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  Table of Contents    
LETTER TO EDITOR  
Year : 2020  |  Volume : 63  |  Issue : 4  |  Page : 666-667
Soft tissue myxoma of tongue: An infrequent case report


1 Department of Oral Pathology and Microbiology, Manav Rachna Dental College, Faridabad, Haryana, India
2 Department of Periodontology, Manav Rachna Dental College, Faridabad, Haryana, India

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Date of Submission22-Feb-2019
Date of Decision21-Jul-2019
Date of Acceptance24-Jul-2019
Date of Web Publication28-Oct-2020
 

How to cite this article:
Sharma J, Raina AB, Varshney A, Chopra D. Soft tissue myxoma of tongue: An infrequent case report. Indian J Pathol Microbiol 2020;63:666-7

How to cite this URL:
Sharma J, Raina AB, Varshney A, Chopra D. Soft tissue myxoma of tongue: An infrequent case report. Indian J Pathol Microbiol [serial online] 2020 [cited 2020 Dec 1];63:666-7. Available from: https://www.ijpmonline.org/text.asp?2020/63/4/666/299298




Dear Editor,

Odontogenic myxoma (OM) is a mesenchymal tissue benign neoplasia, being relatively rare which is almost exclusively seen in tooth-bearing areas. It accounts for 0.2-1 7.7% of odontogenic tumors.[1] Most soft tissue myxomas are deeply situated lesions, occurring in the skin or the subcutaneous tissues, gastrointestinal tract or in organs, such as liver, spleen, or even parotid gland.[2] These tumors may occur almost in every decade of life, with a peak occurrence in the fourth decade.[3] They present macroscopically as gray white, mucoid masses with a smooth or multinodular external appearance and they are usually encapsulated or circumscribed.[4] The clinical presentation of intraoral soft tissue myxoma are not pathognomonic. Most cases are misdiagnosed as irritational fibroma, fibro epithelial polyp and tumors of minor salivary glands. Diagnosis can be established only after histologic examination of the lesion.[5] Because of the rarity of this lesion, we report a case of soft tissue myxoma located on the posterolateral aspect of tongue.

A 68-year-old female patient reported with chief complaint of painless mass on the right posterolateral aspect of the tongue since 7–8 months [Figure 1]a. History of presenting illness revealed growth started 7–8 months back. Initially it was small and has grown to the present size. The swelling was painless. Occasionally, the patient complained of discomfort while chewing food. There was no associated history of trauma, pain, tooth extraction, or intraoral bleeding. On intraoral examination, a 2 × 2 cm smooth, sessile, firm, non-tender swelling was noticed on the right posterolateral aspect of the tongue. The overlying mucosa was normal. Excisional biopsy was performed following administration of local anesthesia, and the tissue was sent for histological evaluation. The histopathologic examination of hematoxylin and eosin-stained section of the tissue reveals loose myxomatous tissue with stellate shaped fibroblasts and some diffuse fat cells are seen in the surrounding normal connective tissue stroma [Figure 1]b and [Figure 1]c. An immunohistochemical study was done to help in confirming the diagnosis. An immunohistochemical examination showed positivity for Vimentin, a low index of expression of Ki-67 protein (<1%) [Figure 1]d and [Figure 1]e. To differentiate myxoma from low-grade sarcomas MUC 4 marker was used and found a negative expression [Figure 1]f. By correlating both the above clinical and histological findings, a final diagnosis of intraoral soft tissue myxoma was made. No recurrence was present at a 6 months follow-up.
Figure 1: (a) Clinical appearance of the lesion (b) Photomicrograph showing haphazardly arranged stellate and spindle-shaped cells (H and E, 10×) (c) Photomicrograph showing loose myxomatous tissue with stellate shaped fibroblasts (H and E, 40×) (d) Immunohistochemical examination showed positivity for Vimentin (40×) (e) Low index of expression of Ki-67 (10×) (f) Negative expression of MUC 4 (10×)

