a, GCF of the mandibular facial gingiva presenting as a pale pink sessile nodule with a pebbly surface. b, Low-power view of a GCF. The pedunculated, bosselated, polypoid nodule is composed of fibrous connective tissue and orthokeratotic stratified squamous epithelium. Note: the elongated, pointