原文題目

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口腔病理科 On-Line KMU Student Bulletin

原文題目(出處)： Intraoral superficial angiomyxoma of the upper alveolus:

report of a unique case. Case Rep Med 2012, Article ID 859021

原文作者姓名： Ravindra SV, M Srinivasa Raju, Sunitha JD, Neeraj Taneja, Sunira Chandra, Shaveta Mahajan, Eesha Panwar

通訊作者學校： Department of Oral Medicine and Radiology, Teerthanker Mahaveer Institute of Dental Sciences and Research Center, Teerthanker Mahaveer university, Bagarpur, India

報告者姓名(組別)：郭哲豪(Intern F 組)

報告日期： 102/2/4

內文：

Abstract

1. A case report of a rare case of angiomyxoma intraorally in the upper posterior alveolar mucosa

Introduction

1. Frequent local recurrences and lack of metastatic potential

2. Three types: aggressive, superficial (cutaneous myxoma) and

angiomyofibroblastoma

3. Truly intraoral case are really rare with 4 previously reported cases occurring in the buccal mucosa and floor of the mouth

Case report

Present illness:

1. A 30-year-old male with a slow-growing mass over right upper posterior area for 2 years, pain when eating. In the same region about 1.5 year ago a tooth got extracted since mobility, and the swelling continued to grow after extraction.

Medical and dental history:

1. Non-contributory Oral examination:

1. Diffuse, reddish, slightly ulcerated,

2. Rubbery to firm, tender(+), bleeding on palpation 3. No specific finding in radiographs

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Biopsy Findings :

1. Epithelium overlying loose myxoid stroma accompanied by a prominent vasculature (F.2)

2. Myxoid stroma showed a scattered spindle to stellate-shaped cells which had distinct borders and oval nuclei (F.3)

3. No cellular or nuclear atypia or hyperchromasia and mitotic activity an necrosis 4. Small, thin-walled curvilinear bold vessels were prominent throughout the stroma 5. Mild inflammatory infiltrated was present predominantly neutrophils

6. Imunohistochemical staining done by vimentin and CD34 antigens, most of the stromal tumor cells were immunopositve for vimentin and the endothelial cells of the blood vessels displayed immunoreactivity for CD34 (Figures.4 & 5)

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Treatment Outcome:

1. Treatment was not done due to patient unwillingness

DISCUSSION 1. Predilection

A. Rare distinctive, benign, cutaneous soft tissue lesions B. Male predilection, most in middle age

C. Predilection for the trunk, head, and neck, lower extremities, genital area 2. Distinctive hisological features for diagnosis :

A. Multilobular growth pattern composed of spindle to satellite-shaped cells in a copious myxoid stroma

B. Small, thin-walled vessel (mainly)

C. Stromal inflmmatory cells (esp. neutrophils)

3. Differential diagnosis

A. Aggressive angiomyxoma

i. Prominent and large vascular components in myxoid stroma B. Soft tissue myxoma

C. Angimyolipoma

i. Composed of a mixture of thick-walled blood vessels, smooth muscle, and adipose tissue found mostly in the kidney

D. Myxoid nerve sheath tumor(neurothekeoma) i. Smaller individual nodules

ii. Less vascular

iii. Contains occasional eosinophilic histiocytic cells E. Myxoid neurofibroma

i. Cells are typically slender with wavy nuclei and intra-lesional nerve bundles

F. Oral focal mucinosis

i. Acellular with very few blood vessels ii. Lack of a lobular architectural pattern iii. No stromal inflammation

G. Myxofibrma or odontogenic myxoma i. Diffuse an non-lobulated

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ii. No stromal inflammation

iii. May contain odontogenic epithelial rests

4. Treatment is by localized surgical excision, with careful follow up owing to its high rate of local recurrence between 20% and 40%

5. Good prognosis as this lesion stays superficial

題號題目

1 Which range of age for the patients with odontogenic myxomas ? (A) 5~10 years old

(B) 25~30 years old (C) 35~40 years old (D) No age predilection

答案(B) 出處：Oral and maxillofacial pathology third edition P.730

題號題目

2 How to differential diagnosis between angiomyxoma and myxoid neurofibroma?

(A) Myxoid neurofibroma is composed of interlacing bundles of cells that often exhibit spindle- to satellite-shaped nuclei

(B) Angiomyxoma is immunohistochemically positive reaction for S-100 protein

(C) Myxoid neurofibroma is uncommon intraorally (D) None of above

答案(D) 出處：Oral and maxillofacial pathology third edition P.528