387
Odontogenic Myxoma. Report of a Periodontally-Located
Case
Ömer Günhan, * Nejat Arpak,+ Bülent Celasun, * and Cevat Can*
In this article, a case of odontogenic myxoma with deceptively bland radiographie findings and a clinical impression of periodontal abscess is presented. J Periodontol
1991;62:387-389.
Key Words: Myxoma; periodontal abscess; odontogenic tumor.
The typical clinical, radiographie, and histopathologic appearances of the odontogenic myxomas have been well de-
scribed.13 In the present case, the location of the lesion in the periodontal tissues and the lack of characteristic radiographie
findings prompted a clinical impression of a periodontal abscess. Histopathologic examination revealed an unusually small odontogenic myxoma. CASE REPORT The patient was a 27 year-old Turkish woman who presented with a slowly growing swelling on the left maxillary area between central and lateral teeth of 1-year duration (Fig. 1). There were no other symptoms and no recent history of pain. The radiographie examination was normal except a slight radiolucency between central incisors (Fig. 2). Vestibular aspects of the left maxillary central and lateral teeth showed periodontal pockets 9 mm in depth without pus discharge (Fig. 3). The overlying mucosa was slightly inflamed. A clinical diagnosis of "walled-off periodontal abscess" was entertained. At surgical exploration a grayishwhite, bright and gelatinous mass, 1.3 cm at its greatest diameter, was found (Fig. 4). This mass was quite different from the expected inflammatory granulation tissue. The cortical bone was found to be slightly eroded and the lesion was curetted. The microscopic appearance consisted of stellate and spindle-shaped cells loosely arranged in a myxomatous connective tissue matrix (Fig. 5). No rests of odontogenic epithelium were seen. A diagnosis of "odontogenic myxoma" was made. The patient was followed for 4 years and was found to be free of tumor.
'Department of Pathology, Gülhane Military Medical Academy and MedSchool, Etlik, Ankara, Turkey. tDepartment of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey. ical
Figure 1. Clinical appearance of the lesion which resembles a periodontal abscess.
DISCUSSION The clinical impression of "periodontal abscess" makes this myxoma case unusual since none of the oral pathology texts reviewed4 8 cite odontogenic myxoma in the differential diagnosis of the periodontal abscess. Although the history of pain is usual in periodontal abscess, the absence of such history in the present case did not prevent us from considering a diagnosis of periodontal abscess since some chronic lesions could be asymptomatic.9 Odontogenic myxomas are believed to derive from the mesenchymal elements of the dental papilla, dental follicle, or the periodontal membrane;4,5'7'10 therefore, it is not surprising to see this tumor in the periodontal tissues. Myxomas usually do not cause symptoms until they attain a large size. To our knowledge, no odontogenic myxoma with such a clinical appearance and limited periodontal location as in our case has been reported previously. However, Bernier and Ash11 mentioned the presence of myxomas on the al-
388
J Periodontol June 1991
ODONTOGENIC MYXOMA. REPORT OF A PERIODONTALLY-LOCATED CASE
Figure 4.
Gross appearance
of the glistening, bulky, friable mass.
Figure 2. Radiographie appearance of the lesionai site with no discernable change.
Figure 5. Histologie appearance of the myxoma consisting of spindleshaped cells in a myxoid matrix (H & E; original magnification x 70).
In
conclusion,
suggest that periodontally located should be included in the clinical difodontogenic myxoma ferential diagnosis of periodontal abscess. we
REFERENCES 1. Barros RE, Dominiquez FV, 2.
Figure 3. Periodontal probe extends into the lesion, deep in the periodontium. 3.
veolar ridges and Tahsinoglu et al 12 reported a localized myxoma in the gingiva. The radiologie findings of myxomas in their early stage consist of areas of osteoporosis with accentuation of the normal trabeculation of bone.1 Destruction of bone is a late finding.1 Our case is characterized by minimal radiological findings, which are compatible with its unusually small size.
4.
5.
