Massive Myofibroma of the Tongue; A Patient’s Dilemma Following Multiple Variant Histologic Diagnosis

Background: Myofibromas are uncommon benign soft tissue tumors exhibiting considerable histopathologic overlap with other benign and malignant entities 1. Challenges in the diagnosis do arise when the tumor becomes massive as seen in our patient. An initial incisional biopsy in another centre reported a malignant lesion and patient was booked for partial glossectomy and radiotherapy. The fear and anxiety associated with the planned glossectomy prompted her to seek for a second medical opinion at our centre.

Objective: To present a rare case of large myofibroma of the tongue in a 25-year-old female which was surgically excised under local anaesthesia with no recurrence twenty months post op.

Findings: A 2-year history of a solitary pedunculated swelling located on anterior two third of the tongue at the left ventral surface. It measured 7.0cm by 5.2cm, pinkish in color, rubbery and slightly tender. Incisional biopsy report showed myofibroma; composed of cellular fibrous connective tissue stroma consisting of plump and spindle-shaped fibroblasts arranged in storiform pattern interspersed with foci of basophilic cementum-like calcifications. A surgical excision was done under local anaesthesia. The unique clinical presentation and the histological findings of this rare tumor are presented and compared with previously reported cases.

Conclusion: Myofibromas may exhibit variation in histology sections. When required, repeat biopsies should be performed to prevent unwarranted mutilating surgeries. Long term post operative review is emphasized.
Key words:Myofibroma, Tongue, Massive, Variant

I Molly HS, John DR, Donald MC, et al. An update on myofibromas and myofibromatosis affecting the oral regions with report of 24 new cases. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2017; 124(1): 62-75.