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Introduction: Reactive lesions encompass a category of fibroepithelial lesions that are frequently observed in the oral mucosa. Due to the oral cavity’s significant exposure to trauma or frictional forces, the incidence of these reactive lesions is notably higher within this anatomical region. Despite resembling neoplastic proliferations clinically, proper knowledge about these lesions is crucial for accurate diagnosis. Materials and Methods: Clinical data of all the reactive lesions were collected retrospectively from the 5-year archives of the Oral Pathology Department, GITAM Dental College and Hospital, Visakhapatnam. A comprehensive clinical and histopathological assessment was conducted for all Reactive lesions. The collected data comprised age, gender, dimensions, location, and histopathological diagnosis, systematically compared and organized into tabulated formats. Results: In our study, we found that (54%) were females, with a slight female prediction. The 1st most common reactive lesion observed in our study was fibroepithelial polyp (29.85%). The gingiva was the most affected site (38.8%), followed by the buccal mucosa (31.3%). Conclusion: Reactive lesions are more prevalent in the oral cavity. As they can mimic multiple conditions, the clinical assessment was aligned with the histopathological characteristics to facilitate precise diagnosis while also delving deeper into the etiological factors implicated. Oral reactive lesions like pyogenic granuloma with unknown etiological factors need to be justified to arrive at a proper diagnosis, as suggested by Daley et al. Keywords: Reactive lesions; Fibroma; Pyogenic granuloma; Peripheral giant cell granuloma.

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Background: The gingiva is the soft tissue component of the periodontium. Gingival diseases could be the first sign to identify underlying local diseases and could be the oral manifestation of systemic illnesses. A retrospective assessment of gingival biopsies could provide us valuable information about existing periodontal diseases. The purpose of this study is to evaluate the frequency and distribution of various gingival lesions biopsied between 2016 - 2019. Material and methods: A cross-sectional retrospective study retrieved data from all gingival lesions biopsied from 2016-2019 and referred to the Department of Oral pathology, Surendera Dental College. Histologic sections were reviewed in a blinded manner by two certified oral pathologists to confirm the histologic findings and its diagnosis. The pattern of the gingival epithelium, nature of keratinization, other epithelial features, type of connective tissue, vascular features, type of inflammatory cell infiltrate, the intensity of inflammatory cell infiltrate, distribution of inflammatory cells, distribution of mineralization, multinucleated giant cells and various other characteristics were noted. The results were tabulated and statistical significance was analysed with SPSS v23.0 using Chi-square test. Results: Out of 1990 biopsies sent to the oral pathology department, 169 (8.49%) were gingival biopsies. 70.4% of gingival lesions were non-neoplastic, 17.2% were neoplastic and 12.4% were Oral potentially malignant disorders (OPMD). The gingival neoplasms were more common in the 3rd decade of life and had a female preponderance. The non-neoplastic lesions had a slight male predilection. The neoplasms consisted of 29 entities - 23 (79.3%) benign and 6 (20.7%) malignant. Observed neoplasms included ameloblastoma, peripheral odontogenic fibroma, squamous papilloma, fibroma, hemangiopericytoma, lobular capillary hemangioma, peripheral ossifying fibroma and traumatic neuroma. Out of the six malignant neoplasms, three cases (50.0 %) were oral squamous cell carcinoma and two cases (33.3 %) were verrucous carcinoma and one case (16.7%) was round cell neoplasm. Out of the 119 nonneoplastic lesions, 55 cases (46.2%) were inflammatory lesions and 41 cases (34.5%) were fibroepithelial hyperplasia. Out of the 21 OPMD, seventeen cases (81.0%) of epithelial dysplasia mild and three cases (14.3%) of epithelial dysplasia moderate were the most frequent, followed by one case (4.8.%) of lichen planus with dysplasia. Conclusions: Inflammatory lesions were the most common gingival lesions. We observed higher incidence of neoplasms than reported literature. This study gives valuable data about the frequencies and distributions of various gingival lesions anong Rajasthani population over 4 years. [ABSTRACT FROM AUTHOR]

“Epulis” is a widely used term to describe a localized gingival enlargement. However, a wide range of neoformations might present as localized, slow-growing, asymptomatic gingival masses. A systematic review was conducted to outline the pathological entities that were provisionally dignosed as “epulis” and whose final diagnosis was made after microscopic examination. An electronic search of PubMed, Google Scholar and Scopus databases from January 2000 to February 2021 was performed. An initial search of the databases identified a total of 864 documents, and after a careful process of screening and selection, 14 studies were included in this systematic review and processed for data extraction. The results show that histological examination, sometimes combined with immunohistochemistry, might reveal a wide spectrum of lesions, including hamartomatous lesions, non-neoplastic lesions, benign and malign neoplasms and metastases from distant cancers.