Cabrini RL. Myxoma of the jaws. Oral Surg Oral Med Oral Pathol 1969; 27:225-236. Pindborg JJ, Kramer IRH, Torloni H. Histologie Typing of Odontogenic Tumours, Jaw Cysts and Allied Lesions. Geneva: World Health Organization; 1971:31. Kangur TT, Dahlin DC, Turlington EG. Myxomatous tumors of the jaws. / Oral Surg 1975; 33:523-528. Gorlin RJ, Goldman HM. Thomas Oral Pathology. St. Louis: The C.V. Mosby Company; 1970; 501-503. Shafer WG, Hiñe MK, Levi BM. Textbook of Oral Pathology. Philadelphia, London, Toronto: W.B. Saunders Company; 1974;265-
267. 6. Lucas RB.
Pathology of Tumours of the
Oral Tissues.
Edinburgh,
London, Melbourne, New York: Churchill Livingstone; 1984:164168. 7. Bhaskar SN. Synopsis of Oral Pathology. St. Louis, don: The C.V. Mosby Company; 1986;281-282.
Toronto, Lon-
Volume 62 Number 6 8. Matteson SR. Benign tumors of the jaws. In: Goaz PW, White SC, eds. Oral Radiology, Principles and Interpretation. St. Louis: The C.V. Mosby Company; 1987;543-548. 9. Carranza FA. Glickman's Clinical Periodontology. Philadelphia, London, Toronto, Montreal, Sydney, Tokyo: W.B. Saunders Company; 1990:496-497. 10. Hendler BH, Abaza NA, Quinn P. Odontogenic myxoma. Oral Surg Oral Med Oral Pathol 1979; 47:203-216.
GÜNHAN, ARPAK, CELASUN, CAN
389
11. Bernier JL, Ash JE. Atlas of Dental and Oral Pathology. Washington: Army Institute of Pathology; 1948:159. 12. Tahsinoglu S Çôloglu S, Kuralay T. Myxoma of the gingiva, a case report. Br J Oral Surg 1975; 13:95-96.
reprint requests to Dr. Omer Gühnan, Giilhane Askeri Tip Akademisi, Patoloji ABD, Etlik, 06018, Ankara, Turkey. Accepted for publication January 9, 1991. Send
Odontogenic Myxoma. Report of a Periodontally-Located
Case
Ömer Günhan, * Nejat Arpak,+ Bülent Celasun, * and Cevat Can*
In this article, a case of odontogenic myxoma with deceptively bland radiographie findings and a clinical impression of periodontal abscess is presented. J Periodontol
1991;62:387-389.
Key Words: Myxoma; periodontal abscess; odontogenic tumor.
The typical clinical, radiographie, and histopathologic appearances of the odontogenic myxomas have been well de-
scribed.13 In the present case, the location of the lesion in the periodontal tissues and the lack of characteristic radiographie
findings prompted a clinical impression of a periodontal abscess. Histopathologic examination revealed an unusually small odontogenic myxoma. CASE REPORT The patient was a 27 year-old Turkish woman who presented with a slowly growing swelling on the left maxillary area between central and lateral teeth of 1-year duration (Fig. 1). There were no other symptoms and no recent history of pain. The radiographie examination was normal except a slight radiolucency between central incisors (Fig. 2). Vestibular aspects of the left maxillary central and lateral teeth showed periodontal pockets 9 mm in depth without pus discharge (Fig. 3). The overlying mucosa was slightly inflamed. A clinical diagnosis of "walled-off periodontal abscess" was entertained. At surgical exploration a grayishwhite, bright and gelatinous mass, 1.3 cm at its greatest diameter, was found (Fig. 4). This mass was quite different from the expected inflammatory granulation tissue. The cortical bone was found to be slightly eroded and the lesion was curetted. The microscopic appearance consisted of stellate and spindle-shaped cells loosely arranged in a myxomatous connective tissue matrix (Fig. 5). No rests of odontogenic epithelium were seen. A diagnosis of "odontogenic myxoma" was made. The patient was followed for 4 years and was found to be free of tumor.
'Department of Pathology, Gülhane Military Medical Academy and MedSchool, Etlik, Ankara, Turkey. tDepartment of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey. ical
Figure 1. Clinical appearance of the lesion which resembles a periodontal abscess.
