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DENTAL SCIENCE - CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 6  |  Page : 166-168  

Benign fibroushistiocytoma of the gingiva


Department of Oral and Maxillofacial Pathology, Vinayaka Missions Sankarachariyar Dental College and Hospital, Ariyanoor, Salem, Tamil Nadu, India

Date of Submission16-May-2013
Date of Decision24-May-2013
Date of Acceptance24-May-2013
Date of Web Publication1-Jul-2013

Correspondence Address:
Palani Rajathi
Department of Oral and Maxillofacial Pathology, Vinayaka Missions Sankarachariyar Dental College and Hospital, Ariyanoor, Salem, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.114324

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   Abstract 

Benign fibroushistiocytoma is a benign connective tissue tumor rarely seen affecting the head and neck region. These tumors were believed to be of histiocytic origin as they are comprised of cells, which showed spindled morphology and cells with a round histiocytic appearance. The current concept consents that the lesional cells rather represent a fibroblastic differentiation. Diagnosis of these tumors proves to be challenging even with the use of immunohistochemistry due to lack of any specific markers. Here, we describe a case which presented in the gingiva mimicking a reactive lesion, which in fact was a tumor.

Keywords: Benign, fibrous histiocytoma, gingiva, reactive lesion


How to cite this article:
Rajathi P, Jacob M, Priyadharshini I, Sekar B. Benign fibroushistiocytoma of the gingiva. J Pharm Bioall Sci 2013;5, Suppl S2:166-8

How to cite this URL:
Rajathi P, Jacob M, Priyadharshini I, Sekar B. Benign fibroushistiocytoma of the gingiva. J Pharm Bioall Sci [serial online] 2013 [cited 2019 Jul 22];5, Suppl S2:166-8. Available from: http://www.jpbsonline.org/text.asp?2013/5/6/166/114324

Benign fibrous histiocytoma is a benign connective tissue tumor comprising of cells resembling both fibroblasts and histiocytes occurring in both cutaneous and non-cutaneous soft-tissues. These tumors represent fibrohistiocytic differentiation, which describes the nature of the tumor and not the cell of origin. [1]

The most common sites affected by benign fibrous histiocytoma are the soft-tissues of the lower extremities, less frequently in the upper extremities, retroperitoneum and orbit.

The occurrence in the head and neck is rare and has been seen within the nasal cavity, temporomandibular joint, the submandibular and parotid glands, larynx, trachea, paranasal sinuses, [2] external auditory canal [3] and a single case occurring within the condyle. [4]

Oral cavity being an uncommon site, but when seen, occurs predominantly in the buccal mucosa and vestibule. [5] This tumor has also been seen on gingival or alveolar ridges, soft palate, floor of mouth, lips and tongue. [6]

The earliest concept that these tumors showed fibrohistiocytic differentiation was based on the biphasic cell population of fibroblasts and histiocytes seen in these tumors. The lesional cell also exhibited phagocytic activity and amoeboid extensions in cell culture, which further supported the fibrohistiocytic pattern. This concept is now understood to be incorrect and that the histiocyte like cells did not show immunoreactivity with CD68 usually taken by macrophages with lysomal activity and the cells tend to express immunoreactivity favoring a fibroblastic differentiation. The name fibrohistiocytic tumors is still ascribed to this tumor for the presence of cells, which resemble fibroblast and histiocytes. [7]


   Case Report Top


A 23-year-old male patient reported with a chief complaint of a growth on the gums of the lower front teeth region for past 1 month. The growth was small when he noticed it and gradually increased in size. Clinical examination revealed two small growths, on both the buccal and lingual aspect of the interdental papillae of 32 and 33. The surface of these growths appeared reddish pink in color measuring around 1 cm × 1 cm in size. On palpation, the growth was firm in consistency and non-tender [Figure 1] and [Figure 2].
Figure 1: (a) Growth on the buccal aspect of the gingiva of 32 and 33, (b) growth on the lingual aspect of the gingiva of 32 and 33

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Figure 2: OPG - showing no resorption of bone in 32 and 33 region

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An excisional biopsy was carried out and both the buccal and lingual growth were submitted separately for histopathological investigations. The section made from the buccal growth showed a connective tissue mass devoid of epithelium. The connective tissue showed budding capillaries toward the center with dense infiltrate of chronic inflammatory cells. The periphery of the mass appeared to be covered by a pseudomembranous layer.

The lingual growth showed a highly cellular connective tissue mass covered by a proliferating epithelium. The lesional cells were plump spindle shaped cells, which in certain areas showed the crisscross pattern or storiform arrangement. The connective tissue had also shown numerous round histiocytic cells and blood vessels.

The sections were sent for immunohistochemistry to detect the expression of Vimentin, smooth muscle actin (SMA), desmin, S-100 protein and CD34. The sections showed strong positivity for vimentin and negative expression for vascular, muscular or neural markers [Figure 3].
Figure 3: (a) Highly cellular connective with plump spindle shaped cells showing sto r i form arrangement (×40) (b) immunohistochemistry - positive for vimentin marker

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Based on the histopathological features and immunohistochemistry findings, a diagnosis of benign fibroushistiocytoma was given.


