S28 Journal of the College of Physicians and Surgeons Pakistan 2017, Vol. 27 (Special Supplement 1 of Case Reports): S28-S29 INTRODUCTION Odontogenic myxoma (OM) is a benign odontogenic tumor of mesenchymal origin believed to originate from the dental papilla. It was first described by Rudolf Virchow as myxofibroma in 1863. 1 However, Thoma and Goldman renamed it as OM in 1947. 2 Peripheral odontogenic myxoma (POM) is considered as an extra-osseous counterpart of OM. 3 POM is very rare compared to OM. Moreover, it is a less aggressive tumor compared to its central counterpart. 4 Less than 10 cases of POM have been reported in the English literature. 3-5 Furthermore, no clinical data of POM has been described in standard oral pathology books. 6 POM usually presents as an asymptomatic, exophytic gingival mass without bony involvement. 3 CASE REPORT An otherwise healthy, 27-year lady presented to the Department of Oral Medicine and Radiology with the chief complaint of gum swelling on her upper left front region of the jaw since 3 months. Past medical history and family history was non-relevant to the presenting symptom. Intra-oral examination revealed a localised, reddish swelling extending from the gingiva of maxillary left central incisor to maxillary left canine measuring about 2x1 cm. The swelling exhibited two different areas of color variation; one area showed reddish color and other area showed a normal color of mucosa (Figure 1a). On palpation, it was found to be soft to firm in consistency. Panoramic radiograph revealed no bony changes (Figure 1b). Based on the clinical and radiological features, a provisional diagnosis of pyogenic granuloma was given. A surgical excision was performed under local anesthesia and tissue was sent to the Department of Oral and Maxillofacial Pathology, for microscopic evaluation. Microscopic examination of tissue sections revealed numerous stellate shaped fibroblasts in a mucoid rich stroma with inactive rests of odontogenic epithelium. (Figure 2a and 2b). The collagenous stroma was sparse and showed few dilated blood vessels lined by endothelial cells. On the basis of microscopical features a final diagnosis of Extra-osseous/ Peripheral odontogenic myxoma rendered. DISCUSSION POM is a rare and less aggressive, soft tissue counterpart of OM, believed to originate from the embryonic connective tissue associated with the tooth bearing apparatus. 4 The frequency of POM is significantly lower as compared to other peripheral odontogenic tumors. 5 Because of the rare occurrence of POM, standard textbooks of oral and maxillofacial pathology are devoid of its clinical and histological data. 6 This paucity of the literature regarding this unusual neoplasm, prompted us to report this case. POM is considered less aggressive compared to its central counterpart. 2 The present case also showed no recurrence for one year after a surgical removal. Clinically, it presents as an asymptomatic gingival mass, similar to the present case where the lesion was painless. Fibroma, irritational fibroma neurofibroma, peripheral giant cell granuloma, pyogenic granuloma and other peripheral odontogenic tumors can be considered as clinical differential diagnoses of POM. 7 In the present case, the lesion was provisionally diagnosed as pyogenic granuloma. Microscopic examination is mandatory to reach definitive diagnosis. Histologically, this neoplasm is composed of haphazardly arranged spindle, stellate shaped cells in a mucoid stroma with or without islands of odontogenic epithelium. 4,5 The present case also CASE REPORT Extra-Osseous Odontogenic Myxoma of Maxillary Gingiva Manas Bajpai and Nilesh Pardhe ABSTRACT Odontogenic myxomas are rare odontogenic tumors of jaw characterised by accumulation of mucoid ground substance with little collagen. Peripheral odontogenic myxoma (POM) is extra-osseous variant of odontogenic myxomas, occurring solely in the soft tissue covering the tooth bearing portion of jaws. POM is exceedingly rare, less than 10 cases have been published till date. A case of POM is reported here in a 27-year female which was provisionally diagnosed as pyogenic granuloma. Key Words: Extra-osseous odontogenic myxoma. Peripheral odontogenic myxoma. Soft tissue myxoma. Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, India. Correspondence: Dr. Manas Bajpai, Assistant Professor, Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, India. E-mail: [email protected] Received: July 23, 2016; Accepted: November 17, 2016.
