JIDAM “An Official Journal of IDA - Madras Branch” ©2021. Available
online

ISSN No: 2582-0559

Volume No: 8, Issue No: 2

REVIEW ARTICLE

A CASE REPORT OF HEMANGIOPERICYTOMA/SOLITARY

FIBROUS TUMOUR OF BUCCAL MUCOSA

Dr. Mathew Jose, Dr. Sajesh, Nandagopan, Dr.Effie Edsor, Dr.Sindhuja Devi, Dr.Sowmya.

Department Of Oral And Maxillofacial Surgery, Sree Mookambika Institute of Dental Sciences, Kulasekharam, Tamilnadu, India

DOI:1.37841/jidam_2021_V8_I

2_07

Address for correspondence:

Dr. Effie Edsor, MDS,

Assistant Professor,

Department Of Oral And Maxillofacial Surgery, Sree

Mookambika Institute of Dental Sciences, Kulasekharam,

Tamilnadu, India

Email: effieedsor@gmail.com

Received:

18.02.2021 First Published

07.06.2021

Accepted: 3

1.03.2021

Published:

27.06.2021

ABSTRACT

Hemangiopericytomas

(HPCs)/Solitary

fibrous

tumors are rare neoplasms of vascular origin that occur in
head‑and‑neck region. These tumors arise from capillary
pericytes and are difficult to distinguish from other tumors
of vascular origin. HPC, initially described by Stout and
Murray in 1942, usually occur in the fifth decade of life
and account for 3%–5% of all soft‑tissue sarcomas and
1% of all vascular tumors. The tumors usually occur in
limbs, pelvis, or head‑and‑neck region; 15%–30% of all
HPCs occur in head and neck. We report a case of HPC
located in the right buccal area of a 51‑year‑old woman.

KEY

WORDS:

Capillary

pericytes,

hemangiopericytoma, Immunohistochemistry, vascular
tumor

JIDAM “An Official Journal of IDA - Madras Branch” ©2021. Available
online

ISSN No: 2582-0559

Jaishree et al: Lipoxins for Resolution of Inflammation

Volume No: 8, Issue No: 2

INTRODUCTION: -

Solitary fibrous tumour is an unusual vascular neoplasm

of  oral  cavity  which  is  not  clinically  distinguishable  from
other  lesions.  First  described  by  Stout  &  Murray  in  19421,
they  are  tumours  of  pericytes  of  Zimmermann,  which  are
baroreceptors  on  luminal  wall  of  vascular  channels8.
Pericytes  are  mesenchymal  in  origin  and  are  relatively
undifferentiated in the sense that they can apparently develop
into  several  different  cell  types  including  smooth  muscle.
They  are  contractile  and  can  change  their  shape,  thereby
reducing  the  diameter  of  the  capillary  lumen4.  It  usually
occurs in fourth to fifth decade of life. STFs may show many
growth patterns and therefore can be easily mistaken for other
more  common  H&N  spindle  cell  or  epithelial  lesions10.
Haemangiopericytoma  (HPC)  has  over  the  years  been  used
fairly loosely, to describe a wide variety of neoplasms which
have  certain  morphological  characteristics  in  common:  a
monotonous appearance at low-power examination, moderate
to  high  cellularity,  and  the  presence  of  numerous,  variably
thick-walled, branching ‘staghorn’ vessels5. We report a case
of HPC of the  right buccal  mucosa  in a  51‑year‑old female
patient.

CASE REPORT:-

A 51‑year‑old female presented with gradually enlarging

asymptomatic mass in her right buccal mucosa for the past 4
months  (Fig  1:  (  a)).  The  asymptomatic  lesion  was  initially
small which gradually enlarged to the present size of 5 cm ×
4 cm , which was solitary & well‑circumscribed (Fig 1: (b)).
The  overlying  mucosa  appeared  smooth  &  mildly
erythematous  with  no  visible  ulcerations  or  pulsations.
Blanching was seen on the postero inferior aspect of swelling
due  to  impingement  of  48.  The  mass  was  rubbery  in
consistency. No lymphadenopathy. The examination of other
sub sites of oral cavity was normal.

She had no compounding medical history or any recent

history of trauma to the offending site. CT guided  incisional
biopsy  reported  it  to  be  hemangio  endothelioma.
Immunohistochemistry  for  the  same  revealed  strongly
positive CD34.

Fig 1:( a)

Fig 1: (b)

Fig 1:( c)

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ISSN No: 2582-0559

Jaishree et al: Lipoxins for Resolution of Inflammation

Volume No: 8, Issue No: 2

Fig 1: (d)

Fig 1: (a) Extra-oral photograph: an asymptomatic mass

in her right cheek (b) Intra-oral photograph: a painless
submucosal mass in the right buccal region (c) CT axial cut
showing ill-defined heterogenous lesion in right buccal space
with infiltration into adjacent masseter, temporalis muscle &
pressure erosion of maxilla (d) CT coronal cut showing
radiopaque mass in the right buccal space measuring 4.43 X
3.56 cm

