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ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
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DES CONNAISSANCES
DENTAIRES INDISPENSABLES
Publié par
Diagnostic
Applied
Challenge
Research
Cite this article as:
J Can Dent Assoc 2013;79:d88
l’Association dentaire canadienne
Solitary Gingival Lesion in an Adolescent
Catherine Grenier, DMD, MSc, FRCD(C);
Carl Bouchard, DMD, MSc, FRCD(C);
Sylvie Louise Avon, DMD, PhD, FRCD(C)
Case Presentation
Figure 1: Intraoral view showing the gingival lesion on the buccal aspect of tooth 45.
Figure 2: Tissue fragment characterized by
epithelium with a lightly undulating surface
overlying connective tissue containing
numerous lymphatic vessels (hematoxylin
and eosin, magnification 10×).
jcda
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ESSENTIAL DENTAL KNOWLEDGE
Published by
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What is the diagnosis?
A 14-year-old girl with a papillarylike lesion of the buccal gingiva in the
lower right premolar region (Fig. 1)
was referred to a private oral and maxillofacial surgery office. The lesion had
been discovered by chance during a
routine examination by the patient’s
general dentist. The patient’s medical
history was unremarkable: she did not
smoke, was not taking any medications
and did not report having any allergies. Intraoral examination revealed an
erythematous lesion, soft on palpation,
measuring less than 1 cm on the gingiva of the buccal aspect of tooth 45.
No other lesion was found.
An excisional biopsy was performed the day of the consultation.
The specimen was immediately placed
in 10% formalin solution and sent for
histologic examination.
Microscopic evaluation revealed
tissue fragments characterized by
stratified squamous epithelium overlying connective tissue stroma containing vessels of diverse shapes
and sizes. The surface epithelium was
undulated due to infiltration of the
epithelial tissue by lymphatic vessels
(Fig. 2).
Differential diagnosis included a
histopathological evaluation to rule
out verrucous xanthoma. Microscopic
evaluation revealed no epithelial
hyperplasia or foamy hictiocytes
(xanthoma cells) between rete pegs
in the upper connective tissue,
which would have been indicative of
verrucous xanthoma. Localized juvenile spongiotic gingival hyperplasia
was also ruled out, as the microscopic results did not match the condition’s histopathology—epithelial
hyperplasia, severe spongiosis and a
mixed inflammatory infiltrate in the
chorion.
The lymphatic origin of the vessels was confirmed by the absence of
erythrocytes in their lumen (Fig. 3).
This information led to a diagnosis of
lymphangioma.
Lymphang