Extra-Osseous Odontogenic Myxoma of Maxillary Gingiva
Dec 26, 2022
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
S28 Journal of the College of Physicians and Surgeons Pakistan 2017, Vol. 27 (Special Supplement 1 of Case Reports): S28-S29
INTRODUCTION Odontogenic myxoma (OM) is a benign odontogenic tumor of mesenchymal origin believed to originate from the dental papilla. It was first described by Rudolf Virchow as myxofibroma in 1863.1 However, Thoma and Goldman renamed it as OM in 1947.2
Peripheral odontogenic myxoma (POM) is considered as an extra-osseous counterpart of OM.3 POM is very rare compared to OM. Moreover, it is a less aggressive tumor compared to its central counterpart.4 Less than 10 cases of POM have been reported in the English literature.3-5 Furthermore, no clinical data of POM has been described in standard oral pathology books.6 POM usually presents as an asymptomatic, exophytic gingival mass without bony involvement.3
CASE REPORT An otherwise healthy, 27-year lady presented to the Department of Oral Medicine and Radiology with the chief complaint of gum swelling on her upper left front region of the jaw since 3 months. Past medical history and family history was non-relevant to the presenting symptom. Intra-oral examination revealed a localised, reddish swelling extending from the gingiva of maxillary left central incisor to maxillary left canine measuring about 2x1 cm. The swelling exhibited two different areas of color variation; one area showed reddish color and other area showed a normal color of mucosa (Figure 1a). On palpation, it was found to be soft to firm in consistency. Panoramic radiograph revealed no bony changes (Figure 1b). Based on the clinical and radiological features, a provisional diagnosis of pyogenic
granuloma was given. A surgical excision was performed under local anesthesia and tissue was sent to the Department of Oral and Maxillofacial Pathology, for microscopic evaluation.
Microscopic examination of tissue sections revealed numerous stellate shaped fibroblasts in a mucoid rich stroma with inactive rests of odontogenic epithelium. (Figure 2a and 2b). The collagenous stroma was sparse and showed few dilated blood vessels lined by endothelial cells. On the basis of microscopical features a final diagnosis of Extra-osseous/ Peripheral odontogenic myxoma rendered.
DISCUSSION POM is a rare and less aggressive, soft tissue counterpart of OM, believed to originate from the embryonic connective tissue associated with the tooth bearing apparatus.4 The frequency of POM is significantly lower as compared to other peripheral odontogenic tumors.5 Because of the rare occurrence of POM, standard textbooks of oral and maxillofacial pathology are devoid of its clinical and histological data.6
This paucity of the literature regarding this unusual neoplasm, prompted us to report this case. POM is considered less aggressive compared to its central counterpart.2 The present case also showed no recurrence for one year after a surgical removal. Clinically, it presents as an asymptomatic gingival mass, similar to the present case where the lesion was painless. Fibroma, irritational fibroma neurofibroma, peripheral giant cell granuloma, pyogenic granuloma and other peripheral odontogenic tumors can be considered as clinical differential diagnoses of POM.7 In the present case, the lesion was provisionally diagnosed as pyogenic granuloma. Microscopic examination is mandatory to reach definitive diagnosis. Histologically, this neoplasm is composed of haphazardly arranged spindle, stellate shaped cells in a mucoid stroma with or without islands of odontogenic epithelium.4,5 The present case also
CASE REPORT
Extra-Osseous Odontogenic Myxoma of Maxillary Gingiva Manas Bajpai and Nilesh Pardhe
ABSTRACT Odontogenic myxomas are rare odontogenic tumors of jaw characterised by accumulation of mucoid ground substance with little collagen. Peripheral odontogenic myxoma (POM) is extra-osseous variant of odontogenic myxomas, occurring solely in the soft tissue covering the tooth bearing portion of jaws. POM is exceedingly rare, less than 10 cases have been published till date. A case of POM is reported here in a 27-year female which was provisionally diagnosed as pyogenic granuloma.
Key Words: Extra-osseous odontogenic myxoma. Peripheral odontogenic myxoma. Soft tissue myxoma.
Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, India.
Correspondence: Dr. Manas Bajpai, Assistant Professor, Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, India. E-mail: [email protected]
Received: July 23, 2016; Accepted: November 17, 2016.
Extra - osseous odontogenic myxoma of maxillary gingiva
showed similar morphology with inactive islands of odontogenic epithelium. Histologically, it may simulate neoplasms with areas of myxoid degeneration (myxoid area in pleomorphic adenoma, peripheral nerve sheath myxoma, myxoid changes in fibrosarcoma, myxolipoma, chondromyxoid fibroma etc.).3-5 Surgical excision is the treatment of choice and no recurrence has been reported.
REFERENCES 1. Sapp JP, Eversole LR, Wysocki GP. Contemporary oral and
maxillofacial pathology. 2nd ed. St. Louis, MO: Mosby; 2002; p.152-3.
2. Thoma KH, Goldman HM. Central myxoma of the jaws. Am J Orthop 1947; 33:532-40.
3. Ramaraj PN, Sah SP. Myxoma of oral soft tissue. J Nepal Med Assoc 2001; 40:274-6.
4. Jose M, Basheer S, Balan A, Shameena PM. Peripheral odontogenicmyxoma presenting as a gingival mass - a unique presentation with calcification. Oral Surgery 2014; 7:56-60.
5. Raubenheimer EJ, Noffke CE. Peripheral odontogenicmyxoma: A review of the literature and report of two cases. J Maxillofac Oral Surg 2012; 11:101-4.
6. Shafer, Hine, Levy. Shafer's textbook of oral pathology. 4th ed. Japan: W.B. Saunders Co; 1983.
7. Bajpai M, Pardhe N. A simplified working classification for the soft tissue swellings of oral cavity. Cukurova Med J 2016; 41: 198-9.
Figure 1: (a) Clinical picture of the lesion. (b) Panoramic radiograph shows no bony changes associated with the lesion.
Figure 2: (a) Stellate shaped cells arranged in a mucoidstroma (Hematoxylin and Eosin stain X10). (b) High power view shows haphazardly arranged stellate spindle shaped cell in a myxoidstroma with inactive islands of odontogenic epithelium).
INTRODUCTION Odontogenic myxoma (OM) is a benign odontogenic tumor of mesenchymal origin believed to originate from the dental papilla. It was first described by Rudolf Virchow as myxofibroma in 1863.1 However, Thoma and Goldman renamed it as OM in 1947.2
Peripheral odontogenic myxoma (POM) is considered as an extra-osseous counterpart of OM.3 POM is very rare compared to OM. Moreover, it is a less aggressive tumor compared to its central counterpart.4 Less than 10 cases of POM have been reported in the English literature.3-5 Furthermore, no clinical data of POM has been described in standard oral pathology books.6 POM usually presents as an asymptomatic, exophytic gingival mass without bony involvement.3
CASE REPORT An otherwise healthy, 27-year lady presented to the Department of Oral Medicine and Radiology with the chief complaint of gum swelling on her upper left front region of the jaw since 3 months. Past medical history and family history was non-relevant to the presenting symptom. Intra-oral examination revealed a localised, reddish swelling extending from the gingiva of maxillary left central incisor to maxillary left canine measuring about 2x1 cm. The swelling exhibited two different areas of color variation; one area showed reddish color and other area showed a normal color of mucosa (Figure 1a). On palpation, it was found to be soft to firm in consistency. Panoramic radiograph revealed no bony changes (Figure 1b). Based on the clinical and radiological features, a provisional diagnosis of pyogenic
granuloma was given. A surgical excision was performed under local anesthesia and tissue was sent to the Department of Oral and Maxillofacial Pathology, for microscopic evaluation.
Microscopic examination of tissue sections revealed numerous stellate shaped fibroblasts in a mucoid rich stroma with inactive rests of odontogenic epithelium. (Figure 2a and 2b). The collagenous stroma was sparse and showed few dilated blood vessels lined by endothelial cells. On the basis of microscopical features a final diagnosis of Extra-osseous/ Peripheral odontogenic myxoma rendered.
