Answer: Giant-cell epulis
Criteria for diagnosis
histopathologically: Pseudoepithelial hyperplasia of
the epithelium that is ulcerated in the center, an increased number
of dilated blood vessels and granulation tissue containing stellate
fibroblasts, some of those multinucleated giant cells in the lamina
propria, are changes of giant-cell epulis.
histopathologically: Several fibrous hyperplastic
lesions can be considered in the differential diagnosis of
giant-cell epulis, including giant-cell fibroma and
Criteria for diagnosis clinically: A
focally ulcerated papule with a smooth, glossy surface and an
erythematous border located near the gingival margin, is one
presentation of giant-cell epulis.
Differential diagnosis clinically: There is
Clinicopathologic correlation: The papule
results from hyperplasia of the epithelium and the fibrosing
granulation tissue in the lamina propria. The ulcer seen clinically
is reflected histopathologically by replacement of the epithelium
by fibrin deposits and granulation tissue. The erythematous border
is an expression of the increased number of widened blood
Options for therapy predicated on knowledge of
histopathologic findings: Surgical excision is the
treatment of choice.
1) Fibrous hyperplastic lesions of the oral cavity are common.
Giant-cell epulis arises from the periodontal ligament and is
located on the gingiva. Epulis fissuratum describes lesions that
develop on the gums in response to chronic trauma by ill-fitted
dentures. Giant-cell fibroma develops mostly on the gingiva and on
the tongue, locations were bite traumas are common.
2) At scanning magnification, the silhouette of the hyperplastic
epithelium might be mistaken for squamous cell carcinoma, but it
can be distinguished from the latter by the absence of pleomorphic
nuclei and of crowding of nuclei of keratocytes. In
pseudocarcinomatous hyperplasia, an underlying cause for the
hyperplasia can be identified, for example chronic mechanical
trauma, as in the present case.