Cytological findings of odontogenic myxofibroma: A diagnostic dilemma

Abstract

Odontogenic myxofibroma represents a rare slow-growing benign neoplasm, which usually occurs in the second and third decades of life and rarely in children or adults over 50 years of age. Myxomas in general represent from 2.3% to 17.7% of all odontogenic tumors, and myxofibromas represent a small number of all myxomas. Limited evidence is present in literature regarding the cytological diagnosis of odontogenic myxoma/myxofibroma. We hereby report the cytomorphological features of a histologically confirmed case of odontogenic myxofibroma and the pitfalls of the cytological diagnosis. A painless jaw swelling in a young boy was aspirated. Scanty mucoid material was obtained. Cytology Smears were moderately cellular and showed a population comprising predominantly of singly scattered plump to fusiform cells with bipolar cytoplasmic processes showing mild to moderate atypia embedded within dense myxoid matrix and another population of cells arranged in clusters. Case was interpreted as low grade mesenchymal tumor. Subsequent biopsy confirmed it as odontogenic myxofibroma arising in a odontogenic keratocyst. Precise interpretation of intraosseous jaw lesions FNAC may not always be possible, but an attempt should be made to broadly classify the lesion as an inflammatory lesion, cystic lesion, giant cell lesion, fibro-osseous lesion or as an odontogenic tumor. If dual population of odontogenic epithelium and mesenchymal cells embedded in myxoid matrix are identified in such aspirates, a possibility of myxoid odontogenic tumor may be suggested. Triple correlation of cytological, clinical and radiological findings can guide the surgeon for taking appropriate therapeutic decisions.

Characteristic features of the odontogenic myxoma on cone beam computed tomography

“…In reference to the literature, the histopathology of OM needs to be differentiated from various benign lesions with a myxoid change including the dental papilla of a developing tooth. 5,18 OMs have a variable radiographic appearance and can mimic various lesions of the jaw, which often leads to a misdiagnosis. OMs should be differentiated from ameloblastomas, central giant-cell granulomas and intraosseous haemangiomas.…”

Odontogenic fibromyxoma: A case report in myasthenia gravis patient and review of the literature

“…When the literature was searched for the incidence of odontogenic fibromyxoma, no single incidence rate was found. Myxomas constitutes approximately 1–17.7 % of all odontogenic tumors and odontogenic fibromyxomas represent a very small part of all myxomas and their prevalence varies from 0.04 % to 3.7 % [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] .…”

“…It either mixes freely with the tissue from which it comes out or is separated by a pseudocapsule. Myxomas contain little collagen and unlike myxomas, fibromyxomas may show calcification or ossification and contain higher amounts of thick collagen fibers and vessels [7] , [9] , [10] , [12] , [13] , [17] , [18] , [19] . There is no difference in the biological behavior of myxomas and fibromyxomas [21] .…”

“…Recent studies are considered to originate from primitive mesenchymal structures and are thought to arise from bone, tooth germ, or odontogenic tissues such as dental papilla, dental follicle or periodontal ligament. For this reason, we can say that all myxomas seen in the jaws are of odontogenic origin [7] , [8] , [9] , [10] , [11] , [13] , [14] , [15] , [16] , [17] , [20] , [23] , [24] , [25] , [26] , [27] , [28] , [29] .…”

“…It was observed that it peaked in the third decade. [2] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [16] , [17] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] . It is rarely seen in adults over 50 and children under 10 years of age [1] , [8] , [9] , [10] , [11] , [14] , [20] , [21] , [23] , [25] .…”