|Year : 2020 | Volume
| Issue : 3 | Page : 157-159
Odontogenic myxofibroma arising in a patient with a past history of carcinoma
Joshna Rani Premara1, Anusha Vaddi2, Ajay Kumar Enibera3, Haritha Kiranmai Balli4
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 Submission||08-Mar-2020|
|Date of Decision||07-May-2020|
|Date of Acceptance||25-Jun-2020|
|Date of Web Publication||14-Aug-2020|
Joshna Rani Premara
Department of Dentistry, Viswabharathi Medical College, RT Nagar, Near K. Nagalapuram, Kurnool - 518 463, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
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 2020 Sep 23];12:157-9. Available from: http://www.ijds.in/text.asp?2020/12/3/157/292274
| Introduction|| |
Odontogenic myxoma is a locally aggressive benign odontogenic neoplasm with a high recurrence rate., 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.
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). 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.,,
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|| |
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|| |
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., 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. Few authors reported the occurrence of MF in nontooth bearing areas of jaws such as condyle. Pearson et al. reported a case of MF of the cranium in a child previously diagnosed with malignant choroid plexus papilloma.
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. 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. 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.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]