DISCUSSION POM is a rare and less aggressive, soft tissue counterpart of OM, believed to originate from the embryonic connective tissue associated with the tooth bearing apparatus.4 The frequency of POM is significantly lower as compared to other peripheral odontogenic tumors.5 Because of the rare occurrence of POM, standard textbooks of oral and maxillofacial pathology are devoid of its clinical and histological data.6
This paucity of the literature regarding this unusual neoplasm, prompted us to report this case. POM is considered less aggressive compared to its central counterpart.2 The present case also showed no recurrence for one year after a surgical removal. Clinically, it presents as an asymptomatic gingival mass, similar to the present case where the lesion was painless. Fibroma, irritational fibroma neurofibroma, peripheral giant cell granuloma, pyogenic granuloma and other peripheral odontogenic tumors can be considered as clinical differential diagnoses of POM.7 In the present case, the lesion was provisionally diagnosed as pyogenic granuloma. Microscopic examination is mandatory to reach definitive diagnosis. Histologically, this neoplasm is composed of haphazardly arranged spindle, stellate shaped cells in a mucoid stroma with or without islands of odontogenic epithelium.4,5 The present case also
CASE REPORT
Extra-Osseous Odontogenic Myxoma of Maxillary Gingiva Manas Bajpai and Nilesh Pardhe
ABSTRACT Odontogenic myxomas are rare odontogenic tumors of jaw characterised by accumulation of mucoid ground substance with little collagen. Peripheral odontogenic myxoma (POM) is extra-osseous variant of odontogenic myxomas, occurring solely in the soft tissue covering the tooth bearing portion of jaws. POM is exceedingly rare, less than 10 cases have been published till date. A case of POM is reported here in a 27-year female which was provisionally diagnosed as pyogenic granuloma.
Key Words: Extra-osseous odontogenic myxoma. Peripheral odontogenic myxoma. Soft tissue myxoma.
Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, India.
Correspondence: Dr. Manas Bajpai, Assistant Professor, Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, India. E-mail: [email protected]
Received: July 23, 2016; Accepted: November 17, 2016.
Extra - osseous odontogenic myxoma of maxillary gingiva
showed similar morphology with inactive islands of odontogenic epithelium. Histologically, it may simulate neoplasms with areas of myxoid degeneration (myxoid area in pleomorphic adenoma, peripheral nerve sheath myxoma, myxoid changes in fibrosarcoma, myxolipoma, chondromyxoid fibroma etc.).3-5 Surgical excision is the treatment of choice and no recurrence has been reported.
REFERENCES 1. Sapp JP, Eversole LR, Wysocki GP. Contemporary oral and
maxillofacial pathology. 2nd ed. St. Louis, MO: Mosby; 2002; p.152-3.
2. Thoma KH, Goldman HM. Central myxoma of the jaws. Am J Orthop 1947; 33:532-40.
3. Ramaraj PN, Sah SP. Myxoma of oral soft tissue. J Nepal Med Assoc 2001; 40:274-6.
4. Jose M, Basheer S, Balan A, Shameena PM. Peripheral odontogenicmyxoma presenting as a gingival mass - a unique presentation with calcification. Oral Surgery 2014; 7:56-60.
5. Raubenheimer EJ, Noffke CE. Peripheral odontogenicmyxoma: A review of the literature and report of two cases. J Maxillofac Oral Surg 2012; 11:101-4.
6. Shafer, Hine, Levy. Shafer's textbook of oral pathology. 4th ed. Japan: W.B. Saunders Co; 1983.
7. Bajpai M, Pardhe N. A simplified working classification for the soft tissue swellings of oral cavity. Cukurova Med J 2016; 41: 198-9.
Figure 1: (a) Clinical picture of the lesion. (b) Panoramic radiograph shows no bony changes associated with the lesion.
Figure 2: (a) Stellate shaped cells arranged in a mucoidstroma (Hematoxylin and Eosin stain X10). (b) High power view shows haphazardly arranged stellate spindle shaped cell in a myxoidstroma with inactive islands of odontogenic epithelium).
Related Documents
