Quiz 10: What is your diagnosis?

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Diagnosis: Quiz 10

Quiz 10

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.

Differential diagnosis histopathologically: Several fibrous hyperplastic lesions can be considered in the differential diagnosis of giant-cell epulis, including giant-cell fibroma and cemento-ossifying fibroma.

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 none.

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 vessels.

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.

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