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Congenital granular cell epulis (CGCE) is an uncommon lesion of unclear pathogenesis. It occurs predominantly in female newborns with a predilection site of the maxillary alveolar ridge. The mass enlarges prenatally but the growth arrests after birth. Histologically, CGCE is characterized by a proliferation of polygonal cells with eosinophilic, granular cytoplasm and eccentric, bland-appearing nuclei. It closely resembles adult granular cell tumor (GCT) microscopically and S-100 immunostain is often helpful in distinguishing the two (S-100-positive in GCT and S-100-negative in CGCE). Clinically, the lesion should also be distinguished from entities such as infantile myofibroma, rhabdomyoma, melanotic neuroectodermal tumor of infancy, peripheral odontogenic fibroma, and neurofibroma. CGCE demonstrates an excellent prognosis and has not been associated with any syndromes/genetic defects or malignant transformation. Clinicians and pathologists should be familiar with this rare entity and its differential diagnosis for accurate diagnosis and management.

Background Oral focal mucinosis, the oral counterpart of cutaneous focal mucinosis, is a rare disease. As it has no characteristic clinical or radiological features, diagnosis is established by histopathological and immunohistological examination. We present three cases of oral focal mucinosis occurring in the retromolar (which is extremely rare) and gingival regions. Case presentation Case 1 involved a 26-year-old Japanese man with radiolucency in the right retromolar region on panoramic radiograph and computed tomography; no obvious protrusion was observed in the region. This finding was clinically diagnosed as a tumor of the retromolar region. Case 2 involved a 60-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 7 × 6 mm and exhibited elastic hardness and healthy-colored mucosa. The lesion was diagnosed as an epulis. Case 3 involved a 47-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 10 × 10 mm and exhibited elastic hardness and redness of the surface mucosa. This lesion was also diagnosed as an epulis. Resection was performed in all three cases, and the lesions were histopathologically diagnosed as oral focal mucinosis. Postoperative courses were uneventful and, thus far, there have been no recurrences. Conclusions Although it is difficult to diagnose oral focal mucinosis based on clinical symptoms and imaging findings, the disease should be considered a possibility when diagnosing benign oral tumors. We believe that an emphasis on histopathologic study is essential to confirm the clinical suspicion.

The epulis is a relatively frequent benign oral lesion that originates from the gingival and which has no degenerative potential. A 73-year-old-woman came to our attention for a mass, located in the oral cavity and more precisely in the right inferior maxillary alveolar ridge, that the patient firstly noticed 2 years earlier. Its dimensions increased over time and now were relevant. The mass was mobile, and non-ulcerated e did not evoke pain when palpated. It was characterized by a thin pedicle and its resection, under local anesthesia, allowed a complete removal of the mass itself. The histological examination showed a fibrous and plasmacellular epulis with calcific spots and mixoid aspects. We here report this case for the unique dimensions of this epulis and in order to give a useful example that could help in the differential diagnosis of the lesions located in the oral cavity.

Malignant melanoma of oral mucosa is a rare and fatal tumor that occurs exceptionally during pregnancy. Among one of the theories, several authors have discussed the possibility of mali- gnant transformation of a pigmented lesion of the oral mucosa to malignant melanoma during pregnancy. We report the case of a 30-years-old patient who consulted for an increasing volume of a pigmented lesion during pregnancy that the dentist has diagnosed as a pregnancy epulis. Clinical examination reveals the presence of bluish-black budding tume- faction. Histological and immune-histochemical examination confirmed the diagnosis of malignant melanoma of the palatal mucosa. Resume Le melanome malin de la muqueuse buccale est une tumeur rare et mortelle qui survient exceptionnellement pendant la gros- sesse. Parmi l’une des theories, plusieurs auteurs ont discute la possibilite de transformation maligne d’une lesion pigmentee de la muqueuse buccale en melanome malin pendant la grossesse. Nous rapportons le cas d’une patiente de 30 ans qui a consulte pour un accroissement en volume d’une lesion pigmentee pen- dant la grossesse que le dentiste a diagnostique epulis gravi- dique. L’examen clinique a revele la presence d’une tumefaction bleu-noirâtre d’aspect bourgeonnant. Les examens histologiques et immunohistochimiques ont confirme le diagnostic de mela- nome malin de la muqueuse palatine.

After provisional or definitive cementation of fixed implant-supported prostheses, spontaneous gingival proliferation may occur to fill the cervical embrasure areas of the prosthesis. Adequate oral hygiene, osseous spacing between the supporting implants and attached or immovable soft tissue may be the conditions that allow this phenomenon. This proliferation embrasure fill eliminates interproximal gingival voids, that is, black triangles, and makes the outcome more esthetically acceptable. Since interproximal prosthetic deign and implant positioning may be the primary factors for the fill, the gingival fill may be, in fact, an epulis.

