Oral Myxofibroid Lesions-Report of Two Cases Showing Two Ends of The Spectrum with Cytohistological Features

Abstract

Introduction: Oral myxofibroid lesions represent a histopathological spectrum of soft tissue tumors characterized by varying degrees of myxoid stroma and fibroblastic/myofibroblastic proliferation. Although rare in the oral cavity, understanding their spectrum is crucial for accurate diagnosis.

Case Summary

Case 1- A 37-year-old male presented with a growth in the anterior alveolus with a prior history of dental extraction. FNAC yielded few spindle shaped cells and scant fibrillary stroma. No epithelial cells were identified. Possibility of myxoid lesion was suggested. X-ray findings revealed a lytic lesion.The lesion was excised and histopathology was suggestive of odontogenic myxofibroma. Ki67 index was low.

Case 2- A 50-year-old male presented with ulcerated growth on left alveolus. FNAC yielded pink fibrillary stroma, plump spindle cells with eccentric nucleus, marked anisonucleosis,hyperchromasia and multinucleation.The possibility of a sarcomatoid lesion was rendered. X-ray findings revealed a lytic lesion in the left molar region extending into maxillary sinus.The lesion excised was suggestive of a Myxofibrosarcoma. IHC was negative for pancytokeratins and S100 with high Ki67 index.

Discussion: Myxofibroid lesions are prone to misinterpretation with ameloblastic tumors,neurogenic tumors and some sarcomatoid carcinomas. IHC markers such as pancytokeratins, S100, CD56, CD99, Ki67 aid in differentiation and grading.

Conclusion: The cytological features in myxofibroid lesions need to be carefully evaluated with clinicoradiological findings. Histopathological examination and ancillary studies are essential in reaching the final diagnosis.