Oral Fibromas Research Articles

Mining and analysis of adverse event signals for alendronate based on the real-world data of FDA adverse event reporting system database

ABSTRACT Objective Our study aims to assess alendronate-related adverse events (AEs) from the US FDA adverse event reporting system database. Methods The AE data associated with alendronate between the first quarter of 2004 and the first quarter of 2024 were selected. Various signal quantification methods, including the ROR, PRR, BCPNN, and EBGM, were applied for analysis. Results In 34,943 reports where alendronate was the primary suspected drug for the AE, 24 affected system organ classes and 1046 significant preferred terms were identified in this study. Several significant AEs beyond drug instructions with strong signals were determined, including low turnover osteopathy, fracture delayed union, fracture nonunion, loss of anatomical alignment after fracture reduction, fracture malunion, periprosthetic fracture, carotid bruit, oral fibroma, traumatic occlusion, and phlebolith. The median time to onset of alendronate-related AEs was 306 days (interquartile range [IQR] 12–1,461 days), and the majority of cases occurred 2 years later (18.80%) and within 30 days (14.49%). Conclusions The current study detected multiple potential new AE signals for alendronate, and more clinical researches are required to further validate our results and clarify their associations.

Gingival Mucoperiosteal Fibroma-Clinical, Imaging, and Histological Review of a Novel Oral Fibroma in 27 Dogs.

This case series describes the clinical, imaging, and histological features of 27 lesions diagnosed as a benign fibrous mass not previously described in veterinary literature. The authors propose the name gingival mucoperiosteal fibroma (GMPF) to describe these fibrous lesions found in dogs. Histologically, GMPF is characterized by a lack of odontogenic tissue and various degrees of ossification. GMPFs affect adult dogs with an average age of 95 months (range 24-156 months) and appear as expansile growths with superficial appearance matching the surrounding gingiva. The mandibular incisive region is the most commonly affected region (n = 13) and most cases have some level of bone proliferation radiographically (n = 14). Histological examination of the masses shows poorly cellular fibrous tissue with thick interwoven collagen fibers. Bony invasion by the mass was not noted, though histological proliferation of bone was seen in 17 lesions. Surgical resection was curative in all cases when performed, and no recurrence was seen at time of follow-up. Fibrous lesions of the oral cavity in dogs are poorly defined and categorized, though numerous lesions have been described in both human and veterinary literature.

Establishing a causal link between the human papilloma virus and oral fibromas

Fibroma, a benign tumour of fibrous connective tissue, can be seen as a reactive connective tissue hyperplasia in response to trauma and irritation. They typically have a firm consistency, are nodular and asymptomatic, have a colour that is similar to the mucosa, a sessile base, a smooth surface, and are situated in the buccal mucosa along the line of occlusion, tongue, and lip mucosa. We retrospectively investigated total 79 cases and intriguingly, 41 cases were not associated with any history or clinical evidence of chronic trauma of dental origin suggesting different pathogenesis mechanism. Out of 79 cases of oral fibroma, 18 showed evidence of koilocytes in the overlying epithelium with 14 cases not associated with history of any trauma. This might suggest the cause and effect relationship between HPV and oral fibromas, however, the possibility of secondary infection in already existing fibroma can be considered. This intriguing finding prompt us to propose a novel hypothesis explaining the role of human papilloma virus in the pathogenesis of fibroma.

Surgical Strategies and Monitoring in the Treatment of Oral Fibroma: Case Report

Surgical Strategies and Monitoring in the Treatment of Oral Fibroma: Case Report

Management of an Oral Fibroma by Scalpel Excision in a Patient on Anticoagulant Therapy: A Case Report

