Page 36 - AAOMP Meeting 2019

POSTER ABSTRACTS - TUESDAY, JUNE 11, 2019

#23 THE RARE RADIOGRAPHIC SUNRAY APPEARANCE OF ODONTOGENIC MYXOMAS:
A CASE REPORT AND REVIEW OF THE LITERATURE
Dr. Jamie White (Mount Sinai Hospital), Dr. Naomi Ramer (Mount Sinai Hospital), Dr. Todd Wentland
(Mount Sinai Hospital), Dr. Molly Cohen (Mount Sinai Hospital)
Introduction: Odontogenic myxomas often have distinctive radiographic presentations, many of which
are well known and have been termed “soap bubble”, “tennis racket”, and “honeycomb” patterns, while others
are less common such as “sunray” or “sunburst” patterns. The rare radiographic sunray or sunburst appearance
of odontogenic myxomas has been infrequently reported in the literature with only 20 cases reported to
date.
Objective: The objective of this paper is to report a case of an odontogenic myxoma presenting with a
radiographic sunray appearance and present a review of the literature on this uncommon presentation.
Clinical presentation: A 34-year-old male presented with mild expansion of the left posterior mandible.
A panoramic radiograph displayed a sunray appearance of the lesion. Surgeons included osteosarcoma in
their differential diagnosis due to this distinct radiographic appearance. An incisional biopsy was performed
and received a diagnosis of odontogenic myxoma.
Intervention and Outcome: The patient underwent segmental resection of the mandible and the excisional
biopsy confirmed the diagnosis of odontogenic myxoma.
Conclusion:Although the radiographic sunray or sunburst appearance is not the most common presentation of
odontogenic myxomas, undoubtedly, it is necessary for clinicians and pathologists to be cognizant of it. Very
often, the sunray appearance has been associated with a malignant process and prompts a differential diagnosis
that gravitates toward malignant entities; therefore, there is value in the awareness that the benign odontogenic
myxoma can present in the same manner. 20 cases of odontogenic myxoma in the English literature have
presented with this radiographic pattern. To the best of the author’s knowledge, this additional case brings the
number of cases reported to 21.

#24 DESMOPLASTIC FIBROBLASTOMA OF THE PALATAL MUCOSA: A RARE INTRAORAL
PRESENTATION WITH
IMMUNOHISTOCHEMICAL ANALYSIS
Dr. Aparna Naidu (University of Missouri - Kansas City), Dr. Steven Prstojevich (University of Missouri
- Kansas City), Dr. Bruce Barker (University of Missouri - Kansas City)
OBJECTIVE: Desmoplastic fibroblastoma (DF) is a benign, slow-growing, fibroblastic proliferation that was
first described by Evans in 1995. DF most commonly affects the subcutaneous tissues of the limbs, back, and
neck. Only 9 cases in the oral cavity have been reported thus far in the English literature. The peak incidence
of DF is in the fifth and sixth decade. While 80% of cases affect males, females represent 80% of reported
cases in the oral cavity. Cytogenetic studies have shown a consistent gene rearrangement at 11q12, resulting in
a higher expression of FOSL1 when compared to desmoid-type fibromatoses. Histopathologically, DF often
has a well-delineated periphery, and is composed of sparsely distributed, medium to large spindle to stellate-
shaped fibroblastic cells, with rare mitoses, interspersed between dense collagen fibers. The proliferating cells
usually express reactivity with vimentin and, focally, with smooth muscle actin (SMA), suggesting their
myofibroblastic origin. It is questionable whether DF represents a reactive or neoplastic proliferation.
CLINICAL PRESENTATION: A 37-year-old female was referred to an oral and maxillofacial surgeon for
evaluation of a smooth surfaced soft tissue mass of the midline palate that had been slowly increasing in size
for 5 years. The mass was firm to palpation, measuring 4.7 x 3.8 x 2.2 cm in size. Radiographic evaluation and
a computerized tomography scan confirmed the mass was contained within soft tissue. An excisional biopsy
was performed.
RESULTS: Histopathologic examination revealed a well-defined proliferation of stellate shaped fibroblasts in
a densely fibrous stroma. Immunohistochemical studies resulted in positivity with vimentin, and focal
positivity with SMA. Negative reactivity was seen with CKAE1/3, EMA, S100, desmin, GLUT-I, CD34, SOX-
10, Claudin1, p63, and GFAP.
CONCLUSION: The histopathologic features and immunohistochemical studies were compatible with a
diagnosis of desmoplastic fibroblastoma. Postoperatively, the patient healed adequately and no recurrence
was seen at ten months.