Introduction: Gingival overgrowth is a typical clinical manifestation of reactive lesions, which can develop from either known or unknown triggers. There is a dearth of new literature on these reactive conditions, despite the fact that they exert significant influence on the patient's aesthetics, psychology, and oral function. As a result, this report presents three cases of reactive gingival overgrowths. Case Presentation: The three cases of gingival overgrowth that are reported included two females and one male with ages 42 years, 19 years, and 39 years respectively. Traumatic 11mm x 7mm gingival overgrowth was observed in Case 1. Traumainduced sessile gingival overgrowth was 10mm x 8mm in Case 2. Case-3 had 12mm x 9mm pedunculated gingival overgrowth. None of the overgrowths showed any radiographic bone loss or clinical attachment loss. In each of the three cases, the dental hygiene was excellent. Conclusion: Taking into account and comparing the clinical characteristics of these overgrowths with the existing literature, they are identified as reactive pyogenic granuloma. The reported cases shed light on diagnostic steps for this pathology and serve as a reminder for upcoming dental clinicians and researchers. [ABSTRACT FROM AUTHOR]

Although gingival reactive lesions such as pyogenic granulomas (PG) are fairly common in gingiva with natural teeth, their occurrence in association with dental implants is relatively rare. Additionally, these lesions are relatively small in size (10 mm). This case report presents a large PG observed in association with a dental implant and a systematic review of the literature on implant-associated PG. A 66-year-old woman presented at our department with a smooth, slightly red pedunculated lesion measuring 45 mm × 40 mm × 20 mm on the buccal and lingual gingiva surrounding the left mandibular second molar dental implant. Horizontal alveolar bone loss around the dental implant was observed on panoramic radiographs and cone-beam computed tomography. A biopsy was performed, and a histopathological diagnosis of PG was made. Complete resection of the lesion and curettage of the implant surface under local anesthesia was carried out. The patient exhibited no recurrence of PG after one year of follow-up. [ABSTRACT FROM AUTHOR]

Soft-tissue lesions in the oral cavity, one of the most common sites for tumors and tumor-like lesions, can be challenging to diagnose and treat due to the wide spectrum from benign indolent to invasive malignant lesions. We report an abnormally large, rapidly growing hyperplastic lesion originating from the buccal mucosa in a 28-year-old male patient. Clinical examination revealed a well-circumscribed, smooth-surfaced, pinkish nodular lesion measuring 2.3 × 2 cm, which suggested the differential diagnosis of irritation fibroma, pyogenic granuloma, oral lipoma, and other benign or malignant neoplasms such as hemangioma, non-Hodgkin's lymphoma, or metastases to the oral cavity. Dental MRI using a 15-channel mandibular coil was performed to improve perioperative radiological and surgical management, avoiding adverse intraoperative events and misdiagnosis of vascular malformations, especially hemangiomas. Black bone MRI protocols such as STIR (short-tau inversion recovery) and DESS (double-echo steady-state) were used for high-resolution radiation-free imaging. Radiologic findings supported the suspected diagnosis of an irritation fibroma and ruled out any further head and neck lesions, therefore complete surgical resection was performed. Histology confirmed the tentative diagnosis. This article evaluates the use of this novel technique for MR diagnosis in the perioperative management of soft-tissue tumors in oral and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Mesenchymal tissue origin is one of the most common lesion in oral cavity. Most of these lesions are exuberant response to local irritation produces a soft tissue enlargement which are similar to neoplastic pathologic processes. Due to this diagnostic challenge the present study was conducted for reviewing the prevalence of soft tissue lesions. Search Strategy: The English articles in scientific databases including Google Scholar, Science Direct, Medline, and PubMed, published between 2007 and 2019, were searched by using relevant keywords including oral soft tissue lesion, oral mucosal lesion, neoplastic soft tissue lesion, reactive lesion, hyperplastic lesion and non-neoplastic soft tissue lesion. Finally, forty-nine articles were reviewed in this study. Conclusion: Findings showed that the most diagnosed lesions were benign in nature, and inflammatory in origin. Among this reactive/non-neoplastic lesions, fibrotic lesions, such as irritation fibroma or fibrous hyperplasia, were the most abundant lesions reported. There is a pronounced female predilection, and reactive lesions are most common in the fourth to sixth decades of life. Regarding the location of reactive lesions, the gingival mucosa was the most common site of involvement. Tumoral lesions with the origin of vascular, fibrotic and fat were the most commonly reported tumors. Keywords: Mesenchyme; Oral neoplasms; Reactive lesions; Mucosal lesion; Hyperplastic lesion.

One of the most frequent conditions found in the oral cavity includes reactive lesions. Peripheral ossifying fibroma (POF) is a prevalent condition characterized by an overgrowth, originating from the gingival tissue, periodontal ligament, and periosteum. The condition manifests as a small mucosal nodule and can be difficult to accurately identify since it resembles other lesions. Chronic irritation and trauma are considered to be etiological agents. It is more prevalent in females and typically impacts the anterior region of the maxilla and mandible. The recommended therapy for POF involves surgical excision and eliminating any factors that may be causing irritation in the affected area. It can grow significantly if not surgically removed early. Treatment is necessary to prevent recurrence. It can be misdiagnosed due to overlapping features with other lesions. Correct biopsy technique and histopathological evaluation are crucial for accurate diagnosis. This case report illustrates the management of gingival overgrowth in an 18-year-old female patient after comprehensive clinical evaluation by using conventional surgical excision with the help of a scalpel. The final diagnosis of POF was confirmed using histopathologic evaluation. The treatment led to favorable outcomes in the patient regarding mastication, speech, and esthetics., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dare et al.)

