Peripheral granular cell odontogenic fibroma

Peripheral odontogenic fibroma is a rare lesion that arises on the gingiva and can clinically mimic a variety of reactive lesions, benign neoplasms, and metastases. We describe a symptomatic lesion arising on the mandibular gingiva of a 58-year-old female with no history of trauma or dental disease in the area. An excisional biopsy showed the lesional stroma to contain numerous polyhedral granular cells with occasional interspersed islands of inactive odontogenic epithelium. We believe this to represent the fourth case of peripheral granular cell odontogenic fibroma to be reported in detail in the literature.     

The peripheral odontogenic fibroma: an attempt at clarification

Two different lesions of the gingiva that have been referred to previously as peripheral odontogenic fibromas are discussed. The first of these is the rare extraosseous counterpart of the central odontogenic fibroma (WHO type)1 and is therefore referred to in this article as the peripheral odontogenic fibroma (WHO type). It is probably treated adequately by simple excision, but a study of its biologic behavior is lacking. The second lesion is reactive, is common, and has a marked tendency to recur. It has been known by numerous synonyms, including calcifying fibrous epulis and peripheral ossifying fibroma, as well as peripheral odontogenic fibroma. The term peripheral ossifying fibroma should be retained for this lesion to avoid confusion with the peripheral odontogenic fibroma (WHO type).     

Epulides in the dog: a review

This article is based on a review of the literature and the study of pathology sections obtained from various veterinary pathology laboratories. Epulis is a non-specific, clinical designation for a localized, exophytic growth on the gingiva. Four reactive epulides occur in human beings, namely focal fibrous hyperplasia (fibrous epulis). pyogenic granuloma. peripheral giant cell granuloma (giant cell epulis. and peripheral ossifying fibroma (calcifying fibrous epulisl). The first three also occur in dogs but only focal fibrous hyperplasia appears to be common. The peripheral ossifying fibroma has not yet been reported in dogs. Odontogenic tumors occurring on the gingiva (i.e., as epulides) are referred to as peripheral odontogenic tumors. Three types have been reported in dogs. One, the common fibromatous epulis. is equivalent to the rare peripheral odontogenic fibroma in human beings. Another, the acanthomatous epulis. appears to be a form of ameloblastoma but differs from the peripheral ameloblastoma in human beings in that it invades bone; its biological behavior is therefore that of the human intraosseous ameloblastoma. The third, a rare lesion, has been referred to in the veterinary literature as a calcifying epithelial odontogenic tumor, although it is not the canine counterpart of the human CEOT The term, amyloid-producing odontogenic tumor , has been suggested as being appropriate for this lesion.     

Soft tissue myxoma of the gingiva: report of a case and review of the literature of soft tissue myxoma in the oral region

Soft tissue myxoma of the oral cavity is extremely rare. We present a case of soft tissue myxoma arising from a mandibular anterior gingiva in a 51-year-old male patient. Histological examination showed islands of odontogenic epithelium scattered in the mucinous stroma. This lesion was supposed to have a odontogenic origin. The clinical differences between soft tissue myxoma with bone destruction and those without bone destruction are also discussed by a review of the literature.     

Peripheral odontogenic fibroma

Peripheral odontogenic fibroma (WHO type) is an uncommon lesion of the gingiva; 18 well-documented cases have been published. It is considered to be the extraosseous counterpart of the central odontogenic fibroma. Because of the paucity of reported cases, the full histomorphologic spectrum of this lesion has not yet been established. This article presents nine cases of peripheral odontogenic fibroma that illustrate the variety of its histopathologic findings. The connective tissue ranged from loose (almost myxomatous) to markedly cellular to relatively acellular and well-collagenized. Islands and/or strands of odontogenic epithelium were present in all lesions. Matrix of mineralized material was present in three cases, and juxtaepithelial hyalinization was seen in one case. To avoid the introduction of additional diagnostic terms, we suggest that all these lesions be considered a spectrum of the peripheral odontogenic fibroma (WHO type). We also suggest that the term WHO type be used to distinguish peripheral odontogenic fibromas from the peripheral ossifying fibroma with which they have often been confused.     

Peripheral ameloblastoma: a case report

Peripheral ameloblastoma is a rare odontogenic soft tissue tumor, derived from epithelial and/or mesenchymal elements being part of the tooth-forming apparatus. The lesion responses for approximately 1% to 5% of all cases of ameloblastoma affecting alveolar mucosa and gingiva occur, mainly, in the middle age. This article describes a case of peripheral ameloblastoma involving a 20-year-old male located in the (upper/lower, vestibular/buccal) gingiva. After the case presentation, clinical and microscopic findings are discussed.     

Diffuse peripheral odontogenic fibroma: report of 3 cases

Since peripheral odontogenic fibroma (POF) is characteristically described as a solitary lesion and no diffuse POF had been reported in the literature, our cases should be considered as extremely unusual. Three diffuse cases of POF are described of which one case was seen in association with ocular and skin lesions. The question arises whether POF should be considered as a true odontogenic tumor rather than a diffuse hamartomatous lesion caused by uncontrolled induction of the gingiva. It is also possible that such lesions could be part of a yet undescribed syndrome.     