A traumatic or irritational fibroma is the most prevalent submucosal reactive lesion in the oral cavity. It forms as a result of irritation or trauma and is composed of fibrous or connective tissue. Although electrical or laser surgery is beneficial for the excision of oral fibroma in patients taking anticoagulant, but these devices may not be available in all clinical settings. This case report aims to demonstrate scalpel excision as an effective and convenient surgical treatment for the management of the fibroma in patient having anticoagulant drug instead of using electrical, laser, or cryosurgery. A female patient, 70 years old, reported to the department with a chief complaint of painless swelling in the right lower posterior tooth region for the past 2 years. On examination, the lesion was found to be a well circumscribed, smooth, tender, firm, and lobulated pink swelling 1x0.8x0.5 cm in diameter positioned on the buccal mucosa of the right molar region. Surgical therapy was carried out by scalpel excision, followed by medication for the management. In compared to electrical, laser, and cryosurgery, scalpel excision was a simple and effective approach to successfully remove the fibroma, and complete healing of the surgical site was observed after 2 months.

469 Altered expression of genes regulating mTOR and other signaling pathways in skin tumors from patients with tuberous sclerosis complex

Individuals with tuberous sclerosis complex (TSC) develop tumors in multiple organs due to pathogenic variants in TSC1 or TSC2, with skin tumors showing mTOR activation and aberrant cell growth. To identify transcriptional signatures and dysregulated signaling pathways that are shared in different types of TSC skin tumors, we performed RNAseq on 58 samples of fibroblast-like cells grown from TSC skin tumors (27 angiofibromas, 11 fibrous cephalic plaques, 10 ungual fibromas, 8 shagreen patches, 2 oral fibromas) and 28 samples of fibroblasts from patient normal appearing skin, in patients whose blood DNA showed germline variants in TSC2 in 14, TSC1 in 1, mosaicism in 3, and no mutation identified in 3.

Solitary skin-colored nodule on a child’s face

Sir, A healthy, six-year-old boy presented with a slowly grown dome-shaped nodule on the mandibular angle region present for two years. The patient’s past medical and family history were unremarkable. A physical examination revealed a solitary, 1.3 × 1 cm, firm, painless, flesh-colored tumor (Fig. 1). Dermoscopy showed branching, serpentine vessels on a pink background (Fig. 2a). These features disappeared when slight pressure was exerted on the dermoscope and the tumor exhibited a central, white, structureless area (Fig. 2b). An excisional biopsy was performed. A microscopic examination showed a well-circumscribed, paucicellular dermal tumor composed of eosinophilic collagen bundles separated by clefts and forming a storiform pattern. Scattered fibroblasts were found among the collagen bundles. The overlying epidermis was slightly flattened (Fig. 3). The diagnosis of solitary sclerotic fibroma was established. Sclerotic fibroma (SF), also known as storiform collagenoma, is a rare benign skin tumor. It usually manifests itself as an asymptomatic, slowly growing, white-to-skin-colored papule or nodule [1]. It was first described in patients with Cowden’s disease, yet may also occur sporadically [2]. There were no mucocutaneous features of Cowden’s disease (tricholemmomas, oral fibromas, acral keratoses, palmar pits, and gingival and palatal papules) in the patient and her family members. Dermatofibroma, the main differential diagnosis of SF, usually exhibits hyperplastic changes of the epidermis instead of atrophy, and the boundaries of the lesion are unclear [2]. Only two papers have been published describing the dermoscopic findings of SF, consisting of a white background with peripheral arborizing vessels [3]. A white background may be related to an increased dermal collagen density. It is also described in dermatofibroma, typically with a peripheral pigmentation network. Although dermoscopy may improve the clinical diagnosis of SF, histopathological analysis is required.

Identification of elastofibroma and elastofibroma-like lesions in cases diagnosed as oral fibromas

ABSTRACT We investigated elastofibromas (EF) and elastofibroma-like structures (EFL) in 95 cases that had been diagnosed as oral fibromas (OF). Histological sections were stained with Verhoeff-Van Gieson, Congo red and hematoxylin and eosin to enable possible reclassification to EF or EFL, or to retain the diagnosis of OF. To do this, we identified amyloid and used histopathological descriptions and epidemiological clinical profiles. We found 56 EF and 21 EFL cases, while 18 diagnoses of OF were retained. We observed a predilection for EF in females. Also, the most common site for OF was the cheek mucosa. We also found a longer time course for lesion development for OF compared to the other lesions. We found a relation between elastic fibers and amyloid material in EF. We also observed perivascular fibrotic lesions (PVFL) in EF. Most cases of EF exhibited more elastic fibers, thicker fibers, stronger relation with amyloid material deposition, rare evidence of PVFL and a longer time course for development compared to the other lesions. We suggest that EFL may give rise to oral EF.

