Oral cavity & oropharynx

Soft tissue tumors & proliferations

Giant cell fibroma


Editorial Board Member: Molly Housley Smith, D.M.D.
Deputy Editor-in-Chief: Kelly Magliocca, D.D.S., M.P.H.
Sarah H. Glass, D.D.S.

Last author update: 21 February 2022
Last staff update: 21 February 2022

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PubMed Search: Giant cell fibroma [TI]

Sarah H. Glass, D.D.S.
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Cite this page: Glass SH. Giant cell fibroma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/oralcavitygiantcellfibroma.html. Accessed December 10th, 2022.
Definition / general
  • Benign fibrous proliferation of the oral cavity mucosa with distinct stellate fibroblasts
Essential features
  • Fibrous nodule that most commonly presents on the gingiva and can have a papillary appearance
  • Histologic features include large, plump stellate fibroblasts in the superficial connective tissue
  • Treatment is conservative excision and recurrence is rare
ICD coding
  • ICD-10: benign neoplasm of mouth
    • D10.0 - benign neoplasm of lip
    • D10.1 - benign neoplasm of tongue
    • D10.39 - benign neoplasm of other parts of mouth
Epidemiology
Sites
Pathophysiology
Etiology
Clinical features
  • Dome shaped sessile or pedunculated fibrous nodule
  • Surface may be smooth, pebbly, bosselated, nodular or papillary
  • Most lesions are less than 1 cm in diameter (Head Neck Pathol 2019;13:71)
  • Asymptomatic unless secondarily traumatized
Diagnosis
  • Definitive diagnosis is made on histopathology
Prognostic factors
  • Excellent prognosis and recurrence is rare
Case reports
Treatment
  • Conservative surgical excision
Clinical images

Contributed by Sarah H. Glass, D.D.S.
Bosselated gingival mass

Bosselated gingival mass

Small tongue mass

Small tongue mass

Gross description
  • Firm tan nodule with white cut surface
Gross images

Contributed by Sarah H. Glass, D.D.S.
Dome shaped mass

Dome shaped mass

White cut surface

White cut surface

Microscopic (histologic) description
  • Varying numbers of large, plump angular and stellate fibroblasts that may demonstrate multiple nuclei in the superficial connective tissue (Oral Surg Oral Med Oral Pathol 1974;37:374)
  • Proliferation of collagen bundles
  • Overlying surface epithelium with narrow and elongated epithelial rete ridges
  • Absence of inflammation
Microscopic (histologic) images

Contributed by Sarah H. Glass, D.D.S.
Nodular fibrous proliferation

Nodular fibrous proliferation

Elongated rete ridges

Elongated rete ridges

Stellate fibroblasts

Stellate fibroblasts

Multinucleated fibroblasts

Multinucleated fibroblasts

Positive stains
Sample pathology report
  • Oral cavity, excisional biopsy:
    • Giant cell fibroma
Differential diagnosis
Board review style question #1

A 30 year old patient presents with a 5 mm bosselated soft tissue mass on the mandibular gingiva. Histopathology shows a benign fibrous proliferation with stellate fibroblasts in the superficial connective tissue with no inflammation. There is no history of trauma. What is the diagnosis?

  1. Giant cell fibroma
  2. Irritation fibroma
  3. Papilloma
  4. Pyogenic granuloma
Board review style answer #1
A. Giant cell fibroma. All of the answer choices could be included on a clinical differential diagnosis of a gingival mass. Giant cell fibromas demonstrate stellate fibroblasts on microscopic exam. These lesions are not associated with trauma and do not routinely demonstrate inflammation unless secondarily traumatized.

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Reference: Giant cell fibroma
Board review style question #2
Which of the following is true regarding giant cell fibromas of the oral cavity?

  1. Features of human papillomavirus in the epithelium
  2. History of repeated trauma to the site
  3. Majority of lesions are larger than 1 cm
  4. Stellate fibroblasts in the superficial connective tissue
Board review style answer #2
D. Stellate fibroblasts in the superficial connective tissue. Defining histologic feature of a giant cell fibroma is the presence of large, plump angular and stellate fibroblasts that may demonstrate multiple nuclei in the superficial connective tissue. These lesions generally have limited growth potential, are not associated with trauma and are not related to human papillomavirus.

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Reference: Giant cell fibroma
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