Pyogenic granuloma (lobular capillary hemangioma) of the tongue

A patient with a pyogenic granuloma which occurred in an unusual location and at an earlier age is presented. Pyogenic granuloma is not an uncommon entity which may occur on oral mucosa, face and fingers. The most frequent location encountered for oral cavity pyogenic granuloma is the gingiva and the tongue is a rare location for its occurrence. These lesions are usually seen between 11 and 40 years age. Surgical excision and removal of etiological factors are needed for treatment.     

乳突部骨化纤维瘤诊治体会

目的通过对罕见案例分析和文献复习,探讨乳突部骨化纤维瘤的临床表现、诊断及治疗,提高对该病的认识,减少临床漏诊误诊。方法分析2020年8月24日就诊的1例乳突部骨化纤维瘤的女性患者,完善术前临床及影像学检查后,在全麻下行乳突部肿瘤切除术,术后随访12个月。结果术后病理诊断为骨化性纤维瘤。患者术后恢复可,无呕吐、眩晕及面瘫。术后随访12个月,患者未再诉头痛及耳鸣等不适,无复发。结论发生在乳突部的骨化纤维瘤临床上十分罕见,早期无明显临床表现,易被漏诊。目前认为影像学与组织病理学分析是确诊及分类的主要依据,手术切除是患者出现临床症状后的首选的治疗方法,而具体的治疗方式应根据肿块的大小、侵袭程度、周围结构受累情况、临床表现以及患者的预后、耐受程度来灵活选择。     

The results of Kaplan-Meier and multivariate analyses of etiological factors related to the outcome of combined pharmacological therapy against laryngeal granuloma

Conclusions: The present results indicate that the diagnosis of gastroesophageal reflux disease (GERD) is an independent etiological factor predicting retardation of the resolution of laryngeal granuloma.

Objectives: To assess the effects of combined usage of an inhaled corticosteroid plus tranilast and/or a proton pump inhibitor on the size of granulomatous lesions, and to reveal etiological factors related to the outcome using the Kaplan-Meier method and a subsequent multivariate analysis.

Methods: Sixty-two patients with laryngeal granuloma were enrolled. An inhaled corticosteroid plus tranilast (300?mg/day) and rabeprazole (20?mg/day) were administered to all of the patients, and only to those diagnosed to have GERD, respectively. The size of granulomatous lesion was measured for each patient at the initial visit and every 4 weeks. At 48 weeks, the Kaplan-Meier plots for lesion disappearance rate were compared between groups with and without each of the etiological factors, followed by Cox proportional-hazards regression.

Results: The 48-week lesion disappearance rates for the whole population were 82.3%. Although the Kaplan-Meier analysis exhibited significant differences between patients separated by GERD diagnosis, phonotrauma, and habitual smoking, only GERD were identified as a real independent etiological factor affecting the resolution of the lesion by a multivariate analysis using Cox’s proportional-hazards regression.     

Maxillary giant cell reparative granuloma

“Giant cell reparative granuloma” was introduced into medical literature by Jaffe in 1953. Prior to that time most authors considered this lesion to be a variant of the benign giant cell tumor of the long bones, or a giant cell variant of osteitis fibrosa. Bernier and Cahn established the subdivision between the rare central giant cell reparative granuloma and the common peripheral epulis. In the past, considerable emphasis has been placed on the importance of differentiating the true giant cell tumor from the giant cell reparative granuloma of the jaw bones. Most authors now believe the true giant cell tumor does not appear in the jaw bones except in rare cases associated with Paget's disease of the skull. Developing from membranous, rather than cartilaginous, ossification might account for this. Both peripheral and central intraosseous lesions, parathyroid osteopathy and the pathologic tissue of cherubism show no appreciable histologic difference. These tumefactions are histologically a proliferative fibroblastic lesion with multinucleated giant cells. The histopathology of the giant cell tumor of the long bones is probably identical to the histopathology of the giant cell reparative granuloma of the jaw bones. The diagnosis of giant cell reparative granuloma must be made by physical examination, history, laboratory, X-ray parameters and clinical follow-up. Localized maxillary swelling is the most important clinical feature. The swelling is smooth and palaption can reveal a rubbery, elastic sensation where bone has been thinned. There are no specific radiographic signs. Conservative surgical management is indicated and adequate for giant cell reparative granulomas. Radiation is not indicated because of long term risks. Steroids have not been proven useful.     

