A rare case of solitary palatal myofibroma in a young pediatric patient

Myofibroma (MF) is a benign spindle cell neoplasm rarely found in the oral cavity. It is common in males than females (2:1) and mostly seen to develop before 2 years of age with few cases reported in adults. This article reports a rare case of solitary MF of the hard palate in an 8-year-old female child; highlighting the clinical features, histopathology, differential diagnosis while emphasizing the importance of immunohistochemistry in establishing an accurate diagnosis and management of the same. The objective should be to differentiate benign versus malignant spindle cell lesions of smooth muscle, nerve tissue, fibrocytic, and histiocytic origin. Rapid growth of the lesion often raises suspicion of malignancy and may lead to misdiagnosis and inappropriate management.

Intraosseous solitary myofibroma of the orbit in an adolescent woman

A 16-year-old woman presented with a painless, progressive, hard swelling in the left inferolateral orbital wall for the past 1 year. There was no diminution of vision or limitation of ocular motility. Imaging revealed an intraosseous, well-defined, expansile, soft tissue lesion in the inferolateral wall of the left orbit. A left anterior orbitotomy with complete surgical excision was performed. Histopathological evaluation of the specimen revealed fascicular pattern of spindle cells with a rich network of slit-like, branching blood vessels. Tumour cells exhibited smooth muscle actin and vimentin positivity but were negative for CD-34 and STAT-6. In absence of any systemic manifestation, a diagnosis of intraosseous solitary orbital myofibroma was made. The case highlights the importance of integrating clinical, radiological and histopathological features in overcoming the diagnostic challenge of differentiating myofibroma from other mesenchymal neoplasms. It also brings forth the importance of complete resection and curettage to prevent recurrence.

Solitary intraosseous myofibroma of the ilium in an adult patient: A case report and literature review

BACKGROUND

Myofibroma is a rare benign tumor typically occurring in the skin and subcutaneous tissues of the head and neck in infants and young children. The incidence of solitary intraosseous and adult myofibroma is extremely low. Although there have been a few reported cases of solitary intraosseous myofibroma in adult patients, most of these cases involved the craniofacial bones.

METHODS

We present the case of a 64-years-old woman presenting with minimal pain of the right buttock and groin.

RESULT

Radiographs and computed tomography showed a huge tumor spreading around the ilium, and non-uniform calcifications were noted inside the tumor. Iliac tumor biopsy was conducted, and intraosseous myofibroma was suspected. We performed surgical resection of the mass, and a final diagnosis of myofibroma with metaplastic bone production was made.

CONCLUSION

We have presented an extremely rare case of solitary intraosseous myofibroma in an adult patient.

[Inflammatory Pulmonary Myofibroblast Tumor Suspected of Pulmonary Metastasis of the Lung Cancer;Report of a Case]

Inflammatory myofibroblastic tumor (IMT) of the lung is a rare disease. The patient underwent the chemoradiotherapy for primary left lung cancer which showed complete responce (CR) by the treatment. A different nodule of 10 mm in diameter was found in the left lung by computed tomography (CT). Positron emission tomography(PET) showed positive detection correspond to the nodule ( SUVmax 4.82). A partial lung resection was carried out, and the tumor was diagnosed as IMT pathologically.

Solitary myofibroma of the lumbar vertebra in young adult: A case report with 4-year follow-up of postoperative CT or MRI

BACKGROUND

Solitary myofibroma of the spine is extremely rare, particularly among adults. To the best of our knowledge, only 3 cases affecting lumbar vertebrae have been reported in the English language literature. Of them, only 1 case was an adult case of solitary myofibroma affecting the L1 vertebra.

METHODS

We report a case of solitary myofibroma affecting the L5 vertebra in an 18-year-old man and the postoperative imaging of solitary myofibroma for the first time. Conventional radiographs demonstrated an expansile osteolytic lesion with thinned cortex and marginal sclerosis. Computed tomography (CT) showed a purely osteolytic expansile lesion with partial disappearance of thinned cortex. MRI of the lesion revealed an isointense signal on T1-weighted images, an inhomogeneous slightly hyperintense signal on T2-weighed images, and homogeneous avid enhancement with gadolinium.

RESULTS

Surgical excision was performed and the lesion was diagnosed as solitary myofibroma on pathological examination. One-year follow-up postoperative CT demonstrated decreased size of the osteolytic lesion with sclerotic change. Four-year follow-up postoperative MRI revealed complete resolution of the lesion replaced by normal fatty marrow.

CONCLUSION

If a benign-looking expansile osteolytic lesion reveals a homogeneously isointense signal on T1-weighted image, inhomogeneous slightly hyperintense signal on T2-weighted image, and homogeneous avid enhancement with gadolinium, solitary myofibroma should be considered in the differential diagnosis of spine bone tumors. It can be resolved completely.

