Fibrosarcoma: Origin, diagnosis, and a mandibular case report
Journal name: Journal of Indian Society of Periodontology
Original article title: Fibrosarcoma: Origin, differential diagnosis, and report of a case in the mandible
The Journal of Indian Society of Periodontology (JISP) publishes original scientific articles on periodontology (the study of supporting structures of teeth) and oral implantology. It is a bimonthly open-access journal with special issues for specific occasions.
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Original source:
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Harpreet Kaur, Vandana Gupta, Deepika Mishra, Vikender Singh Yadav
Journal of Indian Society of Periodontology:
(A bimonthly open-access journal)
Full text available for: Fibrosarcoma: Origin, differential diagnosis, and report of a case in the mandible
Year: 2022 | Doi: 10.4103/jisp.jisp_188
Copyright (license): CC BY-NC-SA
Summary of article contents:
Introduction
Fibrosarcoma (FS) is a rare malignant tumor composed of spindle-shaped mesenchymal cells, which can pose significant diagnostic challenges due to its histological similarity to both benign and other malignant spindle cell lesions. Immunohistochemistry is pivotal in differentiating FS by utilizing various antibodies that react to specific antigens present in tumor cells. A case report describes the diagnosis and treatment of a 42-year-old male patient with a gingival growth initially misdiagnosed as a reactive fibrous lesion but later confirmed to be FS upon deeper biopsy. This case emphasizes the importance of recognizing the diverse origins and immunophenotypes of spindle cells in achieving accurate diagnoses.
Immunohistochemical Profiling in Diagnosing Fibrosarcoma
The histopathological analysis of FS typically reveals spindle cells arranged in fascicular patterns with variable collagen production. The immunohistochemical profile of the tumor cells in the reported case demonstrated positivity for vimentin while being negative for several other markers such as S100, desmin, and smooth muscle actin. The Ki-67 proliferation index was approximately 15%, indicative of moderate aggressiveness. The diagnosis of FS was enhanced by immunohistochemistry, which underscored the necessity of deeper tissue biopsies that are crucial for accurate diagnosis, as superficial samples may lead to misleading results suggesting benign conditions. Understanding the expression of various markers in spindle cell lesions can help differentiate FS from other similar entities.
Conclusion
The case of fibrosarcoma in the oral cavity, as presented in this report, highlights the rarity of such tumors and the intricacies involved in their diagnosis. Accurate diagnosis requires a comprehensive approach that combines clinical examination, imaging studies, and detailed histopathological evaluations supported by appropriate immunohistochemical analyses. Continuous monitoring of patients post-treatment is essential due to the tumor's potential for recurrence and metastasis. This case reinforces the need for heightened awareness among clinicians regarding the possible presentations and behaviors of fibrosarcoma in the oral cavity.
FAQ section (important questions/answers):
What is fibrosarcoma and its common characteristics in diagnosis?
Fibrosarcoma (FS) is a malignant tumor from mesenchymal cells, characterized by spindle-shaped cells. Diagnosis involves histological examination and immunohistochemistry to differentiate it from other benign and malignant spindle cell lesions.
What are the typical symptoms of oral fibrosarcoma?
Typical symptoms of oral fibrosarcoma include pain, swelling, and paraesthesia. The lesion may present as a firm gingival overgrowth, and radiographically it may show bone loss or an ill-defined osteolytic lesion.
What immunohistochemical markers are associated with fibrosarcoma?
Fibrosarcoma is typically positive for vimentin and shows negativity for markers like S100, desmin, and myogenin. The Ki-67 proliferation index is also evaluated to assess tumor activity.
How is fibrosarcoma treated following diagnosis?
Treatment for fibrosarcoma generally involves wide local excision of the tumor along with a safety margin. If complete excision isn't possible, postoperative radiotherapy and chemotherapy may be recommended.
What is the prognosis for a patient diagnosed with fibrosarcoma?
The prognosis for fibrosarcoma depends on the tumor grade. Five-year survival rates vary, with complete excision being critical to reducing recurrence and metastasis risks. Regular follow-up is essential.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Fibrosarcoma: Origin, diagnosis, and a mandibular case report”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Table:
In the context of this medical text, 'Table' typically refers to organized data or comparative information regarding various spindle cell lesions and their differential diagnosis. Tables are crucial for summarizing extensive information concisely, facilitating easier understanding and comparison of the characteristics, clinical presentations, and diagnostic markers of different neoplasms.
