Intraosseous myofibroma of mandible: A rarity of jaws: With clinical, radiological, histopathological and immunohistochemical features

Abstract

Myofibroma is an uncommon benign mesenchymal neoplasm composed of myofibroblasts, but it can be confused with more aggressive spindle cell tumors. Solitary myofibroma is common in soft tissues of head and neck, but rare in the jaw bones with only 38 cases of central myofibroma of mandible reported in English medical literature. When encountered in the jaws, lesions exhibit clinical and radiographic features suggestive of odontogenic cysts/tumors or other neoplastic conditions. We hereby present the 39th case of intraosseous myofibroma of the mandible which had been reported to our institution. A 16-year-old male reported with a chief complaint of swelling in the right side of face. Intraorally there was a firm, nontender swelling in the right buccal aspect of the mandible. Radiologically the lesion was osteolytic, destroying the buccal cortical plate. Histologically, characteristic biphasic pattern of myofibroma was noticed. Immunoreactivity was positive for vimentin and αSMA but negative for desmin, thus confirming our diagnosis. The patient was treated by local-wide surgical excision of the lesion. A 3-year follow-up revealed no signs of recurrence. Occurrence of myofibroma involving the jaw bones is common in the younger age groups and represents a unique diagnostic and therapeutic challenge. Differentiating this lesion from other benign and malignant neoplasms is crucial in deciding between a radical and a conservative treatment approach.

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“…Soft tissues in the head and neck region are usually involved and are rarely found in the jaws, with only few cases reported in literature. 5 However, when found in jaws, mandible shows greater predilection as compare to maxilla. 6 In the present case the patient presented with the solitary myofibroma of the maxilla.…”

“…The distinctive characteristic of central myofibroma of the jaws is that it includes the teeth that displays clinical or radiographic picture indicative of odontogenic or nonodontogenic lesions. 5 In this study, a central myofibroma of maxilla in a male child of seven years of age is presented, which is a very rare clinical entity.…”

Solitary Intra-Osseous Myofibroma of the Jaw: A Case Report and Review of Literature

“…Other possible radiographic presentations include bilocular and multilocular radiolucencies, at times showing indistinct margins, perforation of bone or marginal sclerosis [ 2 , 21 ]. Odontogenic tumors, such as unicystic ameloblastoma, odontogenic keratocyst and central odontogenic fibroma are the most probable radiographic differential diagnosis for unilocular IM of the jaw [ 9 , 22 ]. Solid multicystic ameloblastoma, aneurysmal bone cyst and central hemangioma could be considered differential diagnoses for a multilocular IM of the jaw [ 9 , 23 ].…”

“…Myofibroma, both arising in soft tissue and bone shows a characteristic histopathological bi-phasic pattern composed of elongated spindle cells at the periphery and polygonal cells with hyperchromatic nuclei at the center [ 4 , 20 , 24 ]. This microscopic picture has to be differentiated from both benign spindle cell tumors such as leiomyoma, schwannoma, neurofibroma, solitary fibrous tumor, desmoplastic fibroma, inflammatory myofibroblastic tumor, nodular fasciitis, benign fibrous histiocytoma, desmoid tumor, myopericytoma and malignant spindle cell neoplasms such as low grade fibrosarcoma, leiomyosarcoma myofibrosarcoma and rhabdomyosarcoma [ 4 , 7 , 9 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Immunohistochemical markers should be used to differentiate spindle cell tumors with similar histopathologic features to confirm the cell of origin [ 4 , 9 , 20 , 21 , 24 ].…”

“…To the best of our knowledge, 40 cases of solitary myofibroma of the mandible in the pediatric age group have been reported in literature [ 8 , 9 ]. We report a case of solitary intra-osseous myofibroma in the lower jaw of a nine-year-old child and present a review of literature of the same lesion in the jaw bones.…”