Introduction Congenital epulis or congenital granular cell tumour is a rare benign lesion arising from alveolar mucosa of neonates which can cause respiratory and feeding problems. It is also known as Neumann’s tumour. Females are affected 10 times more frequent. Method A review of medical record was performed. Result A newborn presented with lesion over left lower gum which was seen during antenatal abdominal ultrasonography scan by Obstetrics team at 35-week of gestation. The case was referred for ex utero intrapartum treatment procedure in view of anticipating upper airway obstruction. Upon delivery via Caesarean section, patient had no obstructive symptoms however was immediately intubated few hours of life to secure airway. Computed tomography scan confirmed a soft tissue mass arising from either lower alveolus or tip of tongue. The lesion was excised and histopathological examination reported as congenital epulis. Conclusion Even though it is a rare case, congenital epulis should be considered as one of differential diagnosis of an oral mass. A multi-disciplinary team management is important in view of possibility of upper airway obstruction post delivery.

Reports of neoplasia in captive reptiles are becoming more frequent; however, there is still scarce knowledge of the occurrence of neoplasia in wild reptiles. A wild black rat snake ( Pantherophis alleghaniensis) was presented to the Zoological Medicine service of the University of Georgia’s Veterinary Teaching Hospital with a 3 cm in diameter solid mandibular mass that was partially ulcerated. Radiographically, the mass was radiopaque with small bone spicules and partial osteolysis of the adjacent mandible. Histologic examination of the mass revealed a neoplasm composed of cuboidal to polygonal cells arranged in islands, anastomosing cords, and trabeculae of pseudostratified epithelium with a palisading peripheral layer of densely packed columnar cells with cytoplasmic clearing. The neoplastic tissue was separated from the mesenchyme by a prominent band of fine collagen. Neoplastic cells were positive for cytokeratin and negative for smooth muscle actin. Electron microscopy highlighted the presence of tonofilaments and microvilli. These findings led to the diagnosis of ameloblastoma, an odontogenic epithelial tumor known to occur in humans and most veterinary species.

Epulis is a relatively common benign polypoid lesion that generally appears in the gingiva of individuals aged between 20 and 50 years. A 6-year-old Japanese girl came to our hospital for consultation regarding swelling of the marginal gingiva in the region between the maxillary left deciduous lateral incisor and canine. An intraoral examination revealed that the surface of the swollen mass was nonulcerated and smooth, and its color was similar to that of the surrounding gingival tissue. X-ray findings showed no calcified body or tooth germ malposition. The lesion was removed surgically under local anesthesia and histopathological findings showed it to be composed of fibrous connective tissue and blood vessels with minimal inflammatory cells, and covered by stratified squamous epithelium cells under the mucosa, which led to a diagnosis of epulis fibrosa. Patient prognosis has been good to date with no symptoms indicating recurrence.

Objectives Oral squamous cell carcinoma (OSCC) is the most common epithelial malignant neoplasm affecting the oral cavity. OSCC can mimic oral lesions of inflammatory origin with benign features, often leading to delay in diagnosis and treatment. Early detection is important to greatly increase the chances of a successful treatment. The present study reports a proteomic analysis of a gingival oral squamous cell carcinoma (G-OSCC) and an epulis. Materials and methods Normal mucosae tissue, G-OSCC tissue, and epulis tissue as a comparative sample of benign nature were collected and immediately frozen in liquid nitrogen. Tissue-extracted proteins were separated by two-dimensional gel electrophoresis and subjected to image analysis. Proteins that showed a significant difference in the expression level in the G-OSCC tissue were identified by the nano-ESI-HPLC-MS/MS experiment and database searchi. Results and conclusion The proteomic analysis of G-OSCC tissue enabled the identification of proteins that are potentially related to the disease; these proteins can be considered as signature molecules for diagnostic and prognostic tumor markers.

