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 Table of Contents  
Year : 2020  |  Volume : 12  |  Issue : 3  |  Page : 157-159

Odontogenic myxofibroma arising in a patient with a past history of carcinoma

1 Department of Dentistry, Viswabharathi Medical College, Nellore, Andhra Pradesh, India
2 Section of Oral Radiology, Department of Oral and Maxillofacial Diagnostic Sciences, UConn School of Dental Medicine, UConn Health, Farmington, CT, USA
3 Department of Community Medicine, Viswabharathi Medical College, Nellore, Andhra Pradesh, India
4 Department of Oral Medicine and Radiology, Narayana Dental College, Nellore, Andhra Pradesh, India

Date of Submission08-Mar-2020
Date of Decision07-May-2020
Date of Acceptance25-Jun-2020
Date of Web Publication14-Aug-2020

Correspondence Address:
Joshna Rani Premara
Department of Dentistry, Viswabharathi Medical College, RT Nagar, Near K. Nagalapuram, Kurnool - 518 463, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJDS.IJDS_36_20

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Odontogenic myxofibroma (MF) is a benign odontogenic neoplasm that predominantly occurs in the mandible. It is a variant of odontogenic myxoma. There are several case reports of odontogenic MF reported in the literature. However, none of them were associated with a past history of malignancy. This article presents a case of odontogenic MF in a patient with a past history of treated carcinoma of the breast and rectum.

Keywords: Benign tumor of jaws, myxofibroma of jaws, odontogenic myxofibroma, odontogenic myxoma, odontogenic tumor

How to cite this article:
Premara JR, Vaddi A, Enibera AK, Balli HK. Odontogenic myxofibroma arising in a patient with a past history of carcinoma. Indian J Dent Sci 2020;12:157-9

How to cite this URL:
Premara JR, Vaddi A, Enibera AK, Balli HK. Odontogenic myxofibroma arising in a patient with a past history of carcinoma. Indian J Dent Sci [serial online] 2020 [cited 2023 Feb 8];12:157-9. Available from: http://www.ijds.in/text.asp?2020/12/3/157/292274

  Introduction Top

Odontogenic myxoma is a locally aggressive benign odontogenic neoplasm with a high recurrence rate.[1],[2] The term “myxoma” was initially used by Virchow in 1871. In 1940, Ewing detected that these tumors originate from embryonal mesenchyme. In later years, Stout described myxomas as benign mesenchymal tumors with loose mucoid stroma and undifferentiated stellate cells.[3]

Odontogenic myxofibroma (MF) is a variant of odontogenic myxoma with an abundance of collagen fibers. The World Health Organization describes these tumors as benign odontogenic neoplasms of ectomesenchyme origin, characterized by stellate and spindle cells in an abundant myxoid or mucoid extracellular matrix (ECM).[4] These myxoid or mucoid ECM replaces the cancellous bone and expands the cortex. Smaller tumors are usually asymptomatic and revealed during routine radiography. The majority of cases reported the occurrence of MFs between the second to fourth decades of life. A slight female predilection with the mandibular posterior region being the predominant site was noted.[2],[5],[6]

We present a case of expansile MF in the mandible of a 40-year-old female who was previously diagnosed with cancer of the rectum and breast.

  Case Report Top

A 40S-year-old woman visited the dental department at Viswabharathi medical college with a 2-year history of gradually enlarging swelling on the left side of the lower jaw. The swelling was small and painless at the initial presentation. As swelling progressed, it led to the displacement of teeth and was associated with dull, continuous aching pain that radiated to the same side of the face and neck. In addition, she reported a reduction in mouth opening and difficulty in mastication. Her medical history is remarkable for the past history of hysterectomy, treated Stage III C carcinoma of the rectum (chemotherapy followed by colostomy), and Stage III B carcinoma of the left breast (chemotherapy followed surgical mastectomy).

Extraoral examination showed a massive, firm, tender swelling on the left side of the face [Figure 1]. Swelling caused gross facial asymmetry and a slight elevation of the left pinna. The surface of swelling was apparently normal with no changes in skin color or texture. Intraoral examination revealed a diffuse, firm, tender swelling in the region of lower left premolar and molar extending on to buccal and lingual vestibules causing their obliteration. Mucosa overlying was smooth and erythematous [Figure 2]. Expansion of buccal and lingual cortical plates and crepitus were noted.
Figure 1: Extraoral examination demonstrating a massive swelling and asymmetry of the left side of the face

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Figure 2: Intraoral view demonstrating the swelling in the region of lower left premolar and molar extending on to buccal and lingual vestibules causing their obliteration

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A panoramic radiograph showed a large well-defined lesion with smooth and noncorticated borders located in the left posterior mandible. The lesion extended from the distal aspect of the root of second premolar to the furcation area of the third molar. Internally, the lesion has mixed radiodensity, radiopacity interspersed in radiolucency. There is resorption of roots of mandibular molars. In addition, roots are divergent compared to contralateral side [Figure 3].
Figure 3: Panoramic radiograph demonstrating well-defined radiolucent lesion with mixed radiodensity in the left mandibular molar region. Resorption and divergence of molar roots

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A biopsy of the lesion was performed with the diagnosis of the odontogenic tumor. Microscopy demonstrated predominant osteoid tissue interspersed between sparsely arranged sheets of stellate cells with the long cytoplasmic process in a dense myxoid stroma. Dense myxoid stroma, consistent with myxofibroma.

