| Giant-cell fibroma | |
|---|---|
| Other names | GCF. |
| Specialty | Dermatology,Dentistry. |
| Usual onset | Typically 10-30 years old.[1] |
| Diagnostic method | Histopathology.[2] |
| Differential diagnosis | Retrocuspid papillae, Oralsquamous papilloma,Verruciform xanthoma, andIrritation fibroma. |
| Treatment | Surgical excision.[2] |
| Frequency | 2 - 5% of all oral benign fibrous growths.[2] |
Giant-cell fibroma is a benign localized fibrous mass. It often mimics other fibroepithelial growths and can be distinguished by itshistopathology. The exact cause of giant-cell fibromas is unknown however there is no evidence to show that it can be caused by irritation. Giant-cell fibromas can be removed by surgical incision,electrosurgery, or laser excision.[3]
Giant-cell fibromas are commonly located on thegingiva. Thetongue is the second most common location, followed by thepalate orbuccal mucosa. Giant-cell fibromas are usually asymptomatic and appear as 0.5-1 cm pedunculated or sessile lesions with a pebbly or bosselated surface.[4]
Giant-cell fibromas are fibroushyperplasic lesions and are diagnosed based onhistopathological examination.[3] Giant-cell fibromas are histologically distinguished bymultinucleated giant cells and numerous largestellate or varying density in the collagenousstroma. The giant cells are typically seen adjacent to theepithelium inconnective tissue. Some of these cells have stain characteristics ofmelanin and contain small brown granules. The overlyingepithelium has long thin rate ridges and ishyperplatic. Sometimes an artifactual space dividing the surrounding fibrous stroma from the giantfibroblasts can be seen.[4]
Histopathological giant fibroblasts can distinguish giant-cell fibromas from other lesions. Differential diagnosis includes anirritation fibroma,lipoma,retrocuspid papillae,peripheral ameloblastoma,focal fibrous hyperplasia,papilloma, intraoralneurilemmoma, odontogenichamartoma,peripheral ossifying fibroma, peripheraladenomatoid odontogenic tumor, peripheralcalcifying odontogenic cyst, andperipheral odontogenic fibroma.[5]
The main treatment for Giant-cell fibromas issurgical excision however,electrosurgery or laser excision is the preferred treatment for children. The main advantage ofelectrosurgery is direct tissuehemostasis without needing sutures. Electrosurgery can also access difficult-to-reach areas and takes less time to perform. Laser treatments have been proposed as an alternative treatment option. Reoccurrence is rare and most cases of reoccurrence have been attributed to incomplete excision of the lesion.[citation needed]
Giant-cell fibroma mostly affects Caucasians and is very rare in other races. Most studies have shown a slight female predominance while however, a few have shown no predominance.[6] Giant-cell fibromas represent about 1-5% of all biopsied fibrous lesions and around 0.4-1% of totalbiopsies. Giant-cell fibroma is diagnosed within the first three decades of life in approximately 60% of cases.[7]
In 1974 Weathers and Callihan first described the giant-cell fibroma. It was named after its unique largemultinucleated andmononuclear stellate-shapedgiant cells. Weathers and Callihan examined over 2,000 fibrous hyperplasias and 108 of them met their criteria for giant-cell fibroma.[8] In 1982 Housten performed a study of 464 giant-cell fibromas at theIndiana University School of Dentistry and agreed that the giant-cell fibroma was truly a distinctive lesion.[9]