It is also called Oral Fibroma or Irritational Fibroma or Focal Fibrous Hyperplasia. Fibroma is a benign neoplasm of fibrous connective tissue origin. It is characterized by excessive proliferation of fibroblast cells with synthesis of large amount of collagen. Although a large number of fibrous over-growths are found inside the oral cavity, most of these are reactive lesions occurring as a result of trauma or local irritation and therefore true fibromas are extremely rare. Jain G et al (2017) stated that traumatic irritants include calculi, foreign bodies, overhanging margins, restorations, margins of caries, chronic biting, sharp spicules of bones, and overextended borders of appliances. Fibroma, a benign neoplasm of fibroblastic origin, is reactive in nature and represents a reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma rather than being a true neoplasm.

1. DR. ISHITA SINGHAL
MDS FIRST YEAR

2. PERSONAL
DATA
CASE NO. 1
OPD NO. 567287
NAME SUNITA
AGE 48 YEARS
SEX FEMALE
ADDRESS HARYANA
RELIGION HINDU

3. CHIEF
COMPLAINT
Patient complained of growth on the left side
of the cheek since 1.5 years.

4. ONSET
Since 1.5 years.
ASSOCIATED
SYMPTOMS
Small growth in the associated area.

5.  Past Medical History – No relevant history
 Family History – No relevant family history
 Past Dental History – Restorations - 46
 General Physical Gait – Normal Built, Co-operative with Normal Gait

6. PERSONAL
HISTORY
 Married/ Unmarried –Married
 Educational Status – 12th pass
HABITS
 Patient cleaned her teeth with toothpaste
once daily for 2 minutes
 She had no deleterious habits

7. EXTRA ORAL
EXAMINATION
 Patient was Fair
 Lips were Normal Pink in Colour

8.  TMJ Movements
 Clicking – Mild clicking sound audible on the left side
 Deviation – Mandible is deviated towards the left side
 Lymph Nodes – Non-palpable

9. INTRA ORAL
EXAMINATION
 Number Of Teeth Present - 32
 Missing Teeth – NIL
 Supernumerary Teeth – NIL
 Mobility – NIL
 Caries – 16, 17, 28, 34, 36, 46 and 47
 Abrasion – 26, 35, 37, 38, 44, 45 and 47
 Plaque & Calculus – Generalised Moderate
Calculus Present
 Gingiva – Reddish Pink, Scalloped, Soft and
Oedematous

10. GROWTH
 Number – 1
 Location And Extent – i.r.t. 27, 28, 37 and
38 regions
 Size – 1.5 cm x 1.5 cm
 Colour – Normal Pink and Shiny
 Shape – Round
 Borders – Well Elevated Borders
 Consistency – Firm and Sessile
 Non-Fluctuant
 Non-Tender

11. Contoso
S u i t e s
SINGLE PINK AND SHINY GROWTH
ROUND SHAPE WITH WELL ELEVATED
BORDERS
i.r.t. 27, 28, 37 AND 38 REGIONS

12. PROVISIONAL
DIAGNOSIS
On the basis of Clinical presentation of the
growth, the provisional diagnosis of Irritational
Fibroma i.r.t. Left Buccal Mucosa was made

13. DIFFERENTIAL
DIAGNOSIS
1. Irritational Fibroma
2. Pyogenic Granuloma
3. Lipoma
4. Neurofibroma

14. INVESTIGATIO
N
 HEMOGRAM –
1. HB - 12.8 gm%
2. BT - 1 minute 10 seconds
3. CT - 6 minutes 20 seconds
 DLC –
1. Monocytes - 03 %
2. Eosinophils - 02 %
3. Basophils - 00 %
4. Leukocytes - 30 %
5. Neutrophils - 65 %
 TLC - 7300 /C mm

15. BIOPSY
Excisional biopsy was done in the Department
of Oral and Maxillofacial Surgery and the tissue
was sent to the Department of Oral Pathology
for histopathological examination

16. MACROSCOPIC
DETAILS
 Received 1 small soft tissue specimens
measuring
 1 cm x 1 cm
 Firm in consistency
 Creamy-white in colour

17. MICROSCOPIC
EXAMINATION
The H & E stained tissue section revealed
epithelial and connective tissue stroma.
Epithelium was stratified squamous with
underlying connective tissue exhibiting dense
collagen bundles arranged in haphazard
manner, mild inflammatory cell infiltrate and
blood vessels. Deeper section showed adipose
tissue.

18. Contoso
S u i t e s
OVERLYING EPITHELIUM
UNDERLYING CONNECTIVE TISSUE
WITH ADIPOSE TISSUE

19. Contoso
S u i t e s
PARAKERATINIZED STRATIFIED
SQUAMOUS EPITHELIUM
MILD INFLAMMATORY CELLS
AND BLOOD VESSELS
DENSE COLLAGEN BUNDLES
BROAD RETE RIDGES

20. FINAL
DIAGNOSIS
The Histopathological features were suggestive
of Fibroma i.r.t. 27,28,37 and 38 regions

22. DEFINITION
It is also called Oral Fibroma or Irritational Fibroma or Focal Fibrous
Hyperplasia.
Fibroma is a benign neoplasm of fibrous connective tissue origin.
It is characterized by excessive proliferation of fibroblast cells with
synthesis of large amount of collagen.

