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December 2007

A Firm Papule on the Lateral Tongue—Diagnosis

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Arch Dermatol. 2007;143(12):1583-1588. doi:10.1001/archderm.143.12.1583-g

Histopathologic evaluation revealed an increased number of fibroblasts within thickened fibrotic collagenous tissue in the submucosa. These fibroblasts appeared stellate and displayed characteristic large and angulated nuclei (Figure 3). Occasional multinucleated fibroblasts were also present.

Giant cell fibroma (GCF) was first described by Weathers and Callihan1 in 1974. It is classified as a benign fibrous hyperplasia of the oral cavity, most likely resulting from chronic irritation or trauma. Although it remains controversial whether to distinguish GCF from other forms of fibrous hyperplasia, most authorities have listed it as a separate entity because of its histopathologic characteristics and natural history.2 Clinically, GCF tends to affect young adults in the first 3 decades of life, with a female preponderance. Classically, the lesion presents as a single, firm, pebbly-surfaced, nontender, mucosal-colored papule, measuring less than 1 cm. The most common location is the mandibular gingiva, followed by the tip and lateral border of the tongue and the buccal mucosa.3 This tumor must be differentiated from irritation hyperplasias, peripheral ossifying fibroma, granular cell tumor, and mucosal neuroma. Compared with GCF, irritation hyperplasias are more common in an older age group, with the most common location being within the buccal mucosa.4 Similar in name only, fibromatosis of the tongue is a locally aggressive tumor of musculoaponeurotic tissue origin with a high rate of local recurrence.5

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