Fibro-osseous lesions of the cranio-facial bones.

A brief review of cranio-facial fibro-osseous lesions is given and 15 cases of fibrous dysplasia and ossifying fibroma are presented with clinical, radiological and histomorphological findings. After histological verification of the fibro-osseous nature of the process, 5 lesions were diagnosed on an radiological basis as fibrous dysplasia exhibiting diffuse (blending) margins, while the diagnosis of ossifying fibroma was given to 10 radiologically sharply-demarcated lesions. Both groups of lesions presented the same histomorphological features, although to a varying degree. Spheroidal calcifications, however, were identified in ossifying fibroma only, but not in all of these. Thus, the differential diagnosis of fibrous dysplasia versus ossifying fibroma rests on a radiological criterion after the histopathologist has verified the fibro-osseous nature of a lesion. The observation times varied from 1 1/2 to 34 years. Two cases of fibrous dysplasia and 3 cases of ossifying fibroma recurred. In one case of fibrous dysplasia an osteosarcoma developed 33 years after irradiation. Pain was a common symptom in the present material.     

Recurrence of premalignant oral cavity and oropharynx lesions after pulsed diode laser treatment

PurposeLeukoplakia is common with a 1 % incidence in the population and may harbor preneoplastic changes. Diode lasers provide both precision and coagulation for excision of superficial lesions in clinical and operative settings with little damage to deeper tissue. We aim to determine the rate of oral and oropharyngeal hyperkeratosis and dysplasia recurrence after treatment with diode laser.Materials and methodsPatients with oral or oropharyngeal hyperkeratotic or mild dysplastic lesions treated with pulsed diode laser between 2013 and 2020 at a tertiary academic institution were analyzed. The main outcome measure was recurrence of hyperkeratosis and dysplasia after treatment.ResultsFourteen patients received diode laser treatment for hyperkeratotic or mild dysplastic lesions of the oral cavity or oropharynx. Demographic features included 9 (64.3 %) females and mean age of 66.6 years. In these 14 patients, 18 distinct lesions were identified. Eleven (61.1 %) lesions were located on the oral tongue, 4 (22.2 %) on the buccal mucosa, 2 (11.1 %) on the hard palate, and 1 (5.6 %) on the soft palate. Average time from lesion clinical diagnosis to the first diode laser treatment was 8.3 months with an average number of 1.4 treatments per lesion. Three (16.7 %) lesions experienced recurrence after the most recent treatment. None of the lesions underwent malignant transformation. None of the patients experienced bleeding, tethering, or dysarthria after treatment. One patient developed pyogenic granuloma and reported chronic tongue pain.ConclusionsPulsed diode laser treatment of leukoplakia was well tolerated with low complication rates and reasonable control of precancerous lesions.     

A comparative study of osteopontin and MMP-2 protein expression in peripheral and central giant cell granuloma of the jaw

Introduction

Oral peripheral and central giant cell granulomas are lesions with little-known etiology and pathogenesis.

Peripheral giant cell granuloma of the mandibular condyle presenting as a preauricular mass

Preauricular mass is a common symptom for patients presenting to the otorhinolaryngologist with parotid disease. Some rare extraparotid lesions, originating from the temporomandibular joint and the mandible itself, also share the same localization and therefore are to be taken into consideration for the differential diagnosis with parotid lesions. Giant cell granuloma (GCG) was first described by Jaffe in 1953. Peripheral GCG (PGCG) is an exophytic soft tissue lesion originating from the periodontal ligament and periosteum. It is located only within the oral cavity. Central GCG (CGCG) is an uncommon benign fibro-osseous lesion generally presenting as an expansible mass with cortical bone defect. It is generally located in the mandible. The brown tumor of hyperparathyroidism and giant cell tumor must be ruled out because of the microscopic similarities of these lesions. The first case of PGCG of the mandible condyle is presented, and attention is drawn to mandibular diseases for the differential diagnosis of the preauricular mass.     

