Ischemic Fasciitis-like pseudosarcomatous proliferations of the oral cavity.

Introduction

Ischemic fasciitis is a pseudosarcomatous proliferation of the subcutaneous tissue resulting in variably painful, non-ulcerated tumor-like masses. Most cases are seen overlying bony prominences of the pelvic and pectoral girdle in elderly patients who suffer from immobility due to debilitating conditions. Histopathologically similar lesions have not been reported in the oral cavity. This is the first report of two cases of ischemic fasciitis-like lesions affecting the dorsum of the tongue.

Materials and Method

Two elderly patients presented with a tumor-like mass of the dorsum of the tongue. One patient was otherwise healthy and the other had deep vein thrombosis and was on warfarin anticoagulant therapy. The submitted clinical diagnoses were squamous cell carcinoma and vascular malignancy in the first and second cases, respectively. The lesions were biopsied, and the processed and stained tissue were microscopically examined. Immunohistochemistry (IHC) stains including SMA, AE1/AE3 pankeratin, S100, p63, CD34, desmin and CD31 were used in only the first case.

Results

Surface epithelium was continuous with no dysplasia. The connective tissue deep to the epithelium, including the extrinsic skeletal muscle fibers of the tongue were replaced by a large central hypocellular zone of fibrinoid degeneration. This zone of fibrinoid degeneration was surrounded by a vascular granulation-type tissue containing atypical, plump myofibroblasts with dark smudged nuclei. Ganglion-like myofibroblasts were also seen. While SMA reactivity was focal, other IHC markers were negative.

Conclusion

A diagnosis of ischemic fasciitis-like degenerative, pseudosarcomatous process was given in both cases. Characteristic histopathological features were used to arrive at that working diagnosis. Excision is the preferred treatment, but incomplete removal may also result in healing. The prognosis is excellent.