Case for Diagnosis
Polypoid Lesion of the Gum
Lesión polipoide en la encía
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Puente, Á. Castaño, A. Hernández-Núñez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Puente" "email" => array:2 [ 0 => "nieves.puente@salud.madrid.org" 1 => "npuentedepablo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Á." "apellidos" => "Castaño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." 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The patient reported that the lesion had grown progressively, resulting in increasing discomfort and slight bleeding caused by friction.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a 5-mm polypoid lesion of normal mucosal color and firm rubbery consistency located between the medial and lateral incisors of the upper right gum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No movement or alterations of the teeth were observed, nor were any other lesions detected in either the oral cavity or the cervical region. Curettage of the lesion was performed, followed by hemostasis with silver nitrate.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histology showed fibrous tissue with prominent fusiform fibroblasts, among which lamellar bone trabeculae were dispersed (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). Immunohistochemistry revealed that the cell population was positive for vimentin and had a mean Ki-67 value of 23%, but was negative for the markers CD31, CD34, von Willebrand factor, cytokeratin AE1/AE3, epithelial membrane antigen, smooth muscle actin, muscle-specific actin, desmin, CD68, and S-100 protein.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Peripheral cemento-ossifying fibroma (PCOF).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0075" class="elsevierStylePara elsevierViewall">Two weeks after treatment the appearance of the gum had improved, with no recurrence or residual lesion.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">PCOF is a fibro-osseous, osteogenic, reactive hyperplasia. Its likely origin is the multipotent cells of the periodontal ligament, given its near-exclusive localization in the gums, the inverse relationship between age and incidence, and the presence of oxytalan fibers in the calcified matrix in some PCOF cases. While the pathogenesis of PCOF is unknown, this condition has been associated with trauma, the presence of ectopic remnants of the periodontal ligament, and the influence of female sex hormones and chronic irritants, including dental calculus, plaque, ill-fitting dentures, malpositioned teeth, and irregular dental restorations.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Chronic irritation of the periosteum and periodontium result in the formation of reactive granulation tissue, which ultimately calcifies and undergoes fibrosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">PCOF is rare, with a higher incidence in white women in their second or third decade of life, and accounts for 3.1% of biopsied oral tumors.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">It presents as a slow-growing, asymptomatic lesion in most cases, although large lesions resulting in facial asymmetry or the displacement of adjacent teeth have been described.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Physical examination reveals a firm, erythematous, sessile or pedunculated tumor of normal mucosal color and of less than 2<span class="elsevierStyleHsp" style=""></span>cm in diameter, located in the interdental papilla.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In most cases these tumors develop in the upper maxilla.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Diagnosis is based on clinical-radiologic-pathologic correlation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Histologically, PCOF is a nonencapsulated lesion composed of connective tissue, abundant large fibroblasts, and chronic inflammatory cells, and covered by intact or ulcerated stratified, nonkeratinizing, squamous epithelium. These tumors contain a laminar osteoid-like mineralized material, cement-like concretions, or a mixture of both. Radiography is the imaging test of choice, and reveals a radiolucent, radiopaque, or mixed-density mass that does not affect the underlying bone. Superficial bone erosion, central radiopaque foci, widening of the periodontal ligament, or dental displacement may also be observed.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The differential diagnosis is established based on clinical-pathological correlation and includes other localized reactive gingival hyperplasias such as pyogenic granuloma, gingival fibroma, and peripheral giant cell granuloma; benign conditions such as fibrous dysplasia or osteomyelitis; and bone tumors, both benign (osteoid osteoma, osteoblastoma, cementoblastoma) and malignant (osteosarcoma).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,6</span></a> Juvenile ossifying fibroma, a variant of PCOF with a worse prognosis, was ruled out in our patient.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment consists of excision of the lesion and deep curettage of the periosteum and periodontal ligament, with recurrence in 8% to 30% of cases depending on the series,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> probably due to inadequate curettage and the persistence of chronic irritants. Malignant transformation has not been described.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Dermatologists should be familiar with this entity in order to ensure correct differential diagnosis and to avoid unnecessary tests and procedures.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Puente N, Castaño Á, Hernández-Núñez A. Lesión polipoide en la encía. Actas Dermosifiliogr. 2014;105:947–948.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 663 "Ancho" => 1000 "Tamanyo" => 120944 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 730 "Ancho" => 950 "Tamanyo" => 325609 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×10.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 764 "Ancho" => 950 "Tamanyo" => 327853 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral ossifying fibroma of the maxilla: A case study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.P. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 11 | 20 |
| 2024 Octubre | 100 | 42 | 142 |
| 2024 Septiembre | 93 | 30 | 123 |
| 2024 Agosto | 131 | 55 | 186 |
| 2024 Julio | 115 | 48 | 163 |
| 2024 Junio | 111 | 30 | 141 |
| 2024 Mayo | 101 | 35 | 136 |
| 2024 Abril | 99 | 26 | 125 |
| 2024 Marzo | 85 | 31 | 116 |
| 2024 Febrero | 89 | 34 | 123 |
| 2024 Enero | 87 | 40 | 127 |
| 2023 Diciembre | 81 | 22 | 103 |
| 2023 Noviembre | 103 | 30 | 133 |
| 2023 Octubre | 67 | 31 | 98 |
| 2023 Septiembre | 84 | 31 | 115 |
| 2023 Agosto | 72 | 17 | 89 |
| 2023 Julio | 99 | 33 | 132 |
| 2023 Junio | 92 | 25 | 117 |
| 2023 Mayo | 108 | 25 | 133 |
| 2023 Abril | 95 | 17 | 112 |
| 2023 Marzo | 65 | 25 | 90 |
| 2023 Febrero | 68 | 20 | 88 |
| 2023 Enero | 49 | 20 | 69 |
| 2022 Diciembre | 55 | 51 | 106 |
| 2022 Noviembre | 30 | 20 | 50 |
| 2022 Octubre | 37 | 13 | 50 |
| 2022 Septiembre | 35 | 22 | 57 |
| 2022 Agosto | 37 | 34 | 71 |
| 2022 Julio | 31 | 32 | 63 |
| 2022 Junio | 26 | 20 | 46 |
| 2022 Mayo | 36 | 30 | 66 |
| 2022 Abril | 59 | 39 | 98 |
| 2022 Marzo | 85 | 42 | 127 |
| 2022 Febrero | 58 | 12 | 70 |
| 2022 Enero | 75 | 28 | 103 |
| 2021 Diciembre | 55 | 34 | 89 |
| 2021 Noviembre | 69 | 43 | 112 |
| 2021 Octubre | 85 | 52 | 137 |
| 2021 Septiembre | 53 | 39 | 92 |
| 2021 Agosto | 40 | 29 | 69 |
| 2021 Julio | 46 | 36 | 82 |
| 2021 Junio | 46 | 27 | 73 |
| 2021 Mayo | 33 | 24 | 57 |
| 2021 Abril | 88 | 82 | 170 |
| 2021 Marzo | 68 | 22 | 90 |
| 2021 Febrero | 61 | 29 | 90 |
| 2021 Enero | 46 | 19 | 65 |
| 2020 Diciembre | 28 | 19 | 47 |
| 2020 Noviembre | 27 | 16 | 43 |
| 2020 Octubre | 32 | 17 | 49 |
| 2020 Septiembre | 13 | 13 | 26 |
| 2020 Agosto | 21 | 19 | 40 |
| 2020 Julio | 15 | 11 | 26 |
| 2020 Junio | 32 | 29 | 61 |
| 2020 Mayo | 22 | 31 | 53 |
| 2020 Abril | 27 | 26 | 53 |
| 2020 Marzo | 23 | 21 | 44 |
| 2020 Febrero | 5 | 12 | 17 |
| 2020 Enero | 0 | 5 | 5 |
| 2019 Diciembre | 4 | 12 | 16 |
| 2019 Noviembre | 0 | 8 | 8 |
| 2019 Octubre | 0 | 18 | 18 |
| 2019 Septiembre | 4 | 19 | 23 |
| 2019 Agosto | 0 | 15 | 15 |
| 2019 Julio | 0 | 24 | 24 |
| 2019 Junio | 2 | 10 | 12 |
| 2019 Mayo | 1 | 16 | 17 |
| 2019 Abril | 0 | 38 | 38 |
| 2019 Marzo | 2 | 11 | 13 |
| 2019 Febrero | 1 | 10 | 11 |
| 2019 Enero | 1 | 5 | 6 |
| 2018 Diciembre | 1 | 10 | 11 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 5 | 2 | 7 |
| 2018 Agosto | 0 | 16 | 16 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Junio | 0 | 9 | 9 |
| 2018 Mayo | 0 | 5 | 5 |
| 2018 Abril | 0 | 5 | 5 |
| 2018 Marzo | 0 | 8 | 8 |
| 2018 Febrero | 35 | 4 | 39 |
| 2018 Enero | 29 | 8 | 37 |
| 2017 Diciembre | 37 | 17 | 54 |
| 2017 Noviembre | 34 | 13 | 47 |
| 2017 Octubre | 31 | 7 | 38 |
| 2017 Septiembre | 25 | 6 | 31 |
| 2017 Agosto | 37 | 10 | 47 |
| 2017 Julio | 30 | 7 | 37 |
| 2017 Junio | 32 | 27 | 59 |
| 2017 Mayo | 25 | 10 | 35 |
| 2017 Abril | 18 | 11 | 29 |
| 2017 Marzo | 22 | 28 | 50 |
| 2017 Febrero | 12 | 13 | 25 |
| 2017 Enero | 18 | 17 | 35 |
| 2016 Diciembre | 28 | 9 | 37 |
| 2016 Noviembre | 38 | 11 | 49 |
| 2016 Octubre | 36 | 30 | 66 |
| 2016 Septiembre | 0 | 4 | 4 |
| 2016 Agosto | 0 | 4 | 4 |
| 2016 Julio | 9 | 0 | 9 |
| 2016 Junio | 22 | 13 | 35 |
| 2016 Mayo | 19 | 3 | 22 |
| 2016 Abril | 19 | 5 | 24 |
| 2016 Marzo | 18 | 12 | 30 |
| 2016 Febrero | 8 | 11 | 19 |
| 2016 Enero | 14 | 17 | 31 |
| 2015 Diciembre | 8 | 13 | 21 |
| 2015 Noviembre | 11 | 20 | 31 |
| 2015 Octubre | 15 | 21 | 36 |
| 2015 Septiembre | 16 | 7 | 23 |
| 2015 Agosto | 16 | 4 | 20 |
| 2015 Julio | 20 | 1 | 21 |
| 2015 Junio | 16 | 7 | 23 |
| 2015 Mayo | 16 | 3 | 19 |
| 2015 Abril | 1 | 9 | 10 |
| 2015 Marzo | 12 | 5 | 17 |
| 2015 Febrero | 11 | 4 | 15 |
| 2015 Enero | 2 | 2 | 4 |
| 2014 Diciembre | 5 | 2 | 7 |
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