   Discussion Top


The diagnosis of benign fibrous histiocytoma can prove to be challenging in light microscopy even with the use of immunohistochemistry as these tumors lack any specific markers and are primarily diagnosed based on the absence of marker expression.

Histologically, these tumors show lesional tissue comprising of highly cellular connective tissue comprising of spindle cells. Thus, tumors showing similar histological appearance have to be considered in the differential diagnosis and ruled out by immunohistochemistry for other spindle cell lesions. The panel of markers most commonly employed for spindle cell lesions are SMA, vimentin, S-100 protein, Desmin, cytokeratin, HMB 45, CD34, CD31. [8] Review of literature show that benign fibroushistiocytoma exhibit strong immunoreactivity for vimentin, focal expression of CD68 while no expression for other markers as was observed in the present case.

The histopathology of these tumors shows a submucosal mass, consisting of fibroblasts and histiocytes in rotating or fasciculated bundles, inflammatory cells, multinucleated giant cells and foam cells. The hallmark of these tumors is the characteristic "storiform" or "cartwheel" arrangement of the lesional cells. [9] In the present case, two sections were prepared, one from the nodular mass seen on the interdental papillae of 32 and 33 on the buccal aspect and the other section from the lingual aspect. The section from the buccal aspect showed the histologic appearance of pyogenic granuloma while the lingual mass showed a benign fibrohistiocytic tumor mass with overlying proliferating epithelium. A similar case on the tongue was reported by Syed et al. [6] where primary biopsy report of pyogenic granuloma was given. On recurrence, a deeper biopsy was carried out, which showed fibrohistiocytic appearance confirmed with immunohistochemistry, which showed strong positive expression for vimentin and CD68.

The other diseases to be considered as differential diagnosis include spindle cell lesions as nodular fasciitis, oral inflammatory myofibroblastic tumor, solitary fibrous tumor, neurofibroma, dermatofibroma, leiomyosarcoma and other neurogenic tumors are discussed in [Table 1]. The malignant counterpart of benign fibrous histiocytoma, a low grade tumor, should also be considered in differential diagnosis, as small specimens (not large enough for an accurate pathological diagnosis) appear benign can be encountered in head and neck region. [11]
Table 1: Differential diagnosis for spindle cell lesions

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The current choice of treatment for benign fibrous histiocytoma of the head and neck as well other parts of the body is complete resection and recurrence rate is found to be nil. [2],[3],[5] In conclusion, the tumors occur very rarely in the oral cavity and should be considered in the differential diagnosis.

 
   References Top

1.Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran pathologic basis of disease. 7 th ed. Pennsylvania: Elsevier Saunders; 2005. p. 1252-3.  Back to cited text no. 1
    
2.Baradaranfar MH, Moghimi M. A case report of benign fibrous histiocytoma of paranasal sinuses and role of transnasal endoscopy in its treatment. Acta Medica Iranica 2005;43:230-2.  Back to cited text no. 2
    
3.Rashid A, Goh BS, Ghani A, Saim L. Benign fibrous histiocytoma of the external auditory canal: Case report and literature review. Banglad J Otorhinolaryngol 2012;18:77-80.  Back to cited text no. 3
    
4.Katagiri W, Nakazawa M, Kishino M. Benign fibrous histiocytoma in the condylar process of the mandible: Case report. Br J Oral Maxillofac Surg 2008;46:e1-2.  Back to cited text no. 4
    
5.Gnepp DR. Diagnostic surgical pathology of head and neck. 2 nd ed. Philadelphia: Saunders Elsevier; 2009. p. 200.  Back to cited text no. 5
    
6.Syed A, Hasan SH, Hosein MM. Oral fibro-histiocytic lesions: Immuno-histological investigation and review of an unusual presentation in the tongue. Pak Oral Dent J 2008;28:217-22.  Back to cited text no. 6
    
7.Regezi JA, Scuibba JJ, Jordan RC. Oral pathology, clinical and pathological corelations. 4 th ed. Missouri: Saunders Elsevier; 2003. p. 168.  Back to cited text no. 7
    
8.Ajura AJ, Sumairi I, Lau SH. The use of immunohistochemistry in an oral pathology laboratory. Malays J Pathol 2007;29:101-5.  Back to cited text no. 8
    
9.Mills SE, Carter D, Greenson JK, Reuter VE, Stoler MH. Sternberg's diagnostic surgical pathology. 4 th ed. Philadelphia: Lippincott, Williams and Wilkins; 2004. p. 168.  Back to cited text no. 9
    
10.Binmadi NO, Packman H, Papadimitriou JC, Scheper M. Oral inflammatory myofibroblastic tumor: Case report and review of literature. Open Dent J 2011;5:66-70.  Back to cited text no. 10
    
11.Nakamizo M, Yokoshima K, Sugisaki Y. Malignant fibrous histiocytoma of the hypopharynx: A case report in a young adult. J Nippon Med Sch 2004;71:301-5.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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