Pathology · patient case question
If this bony swelling were biopsied, what would the histology show?
Patient case: Asymptomatic hard swelling on the buccal alveolus
Patient: Male, 55 years old
Chief Complaint: “There is a hard bump on my gum. It has been there for years.”
Background: No pain, no growth noticed recently, no systemic disease, no denture. Attends regularly.
Vital Signs: BP 126/78 mmHg · HR 72 bpm
Findings: A broad, hard, BONY-HARD swelling on the buccal alveolar surface of the posterior maxilla, covered by intact, normal-coloured, thinly stretched mucosa. Non-tender. Radiographs show a well-defined radiopacity continuous with the cortical plate. Separately, a mucosal biopsy taken elsewhere for an unrelated complaint is being reviewed.
Show answer and explanation
Correct answer: C. Normal mucosa overlying normal, mature lamellar bone
- A. Odontogenic epithelium in a loose stroma describes an odontogenic tumour such as an ameloblastoma. Those are radiolucent and expansile, not a hard cortical protuberance.
- B. Fibrous dysplasia produces irregular woven bone trabeculae in a cellular fibrous stroma — the 'Chinese characters' pattern — and radiographically a ground-glass lesion with ill-defined margins that BLENDS into surrounding bone rather than a discrete well-defined outgrowth.
- C. CORRECT. An EXOSTOSIS — like a torus — is a developmental overgrowth of NORMAL bone. Histology shows normal surface mucosa over dense, mature LAMELLAR cortical bone, sometimes with a small marrow component. There is no neoplasm, no dysplasia and no inflammation, which is exactly why biopsy is unnecessary: the diagnosis is clinical, from the bony-hard consistency, the intact overlying mucosa and the stability over years.
- D. Granulomatous inflammation with giant cells suggests a peripheral or central giant cell lesion, sarcoidosis or a foreign body reaction — all of which produce a soft or radiolucent lesion, not normal cortical bone.
Note: Exostoses and tori need NO treatment unless they interfere: with a denture flange or prosthesis path of insertion, with speech or function, or through repeated traumatic ulceration of the thin overlying mucosa. They are also a useful autogenous graft source. Torus palatinus sits in the palatal midline, torus mandibularis on the lingual aspect of the mandible near the premolars and often bilaterally, and buccal exostoses on the facial alveolus as here.