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.