Giant-cell fibroma | |
---|---|
Other names | GCF. |
Specialty | Dermatology, Dentistry. |
Usual onset | Typically 10-30 years old. [1] |
Diagnostic method | Histopathology. [2] |
Differential diagnosis | Retrocuspid papillae, Oral squamous papilloma, Verruciform xanthoma, and Irritation fibroma. |
Treatment | Surgical excision. [2] |
Frequency | 2 - 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]
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]
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]
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 ]
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]
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]
Ameloblastoma is a rare, benign or cancerous tumor of odontogenic epithelium much more commonly appearing in the lower jaw than the upper jaw. It was recognized in 1827 by Cusack. This type of odontogenic neoplasm was designated as an adamantinoma in 1885 by the French physician Louis-Charles Malassez. It was finally renamed to the modern name ameloblastoma in 1930 by Ivey and Churchill.
Cementoblastoma, or benign cementoblastoma, is a relatively rare benign neoplasm of the cementum of the teeth. It is derived from ectomesenchyme of odontogenic origin. Cementoblastomas represent less than 0.69–8% of all odontogenic tumors.
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.
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.
Peripheral giant-cell granuloma (PGCG) is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, pyogenic granuloma and peripheral ossifying fibroma. These three diseases are associated because they appear frequently on gingiva. Due to its similar microscopic appearance, peripheral giant-cell granuloma is considered to be the soft tissue equivalent of central giant-cell granuloma.
A peripheral ossifying fibroma, also known as ossifying fibrous epulis, is “a gingival nodule which is composed of a cellular fibroblastic connective tissue stroma which is associated with the formation of randomly dispersed foci of mineralised products, which consists of bone, cementum-like tissue, or a dystrophic calcification. The lesion is considered part of an ossifying fibroma, but that is usually considered to be a jaw tumor. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, though not because they occur together. Instead, the three are associated with each other because they appear frequently on gingiva: pyogenic granuloma and peripheral giant cell granuloma. Some researchers believe peripheral ossifying fibromas to be related to pyogenic fibromas and, in some instances, are the result of a pyogenic granuloma which has undergone fibrosis and calcification.
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.
Central giant-cell granuloma (CGCG) is a localised benign condition of the jaws. It is twice as common in females and is more likely to occur before age 30. Central giant-cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings.
An odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior mandible and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts.
“Lateral periodontal cysts (LPCs) are defined as non-keratinised and non-inflammatory developmental cysts located adjacent or lateral to the root of a vital tooth.” LPCs are a rare form of jaw cysts, with the same histopathological characteristics as gingival cysts of adults (GCA). Hence LPCs are regarded as the intraosseous form of the extraosseous GCA. They are commonly found along the lateral periodontium or within the bone between the roots of vital teeth, around mandibular canines and premolars. Standish and Shafer reported the first well-documented case of LPCs in 1958, followed by Holder and Kunkel in the same year although it was called a periodontal cyst. Since then, there has been more than 270 well-documented cases of LPCs in literature.
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.
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.
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.
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.
The calcifying epithelial odontogenic tumor (CEOT), also known as a Pindborg tumor, is an odontogenic tumor first recognized by the Danish pathologist Jens Jørgen Pindborg in 1955. It was previously described as an adenoid adamantoblastoma, unusual ameloblastoma and a cystic odontoma. Like other odontogenic neoplasms, it is thought to arise from the epithelial element of the enamel origin. It is a typically benign and slow growing, but invasive neoplasm.
Epulis is any tumor like enlargement situated on the gingival or alveolar mucosa. The word literally means "(growth) on the gingiva", and describes only the location of the mass and has no further implications on the nature of the lesion. There are three types: fibromatous, ossifying and acanthomatous. The related term parulis refers to a mass of inflamed granulation tissue at the opening of a draining sinus on the alveolus over the root of an infected tooth. Another closely related term is gingival enlargement, which tends to be used where the enlargement is more generalized over the whole gingiva rather than a localized mass.
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.
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.
The ameloblastic fibro-odontoma (AFO) is essentially a benign tumor with the features characteristic of ameloblastic fibroma along with enamel and dentin. Though it is generally regarded as benign, there have been cases of its malignant transformation into ameloblastic fibrosarcoma and odontogenic sarcoma. Cahn LR and Blum T, believed in "maturation theory", which suggested that AFO was an intermediate stage and eventually developed during the period of tooth formation to a complex odontoma thus, being a hamartoma.