Six dogs with clinically and histologically confirmed epulis were included in this study Five dogs had a localized smooth non ulcerated oral mass protruded from the margins of either lower or upper lips whereas in one animal ulcerated diffuse and areas of necrosis located at lower jaw was seen During physical examination mass was detected in the oral cavity originated from the gums darkly pigmented varied in sizes and foul smelling All tumours were histologically benign except one Fibromatous and acanthomatous epulis were observed In one case distant pulmonary metastasis was confirmed radiologicaly Nitrous oxide cryoprobe was used in benign cases to excise these tumours under general anesthesia Nanosomal docetaxel was used as chemotherapy in one metastatic case Complete healing without any postoperative complications was observed in cryosurgery No recurrence was observed after six months of cryoablation Chemotherapy in metastatic epulis cases was found unsatisfactory It may be concluded that cryosurgery can be used for treatment of benign epulis in canines

In the oral cavity, several growths may occur, while some of these growths may be malignant, most of them tend to be benign. Even the benign lesions can be a big problem. Many are locally invasive and inclined to recur and their physical presence in the mouth can lead to traumatic occlusion and entrapment of debris, predisposing to infection. It is therefore of great importance that these growths be treated carefully with the elimination of the causative factors. The aim of this article is to present two such cases where benign pyogenic growths were misdiagnosed as malignant growth causing unnecessary stress and mental trauma to the patient.

A mucous cyst (mucous extravasation cyst, mucocele, ranula, mucous retention cyst) is a thin sac on the inner surface of the lips. They are painless swellings but can be bothersome. The cysts are thought to be caused because of trauma by sucking of the lip membranes between the teeth, if left untreated; they can organize and form a permanent bump on the inner surface of the lip. They are Case Study Agarwal et al.; BJMMR, 10(2): 1-5, 2015; Article no.BJMMR.15245 2 known as ranula when on the floor of the mouth, and epulis when present on the gums. This article highlights the advantages and evaluates the efficacy of treatment of mucocele with the help of diode lasers.

Background Gastric cancer rarely metastasizes to the oral cavity, especially to gingiva. Only 18 cases have been reported worldwide to date. This paper herein presents the nineteenth case of gingival metastasis from gastric cancer. Case presentation A 75-year-old man who underwent a radical gastrectomy for gastric adenocarcinoma was admitted to clinical oncology center for gingival mass which was originally diagnosed as epulis. The subsequent positron emission tomography-computed tomography (PET-CT) and histopathological examination revealed a gingival metastatic adenocarcinoma originated from gastric carcinoma. Then three-dimensional conformal radiotherapy (3D–CRT) with synchronization and sequential chemotherapy demonstrated clinical benefit in this patient. Furthermore, this research reviewed the records of 18 cases of gingival metastasis from gastric carcinoma in English, Japanese, and Chinese literature, and summarized the clinicopathologic features of the disease based on previously published papers. Conclusion This case suggests that gingival metastasis from gastric cancer is worthy of vigilance. Biopsy and immunohistochemical (IHC) staining should be used for the final diagnosis. Moreover, the patient with uncommon gingival metastatic lesion can be successfully treated by radiotherapy with adjuvant chemotherapy.

The work consists of 41 pages, 25 pictures, 48 references were used. The aim of this study: to evaluate the incidence of canine and feline epulides. The tasks: to findout what part of all gingival pathologies consists epulides, to find out if dog or cats more ofen has epulides, to asses the predisposition of sex, age and breed, and to find out the most common types of epulides diagnosed for cats and dogs. Methods: the gingival hyperplasias were also counted as epulides. 4 feline and 2 canine gingival samples were collected at private small animal clinic in Kaunas between 2015 – 2016 years and 6 feline and 18 canine gingival samples were evaluated from LUHS Veterinary academy Pathology center archivied during 2012 – 2016 years. 10 feline and 20 canine gingival samples were evaluated during this study. Conclusions: the study showed that epulides were diagnosed 58,33 % of canine gingival samples and 42,86 % of feline gingival masses. Epulides were most commonly diagnosed for dogs, most commonly for males. 58,33 % of canine epulides were diagnosed from 6 to 9 years old dogs, 50 % of feline epulides were diagnosed for from 4 to 6 years old cats. There was no breed predisposition for dogs, among cats, the epulides were the most common diagnosed in mixed breed cats. The study showed that 71,4 % of canine epulides were fibromatous epulides, 14,3 % were gingival hyperplasias, acantomateus and ossifying epulides contained at 7,14 % each. For cats, the most common diagnosed types of epulides were gingival hyperplasia (66,7 %) and fibromatous epulides (33,33 %), the multiple feline epulides, identified as fibromatous epulides, were diagnosed for 1 cat.

