|Year : 2021 | Volume
| Issue : 1 | Page : 41-43
Fibroepithelial polyp: A pediatric case report with clinicopathologic overview
Tharani Vijayakumar1, P Krishna Vinoth2, D Kiruthika2, S Krishnaraj2, M Kiruthika2, V Vasanthi3
1 PG Student, Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, India
2 CRRI, Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, India
3 Senior Lecturer, Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, India
|Date of Submission||27-Nov-2020|
|Date of Decision||20-Feb-2021|
|Date of Acceptance||22-Feb-2021|
|Date of Web Publication||30-Mar-2021|
Dr. Tharani Vijayakumar
SRM University, Tiruchirappalli, Tamil Nadu
Chronic irritation to the mucosa manifests as reactive lesions or mucocele in pediatric population. Reactive lesions may range from developmental, inflammatory to neoplastic. Adverse oral habits such as lip biting and cheek biting also contribute to these types of oral lesions. We present a case of a 9-year-old pediatric patient who reported with the complaint of swelling in the right side of the lower lip and history of chronic lip biting. After intraoral examination, clinical diagnosis of mucocele was made. Following excision, the histopathological features were suggestive of fibroepithelial polyp. To avoid misdiagnosis, proper history, clinical and histopathological correlation is advisable to evade misdiagnosis and disparity between clinical and histopathological diagnosis.
Keywords: Fibroepithelial polyp, lower lip swelling, pediatric patient
|How to cite this article:|
Vijayakumar T, Vinoth P K, Kiruthika D, Krishnaraj S, Kiruthika M, Vasanthi V. Fibroepithelial polyp: A pediatric case report with clinicopathologic overview. SRM J Res Dent Sci 2021;12:41-3
|How to cite this URL:|
Vijayakumar T, Vinoth P K, Kiruthika D, Krishnaraj S, Kiruthika M, Vasanthi V. Fibroepithelial polyp: A pediatric case report with clinicopathologic overview. SRM J Res Dent Sci [serial online] 2021 [cited 2021 Jun 25];12:41-3. Available from: https://www.srmjrds.in/text.asp?2021/12/1/41/312472
| Introduction|| |
Oral tissues are under constant exposure to external and internal stimuli that bring about horde of lesions ranging from developmental, inflammatory, reactive to neoplastic. The presentation of lip is unique as the internal mucosa is wet and the external mucosa is dry with a white line at the junction. Labial mucosa is more prone to damage from trauma, environmental factors as it is seen in the center of the face. Clinically, lower lip swellings in response to chronic irritation appear either as sessile/pedunculated, soft-firm swelling, fluctuant/nonfluctuant, pinkish-reddish mass depending on the etiology. History, clinical presentation, inspectory, and palpatory findings help the clinician in arriving at clinical diagnosis. However, histopathological examination of biopsied specimen only confirms the diagnosis.
We present a case of lower lip swelling in a 9-year-old female patient in relation to 43 with a history of chronic lip biting and similar swellings in buccal mucosa. Clinical correlation to histopathological diagnosis is being emphasized in the present case report.
| Case Report|| |
A 9-year-old female patient presented to the department with the complaint of swelling in the right side of the lower lip for the past 1 month. The patient gave a history of lip biting for the past 1 year. The swelling was smaller in size 1 month back and progressively increased to reach the present size. The patient also gave a history of similar swelling in the buccal mucosa few days back which apparently ruptured.
Intraoral examination revealed a smooth, well-defined, sessile, pinkish swelling of 5 mm × 5 mm in size on the right side of the lower lip in relation to 43 [Figure 1]. On palpation, the growth was firm, not movable, nonfluctuant, and nontender. Lymph nodes were not palpable. The lower lip lesion was clinically diagnosed as a mucocele considering the history of chronic lip biting and similar swellings in buccal mucosa which ruptured recently. Irritation fibroma, lipoma, and epulis were contemplated as differential diagnosis owing to the firm nature of the swelling.
Excisional biopsy of the lower lip lesion was done under local anesthesia and submitted for histopathological examination. Macroscopically, the gross specimen was soft to firm in consistency, white in color, irregular in shape, and measured about 5 mm × 7 mm in size [Figure 2].
Histopathological examination revealed hyperplastic parakeratinized stratified squamous epithelium with arcading pattern. The underlying connective tissue was loose to dense with mixed inflammatory cell infiltrate predominantly lymphocytes with few macrophages and plasma cells [Figure 3]. The histopathological features were suggestive of fibroepithelial polyp. Postoperative follow-up of the patient was uneventful. The patient was also advised to withdraw from the habit of lip biting.
|Figure 3: Photomicrograph showing hyperplastic parakeratinized stratified squamous epithelium and underlying loose to dense connective tissue with mixed inflammatory cell infiltrate|
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| Discussion|| |
Reactive oral lesions possess clinical similarities and histopathologic uniqueness. Lip lesions in pediatric patients due to chronic irritation depend on the history, onset of the lesion, color, and consistency. The clinical presentation also depends on the phase of the lesion as chronic mucocele would be nonfluctuant due to fibrosis.
Fibrous inflammatory hyperplasia is a common response to chronic irritation from prosthesis, teeth, calculus, overhanging restorations, chronic biting, and rare before fourth decade with no sex predilection. Clinically, presents as sessile or pedunculated growth, on any surface of mucosa, <1 cm in size, lighter due to reduced vascularity. Lesion is common in buccal mucosa, gingiva, lips, tongue, palate, and retromolar trigone.,,
Histopathologically presents as hyperplastic stratified squamous epithelium in association with loose to dense collagen (type I/III collagen), chronic inflammatory cell infiltrate in the underlying connective tissue., Differentiating between hyperplasia and neoplasia is of utmost importance as reactive lesions subside on removal of the stimulus. Fibroepithelial hyperplasia is self-limiting unlike neoplasia.
Our case was consistent with the case of fibroepithelial polyp mimicking mucocele in a 10-year-old female patient in the right lower labial mucosa. Similarly, Rangeeth et al. reported mucocele and irritation fibroma of lower lip in a 9-year-old girl. To the contrary, Gudi et al. described that not all swellings of the lower lip are mucocele and reported schwannoma of lower lip in a 21-year-old female. Nerune et al. also reported that not all swellings of lip are mucous retention cyst as they diagnosed schwannoma in the upper lip of a 26-year-old male.
Surgical excision is the treatment of choice. Other treatment modalities include laser, cryosurgery, electrocautery, intralesional corticosteroids, intralesional ethanol, and sclerotherapy. Recurrence is rare following removal of the offending stimulus.
History and clinical examination is much needed for diagnosis of oral lesions. Clinicopathologic correlation is advisable to evade misdiagnosis and disparity between clinical and histopathologic diagnosis.
| Conclusion|| |
Multiple oral lesions mimic each other clinically though present with distinct histological presentation. Hence, to arrive at a final diagnosis, histopathological assessment of oral lesion is advisable. Clinicopathologic overview of oral lesions might help the clinicians to evade misdiagnosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]