Fibroepithelial polyp - oral cavity

Case contributed by Dr Imran Ahmad Khan

Presentation

Slowly enlarging mass in oral cavity for one year. Occasional bleeding.

Patient Data

Age: 35 years
Gender: Female

Abnormally bulky shadow of the soft palate.

A well-defined polypoidal soft tissue mass is seen in the oral cavity on the right side, arising from the right retromolar trigone and extending up to the midline. It is abutting the tongue inferiorly and soft palate superiorly. Mass is homogeneously hyperintense on T2 and T2FS and of intermediate signal intensity on T1-weighted images (isointense to muscles). Intense homogeneous post-contrast enhancement is noted. There is no evidence of any local invasion. No internal necrotic areas are seen.

MRI findings indicated a benign vascular polyp. The tumor was excised and sent for histopathology. 

Histopathology

Microscopic Findings: 
Sections showed a polyp lined by squamous epithelium with moderate acanthosis, hyperkeratosis and lengthened rete pegs. Significant ulceration of the lining is noticeable with fibrinous exudate containing plenty of neutrophils. Stroma is composed of edematous fibro-collagenous tissue with congested vessels. Moderate to focally very dense perivascular plasma-lymphocytic infiltrate is present. Giant cells, proliferating plump fibroblasts osseous and chondromatous metaplasia are not seen. No evidence of dysplasia or malignancy in the sections studied.

Final Diagnosis: Ulcerated fibroepithelial polyp (Fibrous epulis).

Case Discussion

Fibroepithelial polyps are benign epithelial tumors of the oral cavity. They are considered more of an inflammatory rather than a neoplastic condition. They arise due to chronic irritation by a sharp tooth or a dental prosthesis. The lesions are usually small but sometimes can present as large masses. 

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