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Peripheral Odontogenic Fibroma — MFDS Part 1 MCQ

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HardOral PathologyPeripheral Odontogenic FibromaMFDS Part 1

A 46-year-old patient has a slow-growing, painless, firm, pale-pink sessile nodule on the attached gingiva. Imaging shows no primary intraosseous lesion. Histopathological examination demonstrates an unencapsulated cellular fibrous and focally fibromyxomatous stroma containing scattered islands and strands of inactive-looking odontogenic epithelium. Small foci of dentinoid- or cementum-like calcification are present. What is the most likely diagnosis?

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Correct answer: D — Peripheral odontogenic fibroma

The diagnosis is peripheral odontogenic fibroma, a rare benign extraosseous odontogenic neoplasm presenting as a firm gingival mass. The decisive finding is a fibrous or fibromyxomatous stroma containing islands or strands of odontogenic epithelium, sometimes with dentinoid, cementum-like or osseous calcification. A peripheral ossifying fibroma is a reactive gingival lesion with fibroblastic proliferation and mineralisation but lacks the characteristic odontogenic epithelial component. Peripheral ameloblastoma contains a more conspicuous ameloblastomatous epithelial proliferation rather than scant epithelial rests in a predominantly fibrous tumour. Peripheral giant cell granuloma would contain numerous osteoclast-type giant cells and haemorrhage. Pyogenic granuloma is typically soft, red and vascular, with histological lobular capillary proliferation.

Reference: de Villiers Slabbert H, Altini M. Peripheral odontogenic fibroma: a clinicopathologic study. Oral Surgery, Oral Medicine, and Oral Pathology. 1991;72(1):86–90. https://pubmed.ncbi.nlm.nih.gov/2651484/