Head and Neck Pathology

, Volume 4, Issue 1, pp 44–48 | Cite as

Collagenous Myofibroblastic Tumor of the Mandible: Case Report of a Unique Locally Aggressive Neoplasm

  • Jason W. Nash
  • Amy C. Hessel
  • Nadarajah Vigneswaran
  • Adel K. El-Naggar
Case Report


We report a locally aggressive collagenous myofibroblastic neoplasm of the mandible in an 18-year-old male. Clinically, the lesion presented with rapid growth and irregular mandibular bone destruction. Grossly, the tumor was 10 cm in greatest dimension, light-tan, firm, and involving the posterior one-thirds of the body and inferior half of the left mandibular ramus. Histologically, the lesion was composed of a loose spindle cell proliferation interspersed with periodic dense bands of collagen. The spindle cells reacted positively to smooth muscle actin, calponin, and focally to desmin and were negative for S-100, pan-cytokeratin, CD99, CD34 and caldesmon, supporting myofibroblastic derivation. At our 4 year follow-up, the patient remained free of local recurrence and surgery related complications. The clinicopathologic findings and the differential diagnosis of this lesion is presented and discussed.


Mandible Myofibroblastic neoplasm Mesenchymal tumors Odontogenic tumors 



The authors thank Dr. John G. Batsakis for his review and constructive suggestions.