Common fibro-osseous lesions of the paranasal sinuses

Within in the broad spectrum of disease that can affect the paranasal sinuses is a class of benign bony abnormalities known collectively as fibro-osseous lesions. Fibrous dysplasia, ossifying fibroma, and osteoma are three distinct entities that lie along a continuum from the least to the most bony content. They have similar appearance and makeup; however, their clinical implications vary. This article focuses primarily on sinonasal osteomas, with less emphasis on fibrous dysplasia and ossifying fibroma.     

Clinical pathological analysis of nine cases of aneurysmal bone cyst of the jaws in a Brazilian population

Aneurysmal bone cysts (ABCs) are benign osteolytic lesions that occur rarely in the jaws. The aim of this study was to investigate the clinical, radiographical and pathological features of ABCs of the jaws. A retrospective analysis of the content of a 39-year database, including nine cases of ABCs of the jaws diagnosed from the archives of the Oral Pathology Service. Nine patients (3 males and 6 females), ranging in age from 5 to 33 years were included. Seven (7/9) lesions were located in the mandible and two (2/9) in the maxilla. A painful swelling was the most common clinical finding (n = 4, 4/9). Radiologically, the lesions frequently presented as multilocular (5/9), well defined (4/9), bone expansion and perforation (2/9). Pathological analysis revealed that two cases were associated with central ossifying fibroma and one case with central giant cell lesion. Histomorphology showed a predominance of the solid type (5/9) and of sinusoidal pseudocystic spaces (4/9). Giant cells, osteoid material, calcified material, blood vessels and hemosiderin deposits were observed in 6/9, 7/9, 8/9, 9/9 and 7/9, respectively. The patients with ABCs presented clinical and radiographical features, which often posed a diagnostic dilemma. Knowledge about the most common characteristics of ABCs may contribute to the establishment of a more accurate diagnosis.     

Laryngeal cancer in non-smoking and non-drinking patients

Giant cell granulomas account for 7% of all benign tumors of the jaw. They are commonly seen as asymptomatic masses. A 4-year-old boy with an exophitic, crusty, hemorrhagic mass on the anterolateral region of the right maxilla was referred to our department. Pathological examination was reported as giant cell granuloma. A mixture of prednisolone, lidocaine and adrenaline was injected intralesionally once a week and oral fluocortone was added to this therapy. A limited surgery could be performed. Intralesional prednisolone and systemic fluocortone therapy seems to be effective, as the lesion stopped growing and increase in bony structures was observed radiologically.     

Study of pyogenic granuloma of the oral cavity]

Pyogenic granuloma is one of the diseases sometimes seen in otorhinolaryngology clinics. The clinical features of this disease are understood to be that the lesion is located in the oral cavity in the majority of cases that its causative agent is usually discovered and that it most likely grows as a malignant tumor. However, the entity of pathological diagnosis has not been established. Thirty-one cases of oral pyogenic granuloma, including 16 males and 15 females, are reported in this paper. The granuloma was located most frequently at the tongue, followed, in order, by the gingiva, buccal mucosa, hard palate, lip and oral floor. The period between the patient's first visit to our clinic and the onset of his/her complaint was variable. It was relatively shorter in those cases with the lesion at the gingiva or tongue as compared to other locations. The size of the lesion was smaller than 10 x 10 mm. We classified the pathological features into three patterns; granuloma type, hemangioma type, and intermediate type. Many cases of lesions located at the back of the tongue, buccal mucosa, or hard palate were of the hemangioma type, while many cases of lesions located at the top of the tongue, gingiva, or oral floor were of the granuloma type. We have the impression that pyogenic granuloma could be one of the purulent changes associated with benign oral tumors.     

