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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 87-89

Fibroepithelial polyp from retromolar trigone


Department of Otorhinolaryngology, Yenepoya Medical College, Mangalore, Karnataka, India

Date of Web Publication12-Jun-2019

Correspondence Address:
Dr. V G Nayana
Department of Otorhinolaryngology, Yenepoya Medical College, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_64_19

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  Abstract 


A fibroepithelial polyp is an inflammatory hyperplastic lesion in response to chronic irritation. It is most commonly seen in the buccal mucosa where it is more prone to trauma. Clinically, the features of fibroepithelial polyp overlap with other lesions. Therefore, histopathological confirmation is necessary. The current study presents a case in which the fibroepithelial polyp was arising from the retromolar trigone which is not reported in English literature.

Keywords: Benign tumour, fibroepithelial polyp, irritation fibroma, retromolar trigone tumours, traumatic fibroma


How to cite this article:
Anisa M K, Nayana V G, G. Somayaji K S, Saimanohar S, Sheetal R. Fibroepithelial polyp from retromolar trigone. Arch Med Health Sci 2019;7:87-9

How to cite this URL:
Anisa M K, Nayana V G, G. Somayaji K S, Saimanohar S, Sheetal R. Fibroepithelial polyp from retromolar trigone. Arch Med Health Sci [serial online] 2019 [cited 2019 Aug 23];7:87-9. Available from: http://www.amhsjournal.org/text.asp?2019/7/1/87/260021




  Introduction Top


Fibroepithelial polyp is a benign soft-tissue neoplasm in the oral cavity.[1] The synonyms such as irritation fibroma, traumatic fibroma, and a fibrous nodule or fibroma are used interchangeably.[1] It occurs due to trauma or local irritation. The site of predilection is the buccal mucosa and tongue.[2] Clinically, the patient presents with painless swelling that is sessile or occasionally pedunculated. The various treatment modalities include surgical excision, electrocautery, laser, cryosurgery, intralesional injection of ethanol or corticosteroids, and sodium tetradecyl sulfate sclerotherapy.[1] It does not pose a risk of malignancy. Repetitive trauma at the site of lesion can lead to recurrence of the polyp.


  Case Report Top


A 41-year-old female presented to the department of otorhinolaryngology with a swelling behind the left last lower molar tooth for a duration of 3 years, which was gradually progressive in size. There was no pain or bleeding associated with it. On oral cavity examination, a 3 cm × 1 cm pale smooth pedunculated mass was seen arising from the left retromolar trigone, which was freely mobile [Figure 1]. On palpation, it was not tender and did not bleed on touch. The mandible appeared normal on palpation. From a history, clinical examination and initial investigation provisional diagnosis of minor salivary gland tumor was made. Blood investigations done were within normal limits. The patient was planned for wide excision under general anesthesia. The mass was excised with 0.5 cm margin using electrocautery [Figure 2] and [Figure 3]. The specimen was sent for histopathological examination. Gross appearance of the tumor was single pale white to pale brown tissue mass measuring 1.6 cm × 1.2 cm × 0.2 cm [Figure 4]. Histopathological examination under ×10 magnification using hematoxylin and eosin staining revealed a polypoidal lesion lined by stratified squamous epithelium with fibrovascular core containing adipose tissue, mild inflammatory infiltrate, and congested blood vessels. Adjoining areas showed mucinous glands and hemorrhage [Figure 5]. Follow-up of the patient was done after 2 weeks and it showed healthy and healed operated site.
Figure 1: Preoperative photograph showing pedunculated lesion in the retromolar trigone

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Figure 2: Intraoperative photograph showing polypoidal pedunculated mass

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Figure 3: Postexcision photograph

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Figure 4: Excised specimen

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Figure 5: Histopathological examination under ×10 using H and E stain showing polypoidal lesion lined by stratified squamous epithelium with fibrovascular core containing adipose tissue, mild inflammatory infiltrate, and congested blood vessels. Adjoining areas showing mucinous glands and hemorrhage

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  Discussion Top


A fibroepithelial polyp is an inflammatory hyperplastic lesion in response to chronic irritation. It originates from fibrous connective tissues. The prevalence of the lesion is 1%–2%.[1] It is commonly seen in buccal mucosa and tongue.[2] It can also occur in gingiva, buccal mucosa, tongue, lips, and palate. A rare case arising from the tonsil is also reported in the literature.[3] It occurs as a result of repeated lip/cheek biting, irregular denture borders, overhanging restorations, calculus, sharp tooth edges, or other oral prostheses. It demonstrates two different patterns of collagen arrangement, radiating pattern and circular pattern, depending on the amount of irritation and the site of the lesion.[1] Irritation fibroma shows a radiating pattern when less severe trauma occurs along the sites that are immobile like hard palate. Circular pattern is associated with more severe trauma at sites that are flexible like the cheeks. It is more commonly found in the second to fourth decade of life. It is observed more in females.[2] Although asymptomatic, it can interfere with speech and mastication if it attains big size.[4] It can also obstruct the implantation of oral prosthesis. Clinically, the patient presents with painless swelling that is sessile or occasionally pedunculated. Most fibromas are 1.5 cm in diameter or less. They are typically pink in color similar to the color of surrounding mucosa.[5] If infected, the color may change to red. The clinical features of a fibroepithelial polyp are not exclusive. Other possibilities to be considered in the area of buccal mucosa are mucocele, lipoma, or salivary gland tumor. Fibroepithelial polyp should be differentiated from neoplastic lesions. Hence, histopathological examination following surgical removal is important for diagnosis. Fibroepithelial polyp is treated by conservative surgical excision. Electrocautery, laser, cryosurgery, intralesional injection of ethanol or corticosteroids, or sodium tetradecyl sulfate sclerotherapy are other modalities recommended for the removal.[1] Recurrence is rare. However, repeated trauma at the same site can lead to recurrence.


  Conclusion Top


Identifying and categorizing into fibroepithelial polyp is quite difficult clinically. Our case had a large-sized fibroepithelial polyp which is not much reported in literature. It is a benign tumor prone to recurrence. An important step in preventing the recurrence is excising the tumor in toto and eliminating the source of irritation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mishra A, Pandey RK. Fibro-epithelial polyps in children: A report of two cases with a literature review. Intractable Rare Dis Res 2016;5:129-32.  Back to cited text no. 1
    
2.
Al-Khateeb TH. Benign oral masses in a Northern Jordanian population – A retrospective study. Open Dent J 2009;3:147-53.  Back to cited text no. 2
    
3.
Telugu RB, Ashish G. Fibroepithelial polyp of the tonsil: Report of a rare case. J Clin Diagn Res 2015;9:ED17-8.  Back to cited text no. 3
    
4.
Rajeesh Mohammed PK, Choudhury BK, Dalai RP, Rana V. Fibroepithelial polyp with sebaceous hyperplasia: A case report. Indian J Med Paediatr Oncol 2017;38:404-6.  Back to cited text no. 4
    
5.
Halim DS, Pohchi A, Pang EE. The prevalence of fibroma in oral mucosa among patient attending USM dental clinic year 2006-2010. Indonesian J Dent Res 2010;1:61-6.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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Abstract
Introduction
Case Report
Discussion
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