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Odontogenic myxoma (OM) of the jaws, first described by Thoma and Goldman in 1947, is believed to arise from odontogenic ectomesenchyme.[6] OM commonly occurs in the second and third decade and the mandible is involved more commonly than the maxilla. The lesion often grows without symptoms and presents as a painless swelling. Radiographically, the myxoma appears as a unilocular or multilocular radiolucency.[2] The odontogenic myxomas of the jaw are divided into two types, central myxomas located intraosseous and peripheral myxomas occurring in soft tissue overlying tooth-bearing areas of the mandible and the maxilla.[7] In 1985, Tse and Vander reviewed 43 cases of soft tissue myxoma of the head and neck region. In their study, men were affected more than women (59%) and the most common location was the palate, followed by the parotid area.[8] In 2000, Shimoyama et al. attributed the origin of these tumors to mesenchymal elements derived from dental papilla, dental follicle, or periodontal membrane. However, the histogenesis of these lesions remains obscure and further studies are necessary to clarify its origin.[9] In 2006, Perrotti V, Rubini C, Fioroni M, Piattelli A did an immunohistochemical study using S-100 and Vimentin, they found that S-100 protein were negative, while those with vimentin were positive.[3] Radiographically, the myxoma appears as a unilocular or multilocular radiolucency with irregular or scalloped margins. Large myxomas may show a “soap bubble” radiolucent pattern, which is indistinguishable from that seen in Ameloblastoma. The tumor is not radiosensitive and surgery is the treatment of choice.[1] Treatment of OM varies from local excision, curettage, or enucleation to radical resection. OMs bear a high risk of recurrence, mainly due to its gelatinous aspect and the fact that it does not have a capsule, thus it is necessary that the initial treatment be very efficient.[10]

Purpose of this case is to increase the existing knowledge of this rare entity as clinical presentation of intraoral soft tissue myxoma are not pathognomonic and most cases are misdiagnosed as irritational fibroma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Manjunath SM, Gupta AA, Swetha P, Moon NJ, Singh S, Singh A. Report of a rare case of an odontogenic myxoma of the maxilla and review of literature. Ann Med Health Sci Res 2014;4:45-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
James L, Shetty A, Jaypal N, Okade D. Oral soft tissue myxoma. J Indian Aca Oral Med Radiol 2012;24:152-4.  Back to cited text no. 2
    
3.
Perrotti V, Rubini C, Fioroni M, Piattelli A. Soft tissue myxoma: Report of an unusual case located on the gingiva. J Clin Periodontol 2006;33:76-8.  Back to cited text no. 3
    
4.
Barnes L. Surgical Pathology of the Head and Neck. 2nd ed., Vol. 2. New York, USA: Marcel Dekker; 2001. p. 1649-72.  Back to cited text no. 4
    
5.
Epivatianos A, Iordanidis S, Zaraboukas T. Myxoma of oral soft tissues: Report of a case and literature review. J Oral Maxillofac Surg 2007;65:317-20.  Back to cited text no. 5
    
6.
Noffke CE, Raubenheimer EJ, Chabikuli NJ, Bouckaert MM. Odontogenic myxoma: Review of the literature and report of 30 cases from South Africa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:101-9.  Back to cited text no. 6
    
7.
Gundlach KK, Schulz A. Odontogenic myxoma-clinical concept and morphological studies. J Oral Pathol 1997;6:343-58.  Back to cited text no. 7
    
8.
Tse JJ, Vander S. The soft tissue myxoma of the head and neck region-report of a case and literature review. Head Neck Surg 1985;7:479-83.  Back to cited text no. 8
    
9.
Shimoyama T, Horic N, Kato T, Tojo T, Nasu D, Kaneko T, et al. Soft tissue myxoma of the gingiva: Report of a case and review of the literature of soft tissue myxoma in the oral region. J Oral Sci 2000;42:107-9.  Back to cited text no. 9
    
10.
Simon EN, Merkx MA, Vuhahula E, Ngassapa D, Stoelinga PJ. Odontogenic myxoma: A clinicopathological study of 33 cases. Int J Oral Maxillofac Surg 2004;33:333-7.  Back to cited text no. 10
    

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Correspondence Address:
Jaishree Sharma
856, Dr Mukherjee Nagar, New Delhi - 110 009
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_139_19

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