Case Description and Results
A 26-year-old woman, without any history of drug usage, was referred to Shiraz Oral and Maxillofacial Medicine department from the Periodontal department with a chief complaint of left lower attached gingiva swelling. Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy. The swelling had first been noticed two years earlier and had subsequently exhibited gradual, continuous enlargement. There was no pain or bleeding. The exophytic lesion was a dome-shaped base, smooth surface, non-homogenous color (pale pink-red and somewhere yellow), homogenous texture, soft in palpation but not fluctuant or mobile on the left lower gingiva next to the first and second mandibular molars (Figure 3). Its total measuring was 1.5 \(\times 1\times 0.7\ cm\). She had no medical problems and no familial history due to similar lesions. We asked our patient several clinical questions about the lesion’s pattern of growth, general pain, bleeding, time of lesion existence, trauma, and fever; as already mentioned, it appeared two years ago and had a gradual enlargement, there was no evidence of pain, bleeding, trauma or fever. We operated some clinical and paraclinical examinations such as palpation, examination of other parts of her mouth, lymphadenopathy, aspiration, vitality test, probing, and periapical radiography. There was no other lesion in her mouth similar to our studied lesion, the aspiration was negative, teeth adjacent to the lesion were vital and did not have any periodontal problems. Regarding the differential diagnosis, the exophytic lesion could be reactive or tumoral; a reactive lesion was ruled out as there was no trauma or stimulating factor based on the patient’s history; also, teeth adjacent to the lesion were vital. Therefore, the lesion could be tumoral: due to its continuous enlargement and lack of any stimulating factor. As its growth progress was slow, the tumoral lesion could be benign and as its consistency was soft, it could be a lipoma, neurofibroma, or pyoderma gangrenosum. For patient management, after signing the written consent form, we did an excisional biopsy and considered a follow-up. The tumor was excised under local anesthesia (by long buccal anesthesia or anesthetizing all around the lesion, the lesion was removed from its base with a blade); then, the specimen was placed in a formalin solution, and it was sent for a histopathological examination to the Pathology department. In the microscopic examination, sections showed a piece of oral mucosa covered by parakeratotic stratified squamous epithelium. The underlying connective tissue demonstrated abundant collagen fibers intermixed with lobules of fat cells (Figure 4). Therefore, a fibrolipoma was finally diagnosed. Patient was followed up to 3 months after excision, and no recurrency was reported.