Elastofibromatous changes in giant cell fibroma and amalgam tattoo: Unusual findings in common oral lesions.

Several cases of elastofibromatous lesion affecting the oral mucosa have been reported. Clinically, these lesions may appear as small exophytic lesions or less often as white lesions. Therefore, fibrous hyperplasia and leukoplakia are not uncommonly considered in clinical differential diagnosis. Microscopically, elastic and fibrous connective tissue deposition is seen. Rarely, elastofibromatous changes can be detected when assessing intraoral lesions, including cysts, salivary gland neoplasms, and epithelial dysplasia. Here we report two oral lesions showing elastofibromatous changes, expanding their clinicopathological spectrum. The first case was a 46-year-old man with a history of asymptomatic nodular lesion on the palate 1 year ago, diagnosed as giant cell fibroma with elastofibromatous changes. The second case was a 79-year-old woman who presented a pigmented and mildly symptomatic lesion on the mandibular alveolar mucosa several months ago, diagnosed as amalgam tattoo associated with elastofibromatous changes.

Fibroma de fibroblastos gigantes: presentación de 122 casos / Giant Cell fibroma: presentation of 122 cases

El fibroma de fibroblastos gigantes (FFG), conocido también como fibroma de células gigantes, es una pápula o nódulo asintomático localizado en la encía, paladar y lengua, es del mismo color que la mucosa adyacente, de base sésil o pediculada, con superficie lisa o papilar que por lo general mide menos de 1 cm. Objetivo: Identificar las características demográficas e histopatológicas de los casos de FFG de un laboratorio privado de patología bucal en la Ciudad de México. Material y métodos: Se obtuvieron los datos de edad, sexo, diagnóstico presuntivo y definitivo de 122 casos de FFG de 2004 a 2019 con un total de 7,681 muestras. Se describe su distribución por edad, sexo y localización. Resultados: El rango de edad obtenido es de 1 a 84 años, con un promedio de X = 38 años, se presenta con mayor frecuencia en la segunda década de vida, con una razón de 1.6:1 mujer a hombre. La localización más frecuente es en lengua (46%); sin embargo, sólo 49.1% de los estudios especificaban este dato. Conclusión: La importancia de esta lesión es que clínicamente se parece a otras patologías de tejido fibroso, por lo tanto, se debe tener presente al FFG como diagnóstico diferencial (AU)

Giant cell fibroma (GCF) is an asymptomatic papule or nodule that is similar in color to the surrounding mucosa, with a sessile or pedunculated base. It is usually less than 1 cm in size and it features a smooth or papillary surface. Objective: To identify the demographic and histopathological characteristics of GCF cases in a private oral pathology laboratory in Mexico City. Material and methods: Data on age, sex, as well as on presumptive and definitive diagnosis of 122 GCF cases were obtained from 2004 to 2019 with a total of 7,681 samples. Its distribution by age, sex and localization is described. Results: The age range obtained is from 1 to 84 years, with a mean age of 38 years. Frequently during the second decade of life, the female to male ratio is 1.6:1. The most frequent location is the tongue (46%), however, only 60 of 122 studies specified this data. Conclusion: Since this lesion clinically resembles another fibrous tissue pathology, it is warranted to have prior knowledge on its clinical characteristics, as GCF should be regarded as a differential diagnosis (AU)

Fibroma de Células Gigantes en Lactante Mayor / Giant Cell Fibroma in Older Infant. A Case Report

RESUMEN: El fibroma de células gigantes es considerado un tumor benigno no neoplásico de la mucosa oral. Este aparece en las primeras tres décadas de la vida, siendo relativamente raro en pacientes pediátricos. Puede encontrarse principalmente en la encía mandibular, mostrando predilección por el sexo femenino. Clínicamente se presenta como un crecimiento indoloro, de base sésil o pediculado, que generalmente se confunde con otras lesiones de tipo fibrosas como los fibromas de irritación. Histológicamente, se distingue por presentar fibroblastos estrellados con la presencia de células gigantes multinucleadas cerca de la lámina del epitelio. Presentamos el caso de una paciente femenino de un año de edad la cual presenta crecimiento nodular indoloro en relación con una superficie del paladar de 51 y 61. Teniendo en cuenta el tamaño y la ubicación de la lesión, se realizó escisión, biopsia y se envió para análisis histopatológico que confirmó la lesión como fibroma de células gigantes.

