|Year : 2020 | Volume
| Issue : 1 | Page : 23-26
Benign fibrohistiocytic tumour of the palate
Nilima Sharma1, Mohammad Jaseem Hassan2
1 Department of Dentistry, Hamdard Institute of Medical Sciences and Research and Associated HAHC Hospital, Jamia Hamdard, New Delhi, India
2 Department of Pathology, Hamdard Institute of Medical Sciences and Research and Associated HAHC Hospital, Jamia Hamdard, New Delhi, India
|Date of Submission||10-Mar-2019|
|Date of Decision||16-Mar-2019|
|Date of Acceptance||09-Feb-2020|
|Date of Web Publication||02-Jun-2020|
Department of Dentistry, Hamdard Institute of Medical Sciences and Research, Associated HAHC Hospital, Jamia Hamdard, New Delhi
Source of Support: None, Conflict of Interest: None
Benign fibrous histiocytomas of soft tissue are composed of spindled fibroblasts admixed with secondary elements including histiocytes, foam cells, and inflammatory cells. These tumors occur equally in males and females and most often arise in the dermis and subcutaneous tissues. We report a rare case of benign fibrous histiocytic tumor of the palate with histologic features and immunohistochemical characteristics.
Keywords: Benign, fibrous histiocytoma, histiocytes
|How to cite this article:|
Sharma N, Hassan MJ. Benign fibrohistiocytic tumour of the palate. Indian J Dermatopathol Diagn Dermatol 2020;7:23-6
| Introduction|| |
Benign fibrous histiocytoma (BFH) includes a group of quasi-neoplastic lesions with both fibroblastic and histiocytic differentiation. lesions of the oral mucosa, like their dermatologic counterparts, are representative of reactive inflammatory processes rather than neoplastic processes. Some experts hypothesize that the cells originate from the tissue histiocytes subsequently assuming fibroblastic properties, although immunohistochemical evidence of factor XIIIa positivity favors a dermal dendrocytic cell origin. Consequence to the controversies of origin, BFH has been designated by several different names, such as sclerosing hemangioma, histiocytoma cutis, fibroxanthoma, and nodular subepidermal fibrosis.
Although BFH may occur anywhere in the body, including in visceral organs, skeletal system, or sinuses, the majority arise on the skin of the extremities. When BFH occurs in the dermis, the lesions are designated as dermatofibromas. Furthermore, BFH is also classified as superficial and deep lesions, depending on the location.
Fibrous histiocytoma has a malignant form, which is more often encountered in the literature. An intermediately aggressive variant (angiomatoid variant) has also been recognized since 1995 with local aggressiveness and a low rate of metastasis., Nowadays, BFH is included in the so-called “fibrohistiocytic tumors of the soft tissues” that are divided into cutaneous and noncutaneous types and in the “fibrohistiocytic tumors of the bone.”
The development of immunohistochemical techniques and electronic microscopy during the past three decades has allowed to discriminate between malignant and benign forms; consequently, benign fibrous histiocytoma (BFH) became a clinical entity, although many synonyms are still used.
The prognosis of oral BFH is very good. Local recurrence is present when the excision is incomplete. Of the cases with follow-up reported in the literature, only 2 (11%) out of 18 had a recurrence after a local excision.
| Case Report|| |
A male patient, aged 49 years, reported to the dental outpatient department of HAHC Hospital with the chief complaint of swelling in the palatal aspect of the upper front tooth region for past 1 year. The swelling started as a small in size which increased gradually to the present size. The patient sought treatment as it was painful on touch and gave him difficulty in speaking.
On examination, it was a firm sessile growth in relation to the palatal aspect of the upper central incisors. The surface was smooth, and the color was matching to the adjacent gingiva. The patient had a medical history of diabetes mellitus.
Following a workup on the blood profile and the glycemic control evaluation and radiologic investigation [Figure 1], surgical excision of the fibrous growth was done under local anesthesia. Hemostasis was achieved by electrocautery. The excised sample [Figure 2] and [Figure 3] was sent for histopathologic examination. Grossly, the globular growth measured 1 cm × 1.5 cm × 0.5 cm.
Histopathology revealed tissue lined by stratified squamous epithelium showing acanthosis and focal parakeratosis. The underlying tissue showed circumscribed lesion comprised of short intersecting fascicles of eosinophilic fibroblastic cells with ill-defined cytoplasm, mildly pleomorphic nuclei, and distinct eosinophilic nucleoli [Figure 4]. Furthermore, seen were scattered and aggregates of foamy histiocytes with Touton type of giant cells scattered throughout the lesion [Figure 5] and [Figure 6]. No mitosis or necrosis has been reported. Thus, a diagnosis of benign fibrohistiocytic tumor was rendered histologically.
|Figure 4: Section shows lining of stratified squamous epithelial cells. The underlying tissue shows well-circumscribed proliferation of fibro histiocytic cells (H and E, ×40)|
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|Figure 5: Section shows proliferation of spindle-shaped fibroblast along with the presence of giant cells (arrow) (H and E, ×400). Inset show sheets of foamy histiocytes|
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|Figure 6: Immunohistochemistry shows CD68 positive foamy histiocytes (IHC, CD68 ×400)|
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| Discussion|| |
Benign fibrous histiocytoma (also known as subepidermal nodular fibrosis, dermatofibroma, histiocytoma, and sclerosing hemangioma) refers to a spectrum of firm, nodular, nonencapsulated, often pigmented lesions that occur chiefly on the extremities.
