- Email: [email protected]
Soft-tissue myxoma of the oral cavity
Soft-tissue myxoma of the oral cavity Report
of a case
Jack Traiger, B.S., D.D.S.,* and William Lawson, M.D., D.D.S.,#* New York, N. Y. THE
MOUNT
SINAI
HOSPITAL
W
hether or not a given type of tumor is of more than academic interest in oral dia,gnosis depends partly upon how often it is seen in clinical practice. In the case of aft-tissue myxomas of the oral cavity, this is not often. In any form and in any location, the myxoma is rare. During the past ten years, only a limited number of such cases have been reported.1-6 This tumor rarely occurs in the region of the head and neck, and it represents but a small proportion of the myxomas that involve the oral cavity and facial structures. Of the relatively few myxomas reported in these structures, most have been found in the bone of the maxilla and mandible.’ The present article describes the diagnosis and treatment of a myxoma of the lip. CASE REPORT A 54.year-old white man was referred on July 7, 1965, because of a mass in the lower lip (Fig. 1). The lesion was first observed by the family dentist during a routine dental examination. There was no displacement, facial asymmetry, or interference with mastication or speech. History
of present
illness
The patient had noticed a small “bump” in the lower lip which had not changed in size for several years. There was no history of pain, tenderness, or other discomfort in the area. Presented at the Clinical-Pathological Conference of the New York Institute of Clinical Oral Pathology, Nov. 8, 1965. *Clinical Assistant in Oral Surgery, The Mount Sinai Hospital, New York, N. Y.; Assistant Attending Oral Surgeon, Elmhurst City Hospital, Elmhurst, N. Y. **Formerly Intern, The Mount Sinai Hospital. Present address: 12409 Largo Dr., Savannah, Ga. 31406.
247
Pig. 1. Myxoma
of lip. Prcoporative
Pig. d. Myxoma
of lip, surgical
History
and
present
state
The patient’s history or surgical procedures. Physical
of
viclv shows no visible
specimen. Note firm, ahitish,
swelling
or asymmetry.
elastic mass.
health
revealed
only the usual childhood
diseases, with
no serious illnesses
examination
The patient, a well-developed, well-nourished white man, was in no acute distress. of physical examination and laboratory studies were essentially normal. Oral
Results
examination
The patient was partially edcntulous and had worn a partial maxillary denture since 1958. The tongue, palate, and oral mucosa appeared normal. There was no evidence of visible swelling in the lower lip, but palpation disclosed A small, freely movable mass approximately in the midline opposite the mandibular central incisors. The mass was not tender, and there was no local or referred pain. There was no adenopathy in the submandibular or cervical chain of nodes upon palpation. The tentative diagnoses were (1) lipoma of the lip, (2) mixed tumor of the lip, and (3) mueocele. Treatment
and
course
Local anesthesia was induced with 2 per cent lidocaine hydrochloride with 1:50,000 epinephrine, and an elliptical incision was made. The tumor mass was excised with the intact overlying normal mueosa, after which the muscle was approximated with 3-O plain gut and the mucosa with 3-O black silk sutures. The postoperative course was free of complication, and the sutures were removed in one week’s time. When the patient was seen 4 weeks later, he was found to be free of complaints.
Soft-tissue myxoma
B’Q. J. Histologic section dant intercellular substance.
Pig. 4. Histologic bundles.
Pathologist’s
showing
section showing
masses of stellate
tumor mass extending
of oral cavity
and spindle-shaped
249
cells and abun-
into muscle and separating
muscle
report
The specimen was a firm elastic mass, somewhat whitish and mucoid in appearance, measuring 16 by 16 by 13 mm. (Fig. 2). Microscopic examination revealed a mass of stellate and spindle-shaped cells separated by an abundant, faintly stained intercellular substance. Here and there septa were seen. The mass extended into muscle, separating muscle bundles, and to the site of incision where, in some areas, there was a slight suggestion of a capsule. A special stain for mucous was positive (Figs. 3 and 4).