Pyogenic Granulomas (PG) are reactive hyperplastic lesions that are formed in relation to some chronic irritation, physical trauma or hormonal factors. The PG may present in various clinical and histological forms. These often present as a smooth lobulated exophytic lesions and at times may show a marked resemblance to Peripheral Ossifying Fibroma (POF). However, the characteristic histologic presentation helps in differentiating both the lesions. Microscopically, presence of ossification in pyogenic granuloma is not common and could possibly indicate an altered response of the connective tissue stroma. The present case report shows occurrence of pyogenic granuloma in a 12-year-old female which on histological examination not only exhibited proliferating blood vessels, endothelial cells and inflammatory cells which are typical features of pyogenic granuloma but also exhibited areas of ossifications which are not frequently encountered in PG. It is important to explore the underlying aetiological factors that could lead to formation of such ossifications. It has been suggested that pyogenic granuloma and peripheral ossifying fibroma could represent part of same spectrum of focal reactive lesions. However, it is still considered that these two lesions are separate clinical entities and the histologic presentations are different and unique to both of them.

We hereby report an unusual case which presented as a routinely encountered reactive lesion on the palate, whilst the radiological examination revealed a radiolucent cystic lesion underneath. After the investigations from radiography to histopathology, it was finally diagnosed as a peripheral ossifying fibroma coexisting with a nasopalatine duct cyst. [ABSTRACT FROM AUTHOR]

There are many reports showing localized gingival overgrowth which is most commonly reactive rather than neoplastic. The reactive type of lesion includes pyogenic granuloma, irritation fibroma, peripheral giant cell granuloma, and peripheral ossifying fibroma (POF). Among those, POF is a rare reactive gingival type of lesion. Eversole and Rovin in 1972 first described the POF. The main etiology may be due to trauma, local factors such as plaque and calculus, impingement by dental appliance or restorations. This case report shows a clinical presentation of a 40-year-old male reported with the gingival over growth in the lower front teeth region. The patient was provisionally diagnosed as pyogenic granuloma. Management of the lesion included nonsurgical therapy followed by excisional biopsy. Histologic sections were made and confirmed as POF. The patient was followed up to 6 months with no other complication. [ABSTRACT FROM AUTHOR]

Oral and maxillofacial lesions (OMFLs) in pediatrics differ markedly from their adult counterparts in terms of clinical conduct, pathological behavior, and management. This study aims to determine the frequency of OMFLs among pediatric and adolescent patients and to correlate the demographics information to the site, and histopathological findings. Pathological records of pediatric and adolescent patients were retrieved from three major pathological centers in Sulaimani city of Iraq. Demographic information, surgical procedure, anatomical sites, and histopathological diagnosis were recorded. Furthermore, The World Health Organization (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD-10) was used for coding. A Chi-square test was used to find the relation between different variables, and a p-value < 0.05 was considered statistically significant. This study archived 309 (13.3%) out of 2319 pediatric and adolescent patients, with a mean age of 11.04 ± 4.62. Females were more commonly detected (52.8%). The most frequently diagnosed lesions were salivary gland diseases (20.7%), followed by reactive hyperplastic connective tissue (18.4%). A significant relation was found between age groups and diagnostic categories (p = 0.001). The lips were the most commonly detected sites (20.7%). Mucocele was the most frequently seen non-neoplastic lesions (19.4%), followed by pyogenic granuloma (8.7%). Neoplastic lesions revealed predominant hemangioma (3.2%), followed by peripheral ossifying fibroma (1.9%). Traumatic and or reactive lesions were the most commonly reported lesions. Malignant neoplasms can be identified. The current study enabled systematic data recording of pediatric and adolescent patients, encouraging the importance of the oral healthcare system in identifying and managing the problem early in this critical age in this region.

Introduction: Foreign bodies and tissue reactions to foreign materials are commonly encountered in the oral cavity. Exogenous materials causing foreign body reactions may be metallic (amalgam) or nonmetallic (suture materials, vegetable matter). Implantation of food particles in the oral tissues has been known to cause reactive lesions such as oral pulse granuloma. Implantation could be through extraction sockets, deep periodontal pockets, associated with tumor growth, interdental areas of teeth, unfilled root canals, and grossly decayed teeth. These get rapidly digested and altered by host responses. Cellulose persists as hyaline material and invokes chronic granulomatous response. This change may mimic other pathologies. Materials and Methods: Representative specimens from commonly consumed food groups were selected, fixed in 10% neutral buffered formalin, processed, sectioned, stained with hematoxylin and eosin stain and observed under light microscope. Results: Each specimen revealed unique, distinct histology of each food type. The plant materials had a characteristic appearance of rigid double cell wall while rigid regular partitions containing nutrient material were revealed in seeds and beans. Starch-contained lentils exhibited clear spaces. Following is a brief description of some of the significant histological findings of each of the specimens processed and stained. Conclusion: Thus, the study of histological structure of vegetables and legumes will enable their easy recognition in oral biopsy samples and help in distinguishing them from other pathologies and artifact.

Pyogenic Granulomas (PG) are reactive hyperplastic lesions that are formed in relation to some chronic irritation, physical trauma or hormonal factors. PG may present in various clinical and histological forms. These often present as a smoother lobulated exophytic lesions and at times may show a marked resemblance to Peripheral Ossifying Fibroma (POF). However, the characteristic histologic presentation helps indifferentiating both the lesions. Microscopically, presence of ossification in pyogenic granuloma is not common and could possibly indicate an altered response of the connective tissue stroma. The present case reports occurrence of pyogenic granuloma in a 12-year-old individual which on histological examination not only exhibited proliferating blood vessels, endothelial cells and inflammatory cells which are typical features of pyogenic granuloma but also exhibited areas of ossifications which are not frequently encountered in PG. It is important to explore the underlying aetiological factors that could lead to formation of such ossifications. It has been suggested that pyogenic granuloma and peripheral ossifying fibroma could represent part of same spectrum of focal reactive lesions. However, it is still considered that these two lesions are separate clinical entities and the histologic presentations are different and unique to both of them. [ABSTRACT FROM AUTHOR]

