|Year : 2016 | Volume
| Issue : 2 | Page : 111-114
Solitary neurofibroma of the gingiva: A rare case report
Priyanka Dalvi1, KV Vandana1, Shobha Prakash1, KP Mohan2
1 Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India
2 Department of Oral Pathology and Microbiology, College of Dental Sciences, Davangere, Karnataka, India
|Date of Web Publication||6-Jan-2017|
Department of Periodontics, College of Dental Sciences, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
Solitary neurofibroma is a benign, slowly growing, relatively circumscribed, but nonencapsulated tumor of unknown etiology diagnosed by absence of other features of the associated systemic disease. A 70-year-old female patient reported to us with a localized gingival swelling in the upper right back tooth region. The lesion was an incidental finding at a routine dental checkup. Medical and family history was noncontributory. Apart from the oral cavity, no other similar swellings were found on the rest of the body and the regional lymph nodes were not palpable. Based on history, texture, appearance, and location a differential diagnosis of possible fibroma, peripheral ossifying fibroma, and peripheral giant cell granuloma was made. Excisional biopsy was planned as the lesion was small and solitary. Based on the history, clinical, radiographical, and histopathological findings diagnosis of neurofibroma was given. The patient has not reported with recurrence 6 months postoperatively. Even though it is a rare lesion in the oral cavity, solitary neurofibroma must be considered in the list for differential diagnosis in cases of intraoral swellings and intraosseous lesions of the jaws.
Keywords: Diagnosis; gingiva; neurofibroma; solitary
|How to cite this article:|
Dalvi P, Vandana K V, Prakash S, Mohan K P. Solitary neurofibroma of the gingiva: A rare case report. Indian J Multidiscip Dent 2016;6:111-4
|How to cite this URL:|
Dalvi P, Vandana K V, Prakash S, Mohan K P. Solitary neurofibroma of the gingiva: A rare case report. Indian J Multidiscip Dent [serial online] 2016 [cited 2019 Jul 21];6:111-4. Available from: http://www.ijmdent.com/text.asp?2016/6/2/111/197771
| Introduction|| |
Neurofibromas are benign nerve sheath neoplasms of heterogeneous origin. Although specific cell type involved is controversial, schwann cells and perineural fibroblasts are the main originating cells. Neurofibromas are classified into solitary lesion or multilple (part of the generalised syndrome of neurofibromatosis [NF].  The two forms do not differ except in the presence of systemic and hereditary factors in the multiple form as a constituent of NF. The majority of isolated or solitary neurofibromas are sporadic, and a small minority may be associated with the NF-Type I (NF-I) syndrome.  Herewith, we present a rare case report on solitary neurofibroma occurring at an uncommon site, the gingiva.
| Case Report|| |
A 70-year-old female patient was referred to the Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India, with a localized gingival swelling in the upper right back tooth region. The lesion was an incidental finding at a routine dental checkup. History suggested the lesion had been present for approximately 30 years since patient first noticed it. There had been a gradual development of the growth to its present size. The swelling was completely asymptomatic from the time it was noticed by the patient. The medical and family history was noncontributory. Apart from the oral cavity, no other similar swellings were found on the rest of the body and the regional lymph nodes were not palpable.
On local examination, the lesion was smooth, firm with sessile base, nonulcerated, painless, with the same color as of gingiva measuring 4 mm × 8 mm × 3 mm extending from the mesial of maxillary right premolar till distal of maxillary right second premolar involving the marginal, papillary, and attached gingiva [Figure 1]. Hematologic and radiographic investigations were advised to the patient. Hematologic parameters were under physiologic limits. Intraoral periapical radiograph did not show any significant alterations [Figure 2].
|Figure 1: Intraoral solitary gingival overgrowth seen with respect to maxillary first and second premolar|
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Based on history, texture, appearance, and location a differential diagnosis of possible fibroma, peripheral ossifying fibroma, and peripheral giant cell granuloma was made. Since it was a small solitary intraoral lesion, excisional biopsy was planned under local anesthesia. The surgical procedure was explained to the patient, and informed consent was obtained. Complete excision was achieved using no. 11 blade [Figure 3]. The growth was carefully dissected and separated from the underlying tissues. The complete lesion along with 1 mm of normal tissue was excised. The excised specimen was almost 0.5 cm × 1 cm in size. The lesion bed was examined for any remnants, or tissue tags and hemostasis was achieved. The postoperative period was uneventful. The patient was kept on a regular follow-up. The excised tissue was preserved in formalin and labeled and sent for histopathological examination.
