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Solitary fibrous tumor of the buccal mucosa
Journal of Dental Sciences (2015) 10, 111e113
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.e-jds.com
CORRESPONDENCE
Solitary fibrous tumor of the buccal mucosa
Solitary fibrous tumor (SFT), previously named hemangiopericytoma, is a rare tumor in the head and neck region.1 Here, we report an SFT involving the buccal, infratemporal, and pterygomandibular regions. A 28-year-old female patient visited the Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei, Taiwan for treatment of a soft tissue tumor in the left cheek. Clinical examination revealed a non-tender mass with intact surface mucosa in the left cheek. The patient denied all major systemic diseases and had no history of drug or food allergy. Computer tomography (CT) showed a focal lesion with faint low density on precontrast CT and heterogeneous enhancement on postcontrast CT in the left buccomasseteric space. External carotid arteriography demonstrated a hypervascular tumor at the left maxillary area, which was mainly supplied by the branches of the left internal maxillary artery and drained by the left facial vein. Under the impression of a hemangioma, preoperative devascularization of the tumor was performed by intravascular injection of embolic agents to prevent the massive bleeding during surgical excision of the tumor. After that, the tumor was dissected out and removed under general anesthesia. The patient stood the surgical procedures well. Grossly, the removed specimen showed an elastic tumor measuring 5.8 cm in greatest dimension (Fig. 1A). Microscopically, the tumor was composed of a sheet of compactly packed round or spindle cells surrounding
endothelium-lined vascular channels (Fig. 1B and C). Embolic agents used for embolization therapy were found in the lumens of part of the vascular channels (Fig. 1B and D). Irregular and branching blood vessels with “staghorn” appearance were also noted in the tumor (Fig. 1CeE). However, no mitotic figure, tumor necrosis, or cellular atypia were found in the cut tissue sections. Immunohistochemical study revealed that the tumor cells were diffusely and strongly positive for CD34 (Fig. 1F). Therefore, the histopathological diagnosis of an SFT was confirmed. To the best of our knowledge, there are 38 case reports of SFTs originating from the cheek, buccal space, or buccal mucosa of the oral cavity in the English literature.1 The mean age of patients with SFT is 49.0 years (range 20e83 years). There is no significant sex predilection for the patients.1 Immunohistochemical studies of SFTs show a strong CD34 reactivity of the tumor cells, suggesting that CD34 is a good marker for SFTs. Actually, immunohistochemistry is a valuable method that can be used to differentiate a B-cell from a T-cell lymphoma,2 to confirm a metastatic oral malignant melanoma3 or a metastatic oral hepatocellular carcinoma,4 and to identify the Langerhans cells in the lining epithelia of epidermoid cysts.5 The recurrence rate of SFTs varies from 4.3% to 6.7% and the metastatic rate of SFTs is approximately 5%.1 Because the clinical behavior of SFTs is not very clear, long-term follow-up of the patients is suggested after local surgical excision of the tumor.
http://dx.doi.org/10.1016/j.jds.2015.01.001 1991-7902/Copyright ª 2015, Association for Dental Sciences of the Republic of China. Published by Elsevier Taiwan LLC. All rights reserved.
112
Correspondence
Figure 1 Gross, microscopical and immunostained photographs of our case of solitary fibrous tumor. (A) The surgical specimen showed an elastic tumor measuring 5.8 cm in greatest dimension; (B) low power view of the lesion revealing a hypercellular tumor with part of the blood channels filled with embolic agents; (C) low power view of the tumor showing a sheet of compactly packed round or spindle cells surrounding endothelium-lined vascular channels. The staghorn blood vessels were occasionally seen; (D) staghorn blood vessels and blood channels filled with embolic agents were found in the hypercellular tumor; (E) a typical staghorn blood vessel was noted in a sheet of round or spindle tumor cells. Hematoxylin and eosin stain; original magnification for BeD was 4 and for E was 20 ; and (F) immunostained tissue section demonstrating that the tumor cells were diffusely and strongly positive for CD 34. Original magnification was 20 .
Conflicts of interest The authors declare no conflicts of interest relevant to this article.
References 1. Satomi T, Hasegawa O, Abukawa H, et al. Exceptionally large solitary fibrous tumor arising from the cheek:
an immunohistochemical and ultrastructural study with a review of the literature. Med Mol Morphol 2014;47: 108e16. 2. Chen JC, Chang YK, Chiang WF, Lu D. Palatal diffuse large Bcell lymphoma masquerading as an infiltrative bony mass. J Dent Sci 2013;8:98e9. 3. Lu SY, Lin CF, Huang SC. Metastatic oral malignant melanoma transformed from pre-existing pigmented lesions in mandibular gingiva: report of an unusual case. J Dent Sci 2013;8: 328e32.
Correspondence 4. Chen HM, Wu YC, Wei LY, Chiang CP. Metastatic hepatocellular carcinoma of the anterior palatal gingiva. J Dent Sci 2014;9: 202e4. 5. Wu YC, Wang YP, Chang JYF, Chiang CP. Langerhans cells in lining epithelia of epidermoid cysts. J Dent Sci 2013;8:448e50.
