DOI QR코드

DOI QR Code

Calcifying Aponeurotic Fibroma of the Temporomandibular Joint in an Adult Patient: A Case Report

  • Jeon, Hye-Mi ;
  • Jeong, Sung-Hee ;
  • Ahn, Yong-Woo ;
  • Kim, So-Yeun ;
  • Jung, Kyung-Hwa ;
  • Kwon, Eun-Young ;
  • Ok, Soo-Min
  • Received : 2019.02.22
  • Accepted : 2019.03.18
  • Published : 2019.03.30

Abstract

Calcifying aponeurotic fibroma (CAF) is an uncommon benign soft-tissue fibroblastic tumor with characteristic histological features. It mainly occurs in the distal part of the extremities, such as the hands and feet, in children and adolescents. Males are twice as commonly affected as females. CAF exhibits local invasiveness, and hence, its recurrence rate is also high. Therefore, complete surgical excision is both diagnostic and therapeutic. The occurrence of CAF in the maxillofacial region, especially the temporomandibular joint (TMJ), is very rare, and this necessitates its differentiation from other TMJ neoplasms. The differential diagnosis of CAF requires microscopic examination. Herein, we report a rare case of CAF located at the left mandibular condyle, which was confirmed by histopathological analysis.

Keywords

Adult;Calcifying aponeurotic fibroma;Temporomandibular joint

GGNGBC_2019_v44n1_35_f0001.png 이미지

Fig. 1. Preoperative clinical photograph of patient with localized swelling on left temporomandibular joint (arrow). The overlaying skin is normal in color.

GGNGBC_2019_v44n1_35_f0002.png 이미지

Fig. 3. Computed tomography (CT). (A) Axial CT image, (B) coronal CT image shows a non-specific soft tissue mass (white arrows) on the left temporomandibular joint and high density part. There is no adjacent bone involvement.

GGNGBC_2019_v44n1_35_f0003.png 이미지

Fig. 2. Panoramic radiograph reveals that there are no pathological findings.

GGNGBC_2019_v44n1_35_f0004.png 이미지

Fig. 4. Gross specimen. (A) Resection gross specimen shows a lobulated and circumscribed mass. (B) The sectioned specimen has a homogeneous yellowish white appearance.

GGNGBC_2019_v44n1_35_f0005.png 이미지

Fig. 5. Histologic examination. (A) The lesion demonstrates characteristic scattered foci of calcification (black arrows) (H&E stain, ×40). (B) Calcification area (black star) and collagenous stroma (black arrows) are observed (H&E stain, ×200). (C) Multinucleated giant cell (black star) is seen around the calcification area. Spindled fibroblasts are aligned linearly (black arrows) (H&E stain, ×200). (D) A local chondroid differentiation (black stars) reveals surrounded by peripheral less cellular and fibroblasic component (black arrow) (H&E stain, ×200).

References

  1. Nishio J, Inamitsu H, Iwasaki H, Hayashi H, Naito M. Calcifying aponeurotic fibroma of the finger in an elderly patient: CT and MRI findings with pathologic correlation. Exp Ther Med 2014;8:841-843. https://doi.org/10.3892/etm.2014.1838
  2. Sekiguchi T, Nakagawa M, Miwa S, et al. Calcifying aponeurotic fibroma in a girl: MRI findings and their chronological changes. Radiol Case Rep 2017;12:620-623. https://doi.org/10.1016/j.radcr.2017.04.009
  3. Kim OH, Kim YM. Calcifying aponeurotic fibroma: case report with radiographic and MR features. Korean J Radiol 2014;15:134-139. https://doi.org/10.3348/kjr.2014.15.1.134
  4. Fetsch JF, Miettinen M. Calcifying aponeurotic fibroma: a clinicopathologic study of 22 cases arising in uncommon sites. Hum Pathol 1998;29:1504-1510. https://doi.org/10.1016/S0046-8177(98)90022-3
  5. Oruc M, Uysal A, Kankaya Y, Yildiz K, Aslan G, Sengul D. A case of calcifying aponeurotic fibroma of the scalp: case report and review of the literature. Dermatol Surg 2007;33:1380-1383.
  6. Takaku M, Hashimoto I, Nakanishi H, Kurashiki T. Calcifying aponeurotic fibroma of the elbow: a case report. J Med Invest 2011;58:159-162. https://doi.org/10.2152/jmi.58.159
  7. Kramer JM, Doscher JC, Ruvinsky M, Fantasia JE. Calcifying aponeurotic fibroma with bone islands exhibiting hematopoiesis: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:878-882. https://doi.org/10.1016/j.tripleo.2010.01.020
  8. Corominas L, Sanpera I Jr, Sanpera-Iglesias J, Ramos-Ansesio RF. Calcifying aponeurotic fibroma in children: our experience and a literature review. J Pediatr Orthop B 2017;26:560-564. https://doi.org/10.1097/BPB.0000000000000335
  9. Laskin DM, Green CS, Hylander WL. Temporomandibular disorders : an evidence-based approach to diagnosis and treatment. Chicago: Quintessence; 2006. pp. 509-528.
  10. Kwon YE, Choi KS, An CH, Choi SY, Lee JS, An SY. Recurrent osteochondroma of the mandibular condyle: a case report. Imaging Sci Dent 2017;47:57-62. https://doi.org/10.5624/isd.2017.47.1.57
  11. Kim HS, Lee W, Choi JW, Han WJ, Kim EK. Temporomandibular joint synovial chondromatosis accompanying temporal bone proliferation: a case report. Imaging Sci Dent 2018;48:147-152. https://doi.org/10.5624/isd.2018.48.2.147
  12. Liu X, Huang Z, Zhu W, Liang P, Tao Q. Clinical and imaging findings of temporomandibular joint synovial chondromatosis: an analysis of 10 cases and literature review. J Oral Maxillofac Surg 2016;74:2159-2168. https://doi.org/10.1016/j.joms.2016.04.029
  13. Morii T, Yoshiyama A, Morioka H, Anazawa U, Mochizuki K, Yabe H. Clinical significance of magnetic resonance imaging in the preoperative differential diagnosis of calcifying aponeurotic fibroma. J Orthop Sci 2008;13:180-186. https://doi.org/10.1007/s00776-008-1226-6

Acknowledgement

Supported by : Pusan National University Hospital