Intraosseous myofibroma of mandible: A rarity of jaws: With clinical, radiological, histopathological and immunohistochemical features
A 16-year-old male patient reported with a chief complaint of swelling on the right side of the face for the past 2 months []. The swelling was initially noticed as a small lump which gradually increased to the present size. Medical and family histories were noncontributory. Examination revealed swelling in the right side of the face about 1.5 × 2 cm in size in the region of angle of mandible. There was no draining sinus and the skin over the swelling was clinically normal.\nIntraorally the swelling was present in the buccal aspect of right mandibular second molar measuring about 1.5 cm × 1 cm in dimension. Mucosa over the swelling was clinically normal. Buccal cortical bone expansion was seen along with obliteration of buccal sulcus. On palpation the swelling was firm, nontender and extended superiorly to involve the anterior border of ramus of the mandible.\nCT scan revealed an osteolytic lesion about 2.5 cm × 2 cm in dimension, extending from the distal aspect of 47 to the ramus of the mandible. Destruction of buccal cortical plate was evident. The clinical and radiologic findings were suggestive of odontogenic tumor [Figures –].\nSubsequently, an incisional biopsy was performed under local anesthesia and the specimen was sent for histopathologic examination. Microscopic evaluation of the sections revealed interlacing fascicles of spindle-shaped cells arranged in a biphasic pattern set in a collagenous stroma. Spindle cells were seen with oval, round and tapering nuclei with pale eosinophilic cytoplasm. These cells were seen alternating with closely packed cells with small rounded nuclei and eosinophilic cytoplasm []. Vascular spaces mimicking the hemangiopericytoma pattern were also observed []. Cellular atypia was not noted. Based on these findings we arrived at a diagnosis of myofibroma.\nImmunohistochemical staining was carried out for vimentin, S100, αSMA, CD68, and desmin. Positive immunoreactivity was observed for vimentin and αSMA [Figures and ] and negative immunoreactivity for S100, desmin, and CD68, thus confirming the myofibroblastic nature of the tumor. Further medical and radiographical examination confirmed the solitary nature of the lesion, thus excluding myofibromatosis. Hence local-wide excision of the lesion was performed under general anesthesia. Histopathologic findings of the postsurgical specimen also confirmed the diagnosis of myofibroma.\nCurrently the patient is on third-year follow-up without any evidence of tumor recurrence.