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December 2003
By Youn W. Park, MD, and Kian Ho Bhe, MD
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CASE:
A 75-year-old woman presents with a lesion on the anterior
tongue. She reports that it has been slowly getting bigger
since she first noted it about six months ago. She denies
any bleeding or pain from the growth.
WHAT IS YOUR DIAGNOSIS?
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The lesion is a benign focal fibrous hyperplasia. These fibromas
have a predilection for the tongue, buccal and lip mucosa, and
gum, which supports recurrent local irritation or injury as
an etiologic factor. They usually occur in the third to fifth
decades of life and often grow very slowly and painlessly unless
a repeated injury, such as biting, causes bleeding or infection.
Grossly, the lesion may have a sessile or pedunculated shape
and the mucosa may be keratotic or ulcerated. Microscopically,
it shows interlacing dense collagen bundles and fibroblasts
and overall hypocellularity of the connective tissue. Even though
the diagnosis of fibroma may not be difficult, excision for
a histopathologic evaluation is often required to rule out a
neoplastic process. Other differential diagnoses include pyogenic
granuloma (especially peripheral giant cell granuloma), ossifying
fibroma, and odontogenic fibroma (for gingival lesions). |
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Dr. Park is a clinical professor of otolaryngology
at Northeastern Ohio Universities College of Medicine and
section head of otolaryngology at Barberton Citizens Hospital
in Barberton, Ohio. Dr. Bhe is an attending physician in the
department of family practice at Akron General Medical Center
in Akron, Ohio.
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