OROFACIAL FEATURES AND MEDICAL PROFILE IN A PATIENT WITH TUBEROUS SCLEROSIS COMPLEX

Tuberous sclerosis complex (TSC) is a rare autosomal-dominant multisystemic disorder caused by mutation in the TSC1/TSC2 genes. TSC is characterized by cognitive impairment, seizures, and the presence of benign tumors in multiple organs, including oral mucosa. Among oral findings, enamel hypoplasia, oral fibromas, cleft palate, and alterations of maxillary bone trabeculation are the most frequent. The present report describes the case of a melanodermic female, 41 years old, showing dermatologic and neurologic signs of TSC, with a medical history of epilepsy, cognitive deficit, chronic renal failure, arterial hypertension, cardiac arrhythmia, anemia, and hypothyroidism. Intra-oral exam showed multiple papular lesions in the bilateral buccal mucosa with a diagnosis of inflammatory fibrous hyperplasia and red macule on the hard palate, not associated with prothesis use and without change during the period of treatment. The exfoliative cytologic test was negative for candidiasis, and dental treatment was performed to promote a better quality of life for the patient. Tuberous sclerosis complex (TSC) is a rare autosomal-dominant multisystemic disorder caused by mutation in the TSC1/TSC2 genes. TSC is characterized by cognitive impairment, seizures, and the presence of benign tumors in multiple organs, including oral mucosa. Among oral findings, enamel hypoplasia, oral fibromas, cleft palate, and alterations of maxillary bone trabeculation are the most frequent. The present report describes the case of a melanodermic female, 41 years old, showing dermatologic and neurologic signs of TSC, with a medical history of epilepsy, cognitive deficit, chronic renal failure, arterial hypertension, cardiac arrhythmia, anemia, and hypothyroidism. Intra-oral exam showed multiple papular lesions in the bilateral buccal mucosa with a diagnosis of inflammatory fibrous hyperplasia and red macule on the hard palate, not associated with prothesis use and without change during the period of treatment. The exfoliative cytologic test was negative for candidiasis, and dental treatment was performed to promote a better quality of life for the patient.

Significant cases of central cusps, enamel pits, and oral fibromas in tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder in which benign nodular tumors form in the cerebral cortex, cerebellum, and throughout the body causing various symptoms. In this study, we summarized the incidence of dental findings in patients with TSC at our hospital and its association with diseases in various organs. Patients diagnosed with TSC at our hospital between January 2013 and September 2017, and who were examined in the dental and oral surgery department were included in this study. The presence of intraoral manifestations (central cusps, enamel pits, oral fibromas) was examined by means of visual inspection, intraoral photography, and X-ray photography. In addition, the relationship with associated diseases (neurological, cutaneous, cardiac, renal, and pulmonary) according to organ and disease severity was examined. The mean age (± SD) of the 42 TSC patients (19 men and 23 women) was 27.8 ± 14.6years, of which 24 patients (11 men and 13 women) presented with oral manifestations. Of these patients, seven had central cusps, 10 had enamel pits, and 17 had oral fibromas. The group with central cusps had significantly higher neurological issues in the relationship between intraoral manifestations and associated disease based on the involved organ. The prevalence of central cusps in TSC was 16.7%, which is significantly higher than the 2.6% reported in healthy Japanese subjects. The central cusp is a diagnostic factor alongside the presence of enamel pits and oral fibromas, which can aid in the early diagnosis of TSC by dentists.