Oral benign neoplasms: A retrospective study of 790 patients over a 14-year period

Introduction and objectiveOral benign neoplasms (OBNs) exhibit some features that can guide the professionals to the correct diagnosis and best treatment. Through retrospective studies, medical records can be reviewed to better describe a given population and, furthermore, help clinicians in routine practice. In this context, the objective of this paper was to analyze the cases of OBNs of an oral pathology referral department, from 2003 to 2017, in order to better understand their epidemiological and clinicopathological characteristics.MethodsA total of 8355 histopathological reports were analyzed. Lesions diagnosed as OBNs were selected and the following variables were recorded: gender, age, histological type of the lesion, anatomical location, rate and pattern of growth, type of base, color, symptomatology and diagnostic hypotheses on clinical examination.ResultsOBNs represented 9.4% of all lesions diagnosed. The most frequent histopathological types were fibroma (39.9%), papilloma (22%), fibroblastoma (13.1%), lipoma (10.2%) and hemangioma (6.1%). Overall, most cases affected females (n = 518; 65.6%) and in the fifth decade of life (n = 148; 18.7%). The oral mucosa was the most common site (n = 265; 33.5%). The most common features of each OBN were also highlighted.ConclusionThe most common OBNs were fibroma, papilloma, fibroblastoma, lipoma and hemangioma. Overall, the OBN presented common clinical features; however, in particular cases, there are some characteristics that can lead the professionals to the correct diagnosis. Nevertheless, in general, histopathological analysis must be performed to confirm diagnosis. Intraosseous tumors and large lesions may require imaging tests to help diagnosis.     

Juvenile ossifying fibroma. Case report with diagnostic and therapeutic considerations]

BACKGROUND: Fibro-osseous lesions of the jaws, including juvenile ossifying fibroma, pose diagnostic and therapeutic difficulties due to their clinical, radiological and histological variability. CASE REPORT: The case of an 8-year-old girl with a juvenile ossifying fibroma of the mandible is presented. Extirpation of the tumor and filling of the defect with cancellous bone was performed. After 9 months, a recurrence occurred which made a second extirpation of the tumor necessary. This was done without osteoplasty. After a 2-year follow-up the patient is free of tumor. DISCUSSION: Different classifications for fibro-osseous lesions of the jaws can be found in the literature. This makes a correct diagnosis and standardized treatment difficult. Based on the case presented here, the histological features of juvenile ossifying fibroma and the differentiation from osteosarcoma are discussed. At present, conservative surgical treatment seems to be adequate for these tumors.     

Rare case of pyogenic granuloma of the tongue in an 8-week-old infant

We present a case of a large pyogenic granuloma of the tongue causing swallowing difficulties in an 8-week-old infant. In the literature, we found no case reports of pyogenic granuloma in such a young infant. It is a quickly growing, hypertrophic inflammatory change consisting of exceptionally richly vascularized granular tissue. The granuloma was located in the central part of the tongue and appeared dark pink in color. It was an easily bleeding pedunculated tumor measuring 3×2.5 cm. The etiology of the tumor is unknown; it can arise in sites of previous injury, chronic irritation and infection. The course of the disease is benign and painless, though it can be recurrent. No recurrence was found in the control examination after 3 years.     

Cemento-ossifing fibroma: two cases

INTRODUCTION: Cemento-ossifying fibroma is a rare benign tumor which can affect both jaw bones, particularly the mandible. CASE REPORTS: We report two cases of cemento-ossifying fibroma which illustrate the radiological and anatomic features of these tumors. Differential diagnosis between cementifying fibroma and ossifying fibroma was particularly difficult. The cementifying fibroma was treated by surgical resection followed by immediate reconstruction with an iliac bone graft. The ossifying fibroma was treated by enucleation-resection. DISCUSSION: The clinical, radiological and histological features of cementifying and ossifying fibroma allow distinction. Surgical treatment is achieved by enucleation resection for small-sized ossifying fibromas and mono-bloc resection with bone reconstruction for large-sized cementifying and ossifying fibromas.     

