A woman presents with a red, soft, pedunculated mass on the maxillary facial gingiva that was excised previously and has now recurred at the same site. Which diagnosis is MOST likely?

Correct answer: B. Pyogenic granuloma

• A. ❌ A peripheral giant cell granuloma is characteristically blue-purple and arises only on the gingiva or alveolar ridge, often with underlying 'cupping' bone resorption. It is a reasonable differential but the bright red, soft, granulation-like appearance favors pyogenic granuloma.
• B. ✅ CORRECT — A PYOGENIC GRANULOMA is a red-to-purple, soft, highly vascular, often ulcerated pedunculated mass that bleeds readily and recurs when the local irritant (calculus, overhang, plaque) is not removed with the lesion. Histology shows lobular proliferating granulation tissue with numerous endothelial channels.
• C. ❌ A peripheral ossifying fibroma is firmer, pink to red, arises from the interdental papilla, and shows calcified product radiographically.
• D. ❌ SCC presents as an indurated, fixed, non-healing ulcer with rolled borders, typically in an older patient with risk factors.

Note: All of these reactive gingival lesions look alike clinically — the diagnosis is histopathologic. Recurrence is common if the causative irritant and the involved periosteum/PDL are not removed with the lesion.