoral medial condylar region. Computed tomography (CT) revealed homogenous radiolucent lesion with thinning cortex over the metaphysis of distal femur. Magnetic resonance imaging showed focal marrow replacement by tumor. CT-guide biopsy was performed, and the pathology showed a picture of leiomyoma. Since the definite diagnosis, the lesion was treated with en-bloc resection and endoprosthetic knee joint reconstruction. Satisfied result and disease free were achieved during follow-up.

CONCLUSIONS

Intraosseous leiomyoma of the extremities is difficult to be diagnosed due to extraordinarily rare. This rare benign tumor should be included in the differential diagnosis of any relatively intraosseous lesion with benign imaging findings. This is the first published case of primary intraosseous leiomyoma of distal femur after literature reviews.

Oral leiomyoma

Oral leiomyoma is a benign smooth muscle tumor with a low incidence. Oral leiomyomas present as slow growing, asymptomatic sub mucosal masses, usually in the tongue, hard palate or buccal mucosa. They may be seen at any age and are usually discovered when they are 1 to 2 cm in diameter. The diagnosis is mainly determined by histological studies and special stains that confirm the smooth muscle origin. Surgical excision appears to be the best line of treatment and recurrence is unexpected. The purpose of this article is to present a case of a 32-year old male with a 1 month history of a leiomyoma on his right submandibular region.

Granular cell leiomyoma of the oral cavity

Granular cytoplasmic change is a reported but uncommon finding in leiomyoma. Leiomyoma in the oral cavity is also uncommon, and granular cell change in oral leiomyomas, to the best of our knowledge, has not been previously reported in the English literature. Two cases of oral leiomyomas with significant granular cell change are presented. These tumors may be confused with the more common granular cell tumor, however, routine histology and immunohistochemistry aided in establishing the diagnosis. Ultrastructural studies were done for one case. Both tumors were immunoreactive for muscle markers, namely, smooth muscle actin and desmin. One of the tumors (case 2) reacted postiviely for HHF-35 and alpha-1 antitrypsin. The tumors were unreactive for S-100 protein, pancytokeratin, myoglobin, and factor VIII related antigen (case 2).

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.

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.