- Email: [email protected]
Leiomyoma of the cheek. Case report
Leiomyoma of the cheek Case report.
M. Gerc, eker 1, R. Y(icel Anadolu 1, O. Bulay 2 University of Ankara, Faculty of Medicine, lENT Department, and 2Pathology Department, Ankara, Turkey
M. Gerfeke~ R. E Anadolu, O. Bulay: Leiomyoma of the cheek. Case report. Int. J. Oral Maxillofac. Surg 1993." 22: 42-43. © Munksgaard 1993 Abstract. A case of a leiomyoma in the cheek of a 60-year-old woman is reported, and the literature is briefly reviewed.
Leiomyoma is a benign tumor originating from smooth muscles; it is mostly found in the uterus (95%) and less frequently in the gastrointestinal tract and subcutaneous tissue ]'5'6,7. it occurs quite rarely in the oral cavity2'5,6,7. Oral leiomyoma was first reported by BLANC in 1884, and since that time, only 115 leiomyomas of the oral cavity have been reported (Table 1)a's'6'7. This paper presents an additional case and briefly reviews the literature.
Case report A 60-year-old white woman was referred to the Ear, Nose, and Throat Department of the University o f Ankara, Medical School, with the chief complaint of a swelling in the right cheek. The tumor had increased in size during the last 6 months. The tumor, measuring approximately 3 cm in diameter, was firm at palpation, seemed to be well defined, and was covered with normal oral mucosa (Fig. 1). Further physical examination revealed no abnormalities. The tumor seemed to be well encapsulated, implying enucleation; therefore, an excisional biopsy under general anesthesia was contemplated. The patient
has been followed up for 1 year, and, as yet, no recurrence has been seen. The tumor consisted of a round, welldefined mass, with a smooth and shiny surface. In the cut section the mass was rubbery, firm, and whitish-gray in color. Microscopically, there were smooth muscle cells with spindle-shaped, elongated nuclei with blunt edges. These cells were embedded in a hyalinized and edematous matrix, making large bundles and whorls (Fig. 2). Monoclonal antidesmin and antivimentin (Biogenex, from mouse) antibodies were applied by the Avidin-Biotin peroxydase complex method. The immunohistochemical study revealed positive brown staining with antidesmin and negative staining with antivimentin antibodies. The microscopic findings and the immunohistochemical examination are
Table 1. Distribution of oral leiomyomas Site
Number of cases
Tongue Lips Hard and/or soft palate Cheek Gingiva Buccal sulcus Floor of the mouth Major salivary glands Maxillary alveolar bone Mandible Total * The present case is included.
25 24 24 18" 8 7 3 2 2 3 116
Fig. 1. Preoperative view of tumor.
Key words: leiomyoma. Accepted for publication 20 October 1992
consistent with the diagnosis of leiomyoma.
Discussion The main source of smooth muscle in the oral cavity is the tunica media of the blood vessels4'6. The most common oral sites are the base of the tongue, lips, and cheeks s. The base of the tongue is most commonly involved with most tumors found to be sessile masses 5. Cheek tumors are mainly of the vascular type 5. In the cheek, only 18 cases have been reported, including the present case 7. Aberrant erector pilorum muscles have been suggested as a possible source of leiomyomas arising in the cheek 2. Heterotopic embryonic tissue has also been suggested 7. NATIELLA et al, reported a case which developed as a re-
Leiomyoma o f the cheek
43
antibody is essential to confirm the di: agnosis. , T h e - t r e a t m e n t o f ' c h o i c e is surgical excision 3,7. References
Fig. 2. Low-power view of leiomyoma. Smooth muscle cells form bundles in edematous matrix ( x 100).
suit of trauma because o f an orthOdontic appliance 5. In the present case, the patient was wearing an ill=fitting denture. Leiomyomas are seen in infancy~:as well as in advanced ageS,. There, is no predilection for males .or females. Oral leiomyomas are usually smalll nonulcerated, sessile lesions covered by normal-appearing oral mucosa 5. They
are generally asymptomatic 7. According to the W H O classification, leiomyomas are histologically classified into three gubtypes: solid, vascular (angiomyoma), alad epitheloid leiomyoma (leiomyoblastoma) 2,4,7. They must be differentiated from leiomyosarcoma and fibrosarcoma:, Immunohistochemical examination with monoclonal anti-smooth-muscle
1. BATSAKISJG. Tumors of the head and neck. Clinical and pathological considerations. 2nd ed. Baltimore: Williams and Wilkins, 1979: 354-6. 2. DAMM DD, NEVILLEBW Oral leiomyomas. Oral Surg 1979: 47: 343-8. ' 3. FRIEDMAN M, CHOW J~ et al. Benign neoplasms of the oral cavity. Clin Plast Surg 1987: 14: 223-31. 4. GREENBERG'E, SHUPAK A, et al. Tonsillar leiomyoma. J. Laryngol Otol 1987: 10l: 619-23. 5. HAEDICKEG, KABANLB. Smooth muscle tumors of the oral cavity. Plast Reconstr Surg 1988: 81: 2264-9. 6. HAGY DM, HALPERIN V, et al. Leiomyoma of the oral cavity. Oral Surg 1964: 17:748 55. 7. RAFFAINIM, BAGaI MT, et al. Mandibular leiomyoma in an infant. Report of a case. Int J Oral Maxillofac Surg 1990: 19: 367-9. Address: Dr R. YiicelAnadolu Ziya G6kalp Caddesi 42/3 06420 Yenisehir Ankara Turkey
M. Gerc, eker 1, R. Y(icel Anadolu 1, O. Bulay 2 University of Ankara, Faculty of Medicine, lENT Department, and 2Pathology Department, Ankara, Turkey
M. Gerfeke~ R. E Anadolu, O. Bulay: Leiomyoma of the cheek. Case report. Int. J. Oral Maxillofac. Surg 1993." 22: 42-43. © Munksgaard 1993 Abstract. A case of a leiomyoma in the cheek of a 60-year-old woman is reported, and the literature is briefly reviewed.
Leiomyoma is a benign tumor originating from smooth muscles; it is mostly found in the uterus (95%) and less frequently in the gastrointestinal tract and subcutaneous tissue ]'5'6,7. it occurs quite rarely in the oral cavity2'5,6,7. Oral leiomyoma was first reported by BLANC in 1884, and since that time, only 115 leiomyomas of the oral cavity have been reported (Table 1)a's'6'7. This paper presents an additional case and briefly reviews the literature.
Case report A 60-year-old white woman was referred to the Ear, Nose, and Throat Department of the University o f Ankara, Medical School, with the chief complaint of a swelling in the right cheek. The tumor had increased in size during the last 6 months. The tumor, measuring approximately 3 cm in diameter, was firm at palpation, seemed to be well defined, and was covered with normal oral mucosa (Fig. 1). Further physical examination revealed no abnormalities. The tumor seemed to be well encapsulated, implying enucleation; therefore, an excisional biopsy under general anesthesia was contemplated. The patient
has been followed up for 1 year, and, as yet, no recurrence has been seen. The tumor consisted of a round, welldefined mass, with a smooth and shiny surface. In the cut section the mass was rubbery, firm, and whitish-gray in color. Microscopically, there were smooth muscle cells with spindle-shaped, elongated nuclei with blunt edges. These cells were embedded in a hyalinized and edematous matrix, making large bundles and whorls (Fig. 2). Monoclonal antidesmin and antivimentin (Biogenex, from mouse) antibodies were applied by the Avidin-Biotin peroxydase complex method. The immunohistochemical study revealed positive brown staining with antidesmin and negative staining with antivimentin antibodies. The microscopic findings and the immunohistochemical examination are
Table 1. Distribution of oral leiomyomas Site
Number of cases
Tongue Lips Hard and/or soft palate Cheek Gingiva Buccal sulcus Floor of the mouth Major salivary glands Maxillary alveolar bone Mandible Total * The present case is included.
25 24 24 18" 8 7 3 2 2 3 116
Fig. 1. Preoperative view of tumor.
Key words: leiomyoma. Accepted for publication 20 October 1992
consistent with the diagnosis of leiomyoma.
Discussion The main source of smooth muscle in the oral cavity is the tunica media of the blood vessels4'6. The most common oral sites are the base of the tongue, lips, and cheeks s. The base of the tongue is most commonly involved with most tumors found to be sessile masses 5. Cheek tumors are mainly of the vascular type 5. In the cheek, only 18 cases have been reported, including the present case 7. Aberrant erector pilorum muscles have been suggested as a possible source of leiomyomas arising in the cheek 2. Heterotopic embryonic tissue has also been suggested 7. NATIELLA et al, reported a case which developed as a re-
Leiomyoma o f the cheek
43
antibody is essential to confirm the di: agnosis. , T h e - t r e a t m e n t o f ' c h o i c e is surgical excision 3,7. References
Fig. 2. Low-power view of leiomyoma. Smooth muscle cells form bundles in edematous matrix ( x 100).
suit of trauma because o f an orthOdontic appliance 5. In the present case, the patient was wearing an ill=fitting denture. Leiomyomas are seen in infancy~:as well as in advanced ageS,. There, is no predilection for males .or females. Oral leiomyomas are usually smalll nonulcerated, sessile lesions covered by normal-appearing oral mucosa 5. They
are generally asymptomatic 7. According to the W H O classification, leiomyomas are histologically classified into three gubtypes: solid, vascular (angiomyoma), alad epitheloid leiomyoma (leiomyoblastoma) 2,4,7. They must be differentiated from leiomyosarcoma and fibrosarcoma:, Immunohistochemical examination with monoclonal anti-smooth-muscle
1. BATSAKISJG. Tumors of the head and neck. Clinical and pathological considerations. 2nd ed. Baltimore: Williams and Wilkins, 1979: 354-6. 2. DAMM DD, NEVILLEBW Oral leiomyomas. Oral Surg 1979: 47: 343-8. ' 3. FRIEDMAN M, CHOW J~ et al. Benign neoplasms of the oral cavity. Clin Plast Surg 1987: 14: 223-31. 4. GREENBERG'E, SHUPAK A, et al. Tonsillar leiomyoma. J. Laryngol Otol 1987: 10l: 619-23. 5. HAEDICKEG, KABANLB. Smooth muscle tumors of the oral cavity. Plast Reconstr Surg 1988: 81: 2264-9. 6. HAGY DM, HALPERIN V, et al. Leiomyoma of the oral cavity. Oral Surg 1964: 17:748 55. 7. RAFFAINIM, BAGaI MT, et al. Mandibular leiomyoma in an infant. Report of a case. Int J Oral Maxillofac Surg 1990: 19: 367-9. Address: Dr R. YiicelAnadolu Ziya G6kalp Caddesi 42/3 06420 Yenisehir Ankara Turkey