ABSTRACT: The giant cell fibroma is a benign nonneoplastic fibrous tumor of the oral mucosa. It occurs in the first three decades of life and is relatively rare in pediatric patients. It can be found predominantly in the mandibular gingiva, showing predilection for females. Clinically it presents as a painless, sessile, or pedunculated growth which is usually mistaken for other fibrous lesions like irritation fibroids. Histologically it is distinguished by the presence of stellated fibroblasts along with multinucleated giant cells near the epithelial sheet. We present a case where a one-year-old female patient presented with a painless nodular growth in relation to a palatesurface of 51 and 61. Considering the size and location of the lesion, excision and biopsy were performed and sent for histopathological analysis which confirmed the lesion as giant cell fibroma.

Fibroma gingival de células gigantes de tamaño inusual / Gingival giant cell fibroma of unusual size

Giant cell fibroma is a benign oral fibrous tumor and it is typically an asymptomatic sessile or pedunculated mass that is usually less than 1 cm in diameter. The lesion consists of uninflamed fibrous tissue in which there are numerous large uninucleated or multinucleated spindle- and stellate-shaped cells with prominent basophilic cytoplasm. The purpose of this paper is to report a case of a gingival giant cell fibroma of abnormal size. A 31-year-old white woman was referred to the dental service for evaluation of a growth on the mandibular gingival. The intraoral examination revealed a 3.0 × 1.5 cm exophytic gingival mass located in the lingual gingiva of the right mandibular permanent first and second molars. The differential diagnosis included peripheral ossifying fibroma, peripheral giant cell granuloma, and giant cell fibroma. Complete surgical excision of the lesion was performed and the diagnosis of giant cell fibroma was made. No complications or recurrence of the lesion have been noted after 4 years of follow-up. Although giant cell fibromas are benign lesions in which simple surgical excision is curative, it is very important that dental and medical professionals recognize it in light of the frequency of occurrence and the need for a precise diagnosis(AU)

El fibroma de células gigantes es un tumor fibroso benigno de la mucosa bucal que típicamente se presenta como una masa asintomática sésil o pediculada generalmente menos de 1 cm de diámetro. La lesión consiste en tejido fibroso no inflamado en el que se encuentran numerosas células fusiformes y estrelladas de gran tamaño, mononucleares o multinucleadas con prominente citoplasma basófilo. El propósito de este trabajo es describir el caso de un fibroma gingival de células gigantes de tamaño inusual. Una mujer blanca de 31 años de edad se presentó al servicio dental para la evaluación de un crecimiento en la encía mandibular. El examen clínico intrabucal reveló una masa gingival exofítica de 3,0 cm x 1,5 cm situado en la encía lingual en el área de los primeros y segundos molares permanentes mandibulares del lado derecho. El diagnóstico diferencial incluyó fibroma osificante periférico, granuloma periférico de células gigantes y fibroma de células gigantes. Se realizó la escisión quirúrgica completa de la lesión y el diagnóstico definitivo fue de fibroma de células gigantes. No se han observado complicaciones o recurrencia de la lesión después de 4 años de seguimiento. Aunque los fibromas de células gigantes son lesiones benignas en las que la escisión quirúrgica simple es curativa, es muy importante que los profesionales dentales y médicos reconozcan la necesidad de un diagnóstico preciso en vista de la frecuencia de aparición(AU)

Fibroma de células gigantes: una presentación inusual en un niño de 2 años de edad / Giant cell fibroma: an unusual presentation in a child of 2 years old

El objetivo de este artículo es relatar un caso clínico de fibroma de células gigantes en un niño de 2 años de edad. Asimismo, presentar una revisión de literatura sobre esta entidad y discutir sobre posibles factores involucrados a su etiología

The aim of this paper is to report a clinical case of giant cell fibroma in a 2-years-old child. Also present a review of literature from this entity and discuss possible factors involved in its etiology