Clinically, they maybe single or multiple and have a flat polypoid or depressed shape.
They are usually 1 cm in diameter but seldom may reach huge proportions. When pigmented, they are confused with nevi, malignant melanoma, Kaposi's sarcoma, and other vascular tumors. This explains the pigmented appearance of the growth in our patient.
On transection, they are usually solid and well circumscribed but not encapsulated, the color may range from white to yellow, to dark brown, depending on the amount of fibrous tissue, fat, and hemosiderin.
The etiology of oral BFH is obscure. Chronic irritation, continuous trauma, and spontaneous development have been reported for those located within the oral cavity.
Only rarely lesions may involve the oral mucosa or jawbones in the oral mucosa; BFH shows a predilection to the buccal mucosa and vestibule.
Compared to oral mucosal lesions, intraosseous lesions that involve the jawbones are extremely uncommon, with seven cases of mandibular and two maxillary BFH reported to date.
In our patient, the cause could be irritation due to local factors as the radiograph revealed bone loss. The case was of interest as it is a rare finding in the oral cavity; clinically it gave the impression of pyogenic granuloma, whereas the excised tissue showed fibroblastic component as well.
BFH is diagnosed by the exclusion of entities with similar features such as juvenile xanthogranuloma (S-100, CD1a positive), leiomyomas (smooth muscle actin positive), dermatofibrosarcoma protuberans (CD34 positive), as well as by the absence of positive staining with immunohistochemical markers other than vimentin, factor XIIIa, and CD68.
Peripheral giant cell granuloma is an oral giant cell lesion which can be differentiated from benign fibrous histiocytoma by the presence of abundant multinucleated giant cells of variable shapes and sizes along with numerous proliferating fibroblast in a vascularized fibrous stroma. Sheets of foamy histiocytes and Touton type giant cells as seen in our case are characteristically seen in BFH and are absent in peripheral giant cell granuloma.,
As the recurrence rate if improperly excised is high, it again is deemed necessary to do a deep excision and regular follow-up of the patient [Figure 7].
Indeed, for the BFH, it is necessary that the specimen has wide margins; the simple enucleation of the tumor from the surrounding tissue may facilitate local recurrence. Radiation therapy and chemotherapy have no role in the management of benign fibrous histiocytoma.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Hoffman S, Martinez MG Jr. Fibrous histiocytomas of the oral mucosa. Oral Surg Oral Med Oral Pathol 1981;52:277-83.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. Philadelphia: WB Saunders; 2001. p. 368-9.
Weiss S, Goldblum J. Enzinger and Weiss's Soft Tissue Tumors. 5th
ed. St. Louis: Mobsy; 2008. p. 331-48.
Rullo R, Ferraraccio F, Serpico R, Addabbo F, Mazzarella N, Festa VM. Oral fibrous histiocytoma and its angiomatoid variant. J Craniomaxillofac Surg 2012;40:435-8.
Gray PB, Miller AS, Loftus MJ. Benign fibrous histiocytoma of the oral/perioral regions: report of a case and review of 17 additional cases. J Oral Maxillofac Surg 1992;50:1239-42.
Skoulakis CE, Papadakis CE, Datseris GE, Drivas EI, Kyrmizakis DE, Bizakis JG. Subcutaneous benign fibrous histiocytoma of the cheek. Case report and review of the literature. Acta Otorhinolaryngol Ital 2007;27:90-3.
Enzinger FM, Weiss SW. Soft tissue tumours. St. Louis: Mosby Ed; 2008.
Bielamowicz S, Dauer MS, Chang B, Zimmerman MC. Non-cutaneous benign fibrous histiocytoma of the head and neck. Otolaryngol Head Neck 1995;113:140-6.
Rosai J. Soft tissues. Rosai and Ackerman's Surgical Pathology. 9th
ed. Missouri: Mosby-Elseiver; 2004. p. 2245.
Skin RJ. Rosai and Ackerman's Surgical Pathology. 9th
ed. Missouri: Mosby – Elsevier; 2004. p. 181-2.
Pandey NK, Sharma SK, Banerjee S. A rare case of fibrous histiocytic tumor of the tongue. Indian J Surg 2013;75:1-5.
Saluja H, Kasat VO, Rudagi BM, Dehane V, Kalburge JV, Nikam A. Benign fibrous histiocytoma of the maxilla: A case report and review of literature. Indian J Dent Res 2014;25:115-8.
] [Full text]
Giovani P, Patrikidou A, Ntomouchtsis A, Meditskou S, Thuau H, Vahtsevanos K. Benign fibrous histiocytoma of the buccal mucosa: Case report and literature review. Case Rep Med 2010;2010:306148-306148
Tandon PN, Gupta SK, Gupta DS, Jurel SK, Saraswat A. Peripheral giant cell granuloma. Contemp Clin Dent 2012;3:S118-21.
Patil KP, Kalele KP, Kanakdande VD. Peripheral giant cell granuloma: A comprehensive review of an ambiguous lesion. J Int Clin Dent Res Organ 2014;6:118-25. [Full text]
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]