Surgical excision of the lesion was performed. Histopathology [Figure 4] and [Figure 5] confirmed the diagnosis of odontogenic MF of the mandible.
Figure 4: Histopathology demonstrating predominant myxoid areas showing bland-looking stellate cells with focal bony spicule

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Figure 5: Histopathology specimen demonstrating intervening fibrous elements consistent with benign fibroblast cells

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  Discussion Top

MF is an aggressive, locally infiltrative benign tumor. Smaller lesions are asymptomatic, whereas the large lesions are associated with pain when the lesion invades the surrounding tissue.[2],[7] Other associated signs and symptoms include loosening of teeth due to cortical expansion eventually leading to malocclusion, root resorption, and facial deformity. The involvement of the nerve in the proximity leads to paresthesia.

The majority of centrally originating MF predominantly occurs in jawbones, most commonly in the mandibular premolar and molar region. Maxillary MFs are usually unilateral and may involve antrum.[8] Few authors reported the occurrence of MF in nontooth bearing areas of jaws such as condyle.[9] Pearson et al. reported a case of MF of the cranium in a child previously diagnosed with malignant choroid plexus papilloma.[10]

In the present case, MF occurred in the mandible of the patient treated with chemotherapy for cancer of the breast and colon. Ryu et al. reported a case of synchronous occurrence of myxoma and squamous cell carcinoma in the posterior mandible.[11] Shao et al. reported a case of concurrent occurrence of odontogenic myxoma and multiple keratocystic odontogenic tumors (KOT's) in a patient with nevoid basal cell carcinoma syndrome.[12] In both cases, authors did not find any correlation between the lesions reported.

Clinical and radiographic features of MF's are similar to other odontogenic tumors [Table 1]. MF may be unilocular or multilocular with either distinct or poorly defined margins. The multilocular pattern is the most common presentation in myxomas >4 cm in diameter. Depending on the angulation of septa, the multilocular trabecular pattern is described as a soap bubble, honeycomb, or tennis racquet.
Table 1: Clinical and radiographic differential diagnosis of odontogenic myxofibroma

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Histopathology is essential to establish a definitive diagnosis. There are numerous treatment options for MFs ranging from enucleation to extensive segmental resection. The factors that primarily dictate the choice of treatment include age, location, the extent of the tumor, recurrence rate, and general health status of the patient. Surgical excision or enucleation accompanied with thorough curettage is recommended as the treatment of choice for most MFs. Nevertheless, few clinicians recommend partial or complete segmental resection for locally invasive and recurrent lesions. Evidence suggests the recurrence rate is higher during the initial 3 years of the postoperative period. Careful follow-up during this period is recommended.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Wright JM, Soluk Tekkesin M. Odontogenic tumors: Where are we in 2017? J Istanbul Univer Fac Dent 2017;51 3 Suppl 1:S10-30.  Back to cited text no. 1
Lo Muzio L, Nocini P, Favia G, Procaccini M, Mignogna MD. Odontogenic myxoma of the jaws: a clinical, radiologic, immunohistochemical, and ultrastructural study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:426-33.  Back to cited text no. 2
DeFatta RJ, Verret DJ, Ducic Y, Carrick K. Giant myxomas of the maxillofacial skeleton and skull base. Otolaryngol Head Neck Surg 2006;134:931-5.  Back to cited text no. 3
Kramer IR, Pindborg JJ, Shear M. The WHO Histological typing of odontogenic tumors. A commentary on the second edition. Cancer 1992;70:2988-94.  Back to cited text no. 4
Simon EN, Merkx MA, Vuhahula E, Ngassapa D, Stoelinga PJ. Odontogenic myxoma: A clinicopathological study of 33 cases. Int J Oral Maxillofac Surg 2004;33:333-7.  Back to cited text no. 5
Li TJ, Sun LS, Luo HY. Odontogenic myxoma: A clinicopathologic study of 25 cases. Arch Pathol Lab Med 2006;130:1799-806.  Back to cited text no. 6
Meleti M, Giovannacci I, Corradi D, Manfredi M, Merigo E, Bonanini M, et al. Odontogenic myxofibroma: A concise review of the literature with emphasis on the surgical approach. Med Oral Patol Oral Cir Bucal 2015;20:e1-6.  Back to cited text no. 7
Kheir E, Stephen L, Nortje C, van Rensburg LJ, Titinchi F. The imaging characteristics of odontogenic myxoma and a comparison of three different imaging modalities. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:492-502.  Back to cited text no. 8
Farman AG, Nortjé CJ, Grotepass FW, Farman FJ, Van Zyl JA. Myxofibroma of the jaws. Br J Oral Surg 1977;15:3-18.  Back to cited text no. 9
Pearson AD, Craft AW, Perry RH, Kalbag RM, Evans RG. Four primary tumors in one child. Cancer 1983;52:2363-8.  Back to cited text no. 10
Ryu DM, Kwon YD, Lee BS, Kim YG. Concomitant occurrence of squamous cell carcinoma and myxoma of the mandible: A case report. J Oral Maxillofac Surg 2000;58:425-30.  Back to cited text no. 11
Shao Z, Liu B, Zhang W, Chen X. Synchronous occurrence of odontogenic myxoma with multiple keratocystic odontogenic tumors in nevoid basal cell carcinoma syndrome. J Craniofac Surg 2013;24:1840-2.  Back to cited text no. 12


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

  [Table 1]


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