DISCUSSION The clinical impression of "periodontal abscess" makes this myxoma case unusual since none of the oral pathology texts reviewed4 8 cite odontogenic myxoma in the differential diagnosis of the periodontal abscess. Although the history of pain is usual in periodontal abscess, the absence of such history in the present case did not prevent us from considering a diagnosis of periodontal abscess since some chronic lesions could be asymptomatic.9 Odontogenic myxomas are believed to derive from the mesenchymal elements of the dental papilla, dental follicle, or the periodontal membrane;4,5'7'10 therefore, it is not surprising to see this tumor in the periodontal tissues. Myxomas usually do not cause symptoms until they attain a large size. To our knowledge, no odontogenic myxoma with such a clinical appearance and limited periodontal location as in our case has been reported previously. However, Bernier and Ash11 mentioned the presence of myxomas on the al-
388
J Periodontol June 1991
ODONTOGENIC MYXOMA. REPORT OF A PERIODONTALLY-LOCATED CASE
Figure 4.
Gross appearance
of the glistening, bulky, friable mass.
Figure 2. Radiographie appearance of the lesionai site with no discernable change.
Figure 5. Histologie appearance of the myxoma consisting of spindleshaped cells in a myxoid matrix (H & E; original magnification x 70).
In
conclusion,
suggest that periodontally located should be included in the clinical difodontogenic myxoma ferential diagnosis of periodontal abscess. we
REFERENCES 1. Barros RE, Dominiquez FV, 2.
Figure 3. Periodontal probe extends into the lesion, deep in the periodontium. 3.
veolar ridges and Tahsinoglu et al 12 reported a localized myxoma in the gingiva. The radiologie findings of myxomas in their early stage consist of areas of osteoporosis with accentuation of the normal trabeculation of bone.1 Destruction of bone is a late finding.1 Our case is characterized by minimal radiological findings, which are compatible with its unusually small size.
4.
5.
Cabrini RL. Myxoma of the jaws. Oral Surg Oral Med Oral Pathol 1969; 27:225-236. Pindborg JJ, Kramer IRH, Torloni H. Histologie Typing of Odontogenic Tumours, Jaw Cysts and Allied Lesions. Geneva: World Health Organization; 1971:31. Kangur TT, Dahlin DC, Turlington EG. Myxomatous tumors of the jaws. / Oral Surg 1975; 33:523-528. Gorlin RJ, Goldman HM. Thomas Oral Pathology. St. Louis: The C.V. Mosby Company; 1970; 501-503. Shafer WG, Hiñe MK, Levi BM. Textbook of Oral Pathology. Philadelphia, London, Toronto: W.B. Saunders Company; 1974;265-
267. 6. Lucas RB.
Pathology of Tumours of the
Oral Tissues.
Edinburgh,
London, Melbourne, New York: Churchill Livingstone; 1984:164168. 7. Bhaskar SN. Synopsis of Oral Pathology. St. Louis, don: The C.V. Mosby Company; 1986;281-282.
Toronto, Lon-
Volume 62 Number 6 8. Matteson SR. Benign tumors of the jaws. In: Goaz PW, White SC, eds. Oral Radiology, Principles and Interpretation. St. Louis: The C.V. Mosby Company; 1987;543-548. 9. Carranza FA. Glickman's Clinical Periodontology. Philadelphia, London, Toronto, Montreal, Sydney, Tokyo: W.B. Saunders Company; 1990:496-497. 10. Hendler BH, Abaza NA, Quinn P. Odontogenic myxoma. Oral Surg Oral Med Oral Pathol 1979; 47:203-216.
GÜNHAN, ARPAK, CELASUN, CAN
389
11. Bernier JL, Ash JE. Atlas of Dental and Oral Pathology. Washington: Army Institute of Pathology; 1948:159. 12. Tahsinoglu S Çôloglu S, Kuralay T. Myxoma of the gingiva, a case report. Br J Oral Surg 1975; 13:95-96.
reprint requests to Dr. Omer Gühnan, Giilhane Askeri Tip Akademisi, Patoloji ABD, Etlik, 06018, Ankara, Turkey. Accepted for publication January 9, 1991. Send
