Oral cavity & oropharynx
Benign epithelial tumors & processes
Spongiotic gingival hyperplasia
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PubMed Search: Spongiotic gingival hyperplasia
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Prognostic factors | Case reports | Treatment | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Sample pathology report | Differential diagnosis | Practice question #1 | Practice answer #1 | Practice question #2 | Practice answer #2Cite this page: Goldfaden JS, Bilodeau EA. Spongiotic gingival hyperplasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/oralcavityspongioticginghyper.html. Accessed August 14th, 2025.
Definition / general
- Distinct subtype of inflammatory gingival hyperplasia that does not respond to conventional periodontal therapy and often affects the anterior facial gingiva of young patients
Essential features
- Clinically appears as a solitary, pebbly / velvety, bright red, exophytic, often pedunculated lesion of the attached gingival margin, most often affecting the facial aspect of the anterior maxillary gingiva (J Am Dent Assoc 2019;150:147)
- Spongiotic gingival hyperplasia has a strong predilection for children, with a median age of 14.5 years at diagnosis; hence, this entity has also been termed localized juvenile spongiotic gingival hyperplasia (J Am Dent Assoc 2019;150:147, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:411)
- Surface epithelium is papillary, hyperplastic and exhibits prominent intercellular edema (spongiosis) with transmigration of neutrophils
- Underlying lamina propria has notable vascular congestion, often accompanied by a chronic inflammatory infiltrate
Terminology
- In 2007, Darling et al. first described this lesion as juvenile spongiotic gingivitis to emphasize its predilection for children in addition to its spongiotic and inflammatory nature (J Periodontol 2007;78:1235)
- 1 year later, the term localized juvenile spongiotic gingival hyperplasia (LJSGH) was coined by Chang et al. to emphasize the lesion's localized clinical nature and hyperplastic histologic appearance (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:411)
- Though most commonly seen in children, this entity also occurs in adults and can be multifocal; as such, a more appropriate nomenclature, spongiotic gingival hyperplasia, has been proposed (J Am Dent Assoc 2019;150:147)
- In 2021, Theofilou et al. proposed the terms spongiotic odontogenic gingivitis or spongiotic gingivitis with odontogenic metaplasia due to emerging evidence that these lesions display odontogenic origin via their expression of cytokeratins that are involved in physiologic or pathologic odontogenic epithelia (Oral Surg Oral Med Oral Pathol Oral Radiol 2021;131:329, Histopathology 2016;68:549)
ICD coding
Epidemiology
- Spongiotic gingival hyperplasia affects patients ages 3 - 64 years (median age of 14.5 years) with no remarkable sex predilection (J Am Dent Assoc 2019;150:147)
Sites
- Spongiotic gingival hyperplasia most often affects the maxillary anterior gingiva (Head Neck Pathol 2018;12:517)
Pathophysiology
- Mechanism is unclear; it was previously speculated that spongiotic gingival hyperplasia may arise from ectopic junctional epithelium of the gingival sulcus (J Periodontol 2007;78:1235)
- Immunohistochemical expression profile of cytokeratin in spongiotic gingival hyperplasia suggests that this entity may originate from junctional epithelium that has been exteriorized from the gingival sulcus, thus making it more prone to irritation, leading to inflammation and hyperplasia (Histopathology 2016;68:549)
Etiology
- Etiology of spongiotic gingival hyperplasia has not been determined
- Dental plaque and calculus build up, embedment of foreign material, trauma, orthodontic appliances, mouth breathing, viruses, hormones and developmental abnormalities have all been correlated with the pathogenesis of spongiotic gingival hyperplasia; however, no cause and effect linkage has been established with any of these factors (Head Neck Pathol 2018;12:517)
Clinical features
- Often a solitary, small, bright red, velvety or pebbly, sessile, exophytic growth of the interproximal, facial or lingual attached gingival margin that is typically pedunculated and bleeds with manipulation
- Spongiotic gingival hyperplasia is infrequently multifocal (Oral Surg Oral Med Oral Pathol Oral Radiol 2017;124:e219)
Diagnosis
- May be detected clinically as a pebbly / velvety, bright red, exophytic, pedunculated mass of the facial gingival margin
- Lesion may easily bleed when manipulated
Prognostic factors
- Recurrence rates are favorable and range from 6 to 16% following surgical excision (J Periodontol 2007;78:1235)
Case reports
- 7 year old boy presented with well circumscribed, erythematous overgrowth of the anterior maxillary gingiva (Oral Surg Oral Med Oral Pathol Oral Radiol 2023;136:E56)
- 19 year old woman with circumscribed, erythematous overgrowths of the left and right maxillary and mandibular gingiva (Head Neck Pathol 2018;12:517)
- 56 year old man with a localized erythematous lesion on the maxillary facial gingiva of tooth #9 (J Am Dent Assoc 2022;153:67)
Treatment
- Lesion does not respond to traditional periodontal therapy
- Generally treated by surgical excision
- Cryotherapy appears to be a successful alternative that is well received by pediatric patients (Int J Paediatr Dent 2017;27:231)
- In less common, multifocal cases, laser ablation with a subsequent course of topical corticosteroids is an alternative treatment for extensive involvement of aesthetic areas (Oral Surg Oral Med Oral Pathol Oral Radiol 2017;124:e219)
- Some cases may spontaneously resolve after an unforeseeable amount of time (J Periodontol 2007;78:1235)
Clinical images
Contributed by Katherine Ni, D.M.D., M.S.