Unusual Presentation of Infantile Myofibroma in the Deep Palm of a Child: A Case Report and Discussion of the Differential Diagnosis

Infantile myofibroma or myofibromatosis is a myofibroblastic and fibroblastic proliferation that is most commonly reported in children younger than 2 years of age. It is a benign process composed histologically of a biphasic pattern of spindle-shaped cells surrounding a zone of less differentiated cells in a hemangiopericytoma-like pattern. We report this tumor in a unique presentation in the deep palm of a 2-year-old child without skin ulceration and with an intimate association with the median nerve. The well-circumscribed nature of the tumor facilitated complete excision with neural preservation. Final pathology was consistent with an unusual type of myofibroma or myofibromatosis. Conservative management with partial excision has been advocated for these masses because of potential surgical morbidity and its benign nature. This case report highlights the differential diagnosis of uncommon soft tissue tumors in the pediatric hand as well as the importance of a surgeon's surgical assessment in guiding treatment.

Myofibroma of the mandible

This article is reporting a case of myofibroma involving the mandible of a 12-year-old boy. The patient did not have any swelling nor any redness but of partial mental nerve hypoesthesia. A panoramic radiograph demonstrated a globe like radiolucent lesion in the left angle of the mandible that was an increased uptake spot by FDG-PET. Incisional biopsies indicated myofibroma, therefore the tumor was totally resected under general anesthesia. After surgery there was no complication except for a change for the worse of unilateral mental nerve hypoesthesia. At 29 months postoperative, no evidence of recurrence could be found.

[Congenital myofibroma. A true hemangiopericytoma. A neonatal case with immunohistochemical and ultrastructural studies]

We report the case of a male newborn infant with a pedunculated dermic tumor, located in the right malar region; who underwent a complete surgical resection of the tumor and had a satisfactory postoperative evolution. The histopathologic findings disclosed a subcutaneous tumor with a nodular aspect and a subendothelial intravascular growth, constituted by a dual population of small cells and spindle-shaped cells, distributed in a biphasic pattern. All tumor cells showed a strong pericellular reaction for PAS. The immunohistochemical studies revealed: diffuse cytoplasmic positivity for CD34 and Vimentin in all tumor cells, and only spindle-shaped tumor cells and less differentiated isolated neoplastic cells, presented cytoplasmic positivity for the smooth muscle alpha-actin. The electronic microscopy demonstrated a layer of basal membrane and in the citoplasm, numerous intermediate filaments with focal condensations. Based on all these findings, we conclude that this is a myofibroma, a "true hemangiopericytoma" with myofibroblastic differentiation. For this reason, we propose the term myofibropericytoma, in order to highlight its pericytic origin and its myofibroblastic differentiation. We emphasize the need to recognize this entity, in view of its low frequency and the possibility of a diagnostic mistake with other soft tissues tumors that display haemangiopericytoma-like features.

Central (intraosseous) myofibroma of the mandible: clinical, radiologic, and histopathologic features of a rare lesion

OBJECTIVE

Myofibroma frequently manifests as a solitary soft tissue tumor and less as simultaneous multiple tumors in both soft tissues and bones. The present study evaluated clinical, radiological, and histopathologic features of myofibroma of the jaws.

STUDY DESIGN

Nineteen cases from the literature and 4 new cases were analyzed.

RESULTS

At initial diagnosis, age ranged from birth to 34 years (mean 7.2 years, median 6 years). Male/female ratio was 2.3:1. Myofibromas were radiolucent solitary lesions located solely in the mandible: 70% unilocular, 30% multilocular; 67% with well-defined borders. Conservative treatment was performed on 75% of the patients; 25% underwent partial jaw resection. Where information was provided, no lesion recurred during 6-month to 17-year follow-up.

CONCLUSION

Although rare, myofibroma of the mandible should be considered in the differential diagnosis of radiolucent lesions (particularly unilocular), especially in children. Treatment of choice is conservative surgery to minimize potential functional and/or esthetic damage.

Fetal neck myofibroma

Magnetic resonance imaging (MRI), as an adjunct to ultrasonography, has become a promising tool in prenatal diagnosis and therapy. In this report, the authors described a case of giant solid mass arising in the fetal neck region diagnosed by prenatal sonographic examination at the gestational age of 33 weeks'. MRI was used to confirm the diagnosis, and to assist fetal airway assessment. Due to the concern of fetal airway compromise, the ex utero intrapartum treatment (EXIT) was strategically planned with help from specialists in the according fields. This allowed the authors to secure the fetal airway before fetomaternal circulation was disconnected. It was performed successfully through Cesarean section at the time of birth. Histopathology revealed infantile myofibroma, which is a rare form of such a tumor arising on the fetal head and neck region diagnosed prenatally.