2) Male:
The term 'Male' is significant in this case report as it highlights the demographic characteristics of the patient suffering from fibrosarcoma, which shows a male predilection, especially in the head and neck region. This gender bias is important for understanding the epidemiology of such malignant neoplasms.
3) Swelling:
'Swelling' is a common clinical symptom observed in patients with fibrosarcoma and other neoplasms. It indicates an accumulation of fluids or an increase in tissue size, providing essential clues for diagnosis. The presence of swelling in the oral cavity can prompt clinicians to investigate further for potential malignancies.
4) Surface:
'Surface' refers to the outermost layer of the gingival or other affected tissues in the context of the case report. The characteristics of the lesion's surface, such as color and consistency, play a crucial role in the clinical examination and initial diagnosis of tumors like fibrosarcoma.
5) Pain:
'Pain' serves as an important symptom experienced by patients with fibrosarcoma. Its presence may indicate the aggressiveness of the tumor or its effects on surrounding tissues, thereby guiding clinical diagnosis and management. Understanding associated pain helps evaluate the urgency and nature of treatment required.
6) Radiotherapy:
'Radiotherapy' is a treatment modality employed after the surgical resection of fibrosarcoma to eliminate any remaining cancerous cells and reduce the risk of local recurrence. Its significance lies in improving patient prognosis and survival rates, especially for higher grade tumors that show aggressive behavior.
7) Arrow:
'Arrow' in a medical context often indicates direction or highlights specific areas in images or illustrations within the case report. It may refer to the visual guidance in radiographs or histopathological images, helping clinicians better communicate findings to viewers by directing attention to crucial details.
8) Transformation (Transform, Transforming):
'Transformation' typically refers to the process by which normal cells undergo changes to become malignant. In the context of the report, it emphasizes the importance of recognizing fibrosarcoma's development from benign or reactive lesions, highlighting the need for careful evaluation of cellular characteristics during diagnosis.
9) Field:
'Field' commonly refers to the area of high-powered magnification used in histopathology, where specific lesions are examined. In this context, it describes the size or number of cells observed per high power field, aiding in tumor grading and understanding the lesion's aggressiveness or cellularity.
10) Beta:
'Beta' may reference proteins such as beta-catenin that are involved in cell signaling related to cancer. It can also pertain to various biological markers linked to tumor characterization. Its relevance in the report could denote specific findings related to fibrosarcoma's molecular pathology or immunohistochemical profiles.
11) Line:
'Line' can refer to the delineation of tumor margins or lines used to identify different types of spindle cell lesions during histological evaluations. In this case report, establishing boundaries is crucial for differentiating between benign and malignant lesions, guiding appropriate treatment strategies.
12) Pur:
'Poor' describes the quality or degree of differentiation in tumor grading. In the context of fibrosarcoma, the term highlights the aggressive characteristics observed in high-grade tumors, which typically show a poor prognosis. This correlation informs treatment decisions and expected outcomes for patients with fibrosarcoma.
13) Mutation:
'Mutation' refers to alterations in the genetic material that can lead to cancer. In the report, specific mutations, such as those resulting from exposure to chemicals or radiation, may predispose individuals to developing fibrosarcoma. Identifying such mutations can aid in clarifying tumor pathology and inform targeted therapies.
14) Relative:
'Relative' may refer to the family history of cancer or other health issues impacting an individual's likelihood of developing fibrosarcoma. Understanding relevant familial patterns provides insights into genetic predispositions and influences strategies for screening, prevention, and early detection of possible malignancies.
15) Rules:
'Rules' can refer to the diagnostic criteria used to identify fibrosarcoma among other spindle cell neoplasms. Applying established rules allows clinicians to systematically evaluate clinical, radiographic, and histopathological data for accurate diagnosis, paving the way for effective treatment and management plans.
16) Drug:
'Drug' signifies pharmacological agents administered for treating patients after a cancer diagnosis. In fibrosarcoma management, chemotherapy and other supportive medications may be utilized to alleviate symptoms or address potential metastasis, particularly in cases exhibiting high-grade malignancy requiring more aggressive treatment protocols.
17) Chemotherapy:
'Chemotherapy' is a systemic treatment option used for malignancies like fibrosarcoma. Postoperative chemotherapy aims to target microscopic disease, improving patient outcomes. Its incorporation alongside surgery and radiotherapy underscores the multifaceted approach to cancer management and the importance of personalized treatment strategies.
