Gingival fibroma: An emerging distinctive gingival entity with well-defined histopathology

Abstract

<h3>Introduction</h3> Gingival growths are mostly reactive and seldom exhibit significant true neoplastic potential. The typical etiology is local irritation from dental plaque/calculus, trauma as well as medication-related overgrowth. Such lesions are easily distinguished and categorized into diagnoses such as pyogenic granuloma, peripheral ossi- fying fibroma, peripheral giant cell granuloma, etc. We present a previously undescribed reactive gingival growth with unique histologic features and suggest the diagnostic term "gingival fibroma". <h3>Methods</h3> An IRB approved retrospective review encompassing years 2010-19, of the University of Florida Oral Pathology Biopsy Service, was performed to select cases. Demographics, clinical data, and microscopic diagnoses were recorded and analyzed. Diagnostic criteria were established by four board-certified oral and maxillofacial pathologists and included: a prominent fibromyxoid background, variable cellularity, whorled, or storiform pattern of arrangement of the cellular elements, and absence of significant inflammation or vascularity, calcification, and/or odontogenic islands. <h3>Results</h3> A total of 60 cases were found to meet all criteria and included in the study. The age range in years was 14 to 87 with the mean at 45.11 years. A striking 90% of female predilection was noted. Approximately 62% of cases were reported on the maxillary gingiva, followed by 38.3% in the mandibular gingiva. The lesions were more common in the anterior incisor regions by 66.7%, followed by 11.7% in the canine/first premolar areas. All lesions were treated by surgical excision and 6 cases recurred within 2-3 years of excision. In all cases, lesional tissue appeared to extend to the surgical base of the specimen. <h3>Conclusion</h3> We present 60 cases of a histologically unique entity occurring exclusively on the gingiva and intro- duce the diagnostic term "gingival fibroma" for these lesions. Further studies with adequate clinical follow-up may help understand the true clinical behavior of these lesions.