Introduction: Oral lesions are divided into non-neoplastic lesions, potentially malignant lesions and neoplastic lesions. More clinical data are needed to determine their helpful clinical pattern. Aim: To present the epidemiological, clinical and histopathological characteristics of the oral lesions. Material and methods: The retrospective study group comprised records of 208 patients which were reviewed according to selected epidemiological and clinical features. All the biopsy specimens were classified into: reactive lesions, precancerous lesions/potentially malignant lesions, salivary gland pathologies, benign and malignant tumours. Results: The lower lip was the most common site involved followed by buccal and vestibular mucosa. The most frequent diagnoses were fibroma, mucocele and papilloma. The predominant pathomorphological forms were nodule and bulla. The most frequent salivary gland pathology was mucocele. Fibroma was the most frequent pathomorphological diagnosis, followed by mucocele and reactive lesions such as irritation fibroma (IF) and granuloma. Conclusions: In cases of oral mucosal lesions, we propose the following algorithm: the exclusion of all odontogenic and iatrogenic causes; the detection and elimination of harmful habits, parafunctions and irritants from the oral cavity especially from the vestibule of the oral cavity and from the lips; all surgical treatment should be performed only after the proper detection and elimination of causative factors to decrease the risk of recurrence; excisional biopsy or in more diffuse lesions incisional biopsy is recommended to confirm clinical diagnosis; and consideration of other factors that can modify the clinical pattern of oral lesions, such as oral hygiene, systemic diseases, and drugs. [ABSTRACT FROM AUTHOR]

Objective: This study reviews, analyzes, and compares the demographic data, histopathological features and discusses the treatment and prognosis of reactive lesions (RLs). Materials and Methods: Retrospective study was performed on the departmental archives from July 2006 to July 2016 (total 5000 cases) comprising of 659 cases of RLs of the oral cavity. The recorded data included age, gender, size, site, duration, habits, etiology, histopathological diagnosis, treatment, and prognosis. Results: The most common lesion was found to be inflammatory fibrous hyperplasia (47%) followed by pyogenic granuloma (PG) (27.16%) and the least cases were of peripheral giant cell granuloma (1.6%). The mean age for the occurrence was 4th–5th decade in all the RL's exceptperipheral ossifying fibroma (POF) which presented in the third decade. Female predominance was noted in all lesions except irritational FIB. The sizes of majority of the lesions were approximately 0.5–1 cm. The common sites were anterior maxilla followed by posterior mandible and least in tongue with no associated habits (82.2%). The duration of all the lesions was seen to be

Peripheral ossifying fibroma (POF) is an infrequently occurring, slowly progressing, innocuous, nodular overgrowth of the gingiva, which belongs to the category of the “reactive lesions of the gingiva.” There are several such overgrowths with similar clinical manifestations, but diverse etiology and histopathological features, thus presenting a challenge for the clinician. Thorough clinical examination, radiographic and histopathological features help to establish the diagnosis which is key to the successful management of such lesions. This article describes a case of POF in a 43-year-old male patient. The clinical, radiographic, histologic features, aggressive treatment strategies, relapse and close follow-up of POF are discussed in detail.

Background: In most tertiary centers across sub-Saharan countries, hematoxylin and eosin (H and E) stained slide is the main method of diagnosing lymphomas, and this has been found to be inadequate in diagnostic hematological malignancies. Aim and Objectives: To review the diagnostic utility and limitations of H and E, tissue diagnostic modality of solid hematolymphoid malignancies. Materials and Methods: The diagnosis based on both morphology and immunohistochemistry (IHC) assessments were compared with those based solely on morphology. Results: Of all, the 116 cases of lymphomas, only 32 (27.6%) were correctly diagnosed and subtyped by morphology while 53 (46%) cases were diagnosed to be lymphomas but could not be subtyped by morphology. Nineteen (16.4%) cases were wrongly subtyped. Five cases of reactive lesions were wrongly diagnosed as malignant lymphoma. Conclusion: This study makes a case for the mandatory use of IHC in the diagnosis of suspected cases of lymphomas.

Introduction: Foreign bodies and tissue reactions to foreign materials are commonly encountered in the oral cavity. Exogenous materials causing foreign body reactions may be metallic (amalgam) or nonmetallic (suture materials, vegetable matter). Implantation of food particles in the oral tissues has been known to cause reactive lesions such as oral pulse granuloma. Implantation could be through extraction sockets, deep periodontal pockets, associated with tumor growth, interdental areas of teeth, unfilled root canals, and grossly decayed teeth. These get rapidly digested and altered by host responses. Cellulose persists as hyaline material and invokes chronic granulomatous response. This change may mimic other pathologies.Materials and Methods: Representative specimens from commonly consumed food groups were selected, fixed in 10% neutral buffered formalin, processed, sectioned, stained with hematoxylin and eosin stain and observed under light microscope.Results: Each specimen revealed unique, distinct histology of each food type. The plant materials had a characteristic appearance of rigid double cell wall while rigid regular partitions containing nutrient material were revealed in seeds and beans. Starch-contained lentils exhibited clear spaces. Following is a brief description of some of the significant histological findings of each of the specimens processed and stained.Conclusion: Thus, the study of histological structure of vegetables and legumes will enable their easy recognition in oral biopsy samples and help in distinguishing them from other pathologies and artifact. [ABSTRACT FROM AUTHOR]