23. ETIOLOGY
Although a large number of fibrous over-growths are found inside the
oral cavity, most of these are reactive lesions occurring as a result of
trauma or local irritation and therefore true fibromas are extremely
rare.
Jain G et al (2017) stated that traumatic irritants include calculi,
foreign bodies, overhanging margins, restorations, margins of caries,
chronic biting, sharp spicules of bones, and overextended borders of
appliances. Fibroma, a benign neoplasm of fibroblastic origin, is
reactive in nature and represents a reactive hyperplasia of fibrous
connective tissue in response to local irritation or trauma rather than
being a true neoplasm.
Jain G, Arora R, Sharma A, Singh R, Agarwal M. Irritation fibroma: Report of a case. J Curr Res Sci Med 2017;3:118-21.

24. CLINICAL FEATURES
Age: Fibromas commonly develop in the third, fourth and fifth decade
of life.
Sex: They are more common among females.
Ratio: Male: Female - 1:2
Site: Intraoral fibromas often develop from the gingiva, however,
these lesions may also develop from buccal mucosa, tongue, lips and
palate as well.
SHAFER’S TEXTBOOK OF ORAL PATHOLOGY 7TH EDITION

25. CLINICAL PRESENTATION
Clinically, fibromas appear as small, asymptomatic, round or oval,
well-circumscribed, slow enlarging, nodular growths in the oral cavity.
The size varies between 1 to 2 cm in diameter.
These lesions can be either pedunculated or sessile and their surface is
usually smooth.
On palpation, these lesions are either soft or firm in consistency and
the overlying covering epithelium often appears normal in colour.
Persistent trauma or injury to these lesions often causes pain,
inflammation or surface ulceration. Sometimes , the surface may be
hyperkeratotic.
SHAFER’S TEXTBOOK OF ORAL PATHOLOGY 7TH EDITION

26. NEVILLE’S TEXTBOOK OF ORAL AND MAXILLOFACIAL PATHOLOGY 3RD EDITION

27. DIFFERENTIAL DIAGNOSIS
Mortazavi H, Safi Y, Baharvand M, Rahmani S, Jafari S. Peripheral Exophytic Oral Lesions: A Clinical Decision Tree. Int J Dent. 2017;2017:9193831.

28. HISTOLOGICFEATURES
The fibroma consists of bundles of interlacing collagenous fibers
interspersed with varying number of fibroblasts or fibrocytes and
small blood vessels.
The overlying epithelium is thin stratified squamous epithelium
which frequently appears stretched and it often shows shortening and
flattening of the rete pegs.
In few cases, vasodilation, edema and chronic inflammatory cell
infiltration may be found within the connective tissue stroma,
especially, those lesions which are often traumatized or ulcerated.
SHAFER’S TEXTBOOK OF ORAL PATHOLOGY 7TH EDITION

29. NEVILLE’S TEXTBOOK OF ORAL AND MAXILLOFACIAL PATHOLOGY 3RD EDITION

30. Fibroma, a true neoplasm of connective tissue origin, is
microscopically similar to the condition known as inflammatory
hyperplasia, an increased bulk of connective tissue which forms as
part of an inflammatory reaction.
Hyperplasia is usually considered to be a self limiting process which is
not etiologically related to neoplasia.
Both processes, however, are typified by an increase in the number of
cells brought about by increased mitotic activity.
Hyperplastic tissue sometimes, but not invariably, regresses after the
removal of the stimulus or irritant. Neoplastic tissue shows no such
regression.
SHAFER’S TEXTBOOK OF ORAL PATHOLOGY 7TH EDITION

31. TREATMENT
By surgical excision.
Jiang M et al (2019) stated that complete excision is the recommended
treatment for irritation fibroma. Other therapies including
cryosurgery or intralesional injection of corticosteroids can be
considered on condition that there is a definitive diagnosis based on
histopathologic findings.
Jiang M, Bu W, Chen X, Gu H. A case of irritation fibroma. Postepy Dermatol Alergol. 2019;36(1):125–126.

32. REFERENCES
SHAFER’S TEXTBOOK OF ORAL PATHOLOGY 7TH EDITION
NEVILLE’S TEXTBOOK OF ORAL AND MAXILLOFACIAL
PATHOLOGY 3RD EDITION
Jain G, Arora R, Sharma A, Singh R, Agarwal M. Irritation fibroma:
Report of a case. J Curr Res Sci Med 2017;3:118-21.
Mortazavi H, Safi Y, Baharvand M, Rahmani S, Jafari S. Peripheral
Exophytic Oral Lesions: A Clinical Decision Tree. Int J Dent.
2017;2017:9193831.