Mouth metastatic cancers are very rare and they usually represent the evidence of a widespread disease. Common primary tumors are lung carcinoma in men and breast carcinoma in women, followed by kidney cancer. In the oral soft tissues, the gingiva is the most common site, suggesting a possible role of inflammation in the attraction of circulating tumor cells. Oral metastasis has a serious prognosis. In this work, we describe the case of a 58-year-old man affected by renal cancer, who was brought to our attention for the appearance of a gingival swelling. Initially, the lesion was excised through a provisional clinical diagnosis of epulis. Subsequently, anatomopathological analysis showed a metastasis compatible with clear-cell carcinoma and specifically its renal origin was confirmed by immunohistochemical techniques., SCOPUS: ar.j, info:eu-repo/semantics/published

Congenital epulis is an uncommon benign lesion that affects the oral cavity of newborns, and presents histological features which are similar to those of granular cell tumor. The origin of this lesion has not been fully elucidated, and many hypotheses are considered due to the large variety of cell types observed in histological sections. Epulis development occurs further in the prenatal period, and is more common in newborn females, frequently in the maxilla. This lesion usually is presentend as a nodule covered by normal oral mucosa, which in some cases, interferes with baby's breathing and feeding. This report describes the case of a two-month-old male baby who presented a pedunculated intraoral lesion in the mandibular alveolar ridge. Histological sections revealed presence of mucosal fragments with atrophic squamous stratified epithelium, and fibrous connective tissue composed of cells with granular and eosinophilic cytoplasm. A few days after initial exam, the lesion detached from alveolar ridge, and healed spontaneously.

Tumor, tumor-like diseases of the oral cavity diverse. In the literature cases of these diseases, however, there are contradictions in the notes on the frequency of occurrence, gender differences, the structure of injury, and a description of such diseases in one study missing.

Leiomyosarcoma of the oral cavity is a very rare tumor type associated with aggressive clinical behavior and a low survival rate. However, this tumor may also be encountered as a slow-growing, non-ulcerated, painless mass in its early stage. We report a case of leiomyosarcoma, affecting the gingival mucosa of a 24-year-old male. The tumor mimicked an epulis, because it was encountered as a slow-growing, discreet, firm, non-ulcerated, painless mass without any evidence of resorption of the maxillary bone. Excision of the “epulis” resulted in a histological diagnosis of leiomyosarcoma. The histological findings of a wider excision did not indicate the presence of any tumor cells. The patient has since remained tumor-free for 3 years. A literature review, related to the gingiva of the maxilla or mandible, indicated only a few cases wherein the tumor behavior was similarly mild and benign as it was in this case. Thus, when the tumor is diagnosed at an early stage, while it is small and non-aggressive, successful treatment can lead to a good prognosis.

Introduction: Plasmablastic lymphoma is a high-grade life-threatening immunologic malignancy most often found in patients with human immunodeficiency virus (HIV). It is regarded as a unique AIDS-related lymphoma that has been described in individuals without HIV. Intraoral presentation in such circumstances is extremely rare. CasePresentation:Apatientpresentedwithaninnocuousepulisandchronicperiodontitis.Thepatienthadahistory of renal transplant and long-term immunosuppression with cyclosporine. The localized area of gingival enlargement, although provisionally diagnosed as gingival disease modified by medication, was excised and subsequently confirmed as an acute plasmablastic lymphoma. Excised tissue was sent off for routine histopathologic examination. Latent membrane proteins were found for Epstein-Barr virus. Atypical lymphoid tissue with multiple immune markers was indicative of a plasmablastic plasmacytoma,butthisdiagnosiswasmodifiedin lightofthehistory ofimmunosuppressionandpositiveEpsteinBarr markers to a post-transplant plasmablastic lymphoma. The patient was managed with a combination of chemotherapy and radiotherapy. The patient is now posttreatment, and there are no signs of recurrence or metastasis. Conclusions:Thisisararepresentation.Toourknowledge,therehavebeen

Objective This study evaluated the percentage of cases correctly identified as epulis fissuratum based on the clinical impression and histopathologic diagnosis and evaluated the percentage of cases identified as a malignancy by the histopathologic diagnosis with a clinical impression of epulis fissuratum. Findings A search in the database systems at the biopsy services of University of Nebraska Medical Center College of Dentistry and Tufts University School of Dental Medicine for the clinical impression term epulis/epulis fissuratum from January 1, 2012 until July 1, 2017 was performed which identified 187 cases. The Fisher's exact test measured the similarity between dental practitioners’ clinical impression of epulis fissuratum and histopathologic findings. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the dental practitioners’ clinical impression about the malignancy of epulis fissuratum were calculated. P value Conclusion Based on the collected data, dental practitioners should remove and submit excised tissue for microscopic analysis to rule out malignancy in suspected cases of epulis fissuratum.

