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Clinical Problem Solving: Pathology
June 2007

Pathology Quiz Case 1: Diagnosis

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Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Otolaryngol Head Neck Surg. 2007;133(6):622-623. doi:10.1001/archotol.133.6.622

Myofibromas are rare fibrous tumors that most commonly affect infants and young children. Typical lesions are firm or rubbery and usually present as a solitary mass or as multiple nodules with or without visceral involvement. Solitary lesions have a predilection for the head and neck (36%) and trunk (33%) and can appear in skin, muscle, subcutaneous tissue, and bone.1 While individual tumors can present at any age, approximately 50% of solitary lesions are present at birth and more than 75% emerge before 12 months of age.1,2 There also appears to be a predilection for boys (male-female ratio, 2:1).1 Despite being rare overall, myofibroma is the most common fibrous tumor of infancy and childhood24 and should therefore be considered in any child with a nodular growth in the head and neck region. Within the head and neck, myofibroma has been documented in the scalp, forehead, orbit, oral cavity, larynx, parotid gland, mandible, maxilla, oropharynx, and skull base. In most cases, the overlying tissue appears unchanged, although in some cases, cutaneous or mucosal involvement can produce a purplish discoloration and, rarely, ulceration.2 Most lesions are slow growing and range from 0.3 to 5.0 cm in diameter.1,5,6 The tumors rarely invade but often compress surrounding structures.2

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