Pathology · patient case question
A 28-year-old woman who is not pregnant presents with a rapidly growing, red, pedunculated gingival mass that bleeds readily. The most likely diagnosis is:
Patient case: Two white lesions and a brown one
demo: Three patients seen in one session
chief: Assorted mucosal lesions identified during routine examination.
history: The first is a 24-year-old with a lifelong asymptomatic finding whose brother has the same appearance. The second is a 41-year-old with bilateral buccal findings. The third is a 52-year-old who has chewed betel nut for twenty years.
meds: None relevant.
findings: Patient one has a diffuse, thick, spongy, folded white lesion of the floor of the mouth and buccal mucosa that does not rub off. Patient two has a diffuse blue-grey filmy opacity of both buccal mucosae that fades when the cheek is stretched. Patient three has brownish-red clustered staining of the buccal mucosa near teeth 18 and 19 with a marbled pallor and reduced mouth opening.
Show answer and explanation
Correct answer: C. Pyogenic granuloma
- A. A peripheral ossifying fibroma is firmer, paler, and shows radiopaque foci within it on radiographs.
- B. A peripheral giant cell granuloma is usually more blue-purple, arises only on gingiva or alveolar ridge, and may cause superficial cupping resorption of underlying bone.
- C. Correct. Pyogenic granuloma is a reactive proliferation of granulation tissue driven by local irritation such as calculus or a restoration margin. It is soft, red to purple, pedunculated, grows quickly and bleeds with minimal provocation. Pregnancy raises the incidence but is not required for the diagnosis. Treatment is excision with removal of the local irritant.
- D. Carcinoma in a 28-year-old with this presentation would be very unusual; it presents as an indurated non-healing ulcer rather than a soft bleeding pedunculated mass.