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Oral and Maxillofacial Pathology Case of the Month
ORALand maxillofacial pathology case of the month
Clinical Presentation
A 22-year-old White female was referred to the oral surgeon because of a rapidly enlarging mass involving her left mandibular gingiva. Review of the patient’s medical history revealed that she was 29 weeks pregnant. The patient was otherwise healthy with no underlying medical conditions and was currently taking prenatal vitamins.
Clinical examination revealed an erythematous exophytic mass involving the lingual, interproximal and buccal gingival tissues of the left mandibular first premolar, #21 (Figure 1A, 1B). Slight tooth mobility was observed and the lesion was tender to palpation and bled readily upon manipulation. The patient reported that the lesion had been present for approximately 2 months with rapid growth over the last 2 weeks. A radiograph was taken at the time, showing no overt evidence of an intraosseous component or marked bone loss (Figure 2). Given the clinical features, an excisional biopsy was performed with the use of local anesthetic and submitted for histopathologic evaluation. The histopathologic findings revealed a hyperplastic mucosal nodule with overlying ulceration (Figure 3A). The specimen showed numerous dilated blood vessels and proliferating endothelial cells within a fibrous stroma with scattered subacute inflammation (Figure 3B).
What is your diagnosis? See page 272 for the answer and discussion.
Figure 1A. Clinical image of the exophytic lesion involving the lingual, distal-interproximal, and buccal aspects of #21. The lesion appears hemorrhagic and is red-purple in color with overgrowth along the occlusal aspect. Figure 1B. Buccal aspect of the lesional area shows edema and erythema of the tissue without an exuberant overgrowth.
Figure 2.
Periapical radiograph showing no obvious bone loss or an osseous lesion.
AUTHORS
Paras Bharatkumar Patel, DDS
Assistant Professor, Oral and Maxillofacial Pathology, Department of Diagnostic Sciences, TAMU College of Dentistry, Dallas, Texas
Colten Ducote, DDS, MD
Oral and Maxillofacial Surgeon, Private practice: ArkLaTex Oral and Maxillofacial Surgery, Shreveport, Louisiana
Figure 3A.
Low power view of the lesion showing a nodular lesion with an ulcerated surface with prominent dilated blood vessels (H&E, Original mag x4).
Figure 3B.
Higher power view showing a proliferation of endothelial cells forming variable sized blood vessels in a fibrous stroma with scattered subacute inflammation (H&E, Original mag x 40).
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