Congenital epulis is a rare congenital tumor affecting the oral mucosa. It is usually seen in females and has no known syndromic association. It may cause the interference to feeding or airway obstruction, thus presenting as an emergency. Visually, it causes a lot of undue stress and anxiety to the parents and relatives. Multiple epulis occurs only in 10% of cases. Recurrence of the tumor, malignant change, or damage to dentition is not seen post-excision. Clinicians, particularly those working in the tertiary health care facilities, should be aware of this benign and easily treatable tumor of the neonate. Key words: Epulis, Gingival tumor, Granular cell tumor, Neumann’s tumor

Congenital granular cell epulis is a rarely reported lesion of unknown histogenesis with a strong predilection for the maxillary alveolar ridge of newborn girls. Microscopically, it demonstrates nests of polygonal cells with granular cytoplasm, a prominent capillary network, and attenuated overlying squamous epithelium. The lesion lacks immunoreactivity for S-100, laminin, chromogranin, and most other markers except neuron-specific enolase and vimentin. Through careful observation of its unique clinical, histopathologic, and immunohistochemical features, this lesion can be distinguished from the more common adult granular cell tumor as well as other differential diagnoses.

Uterine leiomyosarcoma (LMS) is a rare tumor constituting 1% of all uterine malignancies. This sarcoma demonstrates an aggressive growth pattern with an high rate of recurrence with hematologic dissemination; the most common sites are lung, liver, and peritoneal cavity, head and neck district being rarely interested. Only other four cases of metastasis in the oral cavity have been previously described. The treatment of choice is surgery and the use of adjuvant chemotherapy and radiation has limited impact on clinical outcome. In case of metastases, surgical excision can be performed considering extent of disease, number and type of distant lesions, disease free interval from the initial diagnosis to the time of metastases, and expected life span. We illustrate a case of uterine LMS metastasis in the upper buccal gingiva that occurred during chemotherapy in a 63-year-old woman that underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy for a diagnosis of LMS staged as pT2bN0 and that developed lung metastases eight months after primary treatment. Surgical excision of the oral mass (previously misdiagnosed as epulis at a dental center) and contemporary reconstruction with pedicled temporalis muscle flap was performed in order to improve quality of life. Even if resection was achieved in free margins, “local” relapse was observed 5 months after surgery.

Plasma cell granuloma is a non-neoplastic lesion rather uncommonly seen in the maxillofacial region. Its etiology, biological behavior, ideal treatment and prognosis are still unclear and rather controversial.A detailed histopathological examination and immunohistochemical study of the excised specimen was carried out, both for making a confirmatory diagnosis as well as to determine the etiopathology, biological behavior and prognosis of the lesion.Light microscopy revealed a hyperplastic stratified squamous epithelial lining, overlying a densely fibrocellular granulation tissue containing a rich proliferation of mononuclear inflammatory cells, among which there was a predominance of plasma cells with their typical eccentric, cartwheel shaped, "clock-faced" nuclei. Strong immunohistochemical positivity was observed for CD-138 by numerous cells of the connective tissue of the lesion, thus confirming them to indeed be plasma cells. Further, immunohistochemistry (IH) analysis also demonstrated the expression of both, the lambda and kappa light chain immunoglobulins by the plasma cell population, thus confirming them to be polyclonal and of an inflammatory, non-neoplastic origin.As a plasma cell granuloma is rarely encountered in the oral and maxillofacial region, its diagnosis could have been very easily missed, had it not been for the detection of the large numbers of plasma cells by light microscopy, which was further confirmed by IH. IH also helped in establishing the likely etiopathology of the lesion and confirmed it to be of a non-neoplastic reactive/inflammatory origin.

Odontogenic neoplasms are locally invasive oral tumors in dogs. The purpose of this retrospective study was to describe CT characteristics for varying histopathologic types of canine odontogenic neoplasms. A board-certified veterinary radiologist who was unaware of histologic findings reviewed and scored imaging studies. A total of 29 dogs were included in the study. Twenty-three of these dogs had concurrent dental radiographs. The most common CT characteristics for all tumor types were a direct association with or in the region of multiple teeth in 96.4% (27/28), contrast enhancement in 96.3% (26/27), alveolar bone lysis in 93.1% (27/29), and mass-associated tooth displacement in 85.2% (23/27). Mass-associated cyst-like structures were identified in 53.6% (15/28) and were only present in tumors containing odontogenic epithelium. Canine acanthomatous ameloblastomas (n = 15) appeared as extra-osseous (10/15) or intra-osseous (5/15) masses. Intra-osseous canine acanthomatous ameloblastomas were more likely to have mass-associated cyst-like structures and were subjectively more aggressive when compared with extra-osseous canine acanthomatous ameloblastomas. Amyloid-producing odontogenic tumors (n = 3) had subjectively uniform CT imaging characteristics and consisted of round soft tissue and mineral attenuating masses with multiple associated cyst-like structures. Fibromatous epulides of periodontal ligament origin (n = 4) were contrast enhancing extra-osseous masses that were rarely referred for CT examinations and 25% (1/4) were not visible with CT. Other odontogenic tumors were less represented or had more variable CT imaging characteristics. Mass-associated tooth destruction was appreciated more often with dental radiographs and extra-oral tumor extension was identified more often with CT.

