Clinicopathologic conference
Slow-growing gingival mass

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Objectives

A 33-year-old woman presented with a slow growing palatal gingival mass. The clinical differential diagnosis included benign tumors and tumor-like lesions, including the pyogenic granuloma, peripheral giant cell granuloma, peripheral ossifying fibroma, giant cell fibroma, peripheral odontogenic tumors, and oral focal mucinosis.

Study design

The lesion was excised and histopathological examination followed by immunohistochemical staining was carried out.

Results

The microscopic findings and the immunohistochemical reactivity was diagnostic for a nerve sheath myxoma.

Conclusions

The clinical features, microscopic findings, immunohistochemistry, and the differential diagnosis including the relationship to the neurothekeoma are discussed.

Section snippets

Differential Diagnosis

The clinical differential diagnosis of this slow-growing, lobulated, smooth-surfaced mass consisted of a number of benign tumors and tumor-like lesions, including pyogenic granuloma, peripheral giant cell granuloma, peripheral ossifying fibroma, giant cell fibroma, and peripheral odontogenic tumors, including the peripheral odontogenic fibroma and oral focal mucinosis.

The pyogenic granuloma is a common, benign, tumor-like growth frequently localized to the gingiva. This painless, lobulated,

Diagnosis and Management

The palatal gingival mass was excised, placed in 10% neutral buffered formalin, and submitted for histopathological examination. Routinely processed, hematoxylin and eosin stained sections were examined under a microscope. The tissue appeared to be lobulated and covered by variably thick but intact surface epithelium. The bulk of the mass consisted of hypocellular, myxoid nodules of varying shape and size. These myxomatous nodules were separated by dense collagenous septa (Figure 2). The

Discussion

The nerve sheath myxoma (NSM) is a benign tumor of perineural or Schwann cell origin. It arises in relation to small peripheral nerves and is diagnosed most frequently as a dermal proliferation of the lower extremities.5, 6 It is diagnosed in a wide age range, from newborns7 to 69 years6; however, most cases cluster in the third and fourth decades of life.5, 6 There is no particular gender predilection, and dermal tumors present as solitary, superficial, slow-growing masses no larger than 2.5

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