Clinical and Histo-Morphological Presentation of Isolated Maxillo-Palatal Fibromatosis

Method: A 35–year–old male reported to the clinic complaining of overgrowth in upper right maxillo–palatal region of gingiva, bleeding when brushing teeth and with difficulties in keeping oral hygiene. The surgery was modified due to the close to the palatal artery location of the lesion, and comprised internal bevel incision, a partial, wedge–shaped excision of the excessive tissue, mobilization of the flap and suturing. Excised tissue size was 0.7 cm in diameter and 3 cm long. Immediately after surgery, gingival biopsy was fixed in 10% formalin in phosphate buffer saline for 24 h at 4 degrees centigrade, dehydrated, paraffin embedded and serially sectioned. Tissue sections were stained by haematoxylin–eosin and Heidenhain’s trichrome methods followed by histo–morphological evaluation (Nikon Eclipse Ti, Japan). 

Result: The medical and dental histories did not contribute for the condition. The lesion along the first, second and third upper molars in the right part of the maxilla was hard in consistency, pale pink in color, and painless on palpation. Histological evaluation revealed locally elongated rete pegs extending into connective tissue stroma. Moderate chronic inflammatory cell infiltrate consisting mainly of histiocytes was found under epithelium. Significantly thickened collagen fibers and dilated venous vessels were visible locally in stroma. Fibroblasts were widely distributed and embedded in a gingival matrix. Patient was diagnosed with isolated fibromatosis of unknown etiology. One month after surgery healing was uneventful and no recurrence was observed at one year follow–up visit.

Conclusion: High–risk located overgrowth localization need modification of the standard surgery procedures to prevent complications. Unknown etiology hypertrophic lesions should be checked histologically because of the possibility of the existence of cancer.