Objectives/Hypothesis Congenital granular cell tumor (CGCT), also known as congenital epulis, is a rare benign mesenchymal tumor of the oral cavity. We report of a 3 years and 7 months old female patient undergoing surgical excision of an oral tumor. Subsequent histological and immunohistological investigations within the clinical course led to the diagnosis of CGCT. However, clinical findings in this case, such as primary onset and an untypical location within the oral cavity, clearly stand in contrast to those usually found in CGCT, resulting in an exceptional case not previously described in the literature. Laryngoscope, 123:2459–2462, 2013

A case of gingival metastatic tumor from a colon adenocarcinoma is reported. The patient had been diagnosed with colon carcinoma and underwent a colectomy with D2 dissection, followed by chemotherapy. Nine months after the initial treatment, she noticed a periodontal gingival swelling at the site of her right lower second premolar and was referred to our clinic. The clinical diagnosis was an epulis granulomatosa or pyogenic granuloma. A metastatic adenocarcinoma in the gingiva from colon carcinoma was identified after the histopathological examination. Although rare, oral metastatic tumors should be included in the differential diagnosis, particularly if the patient has a prior history of malignancies.

Epulis je dobroćudna promjena gingive u području alveolarnog nastavka izazvana lokalnim podražajem. Vanjskim izgledom djeluje kao tumor, a prema histološkoj slici više odgovara prijelaznim oblicima upalnoga procesa. Klinički se rijetko može razlikovati od zloćudnih tumora, metastaza ili bilo koje lezije na gingivi. Može narasti do nekoliko cm. S desnima je obično srasla uskom peteljkastom bazom, a rijetko širokom. Pojavljuje se u nekoliko histoloških slika: epulis gigantocellularis, epulis fibromatosa, kongenitalni epulis, epulis gravidarum, epulis fissuratum, piogeni granulom i iritacijski fibrom. Iako je epulis česta tvorba u usnoj šuplini, kliničaru je nemoguće odrediti dijagnozu temeljem kliničke slike, a samim time i način liječenja, jer pod istom kliničkom slikom može biti različita patohistološka slika. Svaki epulis treba promatrati s oprezom i što je moguće prije uputiti uzorak tkiva na patohistološku obradu.

Background Relapse of granulomatous epulis is common after surgery because of local irritations, hormonal level in vivo, or incomplete resection. Currently, if recurrence occurs, then extraction of the teeth adjacent to the lesion is commonly performed, which may influence the aesthetics or masticatory function. Thus, a more effective and less aggressive treatment method is urgently demanded, particularly for the recurring lesion. This study investigated the effects of the intralesional pingyangmycin (PYM) injections for the recurrent granulomatous epulis and assessed the complications. Material and Methods A total of 16 patients with recurrent granulomatous epulis underwent intralesional PYM injections, between July 2010 and June 2014. The effects and complications of the treatment were retrospectively reviewed. Results The total number of injections performed was 48 (for all patients). The median number of injections per patient was three (range, two to four). All cases completely recovered with no recurrence and resorption of the alveolar bone after a follow-up of more than 12 months. The complications included slight bleeding, local swelling and pain following injection. All these symptoms resolved 7 to 10 days after the injection. Conclusions In summary, intralesional PYM injections may be a preferred option for recurring granulomatous epulis. Key words:Granulomatous epulis, recurrence, pingyangmycin, sclerotherapy.

Background The diagnosis and treatment of a variety of non-plaque related gingival diseases have become an integrated aspect of everyday dentistry. The aim of this study was to analyse the relationship between clinical appearance and histopathological features of gingival lesions in a large Northern Italian population. Material and Methods A retrospective study of 788 cases of gingival and alveolar mucosal biopsies was set up. Statistical analysis was performed by calculating the odds ratio and 95% confidence interval (C.I.), in order to assess the degree of association between the clinical parameters considered (primary lesions) and the single pathologies, statistically evaluated by Mantel-Haenszel tests. The correlation between clinical and histological diagnosis was classified as follow: 1) expected data (ED): provisional clinical diagnosis; 2) real data (RD): final histopathology diagnosis; 3) concordant data (CD): correspondence between the expected data and real data. The correlation was calculated as follow: CC (complete concordance) = CD x 100 / ED, this expressing the percentage in which the clinical and the histological diagnosis overlapped. Results The most frequently observed and biopsied primary lesions resulted to be exophytic, followed by mucosal colour changes and finally by losses of substance. The statistically significant association between primary lesion and their manifestation in gingival pathologies was reported. Volume increases, for instance, were positively correlated to plasma cell epulis, pyogenic granuloma, fibrous reactive hyperplasia and hemangioma. Verrucous-papillary lesions were most often seen in verrucous carcinoma, verrucous leukoplakia and mild dysplasia. White lesion resulted to be related to leukoplakia or oral lichen planus. Red lesions resulted to be related only oral lichen planus. Erosive vesicle-bullous lesions were linked to disimmune pathologies. Ulcerative lesions were positively associated to oral squamous cell cancer. Finally, potentially malignant disorders have the most percentage high concordance. Among the malignant lesions, the correlation increased up to the squamous cell carcinoma and leukaemia. Conclusions This article presented the frequency and the clinico-pathological concordance of all primary lesions and the histopathological diagnosis of gingival lesions. For every primary lesion, it is possible to correlate a specific histopathological diagnosis in a statistical manner. This can be a valuable aid for not specialist clinicians who daily observe mucosae and have the opportunity to intercept major diseases. Key words:Gingival lesions; clinical appearance; histological analysis; clinico-pathological correlation.

