A distinctive oral fibrous proliferation approximating only 2-5% of all benign gingival overgrowths is a unique lesion requiring adequate clinical diagnosis. With no subtle association with chronic irritation, this oral tumor is a diverse lesion. Giant cell fibroma (GCF) requires histopathological examination for its final diagnosis as clinic pathologic features are not sufficient to assess and confirm the lesion. Occurring most commonly during the first three decades of life this asymptomatic pedunculated or sessile lump clinically resembles fibroma and papilloma with no gender predilection. In this paper, we present a unique case of Giant cell fibroma (GCF) in a 4-year-old child.

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International Journal of Applied Dental Sciences 2022; 8(1): 20-22
ISSN Print: 2394-7489
ISSN Online: 2394-7497
IJADS 2022; 8(1): 20-22
© 2022 IJADS
www.oraljournal.com
Received: 27-10-2021
Accepted: 12-12-2021
Nandini Bhardwaj
Senior Lecturer,
Department of Oral Pathology
and Microbiology Himachal
Institute of dental Sciences,
Paonta Sahib, Himachal
Pradesh, India
Nitish Bhat
Registrar, Department of oral &
Maxillofacial Pathology & Oral
Microbiology, Indira Gandhi
Govt. Dental College, Jammu,
Jammu and Kashmir, India
Kalpna Thakur
Lecturer, Department of Oral
Pathology and Microbiology,
H.P Govt. Dental College and
Hospital, Shimla, Himachal
Pradesh, India
Alisha Dogra
Intern, Himachal Institute of
Dental Sciences, Paonta Sahib,
Himachal Pradesh, India
Corresponding Author:
Nandini Bhardwaj
Senior Lecturer,
Department of Oral Pathology
and Microbiology Himachal
Institute of dental Sciences,
Paonta Sahib, Himachal
Pradesh, India
Giant cell fibroma: A case report with literature review
Nandini Bhardwaj, Nitish Bhat, Kalpna Thakur and Alisha Dogra
DOI: https://doi.org/10.22271/oral.2022.v8.i1a.1398
Abstract
A distinctive oral fibrous proliferation approximating only 2-5% of all benign gingival overgrowths is a
unique lesion requiring adequate clinical diagnosis. With no subtle association with chronic irritation,
this oral tumor is a diverse lesion. Giant cell fibroma (GCF) requires histopathological examination for
its final diagnosis as clinic pathologic features are not sufficient to assess and confirm the lesion.
Occurring most commonly during the first three decades of life this asymptomatic pedunculated or
sessile lump clinically resembles fibroma and papilloma with no gender predilection. In this paper, we
present a unique case of Giant cell fibroma (GCF) in a 4-year-old child.
Keywords: Pedunculated, fibroma, stellate, histopathologically, giant cells, pedunculated
Introduction
This oral tumor was first described by Weather and Callihan in 1974 as a separate category of
fibroma who found 108 unique entities among 2000 fibrous hyperplastic lesions because of its
distinct histopathological appearance and therefore does not is considered it as conventional
fibroma [1]
. It was designated as Giant cell fibroma (GCF) because of the characteristic
presence of stellate fibroblasts with multinucleated giant cells histopathologically [2, 3]
. This
categorization was made by Eversole and Rovin who clinically found Giant cell fibroma as
indistinguishable, when they compared 279 fibrous hyperplastic lesions and categorized them
into peripheral ossifying fibroma, peripheral giant cell granuloma, pyogenic granuloma and
peripheral gingival fibroma [2]
. These fibrous hyperplastic gingival lesions showed distinct
characteristics during histopathological examination. This sessile or pedunculated
asymptomatic nodule with bossolated or papillary surface with equal sex predilection &
mostly occurring among 20 +-year olds can be mistaken from papilloma or fibroma [4]
. In this
paper, we present a unique case of giant cell fibroma in a 4 year old girl which was finally
diagnosed on the basis of histopathological examination.
Case Report: A four-year old girl was referred to the department of oral medicine and
radiology with a chief complaint of swelling in the upper front tooth region. The child was
completely healthy and was a product of normal, uncomplicated pregnancy as revealed by her
mother. Dental history revealed that the growth was asymptomatic, appeared one month ago &
was increasing progressively. On intra- oral examination, a round well defined swelling was
seen in the labial mucosa of maxillary anterior region w.r.t to tooth number 51, 52, 61 and 62
on inspection of the lesion (Figure 1). On palpation, the swelling was soft, non- tender,
palpable and was not associated with any purulent discharge. The lesion was
12mm×12mm×6.5mm in size, pedunculated, reddish blue in color with lobulated surface
(Figure 2). Patient’s oral hygiene was not satisfactory and showed grossly carious teeth w.r.t
tooth number 51, 62 and pit and fissure caries w.r.t to 84 were also reported. There was a non-
contributory medical history. Radiographic examination revealed a fibroma was made on the
basis of clinical features. Complete excision of the lesion was done under local anesthesia and
the soft, resilient and reddish blue tissue was sent for histopathological examination.
The histopathological examination revealed hyperparakeratinized stratified squamous
epithelium with long and thin rete ridges (Figure 3) overlying a connective tissue stroma
showing dense amount of collagen fibers interspersed with fibroblasts (Figure 4).

