DIFFERENTIAL DIAGNOSTIC CONSIDERATIONS
FIGURE 3: Dome-shaped, ulcerated peripheral
ossifying fibroma of the anterior maxillary gingiva.
The purplish hue, however, clinically suggests
a diagnosis of peripheral giant cell granuloma,
thus emphasizing the need for histopathologic
examination to confirm the diagnosis.
Although the clinical appearance is identical in many cases, the histopathological
makeup differs significantly among the lesions (Figure 3). The histopathological range
likely represents the entire histologic spectrum of reactive changes through inducing
the differentiation of gingival stem cells into fibroblastic, endothelial, and/or osteogenic
lineages. The differential diagnosis of reactive, solitary gingival masses includes their
neoplastic and infectious counterparts. Among true neoplasms, benign tumors of neural
origin or tumors of odontogenic origin may be identical in clinical presentation. Infectious
entities, such as dental abscesses and parulides, are typically easier to distinguish
from reactive lesions if the patient’s dental and medical histories are well-documented.
In addition, most infections carry associated symptoms such as pain or discomfort.
For benign lesions of the gingiva, surgical removal in the form of an excisional biopsy
is curative. However, we recommend submission of the specimen for histopathological
analysis in all cases because the lesion may be indicative of an overlying systemic
condition, have a higher recurrence rate with positive surgical margins, or cause local
tissue destruction. Moreover, dysplastic or even malignant changes at the tissue level can
only be assessed and confirmed microscopically. For instance, oral squamous cell
carcinomas that occur on the gingiva can mimic hemorrhagic, lobulated growths such
as pyogenic granulomas and peripheral giant cell granulomas. Another consideration
in the differential diagnosis is an oral metastatic tumor. While more common
intraosseously— specifically the mandible—the gingiva represents the most common
site of oral soft tissue metastasis. 1,8
CONCLUSION
Gingival lesions are more frequently reactive than neoplastic. Patients should always be
encouraged to maintain good oral hygiene both prior to and after the development of
such lesions in an attempt to avoid occurrences and recurrences. Given the potential
to occur in esthetic locations and the clinical overlap with neoplastic gingival growths,
excisional biopsy is the recommended treatment for definitive diagnosis.
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