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Gupta S et al. : Benign Fibrous CASE REPORT

Benign Fibrous Histiocytoma: A Rare Case Report Suhani Gupta1, Yukti Dobhal2, Vinay Badyal3, Ranjeeta Mehta4 Correspondence to : 1,2,3-PG student, Seema Dental College And Hospital, Veerbhadra Road, Dr. Suhani Gupta, PG student, Seema Dental Rishikesh. 4- Senior Lecturer, Seema Dental College And Hospital, Veerbhadra College And Hospital, Veerbhadra Road, Rishikesh. Road, Rishikesh. Contact Us: www.ijohmr.com

ABSTRACT

It is also called as “.” It is a common benign mesenchymal tumor composed of fibroblastic and histiocytic cells. Fibrous histiocytoma is a benign tumor arising as a fibrous mass everywhere in the human body. The involvement of the oral cavity is rare. The case is presented here for its rarity and an uncommon site of involvement with its clinical and histological features. KEYWORDS: Benign fibrous Histiocytoma, Mesenchymal Tumor, Lower lip gates, imparting a storiform or crisscross pattern on low AINTRODUCTIONASSSAAsasasss power magnification. 2This article describes a case of Benign fibrous histocytoma of the lower lip and discusses It is also called as “Dermatofibroma.” It is a common its clinical and pathological characteristics and its benign mesenchymal tumor composed of fibroblastic and management. histiocytic cells.1It is a variant of cutaneous histiocytoma or dermatofibroma described by Fletcher in 1990 as a tumor originating in the subcutaneous tissue. In CASE REPORT consequence of the controversies of origin, over the A 32-year-old female came to the department of OMR years, it has been designated by several different names, with the chief complaint of swelling on the lower lip such as sclerosing , histiocytoma cutis, since 1 month. On examination, a dome-shaped swelling fibroxanthoma and nodular subepidermal fibrosis.2 was present on the lower labial mucosa near the Fibrous histiocytoma is a benign soft tissue tumor arising vermillion border. Size of swelling was 1×1 cm (Figure as a fibrous mass everywhere in the human body. Oral 1). The swelling was slightly erythematous due to local and perioral lesions are uncommon, but when they occur, trauma. On palpation, the swelling was firm and non- they predominantly occur on the buccal mucosa and tender with a sessile base. Based on patient‟s history and 2 vestibule. Fibrous histiocytomas can be classified as clinical examination, the provisional diagnosis was given benign and malignant. Benign fibrous histiocytomas can as fibrosed mucocele. The patient underwent an excision be further sub-divided by tissue of origin, either dermal of the mass under local anesthesia. On surgical excision, or subcutaneous. Cutaneous benign fibrous histiocytoma, the mass was easily dissected from the surrounding or dermatofibroma, is localized to the and tissues (Figure 2). The mass was grossly round in characterized by an assortment of spindle and/or rounded appearance, with a sessile base (Figure 3). Histo- cells.1 Lesion are commonly seen in 3rd and 4th decades pathologically it was composed of -like spindle of life. Clinically, it presents as a single, round lesion, cells having a storiform arrangement focally (Figure 4). appearing reddish early on, and changes to more brown There was a scattered inflammatory infiltrate or skin-coloured with time. They are moderately well predominantly composed of lymphocytes and plasma circumscribed and produce the characteristic “dimpling” sign when squeezed between the examiner‟s fingers.1 Fibrous histiocytoma is characterized by a submucosal, cellular aggregation of spindle-shaped, fibroblast-like cells with relatively pale, oval nuclei, scattered rounded histiocytic cells are also present. Foamy histiocytes and Touton-type multinucleated giant cells, with nuclei pushed to the periphery, may be seen to contain phagocytosed lipid or hemosiderin; these cells sometimes are so numerous that they form xanthomatous aggregates.2 The spindled cells may be arranged randomly but usually there are large areas with tumor cells streaming in interlacing fascicles from a central nidus and intersecting with cells from adjacent aggre- Figure 1: Preoperative view of the lesion

How to cite this article: Manandhar A, Vikram M, Agrawal N, BhandarI A. Efficacy of Laboratory and Conventional Radiological methods to identify Canal Configurations in Maxillary First Molars. Int J Oral Health Med Res 2017;4(5):62-64.