Objective: This study reviews, analyzes, and compares the demographic data, histopathological features and discusses the treatment and prognosis of reactive lesions (RLs). Materials and Methods: Retrospective study was performed on the departmental archives from July 2006 to July 2016 (total 5000 cases) comprising of 659 cases of RLs of the oral cavity. The recorded data included age, gender, size, site, duration, habits, etiology, histopathological diagnosis, treatment, and prognosis. Results: The most common lesion was found to be inflammatory fibrous hyperplasia (47%) followed by pyogenic granuloma (PG) (27.16%) and the least cases were of peripheral giant cell granuloma (1.6%). The mean age for the occurrence was 4th-5th decade in all the RL's exceptperipheral ossifying fibroma (POF) which presented in the third decade. Female predominance was noted in all lesions except irritational FIB. The sizes of majority of the lesions were approximately 0.5-1 cm. The common sites were anterior maxilla followed by posterior mandible and least in tongue with no associated habits (82.2%). The duration of all the lesions was seen to be <1 year. Majority of them presented with poor oral hygiene status (87.2%). Recurrences were present in 13.5% of surgically excised lesions. Conclusion: The RLs present commonly in oral cavity secondary to injury and local factors which can mimic benign to rarely malignant lesions. The clinical and histopathological examination helps to categorize the type of lesions. The complete removal of local irritants with follow-up and maintenance of oral hygiene helps to prevent the recurrences of such lesions. [ABSTRACT FROM AUTHOR]

Background: Reactive lesions of the oral cavity are non-neoplastic proliferations with very similar clinical appearance to benign neoplastic proliferation. This similarity is troublesome in the differential diagnosis. The aim of this study was to determine the frequency and distribution of oral cavity reactive lesions. Materials and Methods: The study was a retrospective archive review. The medical records of 2068 patients with histopathologic diagnosis of oral cavity reactive lesions were studied. The patients′ clinical data were registered and evaluated retrospectively. The obtained frequency of patients′ age, gender, and anatomic location were analyzed. Descriptive statistics were used for evaluating the registered data. Results: Peripheral giant cell granuloma was the most prevalent lesion (n=623, 30.12%). This was followed by pyogenic granuloma (n=365, 17.65%), epulis fissuratum (n=327, 15.81%), irritation fibroma (n=288, 13.93%), cemento-ossifying fibroma (n=277, 13.40%), inflammatory fibrous hyperplasia (n=177, 8.56%), and inflammatory papillary hyperplasia (n=11, 0.53%). The age ranged from 2 to 85 years, with a mean of 39.56 years. The lesions were more common in males (n=1219, 58.95%) than in females (n=849, 41.05%). Attached gingiva with 1331 (64.36%) cases was the most frequent place of reactive lesions. Conclusion: Peripheral giant cell granuloma was the most prevalent reactive lesion of the oral cavity. The reactive lesions were more common in males, gingival, and the third decade. Some differences have been found between the findings of the present study and previous reports.

The oral cavity is always exposed to variable chronic and persistent irritations because of its special anatomic location and its various functions, such as chewing. Therefore, many lesions, referred to as reactive or tumor-like lesions, occur in the mouth as a result of these chronic and persistent irritations. Chronic irritating factors of the oral cavity include microbial, chemical and pharmaceutical agents, mechanical traumas, and endocrinal and hormonal factors. Given the role of local irritating factors, such as calculus, dental plaque and local traumas in inducing these lesions, elimination of these factors and agents should be undertaken by dental practitioners to prevent incidence or recurrence of such lesions. In addition, treatment of these lesions is possible by dental practitioners in many cases. Therefore, knowledge about differential diagnosis, treatment plan and prognosis of these lesions is mandatory for dental practitioners. Key words: Reactive lesions, Clinical features, Radiographic features, Histopatholigical features, Differential diagnosis, Treatment.

Objectives: Aim of the present study was clinical and histopathological evaluation of a series of epulides to provide clinicians data to frequency distribution and biological behaviour of different underlying entities. Materials and methods: Ninety-two cases of epulides removed by CO-laser at the Department of Oral Surgery and Radiology, Medical University of Graz from 2000 to 2014 were studied retrospectively for clinical data and histopathological diagnosis. Results: In the presented study, histopathological examination revealed peripheral ossifying fibroma (32.6 %), fibroma/fibrosis (29.3 %), giant cell lesion (13.1 %) and granuloma pyogenicum (8.7 %) as the most frequent underlying entities. For the first time, hyperplastic squamous epithelium (7.6 %), granulation tissue (5.4 %) and peripheral odontogenic fibromas (3.3 %) were detected to clinically appear as epulides. Irrespective of the histological diagnosis, the mean age in our patients was 43.8 years. The majority of the lesions were found in the frontal region of both jaws. In all cases, the patients showed poor oral hygiene, local gingivitis and some of them an occlusal trauma. Conclusions: To identify different entities with different biological behaviour, to exclude malignant tumours and to identify new entities among epulides, histopathological examination is required. Poor oral hygiene and occlusal trauma seem to play an important role in the pathogenesis and could be risk factors for recurrences. Clinical relevance: Frequency distribution of different entities in epulides is provided to clinicians, and new histopathological entities were detected to clinically appear as epulides. [ABSTRACT FROM AUTHOR]

