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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 14  |  Issue : 1  |  Page : 30-32

Unusually large leiomyoma of buccal mucosa – Clinical case report


MDC, Bareilly, Uttar Pradesh, India

Date of Submission17-Dec-2019
Date of Acceptance20-Dec-2019
Date of Web Publication31-Jan-2020

Correspondence Address:
Rajashekhar D Gadad
MDC Bareilly C/o 56 APO
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JODD.JODD_2_19

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  Abstract 


Leiomyomas are benign smooth muscle tumors, which occur most commonly, in the uterine myometrium, gastrointestinal tract, skin, and lower extremities of women. Only 1% of leiomyomas occur in the head-and-neck region. A thorough differential diagnosis is required before undertaking surgical excision of a lesion as it mimics fibromas, lipomas, and sometimes, leiomyosarcomas. We report a case of a 40-year-old male with an unusually large leiomyoma on the right buccal mucosa, which was present for 4 years. A complete surgical excision of the lesion was done. There was no recurrence of the lesion seen anywhere in the oral cavity.

Keywords: Benign, leiomyoma, oral cavity, smooth muscle


How to cite this article:
Gadad RD, Jha A K, Rani I. Unusually large leiomyoma of buccal mucosa – Clinical case report. J Dent Def Sect. 2020;14:30-2

How to cite this URL:
Gadad RD, Jha A K, Rani I. Unusually large leiomyoma of buccal mucosa – Clinical case report. J Dent Def Sect. [serial online] 2020 [cited 2020 Jul 2];14:30-2. Available from: http://www.journaldds.org/text.asp?2020/14/1/30/276404




  Introduction Top


Soft-tissue tumors of the oral cavity have been for long a reason of interest and concern for the varied nature of their etiology and their treatment modalities. Leiomyomas are benign soft-tissue neoplasms, which arise from the smooth muscle. Virchow was the first to describe in 1854, and later, Blanc in 1884 first reported about these neoplasms. Several histological variants are described such as solid leiomyoma, vascular leiomyoma, and epithelioid leiomyoma.[1],[2]

The tumor usually manifests clinically as a painless slow-growing asymptomatic submucosal mass which is solitary and nodular located principally on the tongue, lips, palate, buccal mucosa, gingiva, and palate and are frequently asymptomatic, but symptoms such as pain and mobility of the teeth have been reported.[2],[3],[4] Differential diagnosis must include the malignant form of leiomyoma that is leiomyosarcoma, which has also been reported.


  Case Report Top


A 40-year-old male presented with an unusually large swelling of 4-year duration involving the right buccal vestibule near the mandibular third molar region [Figure 1]. The swelling was initially a pea-sized swelling when he first observed and has progressively grown to its present size over the years. There was no associated pain or discharge from the swelling. The medical history was noncontributory and he had never shown the swelling to anybody. On eliciting the personal history, he was a known tobacco chewer for the past 22 years and had quit chewing tobacco for the past 2 years after he noticed that the swelling was slowly growing in size. The clinical examination revealed a large nonulcerated, ovoid swelling of approximately 4 cm × 3 cm in size over the right buccal vestibule region arising from the mucogingival junction adjacent to the right mandibular third molar. The lesion was nonulcerated, firm, nontender, and nonfluctuant with no local rise in temperature. An incisional biopsy was performed which was suggestive of an irritation fibroma. All routine blood investigations were done along with an ultrasonography of the neck to rule any lymph node involvement. An excisional biopsy along with margins was done under general anesthesia and the mass was removed en masse and the surgical margins were closed with sutures. The excised tissue was sent for histopathological examination [Figure 2]. The report suggested a stratified squamous keratinized epithelium enclosing a tumor composed of interlacing bundles of smooth muscle fibers, which was histopathologically diagnosed as leiomyoma of the right buccal mucosa. Postoperative status of the patient was uneventful [Figure 3]. The individual had completely stopped his tobacco chewing habit. There was no recurrence seen in a follow-up period of 2 years.
Figure 1: Preoperative view of an intraoral lesion

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Figure 2: Postoperative tumor en masse

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Figure 3: Postoperative site 15th day

