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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 41-43

Fibroepithelial polyp: A pediatric case report with clinicopathologic overview


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 Submission27-Nov-2020
Date of Decision20-Feb-2021
Date of Acceptance22-Feb-2021
Date of Web Publication30-Mar-2021

Correspondence Address:
Dr. Tharani Vijayakumar
SRM University, Tiruchirappalli, Tamil Nadu
India
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DOI: 10.4103/srmjrds.srmjrds_127_20

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  Abstract 

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 Top


Oral tissues are under constant exposure to external and internal stimuli that bring about horde of lesions ranging from developmental, inflammatory, reactive to neoplastic.[1] 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.[2] 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 Top


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.
Figure 1: Intraoral clinical presentation of the lower lip lesion

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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].
Figure 2: Macroscopic presentation of the excised specimen

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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 Top


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.[3]

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.[4] 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.[4],[5],[6]

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.[7],[8] 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.[7]

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.[9] Similarly, Rangeeth et al. reported mucocele and irritation fibroma of lower lip in a 9-year-old girl.[10] 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.[11] 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.[12]

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.[13]

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 Top


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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Naderi NJ, Eshghyar N, Esfehanian H. Reactive lesions of the oral cavity: A retrospective study on 2068 cases. Dent Res J (Isfahan) 2012;9:251-5.  Back to cited text no. 1
    
2.
Bentley JM, Barankin B, Guenther LC. A review of common pediatric lip lesions: Herpes simplex/recurrent herpes labialis, impetigo, mucoceles, and hemangiomas. Clin Pediatr (Phila) 2003;42:475-82.  Back to cited text no. 2
    
3.
More CB, Bhavsar K, Varma S, Tailor M. Oral mucocele: A clinical and histopathological study. J Oral Maxillofac Pathol 2014;18:S72-7.  Back to cited text no. 3
    
4.
Patil VS, Ramanojam S. Importance of histopathology in diagnosis of large fibroepithelial polyp in oral cavity: A case report. Ann Clin Case Rep 2018;3:1489.  Back to cited text no. 4
    
5.
Telugu RB, Ashish G. Fibroepithelial polyp of the tonsil: Report of a rare case. J Clin Diagn Res 2015;9:ED17-8.  Back to cited text no. 5
    
6.
Pour MA, Rad M, Mojtahedi A. A survey of soft tissue tumor-like lesions of oral cavity: A clinicopathological study. Iran J Pathol 2008;3:81-7.  Back to cited text no. 6
    
7.
Kolte AP, Kolte RA, Shrirao TS. Focal fibrous overgrowths: A case series and review of literature. Contemp Clin Dent 2010;1:271-4.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Prasanna J, Sehrawat S. Fibroepithelial hyperplasia: Rare, selflimiting condition-two case reports. J Adv Oral Res 2011;3:63-70.  Back to cited text no. 8
    
9.
Jain K, Singh BD, Dubey A, Avinash A. Fibro-epithelial hyperplasia mimicking mucocele. Kathmandu Univ Med J (KUMJ) 2014;12:146-8.  Back to cited text no. 9
    
10.
Rangeeth BN, Moses J, Reddy VK. A rare presentation of mucocele and irritation fibroma of the lower lip. Contemp Clin Dent 2010;1:111-4.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Gudi SS, Sikkerimath BC, Puranik RS, Kasbe SS. Swelling on lower lip…not always a mucocele !!! Ann Maxillofac Surg 2013;3:98-9.  Back to cited text no. 11
    
12.
Nerune SM, Potekar RM, Rodrigues LD, Mestri NB. Swelling of the upper lip. not always a mucous retention cyst!! J Krishna Inst Med Sci 2017;6:120-22.  Back to cited text no. 12
    
13.
Mishra A, Pandey RK. Fibro-epithelial polyps in children: A report of two cases with a literature review. Intractable Rare Dis Res 2016;5:129-32.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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