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. 2023 Jun;17(2):355-363.
doi: 10.1007/s12105-022-01493-y. Epub 2022 Dec 6.

Immunohistochemical Characterization of Gingival Fibromas

Mark Darling  1   2 , Kunning Li  3 , Keeley Burnside  3 , Nicole Smith  3 , Linda Jackson-Boeters  3 , Douglas Hamilton  3
Affiliations

Immunohistochemical Characterization of Gingival Fibromas

Mark Darling et al. Head Neck Pathol. 2023 Jun.

Abstract

Purpose: Gingival fibromas (GFs) are fibrous lesions of the gingiva that are not well defined in the literature. They are histologically similar to peripheral ossifying fibromas (POFs), both being characterized as cellular proliferations of dense fibrous tissue, with POFs differing in that they demonstrate foci of calcification. This study aims to expand upon the immunohistochemical characterization of GFs, and to confirm their osteoblastic phenotype.

Methods: Formalin fixed, paraffin embedded GFs, POFs and fibroepithelial polyps (FEPs) of the gingiva were examined. Immunohistochemical staining was performed for special AT-rich sequence binding protein 2 (SATB2), runt-related transcription factor 2 (RUNX2), osteocalcin and alpha-smooth muscle actin (αSMA). Sections were evaluated by light microscopy and the immunohistochemical staining patterns were assigned immunoreactive scores (IRS) based on percentage of stained cells and intensity of staining.

Results: GFs, POFs, and FEPs of the gingiva expressed osteoblastic markers SATB2, RUNX2 and osteocalcin. GFs and POFs expressed αSMA while FEPs of the gingiva did not. GFs and POFs had similar staining patterns of SATB2, RUNX2 and αSMA.

Discussion: These findings demonstrate that GFs and POFs exhibit a similar immunohistochemical profile, and supports a theory that GFs are osteoblastic lesions possibly related to POFs.

Keywords: Fibroepithelial polyps of the gingiva; Gingival fibroma; Gingival lesions; Peripheral ossifying fibroma.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
(A) Hematoxylin and eosin stained gingival fibroma demonstrating moderately cellular, dense fibrous connective tissue with overlying stratified squamous epithelium. (B) Hematoxylin and eosin stained peripheral ossifying fibroma demonstrating similar histological characteristics to the gingival fibroma, but with several foci of ossification. (100x original magnification)
Fig. 2
Fig. 2
Gingival fibromas (GFs), peripheral ossifying fibromas (POFs) and FEPs arising from the gingiva stained with runt-related transcription factor 2 (RUNX2), osteocalcin, special AT-rich sequence binding protein 2 (SATB2) and alpha smooth muscle actin (αSMA). (100x original magnification)
Fig. 3
Fig. 3
Immunoreactive scores of gingival fibromas (GFs), peripheral ossifying fibromas (POFs), FEPs arising from the gingiva, FEPs from soft tissues, and normal gingiva stained with osteoblastic differentiation markers of (A) RUNX2, (B) SATB2, (C) osteocalcin, and (D) periostin. Scores are presented as mean with standard deviation. *p < 0.05, **p < 0.01, ***p < 0.001, and ****p < 0.0001 indicates statistically significant differences
Fig. 4
Fig. 4
Percentage of cells expressing SATB2 in GFs, POFs, FEPs arising from the gingiva, FEPs from soft tissues, and normal gingiva, determined using QuPath. Data are presented as mean with standard deviation. *p < 0.05, **p < 0.01, ***p < 0.001, and ****p < 0.0001 indicates statistically significant differences
Fig. 5
Fig. 5
A. Gingival fibromas (GFs), peripheral ossifying fibromas (POFs) and FEPs arising from the gingiva stained with alpha smooth muscle actin (αSMA). Myofibroblasts were identified by a “tram-track” staining pattern of αSMA, with more intense staining surrounding bone/calcifications in POFs. (100x original magnification). B. Area measurements of myofibroblast clusters determined by using QuPath
Fig. 6
Fig. 6
Periostin stain distribution in gingival fibromas (A) and peripheral ossifying fibromas (B). Periostin has a more concentrated sub-epithelial distribution in gingival tissues, and is more intense around the bone in peripheral ossifying fibromas (50x original magnification)
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References

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