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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
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Year : 2011  |  Volume : 15  |  Issue : 3  |  Page : 361-362
 

Oral leiomyoma


1 Department of Oral Pathology, Gian Sagar Dental College and Hospital, Banur, Punjab, India
2 Department of Pathology, GB Pant Hospital, New Delhi, India

Date of Web Publication25-Oct-2011

Correspondence Address:
Gurkiran Kaur
Department of Oral Pathology, Gian Sagar Dental College and Hospital, Banur, District Rajpura, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-029X.86727

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   Abstract 

Oral leiomyoma is a benign smooth muscle tumor with a low incidence. Oral leiomyomas present as slow growing, asymptomatic sub mucosal masses, usually in the tongue, hard palate or buccal mucosa. They may be seen at any age and are usually discovered when they are 1 to 2 cm in diameter. The diagnosis is mainly determined by histological studies and special stains that confirm the smooth muscle origin. Surgical excision appears to be the best line of treatment and recurrence is unexpected. The purpose of this article is to present a case of a 32-year old male with a 1 month history of a leiomyoma on his right submandibular region.


Keywords: Leiomyoma, oral cavity, spindle cell tumor


How to cite this article:
Kaur G, Gondal R. Oral leiomyoma. J Oral Maxillofac Pathol 2011;15:361-2

How to cite this URL:
Kaur G, Gondal R. Oral leiomyoma. J Oral Maxillofac Pathol [serial online] 2011 [cited 2019 Sep 22];15:361-2. Available from: http://www.jomfp.in/text.asp?2011/15/3/361/86727



   Introduction Top


Leiomyomas are benign smooth muscle tumors that are relatively common, especially in the uterus (about 95%). In the oral cavity these neoplasms are rarely encountered (around 0.42%). [1] Oral leiomyomas present as slow-growing, asymptomatic submucosal masses, usually in the tongue, hard palate or buccal mucosa. Other less frequent locations are the floor of the mouth and the gingiva. Due to its unspecific clinical presentation, the diagnosis is made after a histological study. [2] Special stains help to differentiate from other spindle cell tumors. Immunohistochemical stains confirm the smooth muscle origin. [3] Surgery is the most successful line of treatment and the only one used presently. [4]


   Case Report Top


A 32-year-old male patient, with an unremarkable medical or habit history, came with an asymptomatic round firm swelling, normal in color and freely movable over the right submandibular region for the last 1 month. Radiographic examination did not show any changes in the associated bone. The mass was excised under local anesthesia as a single firm 1.5 × 2 cm soft tissue mass. Macroscopically the tumor was grayish white, firm, and appeared encapsulated.

The histological report showed a well-circumscribed tumor constituting of spindle shaped cells [Figure 1]. These cells had elongated, blunt-ended nuclei. The fascicles of tumor cells were arranged in whorls and intersecting each other. No mitotic figures were found. The immunohistochemical study revealed the expression of vimentin [Figure 2] and smooth muscle actin (SMA) [Figure 3] within the tumor cells, whereas expression of cytokeratin was negative. With all these findings a diagnosis of oral leiomyoma was made. No signs of any recurrence were observed six months after the excision of the lesion.
Figure 1: Bundles of spindle-shaped cells with oval nuclei intersecting each other (H and E, ×200)

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Figure 2: Tumor cells with positivity for vimentin (IHC, ×400)

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Figure 3: Lesional tissue showing diffuse positivity for smooth muscle actin (SMA) (IHC, ×400)

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   Discussion Top


Leiomyoma is a benign tumor of smooth muscle. The source of smooth muscle in the oral cavity is either the arterial tunica media as suggested by Stout, [5] or the ductus lingualis and the circumvallate papillae as proposed by Glass [6] or heterotopic embryonal tissue. [7]

Oral leiomyoma is more frequent in men than in women, with a 1.43:1 ratio. [8] Peak age incidence reported is 40-49 years old. [4] The majority of the cases reported indicated an asymptomatic slow-growing mass, firm to touch and the color of the lesions depended on their depth and on their vascularity. Lucas [9] published a case of a gingival leiomyoma, which appeared as purple swelling. Most of the lesions are asymptomatic masses but some authors have reported symptomatic lesions, most frequently having difficulty in chewing or swallowing, and loose teeth, induced due to local growth. [10]