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International Journal of Applied Dental Sciences http://www.oraljournal.com
The fibroblasts were large, stellate shaped with short dendritic
processes and were multinucleated. Endothelial cell lined
blood vessels were also seen and normal bone was also
evident (Figure 5). Co-relating clinic-pathologically, the
features were suggestive of Giant Cell Fibroma.
Fig 1: A round swelling on labial Mucosa of 4- year old
Fig 2: Soft, pedunculated reddish blue lesion and lobulated
Fig 3: Hyperparakeratinized stratified squamous epithelium with
long and thin rete ridges
Fig 4: The connective tissue stroma shows dense collagen fiber
bundles interspersed with fibroblasts
Fig 5: The connective tissue stroma shows multinucleated fibroblasts
and endothelial cell lined blood vessels
Discussion
Giant cell fibroma is categorized as a non-neoplastic fibrous
growth which constitutes only 2-5% of all the oral fibrous
proliferations sent for biopsy. The lesion’s clinical
presentation and epidemiology mimics fibroma or papilloma
and are distinguished only by histopathological features.
Minor trauma according to many reports contributes as a
major etiological factor which results in GCF due to change in
fibroblasts functional status [5]
. The lesion occurs usually at a
younger age (10-30 years) and is diagnosed during the first 3
decades of life in 60% of the cases with no gender
predilection. Slight female predilection is also reported in
some studies. This papillary or bossolated mass is small and is
less than 1 cm in diameter. Gingiva being the most common
site of occurrence constituting 50% of all the cases of Giant
cell fibroma. Mandibular gingiva is affected twice than
maxillary gingiva followed by tongue and palate [6]
. The site
of occurrence of the lesion other than oral cavity is nose in
giant cell fibroma which shows a tendency to reoccur and is
distinguished on the basis of larger size of stellate fibroblasts
[7]
. According to Regrezi et al. gingival and palatal oral
lesions shows highest amount of stellate cells whose presence
are itself dependent on the collagen pattern in the lamina
propria [8]
.
It clinically appears pebbly and papillary raised asymptomatic
pedunculated or sessile nodule with less than 1 cm diameter
with color of the normal mucosa and thus can be an important
aspect of differential diagnosis among all fibrous lesions
occurring in children [9]
. On the basis of clinical presentation
Sabarinath et al. diagnosed not a single correct lesion as GCF
among all the 21 lesions [5]
. Lesions such as peripheral
ossifying fibroma have similar clinical presentation as GCF
and can be only distinguished histopathologically because of
the presence of osteogenic cell islands [10]
. A microscopically
similar developmental mucosal lesion with giant fibroblasts
occurs in the gingiva lingual to mandibular cuspid and is
known as retrocuspid papilla. With less than 5 mm in
diameter, it clinically appears as small, pink papule with
bilateral distribution. Representing a normal anatomic
variation which disappears with age, it is reported in 25 to
99% of children and young adults with 6 to 19% prevalence
in older adults [6]
. Other mucosal lesions similar to GCF
includes pearly penile papule of glans penis, a virus induced
tumor of deer, fibroblastoma & fibrous papule of nose [1]
.
Savage and Monsuer in there retrospective study concluded
that in pathologic or normal lesions, there were no sufficient

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International Journal of Applied Dental Sciences http://www.oraljournal.com
characteristic histological features in all the lesions which
comes under fibro epithelial polyps and therefore grouping of
lesions as separate entities is not required [11]
.
Microscopically, an encapsulated mass of vascular fibrous
loosely arranged connective tissue is revealed. The hallmark
for differentiating GCF from other fibromas is the presence of
large, angular or stellate, non-hyper chromatic, plump/spindle
shaped & multinucleated atypical fibroblasts appearing as
giant cells seen in the periphery of the lesion as the central
areas contains typical fusiform fibroblasts. These stellate
fibroblasts are seen within the superficial connective tissue
and are closely related to corrugated and atrophic epithelium
with thin and elongated rete ridges [6, 12]
.
Giant cell origin is determined by immunohistochemistry and
ultrastructural studies. Ultra structurally, multinucleated giant
cells were fibroblasts [13]
. Immunohistochemistry reveals a
positive response to vimentin and prolyl-4-hydrolase thus
suggesting it as a phenotypically fibroblastic origin [1]
.
Vimentin positivity and fibroblastic origin of stellate and
multinucleated giant cell was also observed by Odell et al. in
his study. In a study done by Jimson et al. on immunostaining
with Ki 67 and PCNA, Ki 67 showed negative response while
PCNA revealed expression variability and concluded
mononuclear fibroblastic cell as the possible origin of
multinucleated and stellate giant cell seen in GCF.
Cytokeratin, neurofilament, HHF, CD 68, HLA DR, Tryptase,
and S-100 protein showed negative reactivity. Giant cell
origin was not considered as myofibroblastic as there was a
negative response of Desmin for giant cells.10
Also,
fibroblastic origin of giant cells was also supported by its
positive reactivity to factor XIIIa [14]
.
The treatment modalities of GCF are surgical/laser excision
along with periodic follow ups and the lesion reported rare
recurrence.
Conclusion
These rare and unique lesions should be extensively
considered and encountered in dental practice. Proper
treatment planning and compulsive investigations should be
done for correct diagnosis.
Conflicts of interest: Nil
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