clinical, radiological , histopathological features, differential diagnosis and plan management of patient with gingival swelling / oral surgery courses

Case presentation
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com

Purpose Statement
• At the end of the presentation learner
should be able to descibe clinical,
radiological , histopathological features,
differential diagnosis and plan management
of patient with gingival swelling

Learning Objectives
S.No Learning objectives Domain level criteria condition
1 Initiate examination of
gingival swelling
Cognitive &
psychomotor
Must
know
All
2 Explain clinical and
radiological features of
gingival swelling
Cognitive &
psychomotor
Must
know
All
3 Explain
histopathological
features of gingival
swellings
Cognitive &
psychomotor
Must
know
All
3 Explain and plan the
management of gingival
swellings
Cognitive &
psychomotor
Must
know
All

Demographic details
 Opd no.1210040136
 Name – Shewantabai Satpudke
 Age – 60/f
 Address – Samudrapur
 Date – 4/10/2012

Clinical examination

Clinical Provisional diagnosis
with differential diagnosis
• Pyogenic Granuloma
• Peripheral giant cell granuloma
• Peripheral ossifying fibroma

Investigations advised
• IOPA of the region
• OPG
• Hb, BT, CT, RBS.

Radiographical examination

SURGICAL MANAGEMENT
INCISION PLACED AT SITE

GROWTH EXCISED

REGION AFTER EXCISION OF GROWTH

FLAP REFLECTED

OSSEOUS RECONTOURING DONE AT SURGICAL
SITE

EXTRACTION OF HOPELESS TOOTH

FLAP REPLACED

SUTURES PLACED

PERIODONTAL DRESSING PLACED

POST OPERATIVE VIEW AFTER 3 MONTHS

Examination of specimen

Scanner view (4x)
Overlying
Epithelium
Connective
tissue

Low power view (10x)
Parakeratinized
Stratified
squamous
epithelium
Connective
tissue
stroma
Dense
chronic
inflammatory
infiltrate

High power view (40x)
Plasma
cells

Final diagnosis
• Therefore, on the basis of –
- clinical features
- radiographic findings combined with
- histopathological features
• Final diagnosis was made on
Gingival growth with plasma cell
infiltration. (plasma cell granuloma)

Discussion
• Introduction
• During the late 1960s and early 1970s, cases of
plasma cell infiltrates of the lips, gums, and
tongue were described primarily in the dental
literature under various names
• Atypical Gingivistomatitis,
• Idiopathic Gingivistomatits,
• Allergic Gingivostomatitis.

Discussion
• Plasma cell granuloma is a rare non-neoplastic
lesion that was first described in 1973 by
Bahadori and Liebow
• Plasma cell granuloma has been called by
different terms, for example,
• Inflammatory pseudotumour,
• Inflammatory myofibroblastic tumour,
• Inflammatory myofibrohistiocytic proliferation,
• Xanthomatous pseudotumour.www.indiandentalacademy.com

Discussion
• Plasma cell granuloma has been classified as an
inflammatory pseudotumour which may occur in
any organ or soft tissue.

Discussion
• Etiology:
• The exact causes of plasma cell granuloma is
unknown.
• Usually it is arise as a hypersensitive reaction to
a component of
• chewing gum
• Dentifrices (Cinnamonaldehyde)
• dietary component (chillies, cardamom)www.indiandentalacademy.com

Discussion
• Etiology:
• In some cases, it is thought to arise as a result
of inflammation following minor trauma or
surgery.

Discussion
• Clinical features:
• Plasma cell granuloma occurs most often seen
in Lung and conducting airways,
• And also seen in
•Larynx,
•Orbit,
•Heart,
•Kidney,
•Retroperitoneum.
•Spleen,
•Stomach,
•Pancreas,
•Liver,
•Thyroid, www.indiandentalacademy.com

Discussion
• Plasma cell granulomas of the oral cavity are
seen primarily on the periodontal tissue.
• These lesions are often single.
• Maxillary and Mandibular gingiva are equally
involved. www.indiandentalacademy.com

Discussion
• Bone loss may occur.
• These lesions have no sex predilection and may
occur at any age.

Discussion
• Histopathological features
• Plasma cell granuloma are microscopically
characterised by a
• Vascular stroma
• With reactive inflammatory cells.

Discussion
• Plasma cells are prominent but are intermixed
with abundant other cellular elements, namely
Lymphocytes,
Neutrophils,
Eosinophils ,
Histiocytes,
and usually surrounded by connective tissue
septae

Discussion
• Russell bodies, which are intra-cytoplasmic
eosinophilic hyaline droplets, may also be seen.

Discussion
• Prognosis
• With respect to prognosis, plasma cell granuloma
seems to be
• Generally benign,
• Non-recurring condition;
• Nevertheless, local aggressiveness and
recurrences may complicate the outcome of the
disease.

Discussion
• Treatment
• Treatment of this condition is frequently
unsuccessful and may include
• Excision,
• Cryotherapy or Radiation
• The most considered common treatment for
plasma cell granuloma is a complete resection.

Take Home Message
• Plasma cell granuloma is a diagnosis of exclusion,
distinguished primarily on the histological finding
of a marked submucosal plasma-cell infiltrate,
after conditions such as infection and
plasmacytoma have been eliminated.

Take Home Message
• The aetiology of this condition is unclear but is
believed to be a non-specific inflammatory
response, in the form of a plasma cell infiltrate,
to an unknown exogenous agent

This case highlights the need to perform biopsy in
unusual lesions to rule out potential neoplasms and
also emphasizes the need to subject all excised
tissue for histological examination regardless of
clinical impression.

clinical, radiological , histopathological features, differential diagnosis and plan management of patient with gingival swelling / oral surgery courses

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