  1. 1.
    Neville BW, Damm DD, Allen CM, Bouquot JE, editors. Oral and maxillofacial pathology. 3rd ed. Amsterdam: Elsevier Saunders; 2009.Google Scholar
  2. 2.
    Takeuchi H, Ozawa S, Ando N, Kitagawa Y, Ueda M, Kitajima M. Cell-cycle regulators and the Ki-67 labeling index can predict the response to chemoradiotherapy and the survival of patients with locally advanced squamous cell carcinoma of the esophagus. Ann Surg Oncol. 2003;10(7):792–800.CrossRefPubMedGoogle Scholar
  3. 3.
    Lombardi T, Lock C, Samson J, Odell EW. S100, alpha-smooth muscle actin and cytokeratin 19 immunohistochemistry in odontogenic and soft tissue myxomas. J Clin Pathol. 1995;48(8):759–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Skalli O, Schurch W, Seemayer T, Lagace R, Montandon D, Pittet B, et al. Myofibroblasts from diverse pathologic settings are heterogeneous in their content of actin isoforms and intermediate filament proteins. Lab Invest. 1989;60(2):275–85.PubMedGoogle Scholar
  5. 5.
    Watanabe K, Kusakabe T, Hoshi N, Saito A, Suzuki T. h-Caldesmon in leiomyosarcoma and tumors with smooth muscle cell-like differentiation: its specific expression in the smooth muscle cell tumor. Hum Pathol. 1999;30(4):392–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Watanabe K, Ogura G, Tajino T, Hoshi N, Suzuki T. Myofibrosarcoma of the bone: a clinicopathologic study. Am J Surg Pathol. 2001;25(12):1501–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Laskin WB, Fetsch JF, Tavassoli FA. Superficial cervicovaginal myofibroblastoma: fourteen cases of a distinctive mesenchymal tumor arising from the specialized subepithelial stroma of the lower female genital tract. Hum Pathol. 2001;32(7):715–25.CrossRefPubMedGoogle Scholar
  8. 8.
    MacGregor AR, Batsakis JG, El-Naggar AK. Myofibroblastoma of the larynx: a study of two cases. Head Neck. 2003;25(7):606–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Prayson RA, Estes ML, McMahon JT, Kalfas I, Sebek BA. Meningeal myofibroblastoma. Am J Surg Pathol. 1993;17(9):931–6.PubMedGoogle Scholar
  10. 10.
    Sahin AA, Ro JY, Ordonez NG, Luna MA, El-Naggar AK, Goepfert H, et al. Myofibroblastoma of the tongue. An immunohistochemical ultrastructural and flow cytometric study. Am J Clin Pathol. 1990;94(6):773–7.PubMedGoogle Scholar
  11. 11.
    Wargotz ES, Weiss SW, Norris HJ. Myofibroblastoma of the breast. Sixteen cases of a distinctive benign mesenchymal tumor. Am J Surg Pathol. 1987;11(7):493–502.CrossRefPubMedGoogle Scholar
  12. 12.
    Weiss SW, Gnepp DR, Bratthauer GL. Palisaded myofibroblastoma A benign mesenchymal tumor of lymph node. Am J Surg Pathol. 1989;13(5):341–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Fisher C. Myofibroblastic malignancies. Adv Anat Pathol. 2004;11(4):190–201.CrossRefPubMedGoogle Scholar
  14. 14.
    Mentzel T, Dry S, Katenkamp D, Fletcher CD. Low-grade myofibroblastic sarcoma: analysis of 18 cases in the spectrum of myofibroblastic tumors. Am J Surg Pathol. 1998;22(10):1228–38.CrossRefPubMedGoogle Scholar
  15. 15.
    Montgomery E, Goldblum JR, Fisher C. Myofibrosarcoma: a clinicopathologic study. Am J Surg Pathol. 2001;25(2):219–28.CrossRefPubMedGoogle Scholar
  16. 16.
    Smith DM, Mahmoud HH, Jenkins JJ 3rd, Rao B, Hopkins KP, Parham DM. Myofibrosarcoma of the head and neck in children. Pediatr Pathol Lab Med. 1995;15(3):403–18.PubMedGoogle Scholar
  17. 17.
    Wenig BM, Devaney K, Bisceglia M. Inflammatory myofibroblastic tumor of the larynx. A clinicopathologic study of eight cases simulating a malignant spindle cell neoplasm. Cancer. 1995;76(11):2217–29.CrossRefPubMedGoogle Scholar
  18. 18.
    Sastre-Garau X, Couturier J, Derre J, Aurias A, Klijanienko J, Lagace R. Inflammatory myofibroblastic tumour (inflammatory pseudotumour) of the breast. Clinicopathological and genetic analysis of a case with evidence for clonality. J Pathol. 2002;196(1):97–102.CrossRefPubMedGoogle Scholar
  19. 19.
    Fujiwara M, Yuba Y, Wada A, Imaoka I, Shintaku N, Miyanishi S. Myofibrosarcoma of the nasal bone. Am J Otolaryngol. 2005;26(4):265–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Meng GZ, Zhang HY, Bu H, Yang GH, Zhang XL, Yang G. Myofibroblastic sarcoma of the nasal cavity and paranasal sinus: a clinicopathologic study of 6 cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(4):530–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Foss RD, Ellis GL. Myofibromas and myofibromatosis of the oral region: a clinicopathologic analysis of 79 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(1):57–65.CrossRefPubMedGoogle Scholar
  22. 22.
    Vered M, Allon I, Buchner A, Dayan D. Clinico-pathologic correlations of myofibroblastic tumors of the oral cavity II. Myofibroma and myofibromatosis of the oral soft tissues. J Oral Pathol Med. 2007;36(5):304–14.PubMedGoogle Scholar
  23. 23.
    Vigneswaran N, Boyd DL, Waldron CA. Solitary infantile myofibromatosis of the mandible. Report of three cases. Oral Surg Oral Med Oral Pathol. 1992;73(1):84–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Dayan D, Nasrallah V, Vered M. Clinico-pathologic correlations of myofibroblastic tumors of the oral cavity: 1. Nodular fasciitis. J Oral Pathol Med. 2005;34(7):426–35.CrossRefPubMedGoogle Scholar
  25. 25.
    Antonescu CR, Erlandson RA, Huvos AG. Primary leiomyosarcoma of bone: a clinicopathologic, immunohistochemical, and ultrastructural study of 33 patients and a literature review. Am J Surg Pathol. 1997;21(11):1281–94.CrossRefPubMedGoogle Scholar
  26. 26.
    Reichart PA, Philipsen HP. Odontogenic tumors and allied lesions. London: Quintessence; 2004.Google Scholar
  27. 27.
    Zhang HY, Gharaee-Kermani M, Zhang K, Karmiol S, Phan SH. Lung fibroblast alpha-smooth muscle actin expression and contractile phenotype in bleomycin-induced pulmonary fibrosis. Am J Pathol. 1996;148(2):527–37.PubMedGoogle Scholar
  28. 28.
    Desmouliere A, Geinoz A, Gabbiani F, Gabbiani G. Transforming growth factor-beta 1 induces alpha-smooth muscle actin expression in granulation tissue myofibroblasts and in quiescent and growing cultured fibroblasts. J Cell Biol. 1993;122(1):103–11.CrossRefPubMedGoogle Scholar
  29. 29.
    Roy SG, Nozaki Y, Phan SH. Regulation of alpha-smooth muscle actin gene expression in myofibroblast differentiation from rat lung fibroblasts. Int J Biochem Cell Biol. 2001;33(7):723–34.CrossRefPubMedGoogle Scholar
  30. 30.
    Meister P, Wockel W, Schmidt D, Trupka A. Pulmonary myofibroblastic nodules with “amianthoid features”. Pathol Res Pract. 1991;187(7):906–11.PubMedGoogle Scholar
  31. 31.
    Liu T, Dhanasekaran SM, Jin H, Hu B, Tomlins SA, Chinnaiyan AM, et al. FIZZ1 stimulation of myofibroblast differentiation. Am J Pathol. 2004;164(4):1315–26.PubMedGoogle Scholar

Copyright information

© Humana 2009

Authors and Affiliations

  • Jason W. Nash
    • 1
  • Amy C. Hessel
    • 2
  • Nadarajah Vigneswaran
    • 3
  • Adel K. El-Naggar
    • 1
    • 2
  1. 1.Department of PathologyThe University of Texas M.D. Anderson Cancer Center, Unit 85HoustonUSA
  2. 2.Head and Neck SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  3. 3.Department of Diagnostic SciencesThe University of Texas Dental Branch at HoustonHoustonUSA

Personalised recommendations