Fibroma

Nonossifying fibroma (metaphyseal fibrous defect) of the mandible in a 15-year-old boy

June 4, 2015     Abul Ala Syed Rifat Mannan, MD; N. Gopendro Singh, MD; Salah Al-Waheeb, MBBCh, FRCPC, FRCPath; Taher N.M. Taher, MBBCh, BDS, MOMS; Emad El Din A.M. Mohammed, BDS, MSc, PhD
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Abstract

We describe a rare case of nonossifying fibroma of the mandible in a 15-year-old boy who presented with a left mandibular swelling. Conventional imaging showed an expansile radiolucent lesion involving the angle and the body of the left mandible. The lesion was curetted, and a miniplate was implanted at the excision site. Microscopic examination of the removed specimen revealed a cellular lesion characterized by a proliferation of uniform spindle-shaped cells in a vague but prominent storiform pattern, which represented the classic appearance of nonossifying fibroma. Three months later, radiography detected a fracture of the implantation plate. The area was re-explored with curettage of the soft tissue, which on microscopy demonstrated findings similar to the initial curettage findings. Follow-up radiology revealed satisfactory healing of the jaw, and no further recurrence was seen 2 years after the initial surgery. We present this case to highlight the importance of recognizing nonossifying fibroma in the mandible, which can be easily confused with more common mandibular lesions.

Juvenile nasopharyngeal angiofibroma staging: An overview

June 4, 2015     Nada Ali Alshaikh, MD; Anna Eleftheriadou, MD, PhD
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Abstract

Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches-the Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future.

Solitary myofibroma of the oropharynx causing airway obstruction in an adult

September 17, 2014     Harrison W. Lin, MD; David Jung, MD, PhD; Linda N. Lee, MD; Peter M. Sadow, MD, PhD; James W. Rocco, MD, PhD
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Abstract

Myofibromas are benign neoplasms believed to be the most common fibrous proliferation of childhood. We present an unusual case of a 44-year-old woman who developed acute airway obstruction from a myofibroma in the oropharynx and accordingly required emergent tracheotomy tube placement. Serial laser excisions to adequately remove the entire lesion while maintaining pharyngeal structure and function were performed, and the patient was successfully decannulated. To date she has remained free of signs and symptoms of recurrence. Although rare in adults, solitary myofibromas should be considered in the differential diagnosis of any subcutaneous or submucosal head and neck lesion. Moreover, clinicians treating adult and pediatric patients with known solitary or multicentric forms of myofibroma should be aware of its potential for airway obstruction. Patients found to have a pharyngeal myofibroma should be managed with airway stabilization, surgical excision with preservation of speech and swallow function, and close postoperative monitoring for recurrence.

Extranasopharyngeal angiofibroma originating in the inferior turbinate

September 18, 2013     Jae Hoon Lee, MD; Ha Min Jeong, MD
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An extranasopharyngeal angiofibroma should be differentiated from other vascular tumors, particularly a hemangioma.

Management of pterygoid venous plexus hemorrhage during resection of a large juvenile nasopharyngeal angiofibroma: A review of 27 cases

April 17, 2013     Lin Chang, MD; Yi Zixiang, MD; Fang Zheming, MD; Lin Gongbiao, MD; Li Zhichun, MD; Zhang Rong, MD; Zhou Aidong, MD; Lan Shuzhan, MD
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Abstract

We retrospectively reviewed the cases of 27 patients who experienced intraoperative bleeding during resection of a large (Fisch type III or IV) juvenile nasopharyngeal angiofibroma (JNA). Of this group, 16 patients had a type III JNA and 11 had a type IV tumor. The degree of hemorrhaging during excision of these JNAs varied greatly among individual patients. The amount of blood lost ranged from 200 to 5,000 ml (mean: 1,800) in the type III cases and from 700 to 8,000 ml (mean: 2,850) in the type IV cases. In 5 of these cases, both intraoperative observations and imaging data suggested that an important factor in the blood loss was damage to the pterygoid venous plexus (PVP). The PVP communicates with the cavernous sinus, ophthalmic vein, maxillary vein, and facial vein; no valve exists between these veins. In patients with a large JNA, the PVP is usually compressed by or adherent to the tumor. When a PVP is seriously damaged during removal of a JNA, hemorrhaging can be very profuse. Therefore, a suitable surgical approach and appropriate hemostatic procedures should be used to prevent or manage PVP hemorrhage as effectively as possible. We also describe in greater detail 5 typical cases of JNA excision that did (n = 3) and did not (n = 2) involve PVP damage.

Chondromyxoid fibroma of the mastoid portion of the temporal bone: MRI and PET/CT findings and their correlation with histology

April 17, 2013     Noeun Oh, MD; Azita S. Khorsandi, MD; Sophie Scherl, BA; Beverly Wang, MD; Bruce M. Wenig, MD; Spiros Manolidis, MD; Adam Jacobson, MD
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Abstract

We report a very rare case of a chondromyxoid fibroma of the mastoid portion of the temporal bone in a 38-year-old woman who presented with left-sided hearing loss. Magnetic resonance imaging identified an expansile mass in the left mastoid bone with a heterogeneous hyperintense signal on T2-weighted imaging and peripheral enhancement. Subsequent positron emission tomography/computed tomography identified erosive bony changes associated with hypermetabolism. The patient underwent an infratemporal fossa resection with a suboccipital craniectomy/cranioplasty. We briefly review the aspects of this case, including a discussion of the differential diagnosis and the correlation between histologic and imaging findings.