Objective of this study was aimed to highlight the frequency and prevalence of oral pathological lesions. Four hundred and twenty five patients visiting the Department of Oral and Maxillofacial Surgery/ Oral Medicine of Qurayyat Specialized Dental Center, Al-Qurayyat, Saudi Arabia, were included in the study. The study was conducted from year 2011 to 2015. Frequency of patients was noted. Males were 260/425 (61.2%) and females 165/425 (38.8%). Age range was 6-77 years with mean 38.4 + 13.65. Reactive lesions were the most common occurrences, diagnosed in 425 cases (8.94%), and followed by fungal infections (7.8%), lichen planus (7.1%) and pulp and periapical lesions (6.82%). Most common malignant lesion was squamous cell carcinoma 4.7 % (30/425). Most common salivary gland pathology was mucoepidermoid carcinoma 3.1% (13/425). [ABSTRACT FROM AUTHOR]

Statement of Problem: Giant cell granuloma (G.C.G) is a reactive lesion which affects the jaws and oral mucosa of gingiva.This lesion is classified to central and peripheral ones. The histopathologic aspects of central and peripheral G.C.G is the same. The central lesions are aggressive and cause osseous destruction. The peripheral G.C.G produces ulcerative swellings similar to pyogenic granuloma or peripheral ossifying fibroma. Since the peripheral and central G.C.G are common lesions, the awareness of dentists of different aspect of G.C.G is very important. Purpose: The aim of this study was a statistical evaluation of variables such as age, gender and location of peripheral and central G.C.G in oral and maxillofacial pathology department of Dental Faculty of Tehran University of Medical Sciences. Materials and Methods: This study was a cross-sectional, case series one. The medical records of oral and maxillofacial pathology department of Dental Faculty of Tehran University of Medical Sciences was assessed in two steps: In the first stage, the medical records of patients with pathologic report of peripheral and central G.C.G were selected and reviewed. In the next step, the informations such as age, gender and location of peripheral and central G.C.G were registered in data forms. The obtained data were analyzed by SPSS statistical software. Results: The results showed that the age range in peripheral and central G.C.G were 2- 90 and 4-70 years, respectively. The peak incidence of peripheral and central G.C.G was in the third and second decades, respectively. The peripheral G.C.G was more common in men (52.70%) than women (47.30%). This finding in central G.C.G was 37.19% for men and 62.88% for women. 57.06% of peripheral G.C.G cases were in mandible and 42.94% in maxilla. The occurrence of central G.C.G was 67.07% in mandible and 32.93 % in maxilla. Conclusion: Based on this study, the peripheral lesions were more frequent in men, third decade and mandible and the central lesions in women, second decade and mandible.

Plasma cell granuloma is a rare benign lesion characterized by the infiltration of plasma cells; primarily occurring in the lungs. It is also seen to occur in the brain, kidney stomach, heart, and so on. In the intraoral region it is seen to involve the tongue, oral mucosa, and gingiva. This case presents a 42-year-old female, with an enlargement in the maxillary anterior region, treated by excisional biopsy. Histological evaluation revealed plasma cell infiltrates in the connective tissue. The immunohistochemistry revealed kappa and lambda light chains with a polyclonal staining pattern, which confirmed the diagnosis of plasma cell granuloma.

Background/aim: To investigate the relative frequency of biopsied nonneoplastic oral mucosal lesions in Ankara, Turkey. Materials and methods: Biopsy records of a single center from 2000-2012 were retrospectively collected. Diagnosis was recorded and evaluated with respect to patient demographics (age, sex) and location of the lesion. Results: Of 11,980 biopsies, 1732 (14.5%) were mucosal nonneoplastic lesions. Hyperplastic lesions (n = 1000, 57.7%) with fibroepithelial hyperplasia in 30.9% of patients were the most common type of oral nonneoplastic lesions. The mean age of patients differed with respect to type of mucosal lesion, tending to be lower in patients with reactive lesions. Dermatoses showed a female predominance. Conclusion: Our findings revealed that hyperplastic lesions were the most common among nonneoplastic oral mucosa lesions. Geographic and ethnic differences of patients with various types of oral mucosal lesions require further investigation. [ABSTRACT FROM AUTHOR]

Background: Biopsy is an important diagnostic tool used in the diagnosis of lesions ranging from simple non-neoplastic, tumor-like lesions to malignancies, and is often the only way to diagnose oral lesions and diseases. The gingiva is the most common site for some kind of irritation or low-grade injury, resulting in localized overgrowths that are considered to be reactive and non-neoplastic lesions. This aim of this study is to analyze the frequency and distribution of gingival lesions in the Gujarati population. Materials and Methods: In this retrospective study, gingival biopsies submitted for a period of five years were included. Microscopic slides of all the cases were reviewed by two observers for confirmation of the diagnosis. Results: Among the 106 cases of gingival biopsies, the most frequent category of lesions encountered was the non-neoplastic category, which accounted for 73.58% of the cases. Both benign and malignant neoplasms constituted 26.42% of the cases. Among the non-neoplastic lesions, Pyogenic granuloma was the most frequent lesion (38.46%), followed by fibrous hyperplasia (20.51%), inflammatory hyperplasia (19.23%), and Epulis (8.97%). Neoplasms accounted for 26.42% of the gingival biopsies (92.85% benign and 7.15% malignant). Among the benign neoplastic lesions, Fibroma (30.76%) and Fibrolipoma (26.92%) were the most frequent, followed by peripheral ossifying fibroma (23.08%) and peripheral giant cell granuloma (11%). Conclusion: It is difficult to compare studies carried out in various countries due to differences in people's attitudes toward oral health and the accessibility of various population groups to biopsy services. Nevertheless, this study has provided some information about the frequency and distribution of biopsied gingival lesions in the Gujarati population over a period of five years. [ABSTRACT FROM AUTHOR]

