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Giant Cell Fibroma — MFDS Part 1 MCQ

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ModerateOral PathologyGiant Cell FibromaMFDS Part 1

Which microscopic feature most strongly supports a diagnosis of oral giant cell fibroma rather than irritation fibroma?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Large stellate mononuclear and multinucleated fibroblastic cells beneath the epithelium

Giant cell fibroma is characterised by large stellate fibroblastic cells, including mono-, bi- and occasionally multinucleated forms, typically concentrated in the superficial connective tissue beneath the epithelium. Immunohistochemical studies support their fibroblastic rather than osteoclastic lineage. Osteoclast-like giant cells in a haemorrhagic stroma suggest a peripheral giant cell granuloma. Pleomorphic invasive spindle cells and atypical mitoses indicate malignancy. Granular cells with pseudoepitheliomatous hyperplasia suggest a granular cell tumour, while papillary fronds with koilocytosis favour squamous papilloma. Irritation fibroma generally shows collagenised connective tissue with bland spindle fibroblasts and lacks the prominent superficial stellate giant-cell population characteristic of giant cell fibroma.

Reference: Kuo RC et al. Clinicopathological study of oral giant cell fibromas. Journal of the Formosan Medical Association. 2009;108(9):725–729. https://pubmed.ncbi.nlm.nih.gov/19773211/