113 Hung-Pin Lin* Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
Chieh Yuan Cheng Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei, Taiwan
Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
Chun-Pin Chiang Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
*Corresponding author. Department of Dentistry, MacKay Memorial Hospital, Number 92 Zhongshan North Road, Section 2, Taipei, 10449, Taiwan. E-mail address: [email protected] (H.-P. Lin)
Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
Received 28 December 2014 Available online 28 February 2015
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.e-jds.com
CORRESPONDENCE
Solitary fibrous tumor of the buccal mucosa
Solitary fibrous tumor (SFT), previously named hemangiopericytoma, is a rare tumor in the head and neck region.1 Here, we report an SFT involving the buccal, infratemporal, and pterygomandibular regions. A 28-year-old female patient visited the Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei, Taiwan for treatment of a soft tissue tumor in the left cheek. Clinical examination revealed a non-tender mass with intact surface mucosa in the left cheek. The patient denied all major systemic diseases and had no history of drug or food allergy. Computer tomography (CT) showed a focal lesion with faint low density on precontrast CT and heterogeneous enhancement on postcontrast CT in the left buccomasseteric space. External carotid arteriography demonstrated a hypervascular tumor at the left maxillary area, which was mainly supplied by the branches of the left internal maxillary artery and drained by the left facial vein. Under the impression of a hemangioma, preoperative devascularization of the tumor was performed by intravascular injection of embolic agents to prevent the massive bleeding during surgical excision of the tumor. After that, the tumor was dissected out and removed under general anesthesia. The patient stood the surgical procedures well. Grossly, the removed specimen showed an elastic tumor measuring 5.8 cm in greatest dimension (Fig. 1A). Microscopically, the tumor was composed of a sheet of compactly packed round or spindle cells surrounding
endothelium-lined vascular channels (Fig. 1B and C). Embolic agents used for embolization therapy were found in the lumens of part of the vascular channels (Fig. 1B and D). Irregular and branching blood vessels with “staghorn” appearance were also noted in the tumor (Fig. 1CeE). However, no mitotic figure, tumor necrosis, or cellular atypia were found in the cut tissue sections. Immunohistochemical study revealed that the tumor cells were diffusely and strongly positive for CD34 (Fig. 1F). Therefore, the histopathological diagnosis of an SFT was confirmed. To the best of our knowledge, there are 38 case reports of SFTs originating from the cheek, buccal space, or buccal mucosa of the oral cavity in the English literature.1 The mean age of patients with SFT is 49.0 years (range 20e83 years). There is no significant sex predilection for the patients.1 Immunohistochemical studies of SFTs show a strong CD34 reactivity of the tumor cells, suggesting that CD34 is a good marker for SFTs. Actually, immunohistochemistry is a valuable method that can be used to differentiate a B-cell from a T-cell lymphoma,2 to confirm a metastatic oral malignant melanoma3 or a metastatic oral hepatocellular carcinoma,4 and to identify the Langerhans cells in the lining epithelia of epidermoid cysts.5 The recurrence rate of SFTs varies from 4.3% to 6.7% and the metastatic rate of SFTs is approximately 5%.1 Because the clinical behavior of SFTs is not very clear, long-term follow-up of the patients is suggested after local surgical excision of the tumor.
http://dx.doi.org/10.1016/j.jds.2015.01.001 1991-7902/Copyright ª 2015, Association for Dental Sciences of the Republic of China. Published by Elsevier Taiwan LLC. All rights reserved.
112
Correspondence
Figure 1 Gross, microscopical and immunostained photographs of our case of solitary fibrous tumor. (A) The surgical specimen showed an elastic tumor measuring 5.8 cm in greatest dimension; (B) low power view of the lesion revealing a hypercellular tumor with part of the blood channels filled with embolic agents; (C) low power view of the tumor showing a sheet of compactly packed round or spindle cells surrounding endothelium-lined vascular channels. The staghorn blood vessels were occasionally seen; (D) staghorn blood vessels and blood channels filled with embolic agents were found in the hypercellular tumor; (E) a typical staghorn blood vessel was noted in a sheet of round or spindle tumor cells. Hematoxylin and eosin stain; original magnification for BeD was 4 and for E was 20 ; and (F) immunostained tissue section demonstrating that the tumor cells were diffusely and strongly positive for CD 34. Original magnification was 20 .
Conflicts of interest The authors declare no conflicts of interest relevant to this article.
References 1. Satomi T, Hasegawa O, Abukawa H, et al. Exceptionally large solitary fibrous tumor arising from the cheek:
an immunohistochemical and ultrastructural study with a review of the literature. Med Mol Morphol 2014;47: 108e16. 2. Chen JC, Chang YK, Chiang WF, Lu D. Palatal diffuse large Bcell lymphoma masquerading as an infiltrative bony mass. J Dent Sci 2013;8:98e9. 3. Lu SY, Lin CF, Huang SC. Metastatic oral malignant melanoma transformed from pre-existing pigmented lesions in mandibular gingiva: report of an unusual case. J Dent Sci 2013;8: 328e32.
Correspondence 4. Chen HM, Wu YC, Wei LY, Chiang CP. Metastatic hepatocellular carcinoma of the anterior palatal gingiva. J Dent Sci 2014;9: 202e4. 5. Wu YC, Wang YP, Chang JYF, Chiang CP. Langerhans cells in lining epithelia of epidermoid cysts. J Dent Sci 2013;8:448e50.
113 Hung-Pin Lin* Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
Chieh Yuan Cheng Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei, Taiwan
Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
Chun-Pin Chiang Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
*Corresponding author. Department of Dentistry, MacKay Memorial Hospital, Number 92 Zhongshan North Road, Section 2, Taipei, 10449, Taiwan. E-mail address: [email protected] (H.-P. Lin)
Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
Received 28 December 2014 Available online 28 February 2015