Oral leiomyomas are not very big tumors, with an average size between 1 and 2 cm, and with a history of less than a year. [11] Our case was of 1.5 × 2 cm and had a history of one month; this corroborates with the published literature. Several oral tumors should be included in the differential diagnosis, benign lesions such as fibroma, neurofibroma, or malignant ones such as leiomyosarcoma. The definitive diagnosis in leiomyoma is the histological one. Leiomyosarcoma should be taken into account based on a combination of mitotic index (at least two mitotic figures per 10 high power fields is likely malignant), degree of nuclear atypia and zonal necrosis. [12],[13] The World Health Organization (WHO) [2] distinguishes three types of leiomyomas: Leiomyoma (solid), angiomyoma (vascular leiomyoma), and epitheloid leiomyoma (leioblastoma). Special stains such as Mason's trichrome, Van Geison's stain or Mallory's phosphotungstic acid (PTAH) are specific for muscle cells and collagen fibers. Immunohistochemical studies to make the differential diagnosis with other spindle cell tumors can be useful. Wide surgical resection is the only reported treatment in the literature with successful results. Recurrence rate is very low if complete resection is achieved. [4]

 
   References Top

1.Bhattacharyya I, Don-John S, Cohen DM, Ellis GL, Bavitz JB, Gillhan LL. Granular cell leiomyoma of the oral cavity. J Oral Maxillofac Pathol 2006;102:353-9.  Back to cited text no. 1
    
2.Weiss SW, Goldblum JR. Enzinger and Weiss's Soft tissue tumors. 4 th ed. St Louis: Mosby-Year book; 2002. p. 625.  Back to cited text no. 2
    
3.Regezi JA, Sciubba JJ. Oral Pathology: Clinical Pathologic Correlations. 4 th ed. St Louis: Saunders; 2003. p. 178-9.  Back to cited text no. 3
    
4.Wertheimer-Hatch L, Hatch GF 3 rd , HatchB S KF, Davis GB, Blanchard DK, Foster RS Jr, et al. Tumors of the oral cavity and pharynx. World J Surg 2000;24:395-400.  Back to cited text no. 4
    
5.Stout AP. Solitary cutaneous and subcutaneous leiomyoma. Am J Cancer 1937;29:435.  Back to cited text no. 5
    
6.3 rd E. Contributions to the pathology of zungengrudtumoren. Glass wine Wochenshr Klin 1905;18:747.  Back to cited text no. 6
    
7.Loyola AM, Araujo NS, Zanetta-Barbosa D, Mandes VC, Jordao-Silva C, Bittar TO. Intraosseous leiomyoma of the mandible. J Oral Maxillofac Pathol 1999;87:78-82.  Back to cited text no. 7
    
8.Brooks JK, Nikitakis NG, Goodman NJ, Levy BA. Clinicopathologic characterization of oral angioleiomyomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:221-7.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Lucas R. Pathology of tumors of Oral tissues. 1 st ed. London: Churchill Livingstone; 1964. p. 170.  Back to cited text no. 9
    
10.Cherrick HM, Dunlap CL, King OH Jr. Leiomyomas of the oral cavity. Review of the literature and clinicopathologic study of seven new cases. Oral Surg Oral Med Oral Pathol 1973;35:54-66.  Back to cited text no. 10
[PUBMED]    
11.Epivatianos A, Trigonidis G, Papanayotou P. Vascular leiomyoma of the oral cavity. J Oral Maxillofac Surg 1985;43:377-82.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  
12.Kumar V, Cotran RI. Robbins Basic Pathology. 7 th ed. Philadelphia: Elsevier; 2004. p. 1090.  Back to cited text no. 12
    
13.Gorlin RJ, Goldman HM. Thoma's Oral pathology. St Louis, Mosby; 1970. p. 890.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

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