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Pathology of Infantile Myofibromatosis and Myofibroma 

 Dr Sampurna Roy MD

September 2014

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

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Nodular fasciitis

Proliferative fasciitis

Proliferative myositis

Ischaemic fasciitis

Elastofibroma

Fibrous Hamartoma of Infancy

Infantile Myofibromatosis and Myofibroma

Juvenile hyaline fibromatosis

Inclusion  Body Fibromatosis

Calcifying aponeurotic fibroma

Fibromatosis colli

Fibroma of tendon sheath

Desmoplastic fibroblastoma

Storiform Collagenoma 

Giant Cell Collagenoma

Pleomorphic Fibroma

Angiomyofibroblastoma

Dermatomyofibroma

Cellular Angiofibroma

Giant Cell Angiofibroma

Fibromatosis

Lipofibromatosis

Solitary fibrous tumour

[Hemangiopericytoma  including Lipomatous Hemangiopericytoma]

Inflammatory myofibroblastic tumour

Low grade myofibroblastic sarcoma

Myxoinflammatory fibroblastic sarcoma

Infantile fibrosarcoma

Adult fibrosarcoma

Myxofibrosarcoma

Low grade fibromyxoid sarcoma

Hyalinizing Spindle Cell Tumour with Giant Rosettes

Sclerosing epithelioid fibrosarcoma

Infantile Myofibromatosis was first described by Stout in 1954 as 'congenital generalized fibromatosis' and was renamed as infantile myofibromatosis by Chung and Enzinger in 1981 after recognition of the myofibroblastic nature of the lesion.

(1) Solitary myofibromatosis: Characterized by the presence of one nodule in the skin, muscle, bone or subcutaneous tissue; and 

(2)  Multicentric type which can be divided into two sub-types :

(2a) Multicentric lesions but without visceral involvement. (2b) Visceral involvement is present.

(3) Adult-type myofibroma

Note: The term myopericytoma was first proposed in 1996 by Requena as an alternative designation for 'solitary myofibroma' .

It was later adopted in 1998 to describe a spectrum of tumours with striking concentric perivascular proliferation of spindle cells (perivascular myoid cells).

[This spectrum includes - infantile-type myofibromatosis ; solitary myofibroma ; benign myopericytoma; infantile hemangiopericytoma ; glomangiopericytoma]

Infantile Myofibromatosis is the most common fibrous tumour of infancy and must be considered when evaluating children who present with either solitary or multiple tumours, particularly during the neonatal period. 

In Solitary Myofibromatosis  skin, subcutaneous tissue and skeletal muscle are affected most frequently, usually in the head, neck and trunk. 

The most frequently affected bones are the skull, vertebrae, ribs, femur and tibia.

Solitary lesions involving the viscera are rare. 

Solitary or multicentric lesions confined to skin, soft tissues or bone has a good prognosis.

These are usually cured by simple excision.

In the generalized form, the most common locations are the lung, heart, gastrointestinal tract and pancreas, as well as rarely the central nervous system.

Infants with generalized visceral lesions have the worst prognosis.  

Death in these cases often occurs due to cardio-pulmonary or gastrointestinal complications.

Solitary Myofibroma - Adult lesions are often solitary and superficial in nature.

The tumour usually presents as a cutaneous nodule in head and neck region.

Visceral and osseous lesions have not been reported.

Gross features:  The lesion may present as a firm scar or a superficially located well circumscribed but uncapsulated nodule.

The deeper lesions are more infiltrative and diffuse in nature.

Histopathological features: 

Microscopically, each nodule has a central and peripheral area.

The peripheral area consists of spindle cells (myofibroblasts) with eosinophilic cytoplasm and ovoid nuclei arranged in well-demarcated short bundles and fascicles resembling smooth muscle.

The central portion consists of less differentiated rounder cells with pale cytoplasm and basophilic, small round nuclei, arranged in a hemangiopericytoma-like pattern.

Hemangiopericytomatous and myofibroblastic components occur in variable proportions.