鼻腔鼻窦骨化纤维瘤9例

目的：探讨提高鼻腔鼻窦骨化纤维瘤诊治水平的途径。方法：回顾性分析9例鼻腔鼻窦骨化纤维瘤患者的临床资料。根据病变范围不同，其中3例选择上颌窦进路，将鼻腔上颌窦肿块完整切除；6例在全身麻醉下行颈侧切开术。结果：2例因手术切除不彻底，分别于术后8个月和9个月复发而再次手术，其余7例随访2～10年无复发，无并发症发生。结论：鼻腔鼻窦骨化纤维瘤是一种以青少年发病为主，具有局部侵袭性的良性肿瘤，临床症状、特别是CT扫描是临床诊断的基础，彻底切除肿瘤是惟一有效的治疗方法。     

Role of lifestyle modifications for patients with laryngeal granuloma caused by gastro-esophageal reflux: comparison between conservative treatment and the surgical approach

Conclusions: It is considered that a regimen combining pharmacologic management and lifestyle modifications is the most effective treatment for laryngeal granulomas caused by GER.

Objectives: This study compared the results of the combination therapy and surgery to determine the best treatment of laryngeal granuloma caused by gastro-esophageal reflux in 51 patients.

Methods: Prospective study.

Results: In the conservative treatment group, the CR rate was 89.7% and recurrence rate was 2.6%, while the lesions remained in patients (7.7%). This study compared the CR and recurrence rates between conservative treatment and surgery for granuloma. The results showed that the laryngeal granuloma recurrence rate was significantly lower with the conservative treatment regimen compared with surgery (p?=?.0016).     

Idiopathic bilateral central giant cell reparative granuloma of jaws: A case report and literature review

Objectives

The central giant-cell reparative granuloma has been defined as a localized benign but sometimes aggressive osteolytic proliferation consisting of fibrous tissue with hemorrhage and hemosiderin deposits, presence of osteoclast-like giant cells and reactive bone formation. It is a benign lesion usually appears as solitary, multilocular, radiolucencies, located in the mandible and maxilla. Multiple CGCRGs of the jaw bones is very rare and, if it occurs, it is usually associated with hyperparathyroidism in majority of the cases .This report presents an unusual case of a 12-year-old girl who has idiopatic, bilateral giant cell granulomas of the angulus mandible.

Methods

A 12 year-old girl was admitted to our department with complain of swelling on both right and left side of her lower jaw. There was no history of trauma, dental problem or neck infection. Blood chemistry, including calcium, alkaline phosphatase and inorganic phosphorus was normal. Patient had not family history, clinical apperiance like cherubism or noonan sydrome and systemic anomalies. MRI showed, in right ramus mandible, 37 × mm × 35 mm × 28 mm size mass and in lenf ramus mandible, an expansile, 30 mm 38 mm × 12 mm size mass. The patient underwent surgical curettage of the lesion through an intraoral approach under general anesthesia.

Result

The histopathologic examination of the lesion was reported as ‘giant cell reparative granuloma.

Conclusion

Our patient had multiple CGCRG in her jaw. In literature there is several reports about multiple CGCRG but unlike of that report our patient had no syndromes like Cherubism, Noonan syndrome, neurofibromatosis type-1 and systemic disease like hyperparathyroidism ,fibrous dysplasia. So we define this case as Idiopatic bilaterally central giant cell reparative granuloma of jaw.     

Gutartige fibroossäre Tumoren der frontalen Schädelbasis mit intrakranieller Ausbreitung

We report on two patients with ossifying fibroma of the anterior skull base with intracranial extension. A psammomatoid ossifying fibroma was removed from a 29 year old female patient, and in a 37 year old female patient a cemento ossifying fibroma was removed. The main clinical symptom in both cases was headache. Surgery took place after diagnosis and therapy in an interdisciplinary operation with ENT colleagues. The ossifying fibroma is a benign neoplasm mainly affecting the maxilla and mandible. Complete removal is better than a curettage of the tumor.