Svrha rada je prikazati klinički slučaj prekrivanja defekta po eksciziji epulisa korištenjem kolagene membrane u kombinaciji s PRF tehnikom. Iz anamneze doznajemo da se izraslina pojavila oko 2010. godine na istom mjestu te je njegov stomatolog kauterizirao promjenu. Promjena se ponovno pojavila početkom 2014. godine te je bila veličine zrna pšenice, a pacijent nije imao nikakvih simptoma dok se izraslina nije povećala na sadašnju veličinu te ga je smetala prilikom govora i jela te je povremeno krvarila nakon mehaničkih ozljeda te ga je sprječavala u održavanju oralne higijene. Kliničkim pregledom uočena je okrugla izraslina u području gornjeg desnog sjekutića koja je prekrivala gornju četvrtinu krune zuba, tvrde konzistencije na opip, glatke površine sa širokom bazom što je upućivalo na epulis. Zbog velike baze izrasline i velikog defekta koji bi nastao nakon njenog uklanjana u području fronte, odlučeno je nakon uklanjanja izrasline postaviti kolagenu membranu u kombinaciji s PRF tehnikom. Pacijentu su prije zahvata izvađene dvije ampule krvi te su stavljene u centrifugu. Za vrijeme pripreme PRF membrana, izraslina je uklonjena termokauterizacijom kako bi se smanjilo krvarenje. Izraslina je po eksciziji poslana na PHD analizu kako bi se utvrdila dijagnoza. Na granici pomične i nepomične sluznice, sa svake strane rane iznad sjekutića napravljeni su vertikalni rezovi za tunel preparaciju s komunikacijom iznad sjekutića, te je isprepariran mukozni režanj sa sačuvanim periostom. Prema obliku defekta izmodelirana je kolagena membran te je natopljena PRF-om prije adaptacije. Zbog lakše adaptacije, konac je provučen kroz vertikalni režanj i režanj iznad sjekutića te je membrana prošivena koncem i njegovim laganim povlačenjem uz odizanje sluznice adaptirana na željeno mjesto. Radi bolje fiksacije, membrana je fiksirana resorptivnim koncem uz unutarnju stranu režnja. S vanjske strane fiksirana je monofilamentnim koncem 5.0 šavovima kako bi se spriječila dehiscijencija rubova rane. Membrana je ostala djelomično eksponirana, a taj dio je prekriven PRF membranama koje su fiksirane neresorptivnim koncem. Svrha PRF membrane je poticanje stvaranja kolagena zbog svojih čimbenika rasta, a time se ubrzava i cijeljenje rane. PRF membrana omogućava vlaženje eksponiranog dijela kolagene membrane te smanjuje postoperativnu bol. Deset dana nakon operacije konci su skinuti. Rana je u procesu cijeljenja, pacijent nema smetnji i bolova. Prva kontrola, mjesec dana nakon operacije pokazuje dobre rezultate, vidljiva je zdrava gingiva bez ožljkastog tkiva, ružičaste boje, sa prisutnom malom recesijom na mjestu uklonjene lezije. Na zadnjoj kontroli tri mjeseca nakon zahvata, recesija je u potpunosti prekrivena, nema granulacijskog i ožiljkastog tkiva. Nalaz PHD-a je Granuloma pyogenicum.

The word epulis is a clinical term used to describe a localized growth on the gingiva. Histologic examination of epulides indicates that the vast majority are the fibrous hyperplasias, peripheral ossifying fibomas, pyogenic granulomas or peripheral giant cell granulomas. The major epulides are common oral lesions with which dentists should be thoroughly familiar. The clinical and histological relevance of the two cases are discussed and analyzed for their biological behaviour.