TREATMENT & PROGNOSIS: -

Surgery was conducted under general anaesthesia. A 7.0

cm  transcutaneous  incision  at  the  right  buccal  mucosa  was
made  parallel  to  the  anterior  border  of  the  mandible  ramus.
The  identified  anatomic  layers  included  the mucosa  and  the
buccinator muscle. The tumor was found adjacent to the front
part  of  the  buccinator  muscle.  The  tumor  was  encapsulated
with connective tissue. It was easily separated from the layer
structure.  The  tumor  was  ablated  with  extracapsular
dissection.  The  patient  was  discharged  4  days  after  the
surgery.  There  have  been  no  signs  of  facial  nerve  injury  or
recurrence  at  12  months  post-operatively.  Macroscopically,
the  cut  section  of  the  resected  specimen  showed  a
circumscribed  erythematous  mass  measuring  6  ×4  ×2cm
surrounded by a fibrous capsule

Fig 2:( a)

Fig 2: (b)

Fig 2:( c)

Fig 2: (d)

Fig 2: (a) Incisional biopsy site (b) specimen sent for

histopathological  examination(c)  tumor  seen  encapsulated
with  connective  tissue  (d)  Gross  appearance  of  the  resected
specimen. A well-circumscribed nodular mass measuring 6 ×4
×2cm surrounded by a fibrous capsule

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Jaishree et al: Lipoxins for Resolution of Inflammation

Volume No: 8, Issue No: 2

HISTOPATHOLOGIC FINDINGS: -

Excised tissue sent for histopathological examination.

Histopathology  report  revealed  the  presence  of  neoplasm
composed of spindle cells with thin ectactic vascular channels
in  between.  The  cells  have  moderate  amount  of  clear
vacuolated cytoplasm & plump mild to moderate pleomorphic
nuclei.  Mitosis  2-3/hpf  in  areas.  Stroma  shows  areas  of
sclerosis.  The tumor was labelled as benign HPC because of
its  of  cellular  atypia  and  presence  of  mitotic  activity.  The
morphological  and  immunohistochemical  features  were
consistent

with

the

diagnosis

solitary

fibrous

tumor/hemangiopericytoma.

Fig 3:( a)

Fig 3: (b)

Fig 3:( a) The tumor comprised spindle cells with an

irregular disposition associated with collagen bands and
vascular structures branched with an evident lumen (b) Tumor
cells showed strong positivity for CD34 (IHC).

DISCUSSION: -

Hemangiopericytomas are benign neoplasms with

malignant  potential.  The  sinonasal  tract  and  orbit  were  the
most common sites involved (30% and 25%), followed by the
oral  cavity  and  salivary  glands  (15%  and  14%)7.  They  are
distinguished based  on  occurrence  of  metastasis  and
recurrence.  The  appearance  on  a  plain  radiograph  is  not
specific.  Usually,  it presents as  radiopaque  soft  tissue  mass.
Calcification  may  occur,  but  is  uncommon.  A  CT  scan  and
magnetic resonance imaging may aid in identification of the
lesion.  Angiograms  may  show  evidence  of  rapid  circulation

indicated by a richly vascular mass with dilation of the arteries
and  a  diffuse  capillary  blush  or  opacification  in  the  arterial
phase and dilation of the draining veins in the vicinity of the
tumor  in  the  venous  phase2.  Recent  IHC  evidences  now
suggest that conceptually this tumor is not derived from the
pericyte because it does not express actin or myofibroblastic
markers.  There  is  considerable  histologic  overlap  between
myofibroma,  solitary  fibrous  tumor,  synovial  sarcoma,  and
mesenchymal chondrosarcoma. That is why, the diagnosis of
HPC  is  the  diagnosis  of  exclusion.  Chan  et  al19  have
summarized the essential diagnostic criteria for the diagnosis
of

SFT

which

was

augmented

strong

immunohistochemical CD34 positivity which is a consistent
finding  in  most  SFT’s  confirming  the  diagnosis.  Malignant
SFT’s  are  very  rare  and  account  to  10–15%  of  all  cases  in
pleura while in oral cavity there are only two reported cases.
Furthermore,  there  are  no  unifying  histologic  criteria  that
appear to reliably and consistently predict malignancy in SFT.
The management of HPC involves wide surgical excision. In
the head and neck, cervical lymphadenectomy is reserved for
those  instances  where  palpable  lymphadenopathy  is
coexistent.  The  role  of  radiotherapy  has  been  questioned
because these tumors are generally radioresistant. One study
showed  that  only  13%  of  patients  were  cured  with
radiotherapy.  The  recurrence  rate  of  SFT  occurring  in  the
pleura is reported to be approx. 30%. In contrast, recurrence
of  an  SFT  in  an  oral  lesion  is  rare13.  More  importantly,
clinicians should keep in mind that a patient with a past history
of  SFT  can  show  a  malignant  relapse  even  when  the
pathological  features  indicated  a  benign  SFT  in  the  first
diagnosis. Thus, a continuous long term follow-up is needed
for SFT patients.

ACKNOWLEDGEMENT

‘a’ designed the study, searched relevant articles and collected
data. ‘a’ and ‘b’ participated in the data interpretation and
analysis. ‘a’ and ‘c’ prepared the manuscript. All the three
authors read and approved the final manuscript.

CONFLICTS OF INTEREST

There are no conflicts of interest.

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