Case #36 Discussion

Summary: The patient complains of a nontender, easily bleeding, progressive soft tissue enlargement of at least two weeks duration.  The lesion is firm, circumscribed, 5 x 5 mm in diameter, and is located on the maxillary right alveolar ridge in the lateral incisor region.  The lesion is fixed to surface mucosa and underlying structures, has a generally smooth surface, and blanches upon pressure.  Lesions to Exclude from the Differential Diagnosis: This lesion is described as a soft tissue enlargement.  Reactive soft tissue enlargements can be excluded from differential diagnosis because they will regress, they often fluctuate in size and are not persistent and progressive. Within the category of tumors, malignant tumors can be excluded because they are poorly circumscribed.  Soft tissue cysts may be eliminated because they do not blanch, are not firm to palpation, and have a slower growth rate.  Salivary gland tumors, both benign and malignant, can also be excluded because they do not blanch and they occur only where salivary glands are present. Within the category of benign tumors, epithelial tumors may be eliminated because they are white, have a rough surface, do not blanch, and do not bleed easily.  From the category of benign mesenchymal tumors, the lesions that are typically not vascular can be excluded.  Fibroma, lipoma, rhabdomyoma, neurofibroma, schwannoma, and granular cell tumor can be excluded because they are not vascular lesions and do not blanch nor do they bleed easily.  Hemangioma and lymphangioma can be excluded because these are congenital and quite compressible.  Also, lymphangioma is not vascular.  Congenital epulis can be excluded because these lesions are congenital, do not bleed easily and do not blanch.       Lesions to Include in the Differential Diagnosis: Thus, the differential diagnosis includes pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying fibroma.  These lesions are often clinically indistinguishable when they occur on the gingiva.  Note that peripheral ossifying fibroma is sometimes not vascular and in such cases would not be part of the differential diagnosis.  The vascular form of leiomyoma is also included. Management: Treatment is excisional biopsy which provides both a diagnosis and a cure. Final Diagnosis: The microscopic diagnosis of this lesion is peripheral giant cell granuloma.  The prognosis is good, although the lesion recurs in about 10% of cases.