Peripheral ameloblastoma-a clinical dilemma in gingival lesions

A case of peripheral ameloblastoma on the gingiva of a 50-year-old male is presented. The clinical and histological picture of the lesion is described. The etiology and the dilemma in the differential diagnosis of this peripheral odontogenic tumor is discussed.     

The peripheral odontogenic keratocyst

A case with a firm asymptomatic nodule of 1 cm diameter on the gingiva between the left upper cuspid and first bicuspid is presented. Radiographic examination did not reveal any pathology of the bone in that region. Histologic examination revealed a cyst wall lined by squamous stratified epithelium, characteristic to the lining of an odontogenic keratocyst. It is suggested that the term peripheral odontogenic keratocyst be used for the diagnosis of this lesion.     

Peripheral ameloblastoma: a case report and review of the literature

Peripheral ameloblastoma is a rare, benign odontogenic tumor that histologically resembles an intraosseous ameloblastoma but develops in the soft tissues of the gingiva and mucosa and exhibits an innocuous clinical behavior. We report a case of a recurrent peripheral ameloblastoma in a 61-year-old man that presented as a painless swelling on the maxillary anterior labial attached gingiva. Clinical and histopathologic features of this lesion are discussed. The peripheral ameloblastoma should be included in the differential diagnosis of a gingival lesion clinically resembling any of the myriads of entities seen on the gingiva including a pyogenic granuloma, peripheral giant cell granuloma, or parulis/gumboil. We believe this case highlights the need for submitting excised tissue for microscopic examination.     

Peripheral ameloblastoma. A case report and review of the literature.

Peripheral ameloblastoma is a benign odontogenic tumor with the same histological characteristics as the centrally located ameloblastoma, but appearing in the gingiva and mucosa of the tooth-bearing area of the jaws. A review is presented of 53 cases: 45 being reported as peripheral ameloblastoma and 8 as basal cell carcinoma of the gingiva, including the case presented. Based on the review it is recommended to treat this lesion by local excision including a small margin of healthy tissue. Local recurrence is unlikely, unless incomplete removal is performed.     

Odontogenic gingival epithelial hamartoma with a pleomorphic histological appearance: a case report and review of the literature

Odontogenic gingival epithelial hamartoma (OGEH) is a rare odontogenic epitheliallesion. Distinguishing OGEH from peripheral ameloblastoma can pose a differential diagnostic challenge. We report a case of OGEH affecting the lower gingiva in a 78-year-old male patient. The lesion presented as a large, painless, pedunculated mass with a pleomorphic histological appearance. A diagnosis of OGEH was made after the exclusion of peripheral ameloblastoma and peripheral adenomatoid odontogenic tumour. Previous studies have reported differences in sex and age between patients with OGEH and peripheral ameloblastoma; this suggests that peripheral ameloblastoma is not derived from OGEH. Histological findings suggest that the lesions are independent entities.     

Recurrent peripheral odontogenic fibroma of the attached gingiva: a case report.

Peripheral odontogenic fibroma is an uncommon, benign, unencapsulated, exophytic gingival mass of fibrous connective tissue covered with a surface epithelium. Odontogenic epithelium and mineralized material may be found in the mass. A case is reported of a lesion that recurred in the attached gingiva following initial excision. Differential diagnosis of exophytic gingival lesions and post-operative management are also discussed.     

Clinicopathological investigation of odontogenic fibroma in tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is an autosomal dominant inherited disease characterized by systemic hamartoma and diverse systemic features. TSC1 and TSC2 are the causative genes, and mental retardation, epileptic seizures, and facial angiofibroma develop in many patients with the disease. The case of a patient with TSC who developed a central odontogenic fibroma of the mandible is reported here. The patient was a 21-year-old woman who was referred with a swelling of the labial gingiva in the region of the right lower lateral incisor and canine. Dental radiography revealed a multilocular radiolucent region with a clear boundary. The right lower lateral incisor and canine were continuous with the lesion and thus were excised en bloc. The lesion was encapsulated and easily dissected. The diagnosis on immunohistological staining was odontogenic fibroma without an epithelial component. TSC1/2 gene mutation causes abnormal activation of mammalian target of rapamycin (mTOR) downstream of the PI3K–AKT pathway. The odontogenic fibroma in this patient was positive for mTOR, suggesting that the development of the odontogenic fibroma was the result of abnormal activation of mTOR, as in angiofibroma. The clinical course of this patient is presented and the developmental mechanism of central odontogenic fibroma is discussed.     