Histopathologically, hematoxylin and eosin stained biopsy sections showed surface epithelium over the connective tissue. Connective tissue was fibro-cellular and circumscribing the lesional tissue which was composed of fascicles of proliferating spindle-shaped cells with wavy nuclei. Nodular arrangement of spindle cells was evident and focal areas of the stoma also revealed chronic inflammatory infiltrate predominantly composed of lymphocytes and numerous mast cells and blood capillaries were evident in toluidine blue staining [Figure 4]. Based on these features, histopathological diagnosis of neurofibroma was given.
|Figure 4: Connective tissue is fibrocellular and is circumscribing the lesional tissue which is cellular and is composed of fascicles of proliferating spindle shaped cells with wavy nuclei. Stroma also reveals chronic inflammatory infiltrate predominantly composed of lymphocytes and numerous mast cells and blood capillaries (×10)|
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Having confirmed the occurrence of a neurofibroma, a complete exploration of clinical findings and history was done. There was no relevant family history and no evidence of NF, such as caféaulait macules or freckling in the axillary and inguinal regions. No lisch nodules were detected during an ophthalmological study. The patient showed normal physical and mental development. With the above clinical, radiographical, and histological findings, final diagnosis of solitary neurofibroma of the gingiva was made.
| Discussion|| |
Solitary neurofibroma is a benign, slowly growing, relatively circumscribed, but nonencapsulated tumor of unknown etiology diagnosed by absence of other features of the associated systemic disease. Specific cell type involved is controversial. Schwann cells and perineural fibroblasts are the main originating cells. Oral neurofibromas usually present as nontender, un-inflamed, submucosal discrete masses that range from few millimeters to several centimeters. Tumors tend to grow slowly, and patients are usually asymptomatic, but depending on the locality (e.g., tongue, palate), they may be traumatized and give rise to symptoms. 
In the present case, the lesion was painless, asymptomatic and was an incidental finding by the patient's dentist during a routine dental checkup. Common sites of the oral solitary neurofibromas include a tongue (26%), buccal mucosa (8%), labial mucosa (8%), palate (8%), gingiva (2%), and alveolar ridge (2%). The tongue is highly innervated and thus remains the most common site of occurrence of peripheral nerve sheath tumors including solitary neurofibroma in the oral cavity.  The gingiva lacks major nerve trunks hence remains the rare site of occurrence of solitary neurofibromas as in the present case.
Clinically, the other diseases of similar presentation are peripheral giant cell granuloma and traumatic fibroma. A definitive diagnosis can only be rendered, after an incisional or an excisional biopsy followed by histopathological examination which remains the gold standard. Histologically, solitary neurofibromas are circumscribed but nonencapsulated consisting of fascicles of the spindle-shaped cells. The neural origin can be confirmed using immunohistochemical marker S-100. 
Treatment for solitary neurofibroma is local excision and recurrence is rare. Prognosis for solitary neurofibroma is good when compared to the NF-I since malignant transformation common in NF and rare in solitary neurofibroma. , The present case was kept under observation and scheduled for follow-up every 3 months up to 1 year. The lesion has not shown any recurrence after a period of 7 months, and the patient is still ongoing further follow-ups [Figure 5] and [Figure 6].
| Conclusion|| |
The present case is unique as the presentation of lesion was sporadic, and no associated family history was reported. As neurofibromas are more often seen in younger individuals, the older age of this particular patient deserves special mention. Since the gingiva remains a less common intraoral site; this further highlights the unusual nature of the present case, although these are benign tumors and have a fairly good prognosis. Even though it is a rare lesion in the oral cavity, solitary neurofibroma must be considered in the list for differential diagnosis in cases of intraoral swellings and intraosseous lesions of the jaws.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]