Giant cell fibroma is a type of fibrous tumour of the oral mucosa which rarely affects children under the age of 10. The purpose of this paper was to contribute two clinically and histologically documented cases of giant cell fibroma in the free gingiva of a 7 and 6 year old boys.
Both nodules were presented in the mandibular anterior region. In the differential diagnosis several fibrous hyperplastic lesions were considered such as traumatic fibroma, papilloma, peripheral ossifying fibroma, peripheral odontogenic fibroma, giant cell fibroma and odontogenic hamartoma.
The lesions were removed and the histological examination revealed fibrocollagenous connective tissue with the presence of stellate giant cells which confirmed the diagnosis of giant cell fibroma.
Dentists should be aware of the existence of giant cell fibroma in children, which must be included in the differential diagnosis of nodular lesions of the gingiva and adequately diagnosed and treated by removal and histopathological examination.
The Giant cell fibroma (GCF) is a lesion of fibrous connective tissue origin, which
was first described as a distinct entity by Weathers and Callihan in 1974 [
The histological features of the lesion include the presence of stellate shaped
fibroblasts with delicate dendritic-like processes and one, two or multiple nuclei
[
GCF usually affects patients in the 2nd and 3rd decade of life [
The aim of this study was to present the case report of two boys 7 and 6 year-old respectively with GCF of the anterior mandibular gingiva and to review the current literature concerning the demographic, clinical and histopathological features of this uncommon lesion in children.
The patient, a 7 year-old Caucasian boy, was referred by a paediatric dentist for evaluation of a lesion on the free gingiva of the anterior mandible. The lesion was asymptomatic and had been present for 3 years remaining stable in size, shape and colour. The permanent right lateral incisor had uneventfully erupted 6 months ago. Medical history was uneventful except of the presence of allergic rhinitis treated with anthistamine nasal spray.
On oral clinical examination, a penduculated soft tissue nodule measuring 0.4 x 0.3 mm was noticed on the free gingiva distal to the permanent lower lateral incisor. The lesion was non-haemorrhagic, of firm consistency, covered by intact white mucosa. The rest of the oral mucosa was normal and the child's oral hygiene was satisfactory.
Based on the clinical appearance and the lesion's history, the differential diagnosis included primarily reactive and benign neoplastic lesions, such as traumatic fibroma, peripheral ossifying fibroma, peripheral odontogenic fibroma, giant cell fibroma and odontogenic hamartoma. The lesion was excised under local anaesthesia and haemorrhage control was achieved without need for suture application.
Microscopic examination of the excised specimen revealed fibrocollagenous
connective tissue with dispersed spindle-shaped fibroblasts and bigger stellate
cells with 1 or 2 nuclei (
Multiple stellate cells with one or two nuclei and basophilic cytoplasm within a fibrous connective tissue stroma (Case report 1, hematoxylin and eosin stain, original magnification x400).
Stellate giant cells in close proximity to the overlying epithelium, which forms elongated rete pegs (Case report 1, hematoxylin and eosin stain, original magnification x100).
A 6 year-old Caucasian boy was referred for dental restoration. Clinical
examination revealed the presence of a hyperplastic lesion in the interproximal
area between the left deciduous mandibular lateral incisor and canine; the
lesion was extending both buccally (3 x 2 mm) and lingually (4 x 3 mm) (
Based on clinical appearance differential diagnosis included traumatic fibroma, papilloma, peripheral ossifying fibroma, peripheral odontogenic fibroma and giant cell fibroma. The lesion was excised with electrocautery under local anaesthesia.
Microscopic examination of the excised lesion revealed connective tissue with
thick collagenous fibres and presence of dispersed stellate giant cells with
sizeable, vesicular nuclei, mainly in a subepithelial localization. The
epithelium was keratinized squamous stratified forming thin, elongated
projections (
A = buccal view and B = occlusal view of the nodular lesion of Case report 2 in the interproximal area between the deciduous lateral incisor and canine.
A and B = photomicrographs showing multiple stellate cells dispersed in a fibrous connective tissue stroma; elongated epithelial rete pegs are also discerned (Case report 2, hematoxylin and eosin stain, original magnification x400).
