Spongiotic Gingival Hyperplasia Synchronously Involving Multiple Sites: Case Report and Review of the Literature

Abstract

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a gingival lesion with unique clinicopathologic features that may involve synchronously multiple sites. We present a case with lesions clinically consistent with LJSGH in four jaw quadrants, confirmed by biopsy and review the English literature on multifocal LJSGH cases. A 19 year-old woman presented with circumscribed, erythematous overgrowths on the right and left maxillary and mandibular gingiva. With the provisional diagnosis of multifocal LJSGH, total excision of four maxillary lesions was performed. Clinical, microscopic and immunohistochemical examination with cytokeratin 19 confirmed the diagnosis of LJSGH in multiple sites. The excised lesions showed partial to complete recurrence after 4 months, while spontaneous regression of all but one lesion was observed after 15 months. Twenty cases with synchronous involvement of the gingiva of at least two teeth were previously reported. Their clinical features were comparable to that of solitary LJSGH. Only one case involved all four jaw quadrants. Spontaneous remission has not been documented before. The recognition of multiple lesions with clinicopathologic features diagnostic of LJSGH in the same adult patient argue against the designations "localized" and "juvenile". Recurrences are common, while remission might occur.

Characterization of juvenile spongiotic gingival hyperplasia as an entity of odontogenic origin

“…The results of our immunohistochemical study also agree with previous studies . The most outstanding data are those referring to the expression of CK19, CK14, and CK7 in the hyperplasic epithelium and CD20 in the inflammatory infiltrate.…”

“…‒ JSGH usually appears as a unique gingival reddish tumor in the anterior sector of the maxilla. Treatment of choice is the complete surgical removal of the lesion; and although recurrence is low, it may be up to 28.6% . Clinical differential diagnosis includes plaque‐induced gingivitis, pyogenic granuloma, squamous papilloma, plasma cell gingivitis, and fibroepithelial hyperplasia .…”

“…Clinical differential diagnosis includes plaque‐induced gingivitis, pyogenic granuloma, squamous papilloma, plasma cell gingivitis, and fibroepithelial hyperplasia . ‒ …”

“…The histopathological study was carried out through a specific protocol for this pathology, where the main characteristics of each case, stained with hematoxylin and eosin, were collected. All cases showed the characteristic hyperplasic epithelium of JSGH and free gingival epithelium.…”

“…Some authors who performed immunohistochemical studies of JSGH noticed the similarity between the hyperplasic epithelium of JSGH and the junctional epithelium (JE). Allon et al .…”