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  Discussion Top


Leiomyomas were included in the WHO classification (2002) of tumors arising from the smooth muscle. Leiomyomas are benign tumors arising from the smooth muscle, most commonly seen in the uterine myometrium, gastrointestinal tract, skin, and lower extremities of middle-aged women. Leiomyomas are uncommon in the oral cavity with reported incidence of 0.065%, which accounts for 0.42% of all soft-tissue neoplasms in the oral cavity, and the most common site of leiomyoma in the head-and-neck region is the lips (27.46%), followed by the tongue (18.30%), cheeks and palate (15.49%), gingiva (8.45%), and mandible (5.63%).[5],[6] The source of the smooth muscle in the oral cavity is either the arterial tunica media suggested by Stout[7] or the ductus lingualis and the circumvallate papillae or heterotropic embryonal tissue.[8] The highest prevalence of head-and-neck leiomyomas is observed in the fourth and fifth decades of life, with a peak incidence from 40 to 49 years of age.[9] A higher incidence of this tumor (3.75:1 = F:M) in females could be attributed to hormonal variations.[10] Most of the cases indicate an asymptomatic slow-growing mass, but some authors have reported symptomatic lesions with difficulty in swallowing or chewing and loose teeth induced due to the local growth.[3] The clinical differential diagnosis relevant to extraoral leiomyoma includes fibroma, lipoma, neurofibroma, dermatofibroma, lymphangioma, hemangioma, and soft-tissue cysts such as dermoid cysts.[11] Leiomyomas must be carefully distinuished from the malignant variety leiomyosarcoma, as both can demonstrate similar clinical features.

The usual size of oral leiomyomas is between 1 and 2 cm with an average history of less than a year.[12] However, in our case, the size was unusually large with a history of more than 1 year. The treatment of choice is local resection with an adequate margin of normal tissue. As seen in our case, local excision with 5 mm margins can lead to no recurrence of the lesion.

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.
Rajendran R, Sivapathasundaram B. Shafer's Textbook of Oral Pathology. 5th ed. New Delhi: Elsevier Publishers; 2006.  Back to cited text no. 1
    
2.
Gaitan Cepeda LA, Quezada Rivera D, Tenorio Rocha F, Leyva Huerta ER, Mendez Sánchez ER. Vascular leiomyoma of the oral cavity. Clinical, histopathological and immunohistochemical characteristics. Presentation of five cases and review of the literature. Med Oral Patol Oral Cir Bucal 2008;13:E483-8.  Back to cited text no. 2
    
3.
Cherrick HM, Dunlap CL, King OH Jr. Leiomyomas of the oral cavity. Review of the literature and clinicopathologic study of seven new cases. Oral Surg Oral Med Oral Pathol 1973;35:54-66.  Back to cited text no. 3
    
4.
Kelly DE, Harrigan WF. Leiomyoma of the tongue: Report of case. J Oral Surg 1977;35:316-8.  Back to cited text no. 4
    
5.
Gianluca S, Marini R, Tonoli F, Cristalli MP. Leiomyoma of oral cavity: Case report and literature review. Ann Stomatol (Roma) 2011;2:9-12.  Back to cited text no. 5
    
6.
Baden E, Doyle JL, Lederman DA. Leiomyoma of the oral cavity: A light microscopic and immunohistochemical study with review of the literature from 1884 to 1992. Eur J Cancer B Oral Oncol 1994;30B: 1-7.  Back to cited text no. 6
    
7.
Stout AP. Solitary cutaneous and subcutaneous leiomyoma. Am J Cancer 1937;29:435.  Back to cited text no. 7
    
8.
Loyola AM, Araújo NS, Zanetta-Barbosa D, Mendes VC, Jordão-Silva C, Bittar TO. Intraosseous leiomyoma of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:78-82.  Back to cited text no. 8
    
9.
Leung KW, Wong DY, Li WY. Oral leiomyoma: Case report. J Oral Maxillofac Surg 1990;48:735-8.  Back to cited text no. 9
    
10.
Meher R, Varshney S. Leiomyoma of the nose. Singapore Med J 2007;48:e275-6.  Back to cited text no. 10
    
11.
Brooks JK, Nikitakis NG, Goodman NJ, Levy BA. Clinicopathologic characterization of oral angioleiomyomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:221-7.  Back to cited text no. 11
    
12.
Epivatianos A, Trigonidis G, Papanayotou P. Vascular leiomyoma of the oral cavity. J Oral Maxillofac Surg 1985;43:377-82.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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