Giant Cell Fibroma
Quick Summary Introduction References Photos		Clinical Features Histopathology Treatment Prognosis
Scattered fibroblasts located just beneath the epithelium are enlarged  and angular but are not hyperchromatic.  Some cells have multiple nuclei.

 

 

 

 

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Quick Review for Patients

The giant cell fibroma is a localized reactive proliferation of fibrous (scar) tissue, much like the irritation fibroma.  It usually remains small and may have a broad base or be on a thick stalk.  It is painless and often has lobules or nodules on its surface.  It can be seen in other sites, especially the nose, and differs from irritation fibroma in two ways: it contains cells (fibroblasts) with large, angular nuclei, especially near the surface of the fibrous mass, beneath the overlying epithelium; and it has a greater tendency to recur.  Treatment is conservative surgical removal.  There is no risk of transformation to cancer.

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Introduction

Note: click on underlined words for more detail or photos.

The giant cell fibroma is a subtype of irritation fibroma, i.e. it is a localized inflammatory fibrous hyperplasia, but it differs significantly from routine fibromas in that its stroma contains scattered fibroblasts with very large, usually angular (stellate), but not hyperchromatic nuclei.  Lesions with similar histology are found at other body sites, especially the skin of the nose (fibrous papule of the nose), the uterine cervix, vagina, bladder and other skin areas.

This type of fibroma can be seen at any age and on any oral mucosal surface, but it has a predilection for gingival, lateral tongue and tip of tongue locations.  It seldom becomes more than 0.5 cm. in greatest diameter and often are comprised of two or three lobules, or may have a few small papules on the surface.  Most lesions are pedunculated but sessile examples are not unusual.  The surface is almost never ulcerated, unless acutely traumatized, and the color is that of the surrounding normal mucosa (Figures 1 & 2).  Occasional patients will have multiple lesions but they are seldom numerous.

The lesion is characterized by a diffuse, somewhat immature, rather avascular collagenic stroma with small bipolar and slightly stellate fibroblasts scattered throughout in moderate numbers.  Occasional fibroblasts will be quite large and angular, and may have more than one nucleus (Figure 3).  These pathognomonic cells are never hyperchromatic, as they would be if they were truly dysplastic fibroblasts, and they often have a smudged appearance.  They are most numerous in the zone immediately beneath the covering epithelium.  The epithelium is usually normal but may have elongated and narrow rete ridges.  At the inferior margin the lesional fibrosis blends into the normal underlying fibrovascular tissues, with no capsule or pseudocapsule.  Occasional lymphocytes may be seen beneath the epithelium or around capillaries.

The giant cell fibroma is treated by conservative surgical removal but is more likely to recur with this treatment than a more routine irritation fibroma, even when that fibroma is much larger.  If left alone, the giant cell fibroma will not enlarge indefinitely, but will reach its maximum size within a few months and remain unchanged thereafter, unless acute trauma produces edema or areas of granulation tissue proliferation.

Weathers DR, Callihan MD. Giant-cell fibroma. Oral Surg Oral Med Oral Pathol 1974; 37:374-384.

Houston GD. The giant cell fibroma. A review of 464 cases. Oral Surg Oral Med Oral Pathol 1982; 53:582-587.

Reibel J. Oral fibrous hyperplasias containing stellate and multinucleated cells. Scand J Dent Res 1982; 90:217-226.

Regezi JA, Courtney RM, Kerr DA. Fibrous lesions of the skin and mucous membranes which contain stellate and multinucleated cells. Oral Surg Oral Med Oral Pathol 1985; 39:605-614.

Pitrt MA, Roberts ISD, Agambu DA, et al. The nature of atypical multinucleated stromal cells: a study of 37 cases from different sites. Histopathol 1993; 23:137-145.

Odell EW, Lock C, Lombardi TL. Phenotypic characterization of stellate and giant cells in giant cell fibroma by immunocytochemistry. J Oral Pathol Med 1994; 23:284-287.

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Pictures

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		Figure 1:  Giant cell fibroma of the lateral tongue is characteristically small and painless, and has small surface nodules or papules. Photo courtesy of Dr. John Alonge, Erie, PA.  [return to text]
		Figure 2:  A sessile giant cell fibroma of the buccal mucosa was found in the same patient as Figure 1.  Multiple lesions are unusual. Photo courtesy of Dr. John Alonge, Erie, PA   [return to text]
		Figure 3: Scattered fibroblasts located just beneath the epithelium are enlarged and angular but are not hyperchromatic.  Some cells have multiple nuclei.  [return to text]
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