Giant-cell fibroma

Last updated
Giant-cell fibroma
Other namesGCF.
Specialty Dermatology, Dentistry.
Usual onsetTypically 10-30 years old. [1]
Diagnostic method Histopathology. [2]
Differential diagnosis Retrocuspid papillae, Oral squamous papilloma, Verruciform xanthoma, and Irritation fibroma.
TreatmentSurgical excision. [2]
Frequency2 - 5% of all oral benign fibrous growths. [2]

Giant-cell fibroma is a benign localized fibrous mass. It often mimics other fibroepithelial growths and can be distinguished by its histopathology. The exact cause of giant-cell fibromas is unknown however there is no evidence to show that it can be caused by irritation. Giant-cell fibromas can be removed by surgical incision, electrosurgery, or laser excision. [3]

Contents

Signs and symptoms

Giant-cell fibromas are commonly located on the gingiva. The tongue is the second most common location, followed by the palate or buccal mucosa. Giant-cell fibromas are usually asymptomatic and appear as 0.5-1cm pedunculated or sessile lesions with a pebbly or bosselated surface. [4]

Diagnosis

Giant-cell fibromas are fibrous hyperplasic lesions and are diagnosed based on histopathological examination. [3] Giant-cell fibromas are histologically distinguished by multinucleated giant cells and numerous large stellate or varying density in the collagenous stroma. The giant cells are typically seen adjacent to the epithelium in connective tissue. Some of these cells have stain characteristics of melanin and contain small brown granules. The overlying epithelium has long thin rate ridges and is hyperplatic. Sometimes an artifactual space dividing the surrounding fibrous stroma from the giant fibroblasts can be seen. [4]

Histopathological giant fibroblasts can distinguish giant-cell fibromas from other lesions. Differential diagnosis includes an irritation fibroma, lipoma, retrocuspid papillae, peripheral ameloblastoma, focal fibrous hyperplasia, papilloma, intraoral neurilemmoma, odontogenic hamartoma, peripheral ossifying fibroma, peripheral adenomatoid odontogenic tumor, peripheral calcifying odontogenic cyst, and peripheral odontogenic fibroma. [5]

Treatment

The main treatment for Giant-cell fibromas is surgical excision however, electrosurgery or laser excision is the preferred treatment for children. The main advantage of electrosurgery is direct tissue hemostasis without needing sutures. Electrosurgery can also access difficult-to-reach areas and takes less time to perform. Laser treatments have been proposed as an alternative treatment option. Reoccurrences are rare and most cases of reoccurrence have been attributed to incomplete excision of the lesion.[ citation needed ]

Epidemiology

Giant-cell fibroma mostly affects Caucasians and is very rare in other races. Most studies have shown a slight female predominance while however, a few have shown no predominance. [6] Giant-cell fibromas represent about 1-5% of all biopsied fibrous lesions and around 0.4-1% of total biopsies. Giant-cell fibroma is diagnosed within the first three decades of life in approximately 60% of cases. [7]

History

In 1974 Weathers and Callihan first described the giant-cell fibroma. It was named after its unique large multinucleated and mononuclear stellate-shaped giant cells. Weathers and Callihan examined over 2,000 fibrous hyperplasias and 108 of them met their criteria for giant-cell fibroma. [8] In 1982 Housten performed a study of 464 giant-cell fibromas at the Indiana University School of Dentistry and agreed that the giant-cell fibroma was truly a distinctive lesion. [9]

See also

Related Research Articles

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Epulis fissuratum is a benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture. More simply, epulis fissuratum is where excess folds of firm tissue form inside the mouth, as a result of rubbing on the edge of dentures that do not fit well. It is a harmless condition and does not represent oral cancer. Treatment is by simple surgical removal of the lesion, and also by adjustment of the denture or provision of a new denture.

Inflammatory papillary hyperplasia (IPH) is a benign lesion of the oral mucosa which is characterized by the growth of one or more nodular lesions, measuring about 2mm or less. The lesion almost exclusively involves the hard palate, and in rare instances, it also has been seen on the mandible. The lesion is mostly asymptomatic and color of the mucosa may vary from pink to red.

<span class="mw-page-title-main">Pyogenic granuloma</span> Vascular tumor on both mucosa and skin

A pyogenic granuloma or lobular capillary hemangioma is a vascular tumor that occurs on both mucosa and skin, and appears as an overgrowth of tissue due to irritation, physical trauma, or hormonal factors. It is often found to involve the gums, skin, or nasal septum, and has also been found far from the head, such as in the thigh.

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<span class="mw-page-title-main">Dentigerous cyst</span> Medical condition

A dentigerous cyst, also known as a follicular cyst, is an epithelial-lined developmental cyst formed by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. It is formed when there is an alteration in the reduced enamel epithelium and encloses the crown of an unerupted tooth at the cemento-enamel junction. Fluid is accumulated between reduced enamel epithelium and the crown of an unerupted tooth.

<span class="mw-page-title-main">Central giant-cell granuloma</span> Medical condition

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Botryoid odontogenic cyst (BOC) is a type of developmental odontogenic cyst that is extremely rare. It is thought to be a lateral periodontal cyst (LPC) variant with a higher risk of recurrence. Weathers and Waldron coined the term BOC in 1973. Adults over the age of 50 are the most affected. BOC appears as a slow-growing lesion that is symptomatic in approximately 70% of cases.

<span class="mw-page-title-main">Calcifying odontogenic cyst</span> Medical condition

Calcifying odontogenic cyst (COC) is a rare developmental lesion that comes from odontogenic epithelium. It is also known as a calcifying cystic odontogenic tumor, which is a proliferation of odontogenic epithelium and scattered nest of ghost cells and calcifications that may form the lining of a cyst, or present as a solid mass.

