Benign fibrous histiocytoma of the maxillary posterior tooth region.

To cite: Gupta DS, Bumb SS, Jain A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014203934 DESCRIPTION Benign fibrous histiocytoma (BFH) is tumour consisting of a mixture of fibroblastic and histiocytic cells. The occurrence of BFH in the head and neck region, especially in the oral cavity, has been rarely reported. A 19-year-old woman presented with complaints of pain and swelling on the right side of the face. Intra-oral examination disclosed a nodular and sessile mass measuring 4.0×3.5×3.0 cm in the right maxillary posterior tooth region (figure 1). The lesion was not painful on palpation and was clinically suspected to be a soft tissue fibrosis. Radiographic examination (figure 2) revealed the presence of an impacted right side third molar and the surrounding tooth, involving the maxillary tuberosity. After routine haematological investigation, surgical excision of the lesion was carried out under local anaesthesia in aseptic conditions. The wound was closed with 3-0 silk suture. Postoperatively, an antibiotic, an analgesic and chlorhexidine gluconate mouthwash were prescribed along with multivitamins. Later analysis of the specimen revealed a macroscopically smooth, well-circumscribed encapsulated lesion (figure 3). Histologically, fibroblast-like spindleshaped cells with a focally storiform and fascicular arrangement were seen. Non-mitotic figures, multinuclear giant cells, cell pleomorphism and nuclear atypia were visible. Polygonal, plump histiocytic cells were found among the spindle cells. The stroma was collagenised and inflammatory infiltrate was predominantly composed of plasma cells and lymphocytes (figure 4). Due to the varied microscopic appearance of the lesion, various differential diagnoses such as dermatofibroma and fibroxanthoma had been considered. However, based on the histopathological finding, a diagnosis of BFH was confirmed. The patient showed no recurrence of disease at 6-month follow-up (figure 5). Figure 1 Intra-oral examination reveals a nodular and sessile mass in the right maxillary posterior tooth region.