OS.,
0.x
February, The pathologist
(RI. Frcwr~tl, M.D.)
cstablisl~ed
the diagnosis
& 0.1’.
I969
as myxoma of the lip.
DISCUSSION
Myxomas of the soft tissues of the oral cavity and of surrounding structures are considered rare. A search of the literature reveals that only a few cases have been reported in the past I.0 years. These cases do not include the myxomas of the bony structures which comprise 40 per cent of tho’se myxomas locat,ed in and around t,he head and neck.8 Myxomas are classified as benign ncoplasms, since they do not metastasize. In other respects, however, they have the characteristics of malignant lesions. They are nonencapsulated, widely infiltrating growths which are difficult to eradicate, aad they may prove fatal if they extend to vital structures. Myxomatous degeneration, which is common in fibrous overgrowths (an edematous phenomenon and not mucin positive), should not be confused with a true myxoma.9 The myxoma of the soft tissues is a tumor which Stout has described as a true neoplasm made up of tissue resembling primitive mesenchyme. Thus, it is composed of stellate cells arranged in a loose mucoid stroma which also contains delicate reticulin fibem.*O Willis,11 Jaffe,12 and I,ichtenstein13 state that unless mucin can be demonstrated in the tumor, the diagnosis of myxoma. is not justified. This tumor may make its appearance at any age, approximately equal numbers of cases having been reported in every decade of life. There is no definite sex predilection. In a review of the literature of the past 10 years, only two cases of myxoma of the soft tissues of the oral cavity were found. The other myxomas in the head and neck were located in the skin or subcutaneous tissues, parotid gland, pharynx, larynx, tonsils, carotid body, and ear.12 SUMMARY
An extremely rare lesion-an intraoral soft-tissue myxoma of the lip-has been described. Myxomas are benign neoplasms of mesenchyme-like tissue, and they never metasta,size. Surgical removal is the treatment of choice. If excision has been incomplete, recurrence is not uncommon. REFERENCES
1. 2. 3. 4. 5. 6. 7. 8. 9.
Stout, A. P.: Myxoma, Tumor of Primitive Meeenchyme, Ann. Surg. 127: 706, 1948. Stout, A. P.: Sarcomas: of the Soft Tissues, CA, Bull. Cancer Prog. 11: 210, 1961. Dtuz, W., and Stout, A. P. : The Myxomas in Childhood, Cancer 14: 629,196l. Loruvel, R.: Benip Myxoma of the Cheek; Case Report, Prensa m6d. argent. 44: 3083, 1957. Malfatti, T.: Considerations of a Case of Myxoma of the Parotid, Clin. Pediat. (Bologna) 43: 747, 1981. Arena, S.: Somatic Tissue Tumors in the Head and Neck, Tr. Pennsylvania Acad. Ophth. 15: 101, 1962. Thoma, K. H., and Goldman, H. M.: Oral Pathology, ed. 5, St. Louis, 1960, The C. V. Mosby Company, p. 1143. Spengos, M. N., and Schom, C. E.: Myxomas of the Soft Tissues: Report of Case of Myxoma in the Cheek, J. Oral Surg. 23: 140, 1965. U. 8. Naval Dental School: Color Atlas of Oral Pathology, Philadelphia, 1956, J. B. Lippincott Company.
Soft-tissue
nzyxonta of oral cavity
251
10. Shafer, W. G., Hine, M. K., and Levy, B. If.: Te+t,book of Oral Pathology, ed. 2, Philadelphia, 1963, W. B. Saunders Company. 11. Willis, R. A.: Pathology of Tumours, ed. 3, London, 1960, Buttenvorth & Co., Ltd. 12. Jaffc, H. L.: Tumors and Tumorous Conditions of the Hone and Joints, Philadelphia, 1958, Lea & Febiger. 13. Lichtcnstein, L. : Bone Tumors, cd. 2, St. Louis, 1959, The C. V. Mosby Company. to the Study of Myxoma of the Larynx, Minerva otorhino14. Malfatti, T.: Contributions laryng. 11: 395, 1961.