Peripheral ossifying fibroma (POF) a is reactive gingival hyperplasia which originates from cells of the periodontal ligament. Clinical presentations of POF are similar to that of other gingival hyperplasias and definitive diagnosis requires histopathological examination. We report a case of POF in maxillary gingiva. The lesion was asymptomatic, slow growing, reddish pink in colour and histopathologically revealing stratified squamous epithelium and foci of mineralization in the form of bony trabeculae in the connective tissue. This article highlights the nomenclature, clinicopathological features and pathogenesis of POF. [ABSTRACT FROM AUTHOR]

Abstract: The introduction of the BIOMED-2 primers allowed for reliable comparisons of clonality testing data of malignant lymphomas from different laboratories. This study undertook a retrospective analysis of a large cohort of cases; 1862 cases involved the immunoglobulin heavy chain locus (IGH VH–JH), and 1527 cases involved the T cell receptor gamma locus (TCRG). We confirmed previously published clonality rates in various B cell, T cell, and Hodgkin lymphoma cases. In reactive lesions, clonality for the IGH locus was frequently accompanied by additional polyclonal background. Clonality for TCRG was found in a subgroup of diffuse large B cell lymphomas. On closer morphologic inspection, seven cases appeared to have arisen from an underlying peripheral T-cell lymphoma. Five cases with monoclonal TCRG rearrangements, originally diagnosed as Hodgkin lymphomas, were reclassified as T-cell lymphomas. TCRG clonality was very rarely only observed in Hodgkin lymphoma. In case of clear TCRG clonality a T-cell neoplasia must be ruled out on morphological grounds. By careful examination of the rearrangement patterns, including an assessment of a co-amplified polyclonal background, clonality testing provides a powerful tool which in concert with morphologic and immunohistochemical parameters can lead to a firm diagnosis. [Copyright &y& Elsevier]

Background: Reactive lesions of the oral cavity are non-neoplastic proliferations with very similar clinical appearance to benign neoplastic proliferation. This similarity is troublesome in the differential diagnosis. The aim of this study was to determine the frequency and distribution of oral cavity reactive lesions. Materials and Methods: The study was a retrospective archive review. The medical records of 2068 patients with histopathologic diagnosis of oral cavity reactive lesions were studied. The patients’ clinical data were registered and evaluated retrospectively. The obtained frequency of patients’ age, gender, and anatomic location were analyzed. Descriptive statistics were used for evaluating the registered data. Results: Peripheral giant cell granuloma was the most prevalent lesion (n=623, 30.12%). This was followed by pyogenic granuloma (n=365, 17.65%), epulis fissuratum (n=327, 15.81%), irritation fibroma (n=288, 13.93%), cemento-ossifying fibroma (n=277, 13.40%), inflammatory fibrous hyperplasia (n=177, 8.56%), and inflammatory papillary hyperplasia (n=11, 0.53%). The age ranged from 2 to 85 years, with a mean of 39.56 years. The lesions were more common in males (n=1219, 58.95%) than in females (n=849, 41.05%). Attached gingiva with 1331 (64.36%) cases was the most frequent place of reactive lesions. Conclusion: Peripheral giant cell granuloma was the most prevalent reactive lesion of the oral cavity. The reactive lesions were more common in males, gingival, and the third decade. Some differences have been found between the findings of the present study and previous reports. [ABSTRACT FROM AUTHOR]

Oral and maxillofacial lesions (OMFLs) in pediatrics differ markedly from their adult counterparts in terms of clinical conduct, pathological behavior, and management. This study aims to determine the frequency of OMFLs among pediatric and adolescent patients and to correlate the demographics information to the site, and histopathological findings. Pathological records of pediatric and adolescent patients were retrieved from three major pathological centers in Sulaimani city of Iraq. Demographic information, surgical procedure, anatomical sites, and histopathological diagnosis were recorded. Furthermore, The World Health Organization (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD-10) was used for coding. A Chi-square test was used to find the relation between different variables, and a p-value < 0.05 was considered statistically significant. This study archived 309 (13.3%) out of 2319 pediatric and adolescent patients, with a mean age of 11.04 ± 4.62. Females were more commonly detected (52.8%). The most frequently diagnosed lesions were salivary gland diseases (20.7%), followed by reactive hyperplastic connective tissue (18.4%). A significant relation was found between age groups and diagnostic categories (p = 0.001). The lips were the most commonly detected sites (20.7%). Mucocele was the most frequently seen non-neoplastic lesions (19.4%), followed by pyogenic granuloma (8.7%). Neoplastic lesions revealed predominant hemangioma (3.2%), followed by peripheral ossifying fibroma (1.9%). Traumatic and or reactive lesions were the most commonly reported lesions. Malignant neoplasms can be identified. The current study enabled systematic data recording of pediatric and adolescent patients, encouraging the importance of the oral healthcare system in identifying and managing the problem early in this critical age in this region. [ABSTRACT FROM AUTHOR]

