British Journal of Oral and Maxillofacial Surgery 46 (2008) e1–e2 Available online at www.sciencedirect.com
Short communication
Benign fibrous histiocytoma in the condylar process of the mandible: Case report
Wataru Katagiri
a,∗, Mitsuhiro Nakazawa
a, Mitsunobu Kishino
baDepartment of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
bDepartment of Oral Pathology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
Accepted 19 March 2007 Available online 11 June 2007
Abstract
A 48-year-old man was referred for investigation of an asymptomatic radiolucent lesion in the mandible. The margin was partly irregular, and there was no peripheral sclerosis. The tumour was composed of histiocytic cells, spindle cells, and fibrous tissue. Immunohistochemical analysis showed that the tumour cells stained for CD68 and vimentin, and not for cytokeratin, smooth muscle actin, S-100 protein, or CD34.
The tumour was therefore diagnosed as a benign fibrous histiocytoma.
© 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Benign fibrous histiocytoma (BFH); Bone; Mandible; Condylar process
Benign fibrous histiocytoma is a mesenchymal tumour that occurs predominantly on the skin of extremities,1as well as in bone including femur, tibia, and ilium.2,3However, it is rare in the jaw.4–8We report a patient with one in the condylar process of the mandible.
Case report
A 48-year-old man had a radiograph before a tooth extrac- tion, and a unilocular radiolucent lesion with a partly irregular margin at the right condylar process was found (Fig. 1A). No symptoms had been noted before. A computed tomogram (CT) showed expansion of the condylar process and thinning of the cortical bone (Fig. 1B). However, the fluorodeoxy- glucose positron tomograph (FDG-PET) showed no specific uptake in the body.
He was operated on under general anaesthesia, and the cortical bone of condylar process was found to be perfora-
∗Corresponding author at: Department of Oral and Maxillofacial Surgery II, Osaka University, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
Fax: +81 6 6876 5020.
E-mail address:w-kat@med.nagoya-u.ac.jp(W. Katagiri).
ted; the tumour was excised after removal of the cortical bone.
The tumour was a single solid mass 14 mm× 11 mm × 8 mm with no fibrous capsule. Histological examination of frozen sections showed proliferating histiocytic cells with no mali- gnant findings. Additional curettage of the irregular bone showed that the tumour was composed of foamy histiocy- tic cells, spindle cells, and fibrous tissue with hyalinisation (Fig. 2). Immunohistochemical staining showed that the tumour cells stained for CD68 (Fig. 3) and vimentin, but not for cytokeratin, smooth muscle actin, S-100 protein, and CD34.
Discussion
Benign fibrous histiocytoma in the jawbone is uncommon and one has been recorded in the maxilla and four in the mandible, to our knowledge.4–8Buccal swelling was the prominent sign in the mandible and a multilocular or soap-bubble-like radio- lucent lesion involving the ramus.5–8 In contrast, our case had no symptoms and the tumour was identified incidentally from radiographs. However, as the lesion had an irregular margin, it was thought to be a metastatic or primary mali-
0266-4356/$ – see front matter © 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2007.03.020
e2 W. Katagiri et al. / British Journal of Oral and Maxillofacial Surgery 46 (2008) e1–e2
Fig. 1. (A) Panoramic radiograph showing a unilocular radiolucent lesion in the right mandibular condyle. (B) Computed tomogram showing bucco- lingual expansion of the thinning cortical bone.
gnant lesion, and the finding of the FDG-PET and the frozen section diagnosis excluded malignancy.
Non-ossifying fibroma is an important tumour to be differentiated from ours, because it is indistinguishable histologically.4In our case, proliferation of histiocytic cells, shown both histologically and immunohistochemically, was
Fig. 2. Histological findings showing proliferated foamy histiocytic cells and fibrous tissue (haematoxylin and eosin, bar: 100m).
Fig. 3. Immunohistochemical analysis showing the tumour cells stained for CD68 (bar: 200m).
a predominant feature in differentiating the tumour from a non-ossifying fibroma. Radiographic examination showed no well-defined margin of the tumour, so we reached our diag- nosis even though we did not see a typical striform pattern with spindle cells.
As no fibrous encapsulation was generated, complete removal of the tumour was essential to prevent recurrence.9 No recurrence has been found after a year, but a long-term follow-up is essential.
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