El11 White Plains Rd.
of a case
Jack Traiger, B.S., D.D.S.,* and William Lawson, M.D., D.D.S.,#* New York, N. Y. THE
MOUNT
SINAI
HOSPITAL
W
hether or not a given type of tumor is of more than academic interest in oral dia,gnosis depends partly upon how often it is seen in clinical practice. In the case of aft-tissue myxomas of the oral cavity, this is not often. In any form and in any location, the myxoma is rare. During the past ten years, only a limited number of such cases have been reported.1-6 This tumor rarely occurs in the region of the head and neck, and it represents but a small proportion of the myxomas that involve the oral cavity and facial structures. Of the relatively few myxomas reported in these structures, most have been found in the bone of the maxilla and mandible.’ The present article describes the diagnosis and treatment of a myxoma of the lip. CASE REPORT A 54.year-old white man was referred on July 7, 1965, because of a mass in the lower lip (Fig. 1). The lesion was first observed by the family dentist during a routine dental examination. There was no displacement, facial asymmetry, or interference with mastication or speech. History
of present
illness
The patient had noticed a small “bump” in the lower lip which had not changed in size for several years. There was no history of pain, tenderness, or other discomfort in the area. Presented at the Clinical-Pathological Conference of the New York Institute of Clinical Oral Pathology, Nov. 8, 1965. *Clinical Assistant in Oral Surgery, The Mount Sinai Hospital, New York, N. Y.; Assistant Attending Oral Surgeon, Elmhurst City Hospital, Elmhurst, N. Y. **Formerly Intern, The Mount Sinai Hospital. Present address: 12409 Largo Dr., Savannah, Ga. 31406.
247
Pig. 1. Myxoma
of lip. Prcoporative
Pig. d. Myxoma
of lip, surgical
History
and
present
state
The patient’s history or surgical procedures. Physical
of
viclv shows no visible
specimen. Note firm, ahitish,
swelling
or asymmetry.
elastic mass.
health
revealed
only the usual childhood
diseases, with
no serious illnesses
examination
The patient, a well-developed, well-nourished white man, was in no acute distress. of physical examination and laboratory studies were essentially normal. Oral
Results
examination
The patient was partially edcntulous and had worn a partial maxillary denture since 1958. The tongue, palate, and oral mucosa appeared normal. There was no evidence of visible swelling in the lower lip, but palpation disclosed A small, freely movable mass approximately in the midline opposite the mandibular central incisors. The mass was not tender, and there was no local or referred pain. There was no adenopathy in the submandibular or cervical chain of nodes upon palpation. The tentative diagnoses were (1) lipoma of the lip, (2) mixed tumor of the lip, and (3) mueocele. Treatment
and
course
Local anesthesia was induced with 2 per cent lidocaine hydrochloride with 1:50,000 epinephrine, and an elliptical incision was made. The tumor mass was excised with the intact overlying normal mueosa, after which the muscle was approximated with 3-O plain gut and the mucosa with 3-O black silk sutures. The postoperative course was free of complication, and the sutures were removed in one week’s time. When the patient was seen 4 weeks later, he was found to be free of complaints.
Soft-tissue myxoma
B’Q. J. Histologic section dant intercellular substance.
Pig. 4. Histologic bundles.
Pathologist’s
showing
section showing
masses of stellate
tumor mass extending
of oral cavity
and spindle-shaped
249
cells and abun-
into muscle and separating
muscle
report
The specimen was a firm elastic mass, somewhat whitish and mucoid in appearance, measuring 16 by 16 by 13 mm. (Fig. 2). Microscopic examination revealed a mass of stellate and spindle-shaped cells separated by an abundant, faintly stained intercellular substance. Here and there septa were seen. The mass extended into muscle, separating muscle bundles, and to the site of incision where, in some areas, there was a slight suggestion of a capsule. A special stain for mucous was positive (Figs. 3 and 4).
OS.,
0.x
February, The pathologist
(RI. Frcwr~tl, M.D.)
cstablisl~ed
the diagnosis
& 0.1’.