18) Arrangement:
'Arrangement' relates to the histological organization of tumor cells in fibrosarcoma, such as the presence of fascicular patterns or herringbone architecture. Understanding cellular arrangement is integral in histopathology, as these patterns can help distinguish fibrosarcoma from other spindle cell tumors, leading to accurate diagnosis.
19) Discussion:
'Discussion' encompasses the section of the report where findings are interpreted in the context of existing literature. It allows for a comprehensive examination of the case, drawing correlations between histopathological findings and clinical outcomes, ultimately enhancing understanding of fibrosarcoma and its management strategies.
20) Activity:
'Activity' in this context may denote the biological behavior of the tumor, such as mitotic activity that influences grade and prognosis. Understanding tumor activity underlines the importance of diagnostic markers that may direct treatment and assess potential responses to therapies in fibrosarcoma.
21) Grafting:
'Grafting' refers to the surgical procedure of transplanting tissue, which in the context of this report pertains to the reconstruction of the gingival surface post-excision of the fibrosarcoma. This technique plays a significant role in restoring function and aesthetics in patients after tumor surgery.
22) Cancer:
'Cancer' is a general term referring to uncontrolled cell growth and malignancy. In this report, it highlights the significance of fibrosarcoma, a rare soft tissue tumor, contextualizing its characteristics, treatment, challenges in diagnosis, and necessity for awareness in clinical settings.
23) Spider:
'Spider' generally does not have a direct relevance to the case, but it could metaphorically represent the complex interconnections among tumor structures and cellular behaviors in fibrosarcoma. Alternatively, it may relate to visual illustrations where spider-like patterns indicate certain histological features when discussing malignancy.
24) Seat (Seated):
'Seated' might refer to the positional context in which a physical examination is conducted, emphasizing the importance of patient positioning when assessing oral lesions. Proper positioning aids in visibility and evaluation of signs indicating potential malignancies, contributing to diagnostic accuracy.
25) Sugar:
'Sugar' in medical contexts may allude to metabolic aspects related to cancer metabolism. While not explicitly discussed in the report, understanding how cancers utilize energy sources like glucose could play a role in developing targeted therapies related to metabolic pathways in fibrosarcoma treatment.
26) Visit:
'Visit' signifies a medical appointment where patients present symptoms for evaluation. The visit is crucial for assessing conditions and initiating a thorough diagnostic process, including imaging and biopsies, ultimately guiding the management of tumors such as fibrosarcoma based on clinical insights.
27) Blood:
'Blood' relates to systemic aspects of cancer, highlighting the potential for malignant spread via hematogenous routes. Understanding blood’s role in tumor biology assists in evaluating metastatic potential and informs treatment decisions, particularly regarding therapies targeting circulating tumor cells in malignant neoplasms.
28) Study (Studying):
'Study' refers to the comprehensive evaluation conducted through case reports and research to understand fibrosarcoma better. Such studies expand knowledge, guide diagnostic and treatment protocols, and contribute to the broader scientific discourse concerning soft tissue tumors in oncology.
29) Mast:
'Mast' could potentially reference mast cells, which play roles in immune response and may relate to tumor microenvironments. Their presence could influence cancer biology and aid in understanding inflammatory components surrounding neoplasms like fibrosarcoma, particularly concerning immune evasion or response.
30) Rich (Rch):
'Rich' commonly refers to the substance or complexity of a tissue environment, especially regarding the stroma surrounding tumors. A rich stroma can enhance tumor growth and metastasis, impacting clinical outcomes. Furthermore, understanding these properties can inform therapeutic strategies in fibrosarcoma management.
31) Wall:
'Wall' may refer to anatomical structures, such as the gingival or other mucosal barriers in the oral cavity, which may be compromised due to fibrosarcoma. Understanding these boundaries is crucial for surgical intervention and for planning appropriate management strategies for tumor removal and reconstruction.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘Fibrosarcoma: Origin, diagnosis, and a mandibular case report’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Radiotherapy, Differential diagnosis, Pain and swelling, Surgical excision, Oral cavity, Recurrence, Mesenchymal cells, Oral prophylaxis, Biopsy, Immunohistochemistry, Histological grading, Malignant neoplasm, Gingival overgrowth, Fibrosarcoma, Tissue graft, Soft tissue mass, Vimentin, Mitotic figures, Nuclear pleomorphism, Proliferative index.