Velvety red gingival mass
Microscopic (histologic) description
- Epithelium is variably hyperplastic and forms a pebbly to papillary surface with infrequent thinning of the connective tissue papilla
- Notable intercellular edema (spongiosis) and transmigration of neutrophils are frequently seen
- Underlying vascular dilation and congestion as well as a chronic inflammatory infiltrate of the lamina propria are often present
- Histopathologically, the epithelium bears much resemblance to junctional or sulcular tissue
- Less frequent findings include pseudoepitheliomatous hyperplasia, bacterial colonies, acantholysis and dystrophic calcifications (Oral Surg Oral Med Oral Pathol Oral Radiol 2021;131:329)
Microscopic (histologic) images
Contributed by Joshua Seth Goldfaden, D.D.S.
Papillary surface architecture
Intercellular edema (spongiosis)
Narrow connective tissue papilla
Vascular congestion
Transmigration of neutrophils
CK19 positive lesional epithelium
Positive stains
- CK19 is positive in the epithelium in 65% of cases (Histopathology 2016;68:549)
- CK8 / CK18 are diffusely positive within the epithelium in 60% of cases (Histopathology 2016;68:549)
Negative stains
- 30% of cases exhibit CK4 epithelial positivity and 5% of cases exhibit CK1 / CK10 epithelial positivity (Histopathology 2016;68:549)
Sample pathology report
- Anterior maxilla, left, area of #8, excisional biopsy:
- Spongiotic gingival hyperplasia (see comment)
- Comment: This is a benign, reactive lesion.
Differential diagnosis
- Gingivitis:
- Light inflammatory infiltrate consisting of neutrophils that frequently amass in the lamina propria adjacent to the sulcular epithelium
- With progression, the inflammation becomes a more concentrated infiltrate of lymphocytes and plasma cells, in addition to neutrophils
- Pyogenic granuloma:
- Vascular proliferation of granulation tissue, often with ulcerated surface epithelium
- May demonstrate a lobular organization of capillary vessels and proliferating endothelial cells defined by fibrous septa (i.e., lobular capillary hemangioma)
- Squamous papilloma:
- Papillary projections with prominent fibrovascular cores
- Usually pedunculated with exophytic architecture
- Koilocytes may also be noted in epithelium
- Secondarily traumatized squamous papillomas may show spongiosis, transmigration of leukocytes and absence of surface keratin
Practice question #1
A biopsy of the left maxillary facial gingival margin of a 15 year old boy reveals a papillary, hyperplastic epithelial surface with prominent intercellular edema, transmigratory neutrophils and underlying vascular congestion with chronic inflammation. Based on the microscopic findings, what is the most appropriate diagnosis?
- Gingivitis
- Pyogenic granuloma
- Spongiotic gingival hyperplasia
- Squamous papilloma
Practice answer #1
C. Spongiotic gingival hyperplasia. Epithelial hyperplasia with prominent intercellular edema (spongiosis), transmigration of neutrophils and vascular congestion with chronic inflammation of the lamina propria is consistent with spongiotic gingival hyperplasia. Answer A is incorrect because gingivitis often exhibits accumulation of neutrophils within the lamina propria and less prominent epithelial hyperplasia and spongiosis. Answer B is incorrect because pyogenic granulomas demonstrate a lobular organization of capillary vessels and endothelial proliferation. Answer D is incorrect because squamous papillomas have finger-like projections with notable fibrovascular cores and koilocytosis of the epithelium.
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Practice question #2
A 17 year old girl presents with a pebbly, red, exophytic growth of the maxillary gingiva. The patient underwent a biopsy of the lesion. What is the most likely diagnosis based on the photomicrograph?
- Gingivitis
- Pyogenic granuloma
- Spongiotic gingival hyperplasia
- Squamous papilloma
Practice answer #2
C. Spongiotic gingival hyperplasia. The photomicrograph reveals spongiotic epithelium with transmigrating neutrophils and underlying vascular congestion with chronic inflammation, which is consistent with spongiotic gingival hyperplasia. Answer A is incorrect because gingivitis often exhibits accumulation of neutrophils within the lamina propria and less prominent spongiotic epithelium. Answer B is incorrect because pyogenic granulomas demonstrate a lobular organization of capillary vessels with an endothelial proliferation. Answer D is incorrect because squamous papillomas have finger-like projections with notable fibrovascular cores and koilocytic epithelium.
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