The differential diagnosis of exophytic gingival lesions include peripheral odontogenic fibroma, peripheral giant cell granuloma, pyogenic granuloma, and peripheral ossifying fibroma (POF). The peripheral odontogenic broma, the peripheral counterpart of the central dontogenic fibroma, is neoplastic, whereas the othrs are generally regarded reactive in nature. The roliferative activity of the reactive lesions are conidered to be initiated by local irritants occurring in he gingival crevice or associated with adjacent teeth. hese irritants stimulate the gingival fibers of the eriodontal ligament, a specialized periosteal tissue, r the periosteum itself. Depending on the tissue timulated, these fibrous growths may contain bone nd/or cementum. The POF has been described by many names, includng ossifying fibroid epulis, peripheral fibroma with alcification, calcifying fibroplastic granuloma, and eripheral odontogenic fibroma. Gardner convincingly argued that the term peripheral odontogenic fibroma be reserved for those lesions that are neoplastic and have characteristic odontogenic epithelium. This diagnosis would include only those lesions that meet the World Health Organization criteria. He also reinforced the concept that the POF is not the peripheral variant of the central ossifying fibroma, a true neoplasm, but a distinct non-neoplastic inflammatory proliferation. POF occurs more frequently in female than in male individuals, is more common in the maxilla, and generally presents as a painless mass smaller than 2 cm. Occasionally larger lesions have been reported in the literature. The generally ac

The present review introduces heterotopic bone formation, which may be classified into osteoma in the tongue, lipoma with osseous and chondromatous changes, fibrous dysplasia ossificans progressiva (FOP), myositis ossificans traumatica (MOT), Albright's syndrome, vascular ossification in atherosclerotic lesions, ectopic ossification of periodontal epulis, stromal bone formation in the tumors and soft tissue osteogenic tumors (extraskeletal bone tumors). Those ectopic ossifications are unusual conditions, and in the head and neck area, the tongue is the most frequent site of heterotopic osteoma or chondroma. The biologic mechanism of heterotopic ossification may be similar to those of normal ossification, however, pre-existing changes or the transformation into osteogenic cells from non-osteogenic stem cells might be important roles. The myogenic cells in skeletal and smooth muscles suggest they are frequently transformed to osteogenic cells compared to those of mesenchymal cells. Those processes will involve growth promotion factors. Ectopic ossification also mediates epithelial cells, keratinocytic BMP directly induced to trigger ossification, in the case of calcifying epithelioma Malherbe. Classic bone induction theory may also involved epithelial BMP.

A 29-year-old woman consulted her dentist about a localgingival swelling which bled during tooth-brushing and had been present for 1 year. In the differential diagnosis, epulis gravidarum, a peripheral giant cell lesion, and peripheral ossifying granuloma were considered. After surgical removal, histopathological examination revealed a peripheral giant cell lesion. The presence of a peripheral giant cell lesion requires thorough excochleation of the underlying bone. If the bone is cleaned thoroughly, recurrence is rare.

A case of an epulis in an 8-month-old boy is reported. The tumor was localized on the mandibular alveolar ridge and, according to the parents, was a recurrence of a congenital tumor excised when the boy was 2 months old. Microscopically, it was composed of many spindled or ovoid cells with vesicular nuclei and non-granular eosinophilic cytoplasm, and covered by acanthotic parakeratinized squamous epithelium with broad rete pegs. Immunohistochemically, the spindled and ovoid cells were intensely positive for vimentin and neuron-specific enolase, and negative for S-100 protein. The final diagnosis was spindle cell epulis. The possible correlation of this lesion with congenital granular cell epulis is discussed.

Clinical and histologic features of 26 cases of canine peripheral giant cell granuloma (formerly giant cell epulis) are reported. Two main histologic categories were evident: (1) “classic” peripheral giant cell granuloma, characterized by variable numbers of multinucleated giant cells (MNGCs) admixed with densely cellular mononuclear spindle-shaped cells in variable amounts of collagenous matrix, and (2) the “collision” peripheral giant cell granuloma, with features of both a peripheral giant cell granuloma and a fibromatous epulis of periodontal ligament origin. In the 16 dogs for which the outcome was known, 2 peripheral giant cell granulomas recurred after excision. No age or sex predilection was evident; however, lesions were more common in maxillary than in mandibular gingiva. In contrast to cats, peripheral giant cell granulomas in dogs behave like fibromatous epulides of periodontal ligament origin and seldom recur after excision. Positive staining with TRAP (tartrate-resistant acid phosphatase) of the MNGCs and a fraction of the mononuclear cell population is consistent with osteoclastic origin.