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Circumscribed pink-white lingual papule in a child
*Corresponding author: Arun C. Inamadar, Department of Dermatology, Venereology and Leprosy, Shri B. M. Patil Medical College Hospital and Research Centre, BLDE (Deemed to be University), Vijayapur, Karnataka, India. aruninamadar@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Adya KA, Inamadar AC. Circumscribed pink-white lingual papule in a child. CosmoDerma. 2024;4:78. doi: 10.25259/CSDM_88_2024
A 10-year-old girl presented with a gradually enlarging, asymptomatic fleshy growth on her tongue from the past three months. There was neither history of any trauma preceding the lesion, nor was the patient on any dental prosthesis. Examination revealed a solitary pinkish-white, soft-to-firm, non-tender, and dome-shaped circumscribed papule measuring about 1 × 1 cm on the right side of the dorsal tongue [Figure 1]. The rest of the oral cavity and cutaneous examination were unremarkable. The lesion was completely excised under local anesthesia, and histopathology revealed acanthosis and papillomatosis with elongated and fused rete ridges. Dermis showed bland nodular fibrous proliferation, along with coarse collagen bundles and scant chronic inflammatory cell infiltrate [Figures 2 and 3].
- A solitary pinkish-white papule on the tongue.
![Epidermal hyperplasia characterized by acanthosis, papillomatosis, and elongated rete ridges together with dermal nodular fibroblast hyperplasia and dense collagen [H and E, ×40].](/content/130/2024/4/1/img/CSDM-4-78-g002.png)
- Epidermal hyperplasia characterized by acanthosis, papillomatosis, and elongated rete ridges together with dermal nodular fibroblast hyperplasia and dense collagen [H and E, ×40].
![High-power view showing mature spindle-shaped fibroblasts, thickened collagen bundles, a few scattered blood vessels, and mild inflammatory infiltrate [H and E, ×100].](/content/130/2024/4/1/img/CSDM-4-78-g003.png)
- High-power view showing mature spindle-shaped fibroblasts, thickened collagen bundles, a few scattered blood vessels, and mild inflammatory infiltrate [H and E, ×100].
WHAT IS THE DIAGNOSIS?
Answer:
Irritation fibroma.
DISCUSSION
Irritation fibroma (fibroepithelial polyp, bite fibroma or traumatic fibroma) is a relatively common benign oral cavity lesion, which is essentially a reactive focal fibrous hyperplasia to chronic irritation. The underlying cause of irritation may be dental prosthesis, mal-aligned teeth or habitual cheek or lip biting. Although adults are frequently affected, irritation fibroma can occur at any age with no specific gender or racial predilection. The typical clinical presentation is that of a solitary, circumscribed, dome-shaped sessile or pedunculated, and soft-to-firm non-tender papule or nodule. In addition to the lingual surface, the inner aspects of the lips and buccal mucosa are also frequently affected. Histologically, irritation fibroma is characterized by mature fibroblast proliferation, along with thick collagen bundles and scattered blood vessels. There is no/minimal inflammatory infiltrate and occasional focal mucinous degeneration. Overlying epithelium is often hyperplastic reflecting the chronic irritation. Simple excision is usually curative as the condition neither recurs nor undergoes malignant transformation.[1-3] While irritation fibroma is mostly solitary, multiple oral cavity fibromas may be a part of Cowden syndrome, tuberous sclerosis complex, and familial fibromatosis syndromes. Other fibromas involving the oral cavity are outlined in Table 1.[2-5]
| Fibroma Type | Clinical Features | Histopathologic Features |
|---|---|---|
| Giant cell fibroma | A variant of common fibroma situated commonly on the tongue or the gums and exhibiting a papillary aspect. When present on the inner side of the gingival, it is termed retrocuspid papilla | Some of the fibroblasts comprising the tumor are multinucleated and the epidermis is thinner with elongated rete ridges |
| Epulis fissuratum | Papillary mucosal folds with central fissuring due to ill-fitting dentures commonly involving the buccal and labial sulci | Dermal fibrosis and scattered vessels are associated with a prominent epithelial hyperplasia |
| Peripheral ossifying fibroma | Sessile lobular reactive soft-tissue overgrowth arising from periodontal ligament or periosteum and involving the gingival papillae between the teeth. Common in young females | Fibroblast proliferation is associated with osteoid or cementum deposition |
| Peripheral odontogenic fibroma | Nodular or lobulated firm growth involving the gums often in the vicinity of and displacing the teeth | Fibroblastic proliferation is associated with focal clumps or strands of odontogenic epithelium |
| Drug-induced fibrous hyperplasia | Diffuse gingival fibroplasia associated commonly with Dilantin, calcium channel blockers and cyclosporin | Fibrous tissue proliferation is associated with granulation tissue and inflammation |
| Inflammatory papillary hyperplasia of the palate | Similar to epulis fissuratum but involving the palatal area near the ill-fitting dentures | Similar to epulis fissuratum |
| Oral elastofibroma | Rare, usually affects elderly females and commonly involves upper back region. Oral cavity involvement presents as asymptomatic submucosal nodules commonly in the hard palate and floor of the mouth | The tumor is composed of collagen and thickened elastic fibers |
| Sclerotic fibroma | Uncommon benign fibrous tumor that may be sporadic or associated with Cowden syndrome. Primarily a cutaneous tumor, oral cavity involvement may be seen affecting buccal mucosa and inner side of lips | The tumor is composed of dense collagen and scant fibroblasts in storiform pattern that are CD34 and vimentin positive |
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship
Nil.
References
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