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2018 | VOL 4 | ISSUE 5 62

Gupta S et al. : Benign Fibrous Histiocytoma CASE REPORT

aggressive behavior with overlying intact mucosa5 and produce the character „dimpling‟ sign when squeezed between the examiners finger1,5. Prolonged sun exposure, traumatic injury and chronic infection have been suggested as possible causative agents.6 Histopathologically, it typically shows a biphasic cell population of histiocytes and .7 In some cases the cells resemble myofibroblasts, primitive mesenchymal cells, and cells having intermediate or mixed features. 1 Fibrous histiocytoma is characterized by a submucosal, cellular aggregation of spindle-shaped, fibroblast-like cells with relatively pale, oval nuclei, Figure 2: Intraoperative view of the lesion scattered rounded histiocytic cells are also present. Foamy histiocytes and Touton-type multinucleated giant cells, with nuclei pushed to the periphery, may be seen to contain phagocytosed lipid or hemosiderin; these cells sometimes are so numerous that they form xanthomatous aggregates.2 The spindled cells may be arranged randomly but usually there are large areas with tumor cells streaming in interlacing fascicles from a central nidus and intersecting with cells from adjacent aggregates, imparting a storiform or crisscross pattern on low power magnification.2The immune-histochemical features may vary over time, with early lesions of showing reactivity for CD68 and factor XIIIa, which may diminish progressively. CD56 and Figure 3: Excised specimen neuron-specific enolase are variably expressed, and S-100 protein is only exceptionally expressed.8 Lysozyme can also be positive. Treatment and Prognosis: We reported the clinical and microscopic aspects of a case of Benign fibrous histocytoma of the lower lip. In general, local surgical excision is the treatment of choice. The prognosis is excellent. Recurrence is uncommon, but a routine follow- up is necessary. CONCLUSION Benign fibrous histiocytomas are consistent in clinical and histopathologic presentation. Histological examination is mandatory as it is the only way to confirm the benignity of the lesion. Surgical treatment provides Figure 4: H&E stain shows Spindle-shaped cells in a storiform an excellent outcome, with no recurrence in all excised pattern cases. cells. And the final diagnosis on the basis of histopathology was given as benign fibrous histocytoma. REFERENCES 1. LeBoit PE, Burg G, Weedon D, Sarasin A. World Health Organization Classification of Tumours. Pathology and DISCUSSION Genetics. Skin Tumours Lyon: IARC Press; 2006. Benign fibrous histocytoma is a diverse group of tumors 2. Neville BW, Damm DD, Allen CM, Bouquot JE (eds): that exhibit both fibroblastic and histiocytic Oral and Maxillofacial Pathology, ed 2. Philadelphia, WB differentiation. It is a variant of cutaneous histiocytoma Saunders, 2001, pp 368–369. or dermatofibroma. It is described by Fletcher as a tumor 3. Garrido-Ruiz MC, Carrillo R, Enguita AB, Peralto JL originating in the subcutaneous tissue in 1990.3 Fibrous (2009) Signet-ring cell dermatofibroma. Am J Dermatopathol 31: 84-87. histiocytoma that arises in the skin as a cutaneous fibrous 4. Hutchinson J.C., and Friedberg S.A.: Fibrous histiocytoma histiocytoma (dermatofibroma) may be distinguished of head and neck: a case report. Laryngoscope 88： 1950– from the deep benign fibrous histocytoma of the soft 4 1955, 1978. tissue. The incidence is slightly high in 5. Yamada H., Ishii H., Kondoh T., et al.: A case of benign fi- immunosuppression. Clinically, it appears mainly as a broushistiocytoma of the upper lip in a 6-month-old infant. lump, slowly enlarging, well-circumscribed lesion, no J Oral MaxillofacSurg 60：451–454, 2002.

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2018 | VOL 4 | ISSUE 5 63

Gupta S et al. : Benign Fibrous Histiocytoma CASE REPORT

6. Hoffman S., and Martinez M.G.: Fibrous histiocytoma of 8. Giovani P, Patrikidou A, Ntomouchtsis A, Meditskou S, the oral mucosa. Oral Surg Oral Med Oral Pathol 52： Thuau H, Vahtsevanos K: Benign fibrous histiocytoma of 277–283, 1981. the buccal mucosa: case report and literature review. Case 7. E. Calonje, T. Mentzel, and C. D. M. Fletcher, “Cellular Rep Med 2010;2010:306148. benign fibrous histiocytoma: clinicopathologic analysis of

74 cases of a distinctive variant of cutaneous fibrous histiocytoma with frequent recurrence,” American Journal Source of Support: Nil of Surgical Pathology, vol. 18, no. 7, pp. 668–676, 1994. Conflict of Interest: Nil

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2018 | VOL 4 | ISSUE 5 64