Successful Excision of Oral Irritational Fibroma Using 940 nm Diode Laser: Case Series

Background: Irritational fibroma is a frequently observed benign exophytic and reactive oral lesion that develops as a result of trauma. The usual sites of irritational fibroma are buccal mucosa, tongue, and lower labial mucosa. These lesions are excised using conventional surgery, electrosurgery, or more recently by laser. Methods: A total of 36 patients underwent surgical excision of superficial proliferative lesions under local anesthesia using a 940 nm diode laser. Bleeding was stopped using laser dry bandage setting, and no suturing was needed. All specimens were sent for histopathological examination. Patients were examined for intra-operative and post-operative complications. Results: The procedure was simple to perform with minimum bleeding and excellent precision. It was well accepted by the patients, who also reported mild post-operative pain. Optimum healing was achieved with no residual ulceration or scarring. The excised specimens were adequate for histopathological examination and all diagnosed as oral fibromas. Conclusion: The 940 nm diode laser can be utilized in excisional biopsy of irritational fibromas with minimum bleeding, discomfort, scarring, and postoperative pain and should be considered as a practical alternative to the traditional surgical technique. PSMMC REC clinical study registration number: 1203, series of 2019

SATB2 is frequently expressed in ossifying and non-ossifying peripheral oral fibroma of the gingival region but not in reactive fibromatous lesions from other intraoral sites

Ossifying and non-ossifying peripheral oral fibromas (POF) of the gingival and alveolar mucosa are localized, cellular, small fibrous nodular lesions likely resulting from diverse external/ internal physical and chemical irritation or injuries. A central nidus of metaplastic woven bone characterizes and defines the ossifying variant. The inherent tendency of these lesions to ossify remains elusive. We herein analyze SATB2 expression as osteoblastic transcription and differentiation factor in 28 gingival POFs (10 of them ossifying) and compare them to 28 fibrous lesions from different non-gingival intraoral sites. Strong to moderate diffuse nuclear SATB2 immunoreactivity was detected in all ossifying (10/10; 100%) and in 8/18 (44%) non-ossifying gingival POFs, but in only 1/28 (3%) non-gingival oral reactive nodular fibrous lesions. This study illustrates for the first-time consistent expression of the osteoblastic marker SATB2 in ossifying and most of non-ossifying POFs of the gingival area but lack of this marker in reactive fibrous lesions from other oral cavity sites. This finding is in line with the proposed origin of gingival POFs from periodontal ligaments and may explain the frequent ossification observed in them. It is mandatory to consider this finding when assessing biopsies from SATB2-positive oral cavity neoplasms to avoid misinterpretation.

1474 Cowden and MAP Syndrome: The Untold Story of a Screening Colonoscopy—Case Report

INTRODUCTION: Cowden syndrome is a rare autosomal dominant condition associated with PTEN gene mutation. MUTYH-associated polyposis (MAP) is inherited by autosomal recessive fashion. Cowden syndrome presents with multiple hamartomas in a variety of tissues, oral fibromas, and punctate palmoplantar keratoses, and an increased risk of breast, endometrial, thyroid, kidney and colorectal cancers. MAP syndrome is associated with adenomatous polyps and colon cancer predisposition. CASE DESCRIPTION/METHODS: 51-year-old female underwent screening colonoscopy and was found to have multiple polyps throughout the colon. Biopsy showed ganglioneuromas and hamartomous polyps. Medical history was significant for hypothyroidism and hypoparathyroidism secondary to thyroidectomy for a goiter, bilateral mastectomy for a ductal carcinoma in situ, hysterectomy for fibroids, palmar keratosis and oral papillomatosis. Family history was relevant for breast cancer in her mother at age 50. Genetic analysis revealed mosaicism for a loss of function variant in PTEN and autosomal recessive pathogenic single MUTYH variant which confirmed Cowden Syndrome and carrier state for MAP syndrome. Appropriate cancer surveillance was arranged for our patient according to the National Cancer Center Network Guidelines through multidisciplinary approach. DISCUSSION: PTEN gene is a tumor suppressor responsible for regulating the cell cycle. Because of her mutation, our patient is susceptible for an array of different malignancies. Her genetic profile showed mosaicism for PTEN genetic variant. Adequate cancer surveillance for colon cancer, renal cell carcinoma and recurrence of breast cancer were discussed with our patient. MUTYH variant mutation was found in this patient. However, she inherited only one single copy of this recessive gene expecting not to develop clinical MAP syndrome. Risks associated with a single variant in MUTYH are unclear. There are some reports that suggest an inconsistent increased risk of colon, endometrial, and breast cancer. National Cancer Center Network Guidelines has created surveillance guidelines for individuals with a single MUTYH variant but cautioned that these guidelines are likely to change over time. Uniquely, extracolonic neoplastic complications were detected before the diagnosis of Cowden in our patient. High clinical suspicion and early diagnosis of this condition is crucial for effective prevention of colonic and extracolonic malignancies that these individuals are at high risk for.

