DISCUSSION
The patient was referred to an oral maxillofacial surgeon, and the lesion was fully excised. Histopathology demonstrated capillary and inflammatory cells with a predominance of plasma cells. Both spindle and multinucleated giant cells were present, which made the lesion consistent with peripheral giant cell proliferation.
Differential diagnosis Peripheral giant cell proliferations can appear at any age, occurring slightly more frequently in females. Usually the lesion is soft, fleshy, and can bleed easily with manipulation. It can arise from the gingiva and edentulous ridge and is associated with failing dental restorations, sharp tooth edges, and/or foreign bodies. The size of the lesion can vary, ranging from 0.5 to 7 cm. Diagnosis is made via biopsy, with treatment consisting of full excision with surgical margins. The lesion may erode the adjacent bone, so a radiograph should be ordered as well. Because the lesion is benign, prognosis is good; and provided the irritating agent is removed, the lesion should not recur.
A giant cell fibroma would be high on the differential but was ruled out by location and histopathology. These lesions are benign growths that can occur at any age. The exact cause of the lesion is unknown, but some potential reasons for growth include tooth abrasion, cheek biting, or sucking trauma. Giant cell fibromas most commonly occur on the buccal mucosa and appear rounded, nonblanchable, and painless even if manipulated.
An epulis fissuratum is an inflammatory fibrous hyperplasia that arises secondary to irritation, typically from an ill-fitting denture. The lesion is commonly located in the mucolabial and mucobuccal folds corresponding to the margins of the denture. The manifestation can range from a small pink to reddish area appearing as excess gum tissue to a red ulcerated mass. While diagnosis can be made on presentation, many times excision and biopsy are used to rule out carcinoma. The histopathology report for the patient in this case ruled out this diagnosis.
Carcinoma of the gingiva is rare and can manifest as a red-white thickening of the marginal and interdental gingiva without ulceration. It must be a consideration with any nonhealing lesion in the gingival area. The disease is slow growing and has a low likelihood of metastasis. Tobacco use is a common risk factor. Biopsy is necessary, and treatment consists of full excision with margins. Chemotherapy and radiation are typically required.
Outcome At a follow-up visit 8 weeks after excision, the patient had complete healing of the excision site with no recurrence. Additionally, he had had his dentures refitted. JAAPA
Joe R. Monroe, PA-C, MPAS, department editor
Denise Rizzolo practices at the Care Station in Springfield, New Jersey. She is also an assistant professor in the physician assistant program at Seton Hall University in South Orange, New Jersey. Thomas Chiodo is an oral maxillofacial surgeon in Somerville, New Jersey, and a clinical assistant professor at the University of Medicine and Dentistry of New Jersey in Newark. The authors have indicated no relationships to disclose relating to the content of this article.