O objetivo deste artigo é relatar um caso clínico de fibroma de células gigantes em uma criança de 2 anos de idade. Além disso, apresentar uma revisão de literatura sobre esta entidade e discutir sobre possíveis fatores associados a sua etiologia

Expressão Imuno-histoquímica da triptase em mastócitos nos fibromas de células gigantes e hiperplasias fibrosas de mucosa oral / Imuno-histoquímica expression of triptase in mastócitos in fibromas of giant cells and hiperplasias fibrosas of verbal mucosa

O fibroma de células gigantes constitui-se de uma neoplasia benigna, caracterizada pela presença de células gigantes, mono, bi ou multinucleadas, células estas que podem guardar relação com a presença de mastócitos. O propósito desta pesquisa consistiu em analisar descritiva e comparativamente a expressão imuno-histoquímica da triptase em mastócitos de fibroma de células gigantes, hiperplasia fibrosa e espécimes de mucosa oral normal. Foram selecionados 30 casos de fibroma de células gigantes, 10 casos de hiperplasia fibrosa e 10 casos de mucosa oral normal, para a análise da expressão imuno- histoquímica, determinação do número de mastócitos presentes, bem como a sua forma e localização. Constatou-se diferença estatisticamente significativa (p<0,001) em relação a quantidade de mastócitos entre os espécimes analisados, onde o fibroma de células gigantes apresentou a menor quantidade de mastócitos e a hiperplasia exibiu a maior concentração deste tipo celular. Embora a mucosa oral tenha apresentado uma maior quantidade de mastócitos quando comparado com os casos de fibroma de células gigantes, estes se encontravam em localizações usuais no tecido conjuntivo em tecidos normais. Verificou-se, diferença estatisticamente significativa, no que diz respeito ao número de mastócitos não degranulados (p<0,001). Nas áreas de fibrose, observamos diferença estatisticamente significativa (p<0,006) entre os espécimes. Com relação aos mastócitos presentes em localização perivascular não se observou diferença estatisticamente significativa. Na análise morfológica verificou-se uma predominância de mastócitos ovais. Concluiu-se que embora uma menor quantidade de mastócitos estivesse presente nos casos de fibroma de células gigantes, estes exibiam maior relação com os fibroblastos gigantes presentes nestas lesões em torno de 59,62%, sendo evidenciada também uma forte relação entre estas células e áreas de fibrose tanto nos casos de fibroma de células gigantes como de hiperplasias fibrosas e espécimes de mucosa oral normal, utilizados como controle em nosso estudo, confirmando desta forma, o papel dos mastócitos como indutor fibrinogênico (AU).

The giant cell fibroma is a benign neoplasm characterized by the presence of mono, bi or multinucleate cells, which can have a connection to the presence of mast cells. This research aims to analyze, descriptively and comparatively, the immunohystochemistry expression of the tryptase in mast cells of the giant cell fibroma, fibrous hyperplasia and samples of the normal oral mucosa. Thirty cases of giant cell fibroma, ten cases of fibrous hyperplasia and ten cases of normal oral mucosa were selected for the analysis of the immunohistochemistry expression, determination of the number of present mast cells, as well as their location and shape. It could be stated that there was a statistically significant difference (p<0,001) in relation to the quantity of mast cells among other samples analyzed where the giant cell fibroma presented lesser quantity of mast cell and the hyperplasia showed higher concentration of this cellular type. Although the oral mucosa has presented a higher quantity of mast cells when compared to the giant cells fibroma, these were found in usual locations in the connective tissue in normal tissues. There could be noticed a statistically significant difference in relation to the number of non-granulated mast cells (p<0,001). On the areas of fibrosis, we could observe a statistically significant difference (p<0,006) among the samples. In relation to the present mast cells in perivascular location, no statistically significant difference was found. On the morphological analysis there was a predominance of oval mast cells. It was concluded that despite of the fact there was a lesser quantity of mast cells present in cases of giant cell fibroma, they appeared to have a stronger relation to the present giant fibroblasts in this lesions, around 59,62%, being also evidenced a strong relation between these cells and the fibrosis areas in both cases of giant cell fibroma and fibrous hyperplasias and samples of normal oral mucosa, used as control group in our study, confirming, this way, the role of the mast cells as fibrinogenous inductor (AU).