GCF is most commonly reported (90 - 97%) in Caucasians; [
Summary of the demographic data and location distribution of large published series of giant cell fibromas in the literature
Authors | Weathers |
Houston |
Bakos |
Magnusson |
Total |
---|---|---|---|---|---|
N | 108 | 464 | 116 | 103 | 791 |
Sex | |||||
Male | 49 (45%) | 195 (42%) | 46 (40%) | 55 (53%) | 345 (44%) |
Female | 59 (55%) | 269 (58%) | 70 (60%) | 48 (47%) | 446 (56%) |
Race | |||||
Caucasian | 69 (64%) | 415 (89.4%) | 113 (97%) | - | 597 (76.5%) |
Black | 5 (5%) | 19 (4.1%) | - | - | 24 (3%) |
Other | - | 2 (0.5%) | 3 (3%) | - | 5 (0.5%) |
Not specified | 34 (31%) | 28 (6%) | - | 103 | 165 (20%) |
Age | |||||
0 - 10 | 19 (18%) | 81 (17.5%) | 6 (5%) | 16 (15.5%) | 122 (15.4%) |
10 - 20 | 26 (24%) | 114 (24.6%) | 7 (6%) | 34 (33%) | 181 (22.9%) |
20 - 30 | 21 (19%) | 74 (15.9%) | 15 (13%) | 15 (14.6%) | 125 (15.8%) |
30 - 40 | 8 (7%) | 59 (12.7%) | 25 (22%) | 13 (12.7%) | 105 (13.3%) |
40 - 50 | 18 (17%) | 47 (10.1%) | 24 (21%) | 8 (7.7%) | 97 (12.3%) |
50 - 60 | 6 (6%) | 40 (8.6%) | 13 (11%) | 11 (10.7%) | 70 (8.8%) |
60 - 70 | 8 (7%) | 21 (4.5%) | 20 (17%) | 3 (2.9%) | 52 (6.6%) |
70 - 80 | 2 (2%) | 8 (1.7%) | 6 (5%) | 3 (2.9%) | 19 (2.4%) |
Not specified | - | 20 (4.4%) | - | - | 20 (2.5%) |
Location | |||||
Gingiva | 48 (45%) | 227 (48.9%) | 32 (29%) | 55 (53.4%) | 362 (45.8%) |
Maxilla | 13 (12%) | 84 (18.1%) | - | 17 (16.6%) | 114 (34%) |
Mandible | 35 (33%) | 143 (30.8%) | - | 38 (36.8%) | 216 (65%) |
Buccal mucosa | 16 (15%) | 27 (5.8%) | 23 (20%) | 12 (11.7%) | 78 (9.9%) |
Palate | 16 (15%) | 86 (18.5%) | 16 (13%) | 4 (3.9%) | 122 (15.4%) |
Tongue | 18 (16%) | 102 (22%) | 22 (19%) | 24 (23.3%) | 166 (21%) |
Lips | 2 (1.5%) | 12 (2.5%) | 5 (4%) | 1 (0.9%) | 20 (2.5%) |
Floor of mouth | 1 (1%) | 1 (0.3%) | 2 (2%) | - | 4 (0.5%) |
Not specified | 4 (4%) | 7 (1.5%) | - | 7 (6.8%) | 18 (2.3%) |
Other | 3 (2.5%) | 2 (0.5%) | 16 (13%) | - | 21 (2.6%) |
N = number of number of patients.
Summary of the demographic data and location distribution of published in the literature giant cell fibromas in children under 12 years old
Current Cases | Takeda et al. |
Fadavi et al. |
Swan |
Braga et al. |
Kuo et al. |
Campos et al. |
Shapira et al. |
Vergotine |
Uloopi et al. |
Sabarinath et al. |
|
---|---|---|---|---|---|---|---|---|---|---|---|
Sex | Males | Female | Male | Female | Male | Male | Female | Female | Female | Female | Female |
Race/ Nationality | Caucasian | Asian | - | Caucasian | Caucasian | Asian | Caucasian | Caucasian | African-American | Indian | Indian |
Age (years) | 6 and 7 | 3 | 11 | 6 | 3 | 7 | 11 | 6 | 1,5 | 12 | 9 |
Location | Mandibular gingiva | Oral mucosa | Maxillary gingiva | Maxillary gingiva | Maxillary gingiva | Maxillary gingiva | Maxillary gingiva | Tongue | Maxillary gingiva | Tongue | Maxillary gingiva |
Based on the literature, GCF usually affects patients in the 2nd and 3rd decades of
life [
There is no significant sex predilection [
The literature review confirmed the gingiva as the most commonly affected location
(362/773, 46.8%) among cases with specified site, with a predilection for the
mandible (2:1 mandible to maxilla ratio) [
The differential diagnosis of a firm, soft tissue nodule in the gingiva of a child
may include irritation fibroma, papilloma, peripheral ossifying fibroma, focal
fibrous hyperplasia, peripheral odontogenic fibroma and odontogenic hamartoma.
Irritation fibroma usually occurs at an older age, the buccal mucosa being the most
common location [
Retrocuspid papillae is a developmental lesion [
The reactive, hamartomatous or neoplastic nature of GCF is debated. Some authors
support the possible reactive or hamartomatous origin of the lesion as opposed to a
true neoplastic nature [
The origin of the giant cells is also controversial. The most accepted theory
supports a fibroblastic origin of giant cells [
As far as the treatment of GCF is concerned, a conservative surgical excision is
usually curative [
Recurrences have been reported only in solitary cases [
Giant cell fibroma is an uncommon lesion among young children. However, dentists should be aware of the existence of giant cell fibroma in children, which must be included in the differential diagnosis of nodular lesions of the gingiva along with irritation fibroma, papilloma, peripheral ossifying fibroma, peripheral odontogenic fibroma and odontogenic hamartoma. Following adequate diagnosis, lesions can be removed either with conservative surgical excision, electrosurgery or soft tissue laser and should be sent for histopathological examination.
The authors report no conflicts of interest related to this study.
Case 2 was a patient of the postgraduate clinic of Paediatric Dentistry, Dental School, University of Athens.