Localized juvenile spongiotic gingival hyperplasia: A report of 27 cases

Abstract

Background: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a poorly understood but distinctive inflammatory hyperplasia occurring in children and young adults. Fewer than 100 cases have been reported since its initial description.Methods: During the period of 2015 to 2018, cases of LJSGH were identified, retrieved and their clinical and histopathological data reviewed.Results: There were 27 cases, with a median age of 13 years (range 7-72 years).Twenty-four of 27 patients were less than 20 years old, and in three cases the patients were over 60 years of age. The most commonly affected site was the anterior maxillary gingiva presenting as a solitary, red, and papillated lesion. Typical microscopic findings included elevated areas of variably acanthotic, spongiotic nonkeratinized epithelium with elongated rete ridges, accompanied by a neutrophilic-rich infiltrate. An abrupt transition between epithelium affected by LJSGH and normal mucosa was characteristic.LJSGH typically exhibited full-thickness epithelial expression of CK19 without expression of estrogen and progesterone receptors. Conclusions:The clinical and histopathologic characteristics of LJSGH are unique and consistent. Despite the name, the condition is not limited to juveniles and can occur in adults. LJSGH in adults and juveniles shares the same spectrum of histopathologic and immunohistochemical findings. K E Y W O R D Sgingival lesion, gingivitis, inflammatory gingival hyperplasia, oral disease

Lokalisert juvenil spongiotisk gingival hyperplasi: En relativt ny sykdomsenhet

“…LJSGH finnes på festet gingiva, men behøver ikke alltid å omfatte den marginale gingivalrand (1). Frekvensen er relativt lik for begge kjønn (7).…”

“…Wang og Jordan fant 27 LJSGH-pasienter i årene 2015 til 2018 i sitt arkiv og her var 3 stykker over 60 år. Disse 27 pasientene representerte kun 0,1% av alle biopsiene (n= 27901) (7). Tilstanden synes derfor å vaere sjelden, men man kan ikke utelukke at hyperplasien ofte blir feildiagnostisert slik at antallet pasienter med LJSGH kan vaere høyere enn antatt (8).…”

Juvenile spongiotic gingival hyperplasia: Presentation of two clinical cases

“…Currently, approximately 221 cases have been described in which it has been demonstrated that it is not a pathology totally of juvenile predilection because there are reports of cases of patients whose presentation was during the sixth decade of life, indeterminate male-female ratio, that is, without predilection for one or the other gender, likewise it has been located in multiple areas of the attached gingiva in both arches, it was evidenced that being exophytic, this entity should be called "hyperplasia" and there are reports of localized and generalized cases [4]. On the other hand, it is considered as the gingival counterpart of acute spongiotic dermatitis [5]. It is currently described as a patchy or raised lesion, with a papillary, granular, or smooth surface, bright red in color with a velvety appearance; patients do not report any symptoms and may bleed when brushing their teeth [6].…”

“…The etiopathogenesis is not fully clarified, but there are several mechanisms proposed as possible causes of the disease, among which are: viral infections such as HIV or HPV [7], high levels of estrogen or progesterone [8], allergic, bacterial, and fungal factors, external factors such as trauma or orthodontics [3] and local factors such as biofilm or mouth breathing [5]. There is a possibility that it is an entity of odontogenic origin, since it tends to be in the anterior sector of the maxilla [3], so there is a theory that due to the reduction of space when the primary teeth are exfoliated there is residual tissue of the junctional epithelium after the eruption of the permanent teeth [2].…”

“…It is considered that the treatment of preference is conservative, waiting for its spontaneous resolution and assisting it with periodontal hygienic therapy so that the condition does not worsen, in extensive lesions or very close to the gingival margin it is better to avoid invasive treatment in order not to leave scars or affect the aesthetics of the gum by possible gingival recession [2]. In the context of other treatments, there is the cold cut excision, using a scalpel with the possibility of affecting esthetics [7], laser photo biomodulation, since an antimicrobial effect is obtained, reduction of inflammation cell migration [5], increasing the expression of the bFGF gene, an important factor in the regeneration of periodontal tissue, therefore, it will provide an optimal healing. The disadvantages of this technique are the high cost of the equipment, and the professional must be trained in the use of the laser to avoid adverse effects [8].…”