The first reported case of proliferative fasciitis in the oral cavity

Abstract

<h3>Background</h3> Proliferative fasciitis is a benign and reactive lesion involving fibroblasts in the subcutaneous tissues and deep fascia, with a rare occurrence in the head and neck region. It is considered a variant of nodular fasciitis, which could involve trauma as an etiology. Proliferative fasciitis mostly occurs in adults, but cases in children have been reported. Clinically, it can present as an aggressive lesion with pain or no symptoms, mimicking sarcomas. <h3>Case Summary</h3> We report a case of a 53-year-old woman who presented to our clinic for an evaluation of a reddish lesion of the right mandibular gingiva around the molar areas with a relatively rapid onset. The patient had prediabetes with moderate oral hygiene and no other significant medical history.Intraoral examination revealed a poorly circumscribed gingival lesion on the posterior, <1 cm in diameter with no pain on palpation, and soft to firm in texture with no bleeding. A biopsy of the lesion was performed for histologic examination, and the microscopic differential diagnosis included benign and malignant spindle cell tumors; thus, immunohistochemistry was performed for more accurate diagnosis, and a specimen was sent to the pathology lab at Ohio (Central Ohio Skin and Cancer). The immunohistochemical findings were positive for vimentin and smooth muscle actin and negative for CD34, S100, and pan-cytokeratin. The lesion was diagnosed as proliferative fasciitis on the basis of histologic and immunohistochemical features. The feature that differentiates proliferative from nodular fasciitis is the basophilic component that closely resembles ganglion cells without Nissl substance. The treatment rendered was conservative surgical excision with 1-year follow-up, and no recurrence was observed. <h3>Conclusions</h3> Because proliferative fasciitis has not been reported in the oral cavity, to our knowledge, and because it poses a diagnostic challenge and can mimic malignancies, it is essential to know the salient diagnostic features to avoid aggressive treatment in patients presenting with such lesions in the oral cavity.