Lesions of the gingivae are amongst the commonest lesions seen in patients and the vast majority are reactive hyperplasias, related to a number of chronic irritant stimuli. However, there are a number of entities that have a predilection for the gingivae, which are much less common in other parts of the oral cavity. The purpose of this paper is to discuss the clinical and histological differential diagnoses when presented with a lump on the gingivae, including the approach to diagnosis and diagnostic pitfalls.
Benign tumor; Epulis; Fibrous hyperplasia; Giant cell granuloma; Gingiva; Granulomatosis with polyangiitis; Ligneous gingivitis; Malignant tumor; Pyogenic granuloma.
Conflict of interest statement
Conflict of interest
All authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
a A large fibrous epulis on maxillary gingiva. b Widespread fibrous gingival enlargement on a patient on cyclosporine therapy. c Histological image of a nodule of fibrous hyperplasia of the gingiva (H&E, Overall magnification × 20). In this case, the collagen varies from superficially hyalinised to more edematous in deeper tissues. d Histological image showing large stellate fibroblasts in a giant cell fibroma (H&E, overall magnification × 200). e An ulcerated vascular lesion on the maxillary gingiva of a pregnant patient in mid-trimester. f The histology of a vascular epulis/pyogenic granuloma shows attenuated or ulcerated epithelium with an underlying endothelial proliferation. This may have a lobular pattern (H&E, overall magnification × 200)
a A PGCG in an edentulous span of the maxilla. b Numerous multinucleated giant cells in a vascular and monocellular background in PGCG (H&E, Overall magnification × 40). c Lesions of ligneous alveolitis on the edentulous mandibular ridge. d Fibrinous deposits are seen in ligneous gingivitis, closely associated with the surface epithelium. Whilst suggestive of amyloid, these are Congo Red negative (H&E, overall magnification × 100). e Widespread “strawberry gingivitis” appearance of the maxillary gingiva in a patient with GPA. f The classic histological features of GPA can be difficult find in a gingival biopsy. The photomicrograph shows a small vessel with leukocytoclastic vasculitis and a poorly formed granuloma to the left of it (H&E, overall magnification × 100)
a Multiple bony swellings affecting the labial aspect of the maxillary gingivae, consistent with exostoses. b Bluish swelling affecting the attached gingivae in the lower left canine/premolar area, consistent with a gingival cyst (Photograph kindly provided by Dr Susan Muller). c Oral mucosa containing a cystic structure lined by thin epithelium with focal thickenings in a gingival cyst (H&E, overall magnification × 20). d An odontogenic fibroma is characterized by strands of odontogenic epithelium in a collagenous stroma (H&E, overall magnification × 10). e Peripheral ameloblastoma showing islands of odontogenic epithelium with characteristic peripheral palisading (H&E, overall magnification × 4). f Cords of atypical epithelial cells in fibrous stroma in a metastatic lobular carcinoma of breast (H&E, overall magnification × 20)
a Red, nodular swelling affecting the facial gingiva above the left maxillary canine and lateral incisor in Kaposi Sarcoma. b Streams of spindled cells with slit-like vessels and lymphangiomatous pattern superficially in Kaposi’s sarcoma (H&E, overall magnification × 4). c Non-Hodgkin lymphoma presenting as an ulcerated swelling affecting the posterior left retromolar region. d Generalized erythema and swelling affecting the gingiva in a case of AML. e Connective tissue effaced by sheets of atypical myeloid cells in AML (H&E, overall magnification × 20). f Chondrosarcoma classically has a lobular architecture, with blue-grey cartilaginous matrix (H&E, overall magnification × 4)
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Gingival Diseases / diagnosis*
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