More primitive areas show necrosis. Focal areas of calcification may be present. 

Mild to moderate nuclear pleomorphism can be found in most lesions.

Normal mitotic figures may be quite common. Abnormal mitotic figures are usually not present.

Vascular invasion (subendothelial proliferation of perivascular spindle cells) is common, but does not affect the prognosis.

Immmunohistochemistry: 

Cells are vimentin and alpha-smooth muscle actin - Positive.   Desmin- shows inconstant expression. S100 protein, epithelial membrane antigen and keratin - Negative

Differential Diagnosis:  Nodular fasciitis ;  NeurofibromaSchwannoma ; low-grade MPNST; Dermatofibroma ; Leiomyoma  ( Piloleiomyoma ;Angioleiomyoma; Lipoleiomyoma; Genital Leiomyoma ) ; Fibromatosis; Juvenile hyaline fibromatosis ; fibroma of tendon sheath ;

Infantile hemangiopericytoma-  Infantile hemangiopericytoma versus infantile myofibromatosis. Study of a series suggesting a continuous spectrum of infantile myofibroblastic lesions. 

Inflammatory myofibroblastic tumour Low grade myofibrosarcoma ;

Sections from the central cellular portion may show features mimicking small round cell sarcomas with a hemangiopericytoma-like vasculature: Example PNET , mesenchymal chondrosarcoma, poorly differentiated synovial sarcoma.

                                                              

Further reading:

Perivascular neoplasms of skin and soft tissues.  

Multifocal infantile myofibromatosis and generalized fibromuscular dysplasia in a child: evidence for a common pathologic process?

Solitary cutaneous infantile myofibromatosis.

Infantile myofibromatosis of the central nervous system.

Infantile myofibroma in a prematurely born twin: a case report.

Orbital and periorbital myofibromas in childhood: two case reports.

Solitary infantile myofibromatosis: report of two cases.

Adult acral cutaneous myofibromas in a patient with generalized morphea.

Infantile myofibromatosis with visceral involvement and complete spontaneous regression.

Systemic myofibromatosis in an infant.

Myofibromas and myofibromatosis of the oral region: A clinicopathologic analysis of 79 cases.

Myofibromas presenting in the oral cavity: a series of 9 cases.

Solitary form of infantile myofibromatosis: a histologic, immunohistochemical, and electronmicroscopic study of a regressing tumor over a 20-month period.

Perivascular myoma: a new concept for "myofibroblastic" tumors with perivascular myoid differentiation.

Myofibromatosis in adults, glomangiopericytoma, and myopericytoma: a spectrum of tumors showing perivascular myoid differentiation.  

Cutaneous adult myofibroma: a vascular neoplasm.

Infantile myofibromatosis: a case study and review of literature.

Multicentric infantile myofibromatosis.

Solitary cutaneous myofibromas in adults: report of six cases and discussion of differential diagnosis.

Facial myofibroma of the newborn simulating sarcoma.

Congenital generalized myofibromatosis: a disseminated angiocentric myofibromatosis.

Monophasic cellular variant of infantile myofibromatosis. An unusual histopathologic pattern in two siblings. 

Massive apoptosis in infantile myofibromatosis. A putative mechanism of tumor regression.

Solitary myofibroma in adults: clinicopathological analysis of a series.  

Familial occurrence of infantile myofibromatosis.  

Cutaneous myofibroma .  

Infantile myofibromatosis: the most common fibrous tumor of infancy.

Infantile myofibromatosis: the most common fibrous tumor of infancy.  

Infantile myofibromatosis. Evidence for an autosomal-dominant disorder.  

Infantile myofibromatosis.Cancer.

Solitary congenital fibromatosis (infantile myofibromatosis) of bone.

Infantile myofibromatosis: report of two cases.  

Congenital hemangio- pericytoma /infantile myofibro matosis: radical surgery versus a conservative "wait and see" approach.

New entities, concepts, and questions in childhood tumor pathology.

Acquired benign myofibroma of the skin (adult myofibroma)


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