15 Gennaio 2020

A rare histological pattern of odontogenic mandibular fibromyxoma

Clinical case

Massimo Albanese, Luigi Fabrizio Rodella, Dario Bertossi, Luca Parenti, Erminia Manfrin, Francesca Zotti

Objectives  Fibromyxoma is a benign locally aggressive odontogenic tumor with a mesenchymal origin, how­ever its nature is controversial.

The World Health Organization both in 2005 classification and 2017 describes it as odontogenic myxoma; at the same time, some authors classify fibromyxoma as a subtype of odontogenic myxoma comprising only a small percent­age of it.

Due to its rarity, this tu­mor is not well known and, espe­cially, it is not well histologically described.

The only physical ex­amination does not allow per­forming a definitive diagnosis and, frequently, differential diagnoses are carried out in order to shed some light on the nature of neo­plasms.

Anyway, the surgical re­moval of this lesion is always rec­ommended and this condition al­lows carrying out a histological examination. Referral of this case to our attention was surely due to difficulties in differential diagnosis because of complexities in recog­nize, classify and approach this kind of little-known lesion. Histo­logical analysis plays a key role in diagnosis of this kind of lesions; actually it is likely to have several histological forms of this neo­plasm.

The aim of this work is to bring to the attention a rare histo­logical aspect of a surgically treat­ed odontogenic mandibular fibro­myxoma, and to describe histo­logical features in order to provide a more specific typing of lesion.

Materials and methods  A 51 years-old caucasian man was assessed at Section of Oral and Maxillo-facial Surgery of Uni­versity of Verona, three months lat­er of a swelling appearance in the vestibular fornix between lower left canine and premolar. Due to rarity of the disease and lack of clinical knowledge at the moment in this field, patient was referred to our attention after several inconclusive differential diagnoses.

Physical ex­amination showed a hard swelling in the vestibular fornix between left lower canine and first lower pre­molar for three months. An oral surgical intervention was carried out in order to remove the neo­plasm entirely; therefore a histo­logical analysis was performed. Physical and computed tomogra­phy examinations allowed assum­ing a fibromyxoma, histological analysis confirmed the diagnosis.

Results  Histological analysis defined le­sion as a fibrous-myxoid with dis­crete cellularity, without significant atypia, including bone chips. Bland stellate fibroblastic cells embedded in a myxoid-fibrous matrix were highlighted, proving the diagnosis of fibromyxoma.

Conclusions  There is reason to state that fibro­myxoma is a very heterogeneous tumor therefore high accuracy in diagnosis is required, by using both instrumental and histological approaches. The clinical observa­tion alone, both pre-surgery and post-surgery, is not a sufficiently reliable indicator to perform a firm diagnosis of this kind of neoplasm.

The special circumstances of this clinical case seemed to state that confirmed diagnosis and typing are achievable exclusively by his­tological analysis.

Clinical significance  In view of the fact that fibromyxo­ma is a rare form of tumor, not yet well histologically described, the clinical case presented strongly suggests to perform, given the need to always remove the lesion, an histological exam­ination to better characterize the tumor.

Following these advices could be make possible to achieve a firm diagnosis and to increase knowledge in classify­ing several different forms of fi­bromixoma and, maybe, in ap­proaching them.

Per continuare la lettura scaricare l'allegato.

doi: https://doi.org/10.19256/d.cadmos.01.2020.06


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