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. 2019 Jul-Aug;85(4):399-407.
doi: 10.1016/j.bjorl.2018.03.006. Epub 2018 Apr 17.

Incidence of reactive hyperplastic lesions in the oral cavity: a 10 year retrospective study in Santa Catarina, Brazil

Kamile Leonardi Dutra  1 , Lunardo Longo  2 , Liliane Janete Grando  3 , Elena Riet Correa Rivero  3
Affiliations

Incidence of reactive hyperplastic lesions in the oral cavity: a 10 year retrospective study in Santa Catarina, Brazil

Kamile Leonardi Dutra et al. Braz J Otorhinolaryngol. 2019 Jul-Aug.

Abstract
in English, Portuguese

Introduction: Reactive hyperplastic lesions develop in response to a chronic injury simulating an exuberant tissue repair response. They represent some of the most common oral lesions including inflammatory fibrous hyperplasia, oral pyogenic granuloma, giant cell fibroma, peripheral ossifying fibroma, and peripheral giant cell lesions.

Objective: The incidence of those lesions was investigated in an oral pathology service, and the clinical characteristics, associated etiological factors, concordance between the clinical and histopathological diagnostic was determined.

Methods: A total of 2400 patient records were screened from 2006 to 2016. Clinical features were recorded from biopsy reports and patients' files.

Results: A total of 534 cases of reactive hyperplastic lesions were retrieved and retrospectively studied, representing 22.25% of all diagnoses. The most frequent lesion was inflammatory fibrous hyperplasia (72.09%), followed by oral pyogenic granuloma (11.79%), giant cell fibroma (7.30%), peripheral ossifying fibroma (5.24%), and peripheral giant cell lesions (3.55%). Females were predominantly affected (74.19%), the gingiva and alveolar ridge were the predominant anatomical site (32.89%), and chronic traumatism was presented as the main etiological factor. The age widely ranges from the 1st decade of life to the 7th. Clinically, the reactive hyperplastic lesions consisted of small lesions (0.5-2cm) and shared a strong likeness in color to the oral mucosa. The concordance between the clinical and histopathological diagnostic was high (82.5%).

Conclusion: Reactive hyperplastic lesions had a high incidence among oral pathologies. The understanding of their clinical features helps to achieve a clearer clinical and etiological diagnosis, and the knowledge of factors related to their development. This may contribute to adequate treatment and positive prognosis.

Introdução: As lesões hiperplásicas reativas se desenvolvem em resposta a uma lesão crônica que estimula uma resposta acentuada de reparo tecidual. Elas representam uma das lesões orais mais comuns, inclusive a hiperplasia fibrosa inflamatória, granuloma piogênico oral, fibroma de células gigantes, fibroma periférico ossificante e lesão periférica de células gigantes.

Objetivo: A incidência dessas lesões foi investigada em um serviço de patologia bucal e as características clínicas, os fatores etiológicos associados e a concordância entre os diagnósticos clínico e histopatológico foram determinados.

Método: Foram selecionados 2.400 registros de pacientes entre 2006 e 2016. As características clínicas foram registradas a partir de laudos de biópsia e dos prontuários dos pacientes.

Resultados: Um total de 534 casos de lesões hiperplásicas reativas foram recuperados e retrospectivamente estudados, representando 22,25% de todos os diagnósticos. A lesão mais frequente foi hiperplasia fibrosa inflamatória (72,09%), seguida por granuloma piogênico oral (11,79%), fibroma de células gigantes, (7,30%), fibroma periférico ossificante (5,24%) e lesão periférica de células gigantes (3,55%). O sexo feminino foi predominante (74,19%), a gengiva e a crista alveolar foram o local anatômico predominante (32,89%) e o traumatismo crônico foi demonstrado como o principal fator etiológico. A idade variou desde a 1ª década de vida até a 7ª. Clinicamente, as LHR consistiram em pequenas lesões (0,5 a 2 cm) que apresentaram uma forte semelhança de cor com a mucosa oral. A concordância entre o diagnóstico clínico e histopatológico foi alta (82,5%).

Conclusão: As lesões hiperplásicas reativas apresentaram alta incidência entre as patologias bucais. A compreensão das características clínicas ajuda na realização de um diagnóstico clínico e etiológico mais claro, bem como determinar os fatores relacionados ao seu desenvolvimento. Dessa forma contribui para um tratamento adequado e um prognóstico positivo.

Keywords: Cavidade oral; Giant cell granuloma; Granuloma de células gigantes; Granuloma piogênico; Hiperplasia; Hyperplasia; Lesões hiperplásicas reativas; Oral cavity; Pyogenic granuloma; Reactive hyperplastic lesions.

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Figures

Figure 1
Figure 1
General incidence of lesions recorded as it relates to the histologic type.
Figure 2
Figure 2
(A) Inflammatory fibrous hyperplasia; (B) ill-fitting denture over the inflammatory fibrous hyperplasia; (C) oral pyogenic granuloma in the alveolar ridge; (D) oral pyogenic granuloma in the lower lip; (E) peripheral ossifying fibroma; (F) periapical radiography of the peripheral ossifying fibroma; (G) peripheral giant cell lesions; (H) giant cell fibroma.
Figure 3
Figure 3
Distribution according to concordance among clinical and histopathological diagnoses.
Figure 4
Figure 4
Hematoxylin and eosin staining. (A) Inflammatory fibrous hyperplasia (40×); (B) high magnification of the same case showing thick collagen fibers (100×); (C) oral pyogenic granuloma (100×); (D) high magnification of the same case showing greater number of endothelial cells and newly formed blood vessels (400×); (E) giant cell fibroma, with thin and long epithelial projections (100×); (F) high magnification of the same case showing the presence of stellate-shaped (arrow) and multinucleated (arrowhead) fibroblasts (400×); (G) peripheral ossifying fibroma, with mineralized product in the connective tissue (40×); (H) high magnification of the same case demonstrating irregular bone trabeculae formed (100×); (I) peripheral giant cell lesions (100×); (J) high magnification of the same case with large number of multinucleated giant cells associated with hemorrhagic areas (400×).
See this image and copyright information in PMC

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