Fibro-Epithelial Polyp: Case Report with Literature Review

Oral fibroma is the most common benign soft tissue tumor caused due to continuous trauma from sharp cusp of teeth or faulty dental restoration. It presents as sessile or occasionally pedunculated painless swelling which can be soft to firm in consistency. Its incidence occurs mostly during third to fifth decade and shows preference for female. Its occurrence corresponds with intraoral areas that are prone to trauma such as the tongue, buccal mucosa and labial mucosa, lip, gingiva. Even with conservative surgical excision, the lesion may recur until the source of continuous irritation persists. This article presents a case of large size oral fibroma on left alveolar region associated with ulceration along with literature review.

CpG location and methylation level are crucial factors for the early detection of oral squamous cell carcinoma in brushing samples using bisulfite sequencing of a 13-gene panel

BackgroundOral squamous cell carcinoma (OSCC) is usually diagnosed at an advanced stage and is commonly preceded by oral premalignant lesions. The mortality rates have remained unchanged (50% within 5 years after diagnosis), and it is related to tobacco smoking and alcohol intake. Novel molecular markers for early diagnosis are urgently needed. The purpose of this study was to evaluate the diagnostic value of methylation level in a set of 18 genes by bisulfite next-generation sequencing.MethodsWith minimally invasive oral brushing, 28 consecutive OSCC, one squamous cell carcinoma with sarcomatoid features, six high-grade squamous intraepithelial lesions (HGSIL), 30 normal contralateral mucosa from the same patients, and 65 healthy donors were evaluated for DNA methylation analyzing 18 target genes by quantitative bisulfite next-generation sequencing. We further evaluated an independent cohort (validation dataset) made of 20 normal donors, one oral fibroma, 14 oral lichen planus (OLP), three proliferative verrucous leukoplakia (PVL), and two OSCC.ResultsComparing OSCC with normal healthy donors and contralateral mucosa in 355 CpGs, we identified the following epigenetically altered genes: ZAP70, ITGA4, KIF1A, PARP15, EPHX3, NTM, LRRTM1, FLI1, MIR193, LINC00599, PAX1, and MIR137HG showing hypermethylation and MIR296, TERT, and GP1BB showing hypomethylation. The behavior of ZAP70, GP1BB, H19, EPHX3, and MIR193 fluctuated among different interrogated CpGs. The gap between normal and OSCC samples remained mostly the same (Kruskal-Wallis P values < 0.05), but the absolute values changed conspicuously. ROC curve analysis identified the most informative CpGs, and we correctly stratified OSCC and HGSIL from normal donors using a multiclass linear discriminant analysis in a 13-gene panel (AUC 0.981). Only the OSCC with sarcomatoid features was negative. Three contralateral mucosa were positive, a sign of a possible field cancerization. Among imprinted genes, only MIR296 showed loss of imprinting. DNMT1, TERC, and H19 together with the global methylation of long interspersed element 1 were unchanged. In the validation dataset, values over the threshold were detected in 2/2 OSCC, in 3/3 PVL, and in 2/14 OLP.ConclusionsOur data highlight the importance of CpG location and correct estimation of DNA methylation level for highly accurate early diagnosis of OSCC.

