Peripheral Ossifying Fibroma Evolved From Pyogenic Granuloma

Abstract

The aim of the present article is to present the clinical case of a large peripheral ossifying fibroma that evolved from a previously diagnosed pyogenic granuloma in a 50-year-old woman. The patient was referred for treatment of a lesion over the buccal and palatal gingiva close to the left upper first molar. It was purplish-red in color, approximately 3 cm in diameter, having a smooth surface, a pedicled and bleeding base, with seven years of evolution, and diagnosed as pyogenic granuloma. After three years of evasion, the patient returned reporting an increase in the lesion and difficulty in eating. Clinically the nodule was lobular in appearance, pink in color and smooth, pediculated, firm in consistency, non-bleeding, about 5 cm in its greatest extension, extending to the maxillary tuberosity. The lesion was excised and referred for histopathological examination, which led to the diagnosis of peripheral ossifying fibroma. The patient was followed for approximately 18 months, prosthetically rehabilitated, with satisfactory healing and no clinical signs of recurrence. The possible evolution of a pyogenic granuloma to a peripheral ossifying fibroma was observed in this case, based on the histopathological changes that occurred, with the development of calcified material, fibrous maturation, and decreased vascular content of the initial lesion after three years.

Keywords: excisional tissue biopsy; gingival growth; gingival neoplasms; ossifying fibroma; pyogenic granuloma.

Figure 1. Histological image of pyogenic granuloma showing hyperparakeratinized stratified squamous epithelium, with areas of acanthosis and long projections.

Lamina propria formed by dense connective tissue, noting areas of intense cellularity and proliferation of endothelial cells, with opening of vascular spaces and regions of intense chronic inflammatory infiltrate with hemorrhagic areas (Haemotoxylin and Eosin, 100x).

Figure 2. Intraoral images.

(A) Front view showing vertical extension of the lesion, reaching the posterior region of the mandible. Unsatisfactory oral hygiene, non-healthy teeth and hyperemic gingiva are also observed; (B) Occlusal view showing a volumetric increase in the posterior margin of the maxilla on the left involving the buccal and palatal regions, extending from the first molar to the maxillary tuberosity. Poor oral hygiene, presence of calculus, periodontal infection and residual roots are also observed.

Figure 3. Panoramic radiograph showing a radiopaque image associated with the left posterior maxillary alveolar process, with divergence of the crowns of the first and second molars and loss of bone insertion.

Figure 4. Macroscopic image of the excised lesion, showing an irregular aspect and lobulated surface.

Figure 5. Histological image of peripheral ossifying fibroma showing dense connective tissue with intense cellularity, formation of osteoid material, and inflammatory infiltrate (H&E, 400x).

H&E: Haemotoxylin and Eosin

Figure 6. (A) Rehabilitated patient with superior and inferior total prostheses; (B) Clinical aspect in occlusal view of the maxilla, showing healthy and normocorated mucous membranes, with absence of pathological changes.