Peripheral Oral Exophytic Lesions
CHAPTER 10
143
DIFFERENTIAL LIST FOR PFC
A
B
• • • •
FH Other IH lesions Osteosarcoma Chondrosarcoma Metastatic carcinoma Peripheral odontogenic fibroma
eliminated and the inflammation subsides. The resultant lesion is usually nodular and bluish-red, usually bleeds easily, and may blanch on pressure. Indicated treatment is sclerosis, excision, or perhaps a combination of these modalities after determination of the blood supply to the lesion.
Peripheral Fibroma with Calcification
c
Fig. 10-17. Epulis granulomatosum. A, A retained deciduous root was the irritating factor in this case. B, Sharp, bony spicules remaining in an extraction socket caused this lesion. C, This lesion proved to be an antral polyp that had extruded through a socket with an oroantral fistula. (B courtesy P. Akers, Chicago; C courtesy P.D. Toto, Waukegan, 111.)
tracted prevent the formation of an epulis granulomatosum. Treatment requires the excision of the lesion and a careful curettage of the alveolus to ensure the elimination of irritating bony spicules. Because the growth might be malignant, the excised tissue should be examined microscopically.
Acquired Hemangioma A majority of hemangiomas are congenital, but some are acquired later in life. Some of the acquired capillary hemangiomas of the oral cavity may develop from IH lesions mostly on the gingivae. The conditions may be right for certain IH lesions with many patent capillaries to develop significant blood flow during the IH stage. Such capillary systems remain after the irritant has been
The peripheral fibroma with calcification (PFC) (peripheral ossifying fibroma) is a benign overgrowth of gingival tissue that most oral pathologists consider to be a type of IH lesion. It is thought to involve the periodontal ligament superficially, and it often contains calcified deposits resembling cementum, or osteocementum,9 scattered throughout a background of fibrous tissue. If the calcified element is significant, radiopaque foci within the soft tissue tumor mass are observed on radiographs (Fig. 10-18). Papers have clearly differentiated its characteristic features from those of the central odontogenic fibroma. which on rare occasions may occur peripherally and is refelTed to as the peripheral odontogenic fibroma, WHOtype. 33 •34 The latter lesion contains odontogenic epithelium. 3s .36 One study indicates that PFC is more common than previously realized: 46.5% of fibrous epulides contained calcifications. 37 This lesion is also included with the mixed radiolucent-radiopaque lesions in Chapter 25, in the section on the differential diagnosis of osteosarcoma. Features PFC occurs on the gingiva and usually involves the interdental papillae (see Fig. 10-18). The lesion may cause a separation of the adjacent teeth, and occasionally minimal bone resorption can be seen beneath the lesion. Some 50% occur in patients between the ages of 5 and 25 years, predomintly female patients. A total of 80% of the lesions occur anteriorly to the molar areas,38 over 50lle occur in the incisor and canine regionY and 60% occur in the maxi lla.3 4 As with other TH lesions, causative in'itants can usually be identified, and early inflammatory and late fibrotic stages are typical. The fibrotic PFC may be more common. Differential diagnosis The lesions that need to be considered in the differential diagnosis of PFC are listed in the box above.