Fibroma of Buccal Mucosa: Case Report and Literature Review

The fibroma, also referred to as irritation fibroma, is by far the most common of the oral fibrous tumorlike growths. While the terminology implies a benign neoplasm, most if not all fibromas represent reactive focal fibrous hyperplasia due to trauma or local irritation. Although the term focal fibrous hyperplasia more accurately describes the clinical appearance and pathogenesis of this entity, it is not commonly used. We present a case report of oral fibroma in the left side of the buccal mucosa in 50 years old Saudi patient.

Histochemical and immunohistochemical differences between solitary oral fibroma and fibrous papule of the face.

BackgroundThe morphological similarities between fibrous papules of the face and multiple sporadic oral fibromas were mentioned long ago and a relationship between them has been reported in the literature.ObjectiveThe aim of this study was to evaluate the participation of mast cells, elastin and collagen in a series of oral fibromas and fibrous papules of the face in order to better understand the possible role of these factors in fibrosis and the formation of these lesions.MethodsThirty cases of oral fibroma involving the buccal mucosa and 30 cases of fibrous papules of the face were selected. Tissue samples were submitted to picrosirius red staining and immunohistochemistry using anti-elastin and anti-tryptase antibodies.ResultsThe percentage of tryptase-positive mast cells and expression of elastin were higher in cases of fibrous papules of the face (p < 0.05). In contrast, a higher intensity of collagen deposition was observed in oral fibromas. The results showed mast cell accumulation and higher elastin synthesis in fibrous papules of the face, and mast cell accumulation with higher collagen fiber synthesis in oral fibromas.ConclusionThese findings support the hypothesis that mast cells influence the development and growth of these lesions through different mechanisms.

Role of melanin pigmentation in the pathogenesis of Oral Giant Cell Fibroma

Role of melanin pigmentation in the pathogenesis of Oral Giant Cell Fibroma

Slow-Growing Large Irritation Fibroma of the Anterior Hard Palate: A Case Report Using Immunohistochemical Analysis

Irritation fibromas are recognized as fibrous lesions, usually reactive hyperplasias; however, the mechanism of enlargement is unclear. This paper reports on an abnormally large irritation fibroma of extremely gradual growth. The immunohistochemical features (CD34, α-SMA, vimentin, Ki-67, and TGF-α) of this irritation fibroma are presented to distinguish reactive hyperplasia from other true fibrous neoplasm diseases. In the only previous study, it was reported that the expression of TGF-α might be associated with the development of oral fibromas. Therefore, we investigated the relationship between this exceptionally-large fibrous lesion of extremely slow growth and the immunohistochemical reactivity of TGF-α, finding that, in contrast to the previous study, TGF-α was not expressed. This is the first study to evaluate the enlargement mechanism of such a large irritation fibroma using the approach of immunohistochemical analysis, and it indicates that such analysis can help elucidate the diverse causes and enlargement mechanisms of irritation fibromas.

Soft Tissue Reconstruction with Free Gingival Graft Technique following Excision of a Fibroma.

Background. Oral fibromas are benign, asymptomatic, smooth surfaced, firm structured tumoral lesions that originate from gingival connective tissue or periodontal ligament. Histologically, they are nodular masses characterized by a dense connective tissue, surrounded by stratified squamous epithelium. Case Report. This case report includes the clinical, radiographical, and histological findings and periodontal treatment of a 38-year-old female patient having painless swelling on the gingiva. Intraoral examination revealed a fibrotic, sessile, smooth surfaced gingival overgrowth interdentally between the teeth #13 and #14. Radiographical findings were normal. Initial periodontal treatment (IPT) was applied including oral hygiene instructions, scaling, and root planing. Following IPT, the lesion (0.7 × 0.6 × 0.4 cm) was excised and examined histopathologically. Subsequently, flap operation was performed to have an access to alveolar bone. Surgical site was reconstructed with free gingival graft obtained from hard palate. Hematoxylin-eosin stained sections revealed a nodular mass composed by dense collagen fibers in lamina propria covered by a stratified squamous epithelium, which were consistent with fibroma. Gingival healing was uneventful and without any recurrence during the 12-month follow-up. Conclusions. In order to achieve optimal functional and aesthetical outcomes, free gingival graft can be used for the reconstruction of the wound site after the excision of the fibroma.