<span class="mw-page-title-main">Glandular odontogenic cyst</span> Human jaw cyst

A glandular odontogenic cyst (GOC) is a rare and usually benign odontogenic cyst developed at the odontogenic epithelium of the mandible or maxilla. Originally, the cyst was labeled as "sialo-odontogenic cyst" in 1987. However, the World Health Organization (WHO) decided to adopt the medical expression "glandular odontogenic cyst". Following the initial classification, only 60 medically documented cases were present in the population by 2003. GOC was established as its own biological growth after differentiation from other jaw cysts such as the "central mucoepidermoid carcinoma (MEC)", a popular type of neoplasm at the salivary glands. GOC is usually misdiagnosed with other lesions developed at the glandular and salivary gland due to the shared clinical signs. The presence of osteodentin supports the concept of an odontogenic pathway. This odontogenic cyst is commonly described to be a slow and aggressive development. The inclination of GOC to be large and multilocular is associated with a greater chance of remission. GOC is an infrequent manifestation with a 0.2% diagnosis in jaw lesion cases. Reported cases show that GOC mainly impacts the mandible and male individuals. The presentation of GOC at the maxilla has a very low rate of incidence. The GOC development is more common in adults in their fifth and sixth decades.

<span class="mw-page-title-main">Ameloblastic fibroma</span> Medical condition

An ameloblastic fibroma is a fibroma of the ameloblastic tissue, that is, an odontogenic tumor arising from the enamel organ or dental lamina. It may be either truly neoplastic or merely hamartomatous. In neoplastic cases, it may be labeled an ameloblastic fibrosarcoma in accord with the terminological distinction that reserves the word fibroma for benign tumors and assigns the word fibrosarcoma to malignant ones. It is more common in the first and second decades of life, when odontogenesis is ongoing, than in later decades. In 50% of cases an unerupted tooth is involved.

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Reverse smoking is a kind of smoking where the burnt end of a hand rolled tobacco leaf is put in the mouth rather than the unlit end of the cigar. It is practiced in some parts of Andhra Pradesh, India, Lusaka, Zambia and the Philippines. Reverse smoking is considered to be a risk factor for oral cancer.

<span class="mw-page-title-main">Irritation fibroma</span> Fibroma on oral mucosa

Irritation fibroma is a type of fibroma that occurs on the mucosa of the oral cavity. Irritation fibromas are common benign tumors that are asymptomatic and resemble scarring. They are caused by prolonged irritation in the mouth, such as cheek or lip biting, rubbing from teeth, and dental prostheses.

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References

  1. "Giant cell fibroma". DermNet. Retrieved November 23, 2023.
  2. 1 2 3 "Giant cell fibroma". Pathology Outlines. February 21, 2022. Retrieved November 23, 2023.
  3. 1 2 Sivaramakrishnan, M; Sabarinath, B; Sivapathasundharam, B (2012). "Giant cell fibroma: A clinicopathological study". Journal of Oral and Maxillofacial Pathology. Medknow. 16 (3): 359–362. doi: 10.4103/0973-029x.102485 . ISSN   0973-029X. PMC   3519210 . PMID   23248467.
  4. 1 2 Sonalika, Wanjari Ghate; Sahu, Anshuta; Deogade, Suryakant C.; Gupta, Pushkar; Naitam, Dinesh; Chansoria, Harsh; Agarwal, Jatin; Katoch, Shiva (2014). "Giant Cell Fibroma of Tongue: Understanding the Nature of an Unusual Histopathological Entity". Case Reports in Dentistry. Hindawi Limited. 2014: 1–4. doi: 10.1155/2014/864512 . ISSN   2090-6447. PMC   3910466 . PMID   24511398.
  5. Radhakrishnan, Raghu; Kulkarni, Spoorti; Chandrashekar, Chetana; Kudva, Ranjani (2017). "Giant-cell fibroma: Understanding the nature of the melanin-laden cells". Journal of Oral and Maxillofacial Pathology. Medknow. 21 (3): 429–433. doi: 10.4103/jomfp.jomfp_209_16 . ISSN   0973-029X. PMC   5763868 . PMID   29391720.
  6. Magnusson, Bengt C.; Rasmusson, Lars G. (1995). "The giant cell fibroma A review of 103 cases with immunohistochemical findings". Acta Odontologica Scandinavica. Informa UK Limited. 53 (5): 293–296. doi:10.3109/00016359509005990. ISSN   0001-6357. PMID   8553805 . Retrieved November 22, 2023.
  7. Nikitakis, Nikolaos G.; Emmanouil, Dimitris; Maroulakos, Michail P.; Angelopoulou, Matina V. (February 27, 2013). "Giant Cell Fibroma in Children: Report of Two Cases and Literature Review". Journal of Oral and Maxillofacial Research. Stilus Optimus. 4 (1): e5. doi: 10.5037/jomr.2013.4105 . ISSN   2029-283X. PMC   3886105 . PMID   24422028.
  8. Weathers, Dwight R.; Callihan, Michael D. (1974). "Giant-cell fibroma". Oral Surgery, Oral Medicine, Oral Pathology. Elsevier BV. 37 (3): 374–384. doi:10.1016/0030-4220(74)90110-8. ISSN   0030-4220. PMID   4521457 . Retrieved November 22, 2023.
  9. Houston, Glen D. (1982). "The giant cell fibroma". Oral Surgery, Oral Medicine, Oral Pathology. Elsevier BV. 53 (6): 582–587. doi:10.1016/0030-4220(82)90344-9. ISSN   0030-4220. PMID   6954437 . Retrieved November 22, 2023.