Endoscopic Coblation for the treatment of advanced juvenile nasopharyngeal angiofibroma

October 4, 2012     Brandon Pierson, MD; Rosser Powitzky, MD; G. Paul Digoy, MD, FAAP
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Abstract

We present 2 cases of advanced juvenile nasopharyngeal angiofibroma (JNA) to illustrate the advantages of endoscopic Coblation-assisted resection of intranasal extensions of these masses. Both patients—an 11-year-old boy and a 14-year-old boy—presented with a large, extensive mass (Radkowski stage IIIb and Fisch stage IVb in both cases). After embolization was performed on each patient, his JNA was partially ablated via an endoscopic approach with the Coblator II Surgery System with an EVac Xtra Plasma Wand in conjunction with an image-guided navigation system. Both patients experienced resolution of their nasal obstruction with removal of the intranasal extension of the tumor. Coblation allowed for a controlled debulking of the tumors with less blood loss and without the need for multiple instruments. To the best of our knowledge, our report is one of the first to describe image-guided endoscopic Coblation of advanced JNA tumors. Future studies in adequately sized populations are needed to determine the safety and effectiveness of Coblation-assisted endoscopic removal of both advanced and lower-stage JNAs.

Myofibroma of the zygomatic bone in an older child: A case report

July 13, 2011     Engin Acıoğlu, MD, Gül Özbilen Acar, MD, Yalçın Alimoğlu, MD, Harun Cansız, MD, and Sergülen Dervişoğlu, MD
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Abstract

Myofibroma/myofibromatosis is a rare mesenchymal disorder that is part of a heterogeneous group of approximately 20 disorders that are classified primarily according to the proliferation of benign fibrous elements. These lesions can arise during a wide range of ages, with many occurring in the first decade of life, and they are slightly more common in males than females. The etiology of this disease is not well understood. Clinically, patients with myofibroma/myofibromatosis present with various signs, ranging from superficial, cutaneous, purplish macules to freely movable subcutaneous masses to deep-seated fixed lesions. The definitive diagnosis is made on histopathologic grounds. The destructive clinical behavior of myofibroma/myofibromatosis in the setting of insufficient pre- or perioperative diagnostic evaluations (e.g., a failure to perform fine-needle aspiration or frozen-section biopsy) may guide the clinician toward a radical surgical procedure rather than a simple excision.

Odontogenic fibroma

April 30, 2010     Monica Hollowell, MD, David Gang, MD, and Liron Pantanowitz, MD

Successful elective surgery in a patient with a positive preoperative cocaine toxicology screen

February 1, 2010     Robert L. Witt, MD and Patrick Wilson, MD
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Abstract

A positive result on preoperative cocaine toxicology screening has traditionally been a contraindication to immediate nonemergency surgery. We describe a case of major but not emergency head and neck surgery on a patient with a massive ossifying fibroma whose preoperative toxicology screen was positive for cocaine. The surgery was completed without complication, and the patient recovered uneventfully. The decision to proceed with surgery was based on the fact that the results of urine cocaine screening can remain positive long after the cocaine itself has become metabolically inactive, and thus the results may not reflect the actual presence of cocaine or the degree of current intoxication. Our institution has concluded that elective head and neck surgery may be safely performed in carefully selected, hemodynamically stable patients who have tested positive for cocaine ingestion provided that they have been closely observed for 8 hours preoperatively and that they have provided informed consent. Outcome studies are needed.

Extranasopharyngeal angiofibroma of the nasal septum: A case report

October 31, 2009     Satyawati Mohindra, MS, DNB, Gogia Grover, MS, and Amanjit Kaur Bal, MD, DNB
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Abstract

Angiofibroma arising outside the nasopharynx is unusual. The nasal septum is an extremely rare site for the origin of angiofibroma, and to date only 6 such cases previously have been reported in the literature. We report here a case of a 22-year-old man with a vascular mass arising from his nasal septum. The histopathology report was consistent with angiofibroma. We also review other cases in the literature of angiofibroma arising from the nasal septum and discuss a theory of the likely origin of angiofibroma.

Aggressive fibromatosis of the oropharynx: A multidisciplinary approach to a benign disease

April 30, 2009     Eleftheria Kiverniti, MRCSEd, DO-HNS, Ulkem Cilasun, DDS, PhD, Arvind Singh, BSc, MRCS, DLO, Rehan Kazi, MS, Peter M. Clarke, BSc, FRCS, and Daniel J. Archer, FDSRCS, FRCS
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Abstract

We present the case of a 23-year-old woman with aggressive fibromatosis of the oropharynx that was initially treated elsewhere as a peritonsillar abscess. We discuss the characteristics of this rare tumor and review the literature, stressing the importance of postoperative follow-up for peritonsillar abscesses to avoid missing other important diagnoses, such as the one described here.

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