Gingival Fibroma: An Emerging Distinct Gingival Lesion with Well-Defined Histopathology.

Gingival growths, barring a few are mostly reactive and seldom exhibit significant true neoplastic potential. The common etiology is local irritation from dental plaque/calculus, trauma as well as medication-related overgrowth. Such lesions are easily distinguishable and categorized into diagnoses such as pyogenic granuloma, peripheral ossifying fibroma, etc. We present a previously undescribed, but commonly encountered, reactive gingival growth with unique histologic features and suggest the diagnostic term "gingival fibroma." An IRB approved retrospective review of the University of Florida Oral Pathology Biopsy Service encompassing years 2010-2019, was performed to select cases. Demographics, clinical data, and microscopic diagnoses were recorded and analyzed. Four board-certified oral and maxillofacial pathologists agreed upon and established the diagnostic criteria. These are: a prominent fibromyxoid stroma, variable cellularity, a whorled or storiform pattern of arrangement of the cellular elements, lack of significant inflammation or vascularity, and complete absence of calcification, and/or odontogenic islands. A total of 60 cases met all criteria and were included in the study. Age range in years was 14-87 with the mean at 45.11 years. A striking female predilection (90%) was noted. Approximately 62% of cases were reported on the maxillary gingiva, followed by 38.3% in the mandibular gingiva. Majority, 66.7% were in the anterior incisor region followed by 11.7% in the canine/first premolar areas. All lesions were submitted as excisional biopsy, and 4 cases recurred within 2-3 years of excision. In all cases, lesional tissue appeared to extend to the surgical base of the specimen. We present 60 cases of a histologically unique entity occurring exclusively on the gingiva and introduce the diagnostic term "Gingival Fibroma" for these lesions. Further studies with adequate clinical follow-up may help understand the exact clinical behavior of these lesions.

Odontogenic Myxoma: A 23-Year Retrospective Series of 38 Cases.

Odontogenic myxoma (OM) is an uncommon benign odontogenic tumor arising in the jaw. Though it has slight histologic overlap with other entities, definitive diagnosis is imperative considering the tumor's aggressive nature, high recurrence rate, and necessity of radical surgical intervention in large-sized lesions. With IRB approval, a retrospective search of the University of Florida College of Dentistry Oral Pathology Biopsy Service archives from 1994 to 2017 for diagnosis of OM of the jaw was performed. Biopsy reports and original slides for each case were assessed and reviewed along with any accompanying radiographs to confirm the diagnosis. Immunohistochemical staining was utilized to exclude entities with histologic overlaps, such as intraosseous myxoid neurofibroma. A total of 38 cases were included. The patients' age ranged from 6 to 84 years, with a mean age of 37.47 years. Females comprised two-thirds of the cases (n = 25) versus males (n = 13). The mandible was the most affected at 60.5% (n = 23), followed by maxilla 39.4% (n = 15). Posterior jaw involvement was higher than anterior in both the mandible (n = 20 versus n = 3) and the maxilla (n = 11 versus n = 4). Most lesions presented clinically as expansile masses with variable radiographic appearance. The clinical impression from submitting providers included "gelatinous masses", abscesses, odontogenic lesions, fibro-osseous lesions, soft tissue or bone neoplasms, and reactive gingival lesions. A consensus of odontogenic myxoma as a diagnosis was rendered for 30 cases (79%), while in 8 cases (21%) that exhibited a more fibrous stroma was identified as fibromyxoma. OM may exhibit a varied demographic and clinical profile with a wide spectrum of histologic presentations. Pathologists should be sentient of this variability in order to arrive at an accurate diagnosis and correctly manage these patients.

Nevus of Ota: morphological patterns and distribution in 47 Yemeni cases.

BACKGROUND: Nevus of Ota is a rare pigmentary disorder characterized by melanocytic hamartoma of the skin along the distribution of trigeminal nerve branches. AIM: To study the morphological features of nevus of Ota, and their relation with facial regions and trigeminal branches areas. METHODS: Patients with nevus of Ota who attended Kuwait University Hospital dermatology clinic and a private dermatology clinic in Sana'a, Yemen, between January 2008 and December 2010, were clinically evaluated. The morphology of nevus of Ota was classified to homogenous, speckled or mixed. The distribution of the lesions was assessed based on both facial regions and areas supplied by the trigeminal nerve. RESULTS: Forty-seven patients with nevus of Ota (F = 38, M = 9) were evaluated. Eighty percent of patients were females. Mixed (homogenous and speckled) appearance was seen in 47% of all patients. Periocular region was the most commonly affected facial region (67%), and the maxillary area was the most commonly involved trigeminal branch area (94%). Forty-seven percent of cases had scleral pigmentation. Interesting features of nevus of Ota involving the nasal septum and crossing the midline of the face were noted. CONCLUSIONS: To the best of our knowledge, this is the first study that examines the distribution and morphology of nevus of Ota in Middle Eastern population. Including the morphological appearance of the nevus is practical and more clinically descriptive, and therefore should be integrated in the classification in future studies.