Granular cell — Peripheral ameloblastoma: a rare variant

Ameloblastoma is an epithelial odontogenic tumour of the jaw and exhibits diverse microscopic patterns which occurs either singly or in combination with other patterns. Peripheral ameloblastoma is a rare odontogenic soft tissue tumor, derived from epithelial and/or mesenchymal elements being part of the tooth-forming apparatus. The lesions responsible for approximately 1% to 5% of all cases of ameloblastoma affecting alveolar mucosa and gingiva occurring mainly, in the middle age. This article describes a case of peripheral ameloblastoma affecting a 35-year-old female. The lesion was located in the right buccal space. The occurrence and pathogenesis of peripheral ameloblastomas in general, are reviewed. The tumour was excised and no recurrence has been observed after twenty four months of surgery.     

Peripheral dentinogenic ghost cell tumor of the gingiva

BACKGROUND: A dentinogenic ghost cell tumor is a locally invasive neoplasm that is characterized by ameloblastoma-like islands of epithelial cells in a mature connective tissue stroma. METHODS: A 43-year-old male patient presented a well-circumscribed sessile, exophytic mass of the gingiva with a diameter of 2 cm located in the canine area of the right maxilla. The lesion was enucleated. RESULTS: The lesion showed odontogenic epithelium, ghost cells, dentinoid material, and giant cells. The final microscopic diagnosis was a dentinogenic ghost cell tumor. CONCLUSIONS: A dentinogenic ghost cell tumor is an extremely rare tumor, and only a few cases have been reported in the English literature. The peripheral, extraosseous lesion can be easily confused with other gingival lesions such as reactive or inflammatory lesions or other peripheral odontogenic tumors. The clinical appearance of all of these lesions is similar; therefore, the definitive diagnosis depends on histology, and a biopsy with a microscopic examination is mandatory.     

Basal cell extensions in human oral mucosa.

Basal cell extensions have frequently been observed in a variety of odontogenic lesions as well as in the fibrous epulis (fibrous hyperplasia of the gingiva). In order to determine the frequency of these extensions in normal human oral nucosa, a study using autopsy and surgical material was conducted. The results indicated that a specific type of rete ridge morphology exists for gingiva, including the presence of thin double stranded extensions which may be related to the functional role of the gingiva or to the fact that the odontogenic apparatus is derived from surface epithelium in this region in the developing embryo, or both. Similar extensions have not been found in other oral epithelia.     

Peripheral calcifying odontogenic cyst

BACKGROUND: Calcifying odontogenic cyst (COC) is a rare lesion representing about 1% of jaw cysts. It may occur in a central (intraosseous) or peripheral (extraosseous) location. METHOD: A case of peripheral COC located on the gingiva, appearing as a painless, circumscribed, pink nodule has been reported. RESULTS: Peripheral, in contrast to central, COC tends to affect older patients. Peripheral COC is a less aggressive lesion than the central counterpart, and a simple excision biopsy is curative. CONCLUSION: The histological finding of a keratinized epithelium rich in ghost cells has helped in making the diagnosis.     

Ghost cell odontogenic carcinoma arising in the background of a benign calcifying cystic odontogenic tumor of the mandible

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant variant of odontogenic tumor with ghost cells; only 29 cases are documented. Our patient was a 68-year-old man with a painless, well-defined, radiolucent swelling of the mandibular gingiva in the right incisor-to-molar region. It was diagnosed as a benign calcifying cystic odontogenic tumor (CCOT) on fenestration biopsy. Eighteen years later, he returned with swelling in the same area. The lesion was excised, diagnosed as GCOC, and considered a secondary malignant manifestation of the benign CCOT. No adjuvant chemotherapy or radiotherapy was administered, and his postoperative course was uneventful for 48 months, with no recurrence or distant metastasis. Among the 30 reported cases of GCOC, the mean age at diagnosis was 40.3 years, 22 (73%) involved the maxilla. Twelve (40%) were secondary malignant manifestations of benign CCOTs or dentinogenic ghost cell tumors. Five patients died of recurrence or distant metastasis.     

Soft tissue myxoma: report of an unusual case located on the gingiva

BACKGROUND: Soft tissue myxoma of the oral cavity is rare. Only three cases of myxoma of gingiva have been reported in the literature. We present a case of soft tissue myxoma arising from the left maxillary adherent gingiva in a 42-year-old male [correction of female] patient. METHODS: Histological examination showed spindle-shaped cells in a myxoid stroma. Immunohistochemical stains with S-100 protein were negative, while those with vimentin were positive. RESULTS: Clinical examination revealed a soft tissue mass, with tense elastic consistency on palpation. The overlying mucosa was normal and healthy. A clinical diagnosis of fibroma was given. Histological examination showed spindle-shaped and stellate cells, arranged in a myxoid fibrous stroma, with collagen fibres distributed uniformly. Scattered islands or strands of inactive odontogenic epithelium were present. On the basis of the histological and immunohistochemical findings, the final diagnosis was soft tissue myxoma. CONCLUSIONS: Further studies are necessary to clarify the origin and histogenesis of this lesion.