Lymphoproliferations are generally diagnosed via histomorphology and immunohistochemistry. Although mostly conclusive, occasionally the differential diagnosis between reactive lesions and malignant lymphomas is difficult. In such cases molecular clonality studies of immunoglobulin (Ig)/T-cell receptor (TCR) rearrangements can be useful. Here we address the issue of clonality assessment in 106 histologically defined reactive lesions, using the standardized BIOMED-2 Ig/TCR multiplex polymerase chain reaction (PCR) heteroduplex and GeneScan assays. Samples were reviewed nationally, except 10% random cases and cases with clonal results selected for additional international panel review. In total 75% (79/106) only showed polyclonal Ig/TCR targets (type I), whereas another 15% (16/106) represent probably polyclonal cases, with weak Ig/TCR (oligo)clonality in an otherwise polyclonal background (type II). Interestingly, in 10% (11/106) clear monoclonal Ig/TCR products were observed (types III/IV), which prompted further pathological review. Clonal cases included two missed lymphomas in national review and nine cases that could be explained as diagnostically difficult cases or probable lymphomas upon additional review. Our data show that the BIOMED-2 Ig/TCR multiplex PCR assays are very helpful in confirming the polyclonal character in the vast majority of reactive lesions. However, clonality detection in a minority should lead to detailed pathological review, including close interaction between pathologist and molecular biologist.Leukemia (2007) 21, 222–229. doi:10.1038/sj.leu.2404482; published online 14 December 2006 [ABSTRACT FROM AUTHOR]

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Plasma cell granuloma is a rare benign lesion characterized by the infiltration of plasma cells; primarily occurring in the lungs. It is also seen to occur in the brain, kidney stomach, heart, and so on. In the intraoral region it is seen to involve the tongue, oral mucosa, and gingiva. This case presents a 42-year-old female, with an enlargement in the maxillary anterior region, treated by excisional biopsy. Histological evaluation revealed plasma cell infiltrates in the connective tissue. The immunohistochemistry revealed kappa and lambda light chains with a polyclonal staining pattern, which confirmed the diagnosis of plasma cell granuloma. [ABSTRACT FROM AUTHOR]

Background: Tissue eosinophilia may be caused due to reactive, neoplastic or idiopathic reasons. Reactive eosinophils in allergic and inflammatory conditions are transient and recruited from the circulation in response to various stimuli, whereas neoplastic eosinophils of leukemias and hematological malignancies are involved in the pathogenesis of the disease. The differentiation of reactive from neoplastic eosinophils has a serious implication on the treatment and prognosis of diseases. However, both these types of eosinophils display variation in morphology and staining characteristics in routine histopathology leading to a diagnostic dilemma. Aim: The aim of this study is to evaluate the efficacy of special stains for the demonstration of eosinophils in normal/reactive lesions and leukemias. Methodology: A retrospective study comprising twenty histologically diagnosed cases each of reactive oral lesions and leukemias were obtained from institutional archives. These tissue sections were subjected to staining with routine and special stains – Carbol chromotrope, Congo red, Leishman's stain, Periodic Acid–Schiff-papanicolaou (PAS-PAP) and PAS. Statistical analysis was performed using Pearson's Chi-square test to compare the various parameters in the evaluation of the staining efficacy. Results: Carbol chromotrope and Congo red staining showed increased staining efficacy in normal/reactive eosinophils while PAS-PAP followed by PAS and Leishman's stain showed enhanced features such as homogenicity, specificity, increased staining intensity, enhanced nuclear and cytoplasmic details in leukemic eosinophils. Conclusion: Combined PAS-PAP is a novel and cost-effective staining technique in differentiating reactive and leukemic eosinophils. It is significant in recognizing leukemic eosinophils of routine biopsies and alerts the clinician to rule out any underlying malignancies. [ABSTRACT FROM AUTHOR]

Background: Reactive lesions of the oral cavity are nonneoplastic proliferations with very similar appearance to benign neoplastic lesions and are associated with chronic local irritation or trauma. Although these lesions are uncommonly associated with carcinogen exposure, at times, they present histopathologically with dysplastic epithelium, thus making it difficult to differentiate it from true potentially malignant disorders. Hence, the present study was conducted to evaluate the expression of Bcl-2 protein, an antiapoptotic marker, in reactive lesions with and without atypical epithelium and in true epithelial dysplasia, which clinically presents as premalignant disorders. Materials and Methods: The samples included 15 cases each of normal oral mucosa (NOM), reactive lesions with and without dysplasia and oral epithelial dysplasia (OED) associated with carcinogen exposure. All the samples were subjected to immunohistochemical staining using Bcl-2 antibody. The total number of cells in the basal and parabasal layers in each field and total number of cells expressing Bcl-2 among them and the staining intensity were assessed. Statistical Analysis: Kruskal–Wallis ANOVA test was used to compare the number of positive cells among the four groups. The comparison of average percentage of positive cells between the study groups was done using Mann–Whitney U-test. Results: The immunohistochemical staining for Bcl-2 protein was identified in few cells in the basal layers of NOM, reactive lesions without atypical epithelium and in the basal and parabasal layers in reactive lesions with atypical epithelium and OED, as a granular cytoplasmic staining and as an accentuation around the nuclear membrane. There was a gradual increase in the expression and intensity of staining from Group I to IV. Interpretation and Conclusion: The altered or increased expression of Bcl-2 oncoprotein in reactive lesions with atypical epithelium and in OED with carcinogen exposure may lead to prolonged cell survival and can be considered as an early molecular event in carcinogenesis, helping us in understanding the nature of dysplasia in reactive lesions, which was not considered during the histopathology reporting. [ABSTRACT FROM AUTHOR]