Solitary intraosseous orbital myofibroma in four cases

PURPOSE

To report four pediatric cases of a bone-destructive orbital tumor that proved to be a benign solitary intraosseous myofibroma.

METHODS

Four children, aged 1, 7, 11, and 72 months, developed eyelid fullness or slight proptosis. A solitary intraosseous mass was detected in the inferior (n = 2), superotemporal (n = 1), and supranasal (n = 1) orbital walls. On CT, the mass showed bone destruction. On MRI, the mass appeared circumscribed within a shell of normal surrounding bone and with features of isointensity on T1-weighted images, intense homogeneous gadolinium enhancement, and midrange signal on T2-weighted images. Complete surgical excision of the mass in each case was performed.

RESULTS

On histopathologic examination, the tumors were characterized by whorls and bands of plump myoid cells with eosinophilic cytoplasm consistent with myofibroblasts, sometimes associated with a hemangiopericytoma-like vascular pattern. The diagnosis was also supported by immunohistochemical studies showing positive immunoreactivity for vimentin and smooth muscle actin. None of the patients have shown recurrence in follow-up ranging from 6 months to 3 years.

CONCLUSIONS

Myofibroma is a benign tumor that can occur in the orbital bony wall of children. It can manifest as a bone destructive mass and can simulate a malignant process.

Intramandibular inflammatory myofibroblastic tumor--a true neoplasm or reactive lesion?

OBJECTIVE

Inflammatory myofibroblastic tumor (IMT) is an uncommon lesion reported to arise in various organs and by convention believed to be a nonneoplastic reactive inflammatory condition. Because of its radiographic and histologic similarities to malignancy, IMT can pose a considerable diagnostic dilemma. The purpose of this study is to report the first intramandibular IMT and to discuss the possible nature of this lesion.

STUDY DESIGN

Detailed documentation of clinical, radiographic, and histologic features; literature review.

RESULTS

This lesion showed distinct radiographic, histologic, and immunohistochemical features. The lesion recurred 14 months after initial removal with almost identical histology.

CONCLUSION

This is the first documented case of an intramandibular IMT. Due to the rarity of these lesions, their clinical sequelae and prognosis are undetermined. As a result of specific immunohistochemical phenotyping and clinical behavior of this lesion, we favored a diagnosis of inflammatory myofibroblastic tumor. Wide excision with a long-term clinical follow-up is required.

Solitary calvarial myofibroma presenting in adolescence

Myofibroma is a benign fibrous tumour that may be found in the soft tissues, skeleton, and internal organs. It is a rare lesion but is the commonest fibrous tumour in infancy. Involvement of the skull has been reported in some 21 cases in the English-language literature. None of these, however, has arisen outside infancy. Here, we report a myofibroma arising from the temporal bone in a 17-year-old girl.

Solitary infantile myofibroma of the orbital bone

Infantile myofibroma of the orbit is an extremely rare condition. Only a few instances of this condition have ever been reported. A 3-year-old boy visited our clinic with lateral lower eyelid swelling and a palpable mass in the left eye, which had apparently persisted for 2 months. A computed tomography scan revealed a well-circumscribed mass in the inferolateral orbital portion of the zygomatic bone, coupled with erosion of bone and orbital extension with reactive hyperostosis. Immunohistochemical stains proved positive for smooth muscle actin, supporting the diagnosis of solitary infantile myofibroma of the orbital bone (zygoma). Although rarely found in the orbit, solitary infantile myofibroma can display more aggressive or malignant neoplasm. Immunohistochemistry is integral to the differential diagnosis and a systemic evaluation for multicentric myofibroma is essential.

Solitary central myofibroma presenting in the gnathic region

Solitary myofibroma of adults is an uncommon neoplasm that typically arises in soft tissue and subcutaneous sites in the head and neck, but rarely within bone. When encountered in the jaws, the lesions exhibit clinical and radiographic features suggestive of an odontogenic tumor or cyst as well as several other neoplastic conditions. Tooth mobility, displacement of teeth, and dramatic jaw expansion may be observed. Analogous to other sites of involvement, gnathic myofibromas are biologically indolent and show little or no recurrence following excision. In rare instances, however, the ability to obtain adequate surgical margins by conservative measures may be limited; thus, issues of local control may supercede the importance of biologic potential. We present the radiologic and histopathologic findings in a case of central myofibroma presenting as a large lytic lesion of the mandible. Myofibroma involving the jaw bones represents a unique diagnostic and therapeutic challenge, and accurate diagnosis and management is predicated on careful correlation of radiographic and pathologic findings.