I969
as myxoma of the lip.
DISCUSSION
Myxomas of the soft tissues of the oral cavity and of surrounding structures are considered rare. A search of the literature reveals that only a few cases have been reported in the past I.0 years. These cases do not include the myxomas of the bony structures which comprise 40 per cent of tho’se myxomas locat,ed in and around t,he head and neck.8 Myxomas are classified as benign ncoplasms, since they do not metastasize. In other respects, however, they have the characteristics of malignant lesions. They are nonencapsulated, widely infiltrating growths which are difficult to eradicate, aad they may prove fatal if they extend to vital structures. Myxomatous degeneration, which is common in fibrous overgrowths (an edematous phenomenon and not mucin positive), should not be confused with a true myxoma.9 The myxoma of the soft tissues is a tumor which Stout has described as a true neoplasm made up of tissue resembling primitive mesenchyme. Thus, it is composed of stellate cells arranged in a loose mucoid stroma which also contains delicate reticulin fibem.*O Willis,11 Jaffe,12 and I,ichtenstein13 state that unless mucin can be demonstrated in the tumor, the diagnosis of myxoma. is not justified. This tumor may make its appearance at any age, approximately equal numbers of cases having been reported in every decade of life. There is no definite sex predilection. In a review of the literature of the past 10 years, only two cases of myxoma of the soft tissues of the oral cavity were found. The other myxomas in the head and neck were located in the skin or subcutaneous tissues, parotid gland, pharynx, larynx, tonsils, carotid body, and ear.12 SUMMARY
An extremely rare lesion-an intraoral soft-tissue myxoma of the lip-has been described. Myxomas are benign neoplasms of mesenchyme-like tissue, and they never metasta,size. Surgical removal is the treatment of choice. If excision has been incomplete, recurrence is not uncommon. REFERENCES
1. 2. 3. 4. 5. 6. 7. 8. 9.
Stout, A. P.: Myxoma, Tumor of Primitive Meeenchyme, Ann. Surg. 127: 706, 1948. Stout, A. P.: Sarcomas: of the Soft Tissues, CA, Bull. Cancer Prog. 11: 210, 1961. Dtuz, W., and Stout, A. P. : The Myxomas in Childhood, Cancer 14: 629,196l. Loruvel, R.: Benip Myxoma of the Cheek; Case Report, Prensa m6d. argent. 44: 3083, 1957. Malfatti, T.: Considerations of a Case of Myxoma of the Parotid, Clin. Pediat. (Bologna) 43: 747, 1981. Arena, S.: Somatic Tissue Tumors in the Head and Neck, Tr. Pennsylvania Acad. Ophth. 15: 101, 1962. Thoma, K. H., and Goldman, H. M.: Oral Pathology, ed. 5, St. Louis, 1960, The C. V. Mosby Company, p. 1143. Spengos, M. N., and Schom, C. E.: Myxomas of the Soft Tissues: Report of Case of Myxoma in the Cheek, J. Oral Surg. 23: 140, 1965. U. 8. Naval Dental School: Color Atlas of Oral Pathology, Philadelphia, 1956, J. B. Lippincott Company.
Soft-tissue
nzyxonta of oral cavity
251
10. Shafer, W. G., Hine, M. K., and Levy, B. If.: Te+t,book of Oral Pathology, ed. 2, Philadelphia, 1963, W. B. Saunders Company. 11. Willis, R. A.: Pathology of Tumours, ed. 3, London, 1960, Buttenvorth & Co., Ltd. 12. Jaffc, H. L.: Tumors and Tumorous Conditions of the Hone and Joints, Philadelphia, 1958, Lea & Febiger. 13. Lichtcnstein, L. : Bone Tumors, cd. 2, St. Louis, 1959, The C. V. Mosby Company. to the Study of Myxoma of the Larynx, Minerva otorhino14. Malfatti, T.: Contributions laryng. 11: 395, 1961.
El11 White Plains Rd.