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Correspondence to Professor Shivjot Chhina, [email protected]
Background
These lesions rarely occur in the gingiva. Owing to the overlapping histological features with basal cell carcinoma (BCC) and ameloblastic carcinoma, diagnosis is challenging. A proper assessment of the case by conferring with a periodontist and an oral pathologist is warranted, so as delineate a proper treatment plan.
Case presentation
A 42-year-old woman presented with a painless gingival swelling. The lesion presented on the lingual aspect extending from the permanent mandibular right incisor up to the mesial of the right mandibular first molar. The patient reported of difficulty in speech, as the lesion was interfering with her tongue. On intraoral examination, the swelling was non-tender and firm, and measured 2×1.5 cm (approximately) (figure 1). General examination was unremarkable and no associated lymphadenopathy was detected.
Investigations
Haematological and biochemical values were in the normal range. Orthopantomogram and intraoral periapical X-ray did not reveal any bony involvement.
Differential diagnosis
The preoperative differential diagnosis included: gingival tumours, such as peripheral ossifying fibroma, peripheral odontogenic fibroma and inflammatory hyperplastic lesions such as pyogenic granuloma or peripheral giant cell granuloma.1
Peripheral ossifying and odontogenic fibromas show varied clinical appearances that may closely resemble those of peripheral ameloblastoma (PA). Therefore, clinical features of these lesions are not pathognomonic, and histopathological examination is essential for the definitive diagnosis. On the other hand, peripheral fibromas usually lead to a separation between adjacent teeth and radiopaque foci, which can be appreciated radiographically.2
Inflammatory gingival hyperplasias are a second group of conditions that need to be considered in the differential diagnosis. Commonly, these are associated with chronic irritants, such as calculus or overhanging margins of dental restorations, which on elimination usually result in regression. Pyogenic granuloma is an asymptomatic mass that appears red and bleeds readily and presents a rough, ulcerated necrotic surface. Peripheral giant cell granuloma appears red, pink or bluish in colour, is most often nodular or polypoid in shape, and may be soft to hard in consistency.2
PA presents histological characteristics that can be similar to BCC, basaloid variant of squamous cell carcinoma and ameloblastic carcinoma (dedifferentiated),3 as these tumours exhibit similar basal cell proliferation forming epithelial strands....