Home Print this page Email this page
Users Online: 1393
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
LETTERS TO EDITOR
Year : 2015  |  Volume : 4  |  Issue : 4  |  Page : 271-272

Posttraumatic spindle cell lesion of the buccal mucosa


Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication20-Oct-2015

Correspondence Address:
Kavita Mardi
Type VI, Set No 14, IAS Colony, Maheli, Shimla - 171 009, Himachal Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.167659

Rights and Permissions

How to cite this article:
Mardi K. Posttraumatic spindle cell lesion of the buccal mucosa. Int J Health Allied Sci 2015;4:271-2

How to cite this URL:
Mardi K. Posttraumatic spindle cell lesion of the buccal mucosa. Int J Health Allied Sci [serial online] 2015 [cited 2019 Sep 20];4:271-2. Available from: http://www.ijhas.in/text.asp?2015/4/4/271/167659

Sir,

Postoperative/posttraumatic spindle cell nodules were first described in 1990 by Vekemans et al. in urinary bladder.[1] They described it as a reactive lesion that occurs weeks to months after transurethral resection of the prostate (in men) or bladder lesions in the area of surgery. These tumors have similar features as inflammatory myofibroblastic tumor, but with a history of surgery. Though these lesions have been most frequently described in the lower genitourinary tract,[2] rare cases have been reported in other sites such as oral cavity, breast, and skin. Extensive literature search revealed only two cases of postoperative spindle cell nodule in the oral cavity [3],[4]

A 27-year-old male presented with a nodule at a site of laceration in the buccal mucosa since 1 month. On examination, there was a polypoidal mass measuring 10 mm in diameter in the buccal mucosa. Excision biopsy of the mass was done. Microscopic examination of the polypoidal mass was composed of cellular, fascicular growth pattern of plump, or elongated spindle cells which infiltrate with the invasion of underlying muscle and fat and focal destruction of muscle [Figure 1]. These spindle-cell proliferations are composed of bland-looking spindle cells with an indistinct cell border, eosinophilic cytoplasm, and oval nuclei. The nucleoli were inconspicuous [Figure 2]. Mitotic counts were 2–3 per high power field, but no atypical mitotic figures were found. A few atypical stromal cells were present in the myxoid areas. Delicate network of small blood vessels in edematous or myxoid stroma with red blood cell extravasation was noted. No necrosis or significant pleomorphism was noted. On immunohistochemical study, the spindle cells were positive for vimentin [Figure 3].
Figure 1: Fascicular growth of spindle cells with infiltration into surrounding skeletal muscles (H and E, ×20)

Click here to view
Figure 2: Higher magnification revealing plump or elongated spindle cells with an indistinct cell border, eosinophilic cytoplasm, and oval nuclei with inconspicuous nucleoli (H and E, ×40)

Click here to view
Figure 3: Photomicrograph showing tumor cells with vimentin positivity (IHC, ×20)

Click here to view


There has been controversy with regard to whether lesions containing spindle cell nodules are reactive or neoplastic.[2],[3],[5]ALK gene rearrangement and immunohistochemical positivity for ALK were found in approximately 50% of cases, suggesting that postoperative spindle cell nodules are neoplastic. However, the history of trauma or surgical treatment and the microscopic findings of high vascularity and inflammation support that the nodules are a reactive process.[2] Immunohistochemically, these lesions are immunoreactive for vimentin, actin, and desmin, with no labeling for keratin.

In conclusion, this lesion, which histologically mimicked a sarcoma, appears to represent a reactive process similar to that described as postoperative spindle cell nodules of the genitourinary tract. Recognition of this type of benign spindle cell proliferation at traumatized sites in the oral cavity is important if misdiagnosis and subsequent aggressive therapy are to be avoided. Awareness of this entity along with clinicopathologic features makes it possible to recognize it as a benign lesion rather than the malignant lesions for which it can be mistaken.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Vekemans K, Vanneste A, Van Oyen P, Michielssen P, Denys H, Vergison R. Postoperative spindle cell nodule of bladder. Urology 1990;35:342-4.  Back to cited text no. 1
    
2.
Hirsch MS, Dal Cin P, Fletcher CD. ALK expression in pseudosarcomatous myofibroblastic proliferations of the genitourinary tract. Histopathology 2006;48:569-78.  Back to cited text no. 2
    
3.
Ide F, Shimoyama T, Horie N. Post-traumatic spindle cell nodule misdiagnosed as a herniation of the buccal fat pad. Oral Oncol 2000;36:121-4.  Back to cited text no. 3
    
4.
Zellers RA, Bicket WJ, Parker MG. Posttraumatic spindle cell nodule of the buccal mucosa. Report of a case. Oral Surg Oral Med Oral Pathol 1992;74:212-5.  Back to cited text no. 4
    
5.
Micci F, Haugom L, Abeler VM, Bjerkehagen B, Heim S. Trisomy 7 in postoperative spindle cell nodules. Cancer Genet Cytogenet 2007;174:147-50.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed635    
    Printed5    
    Emailed0    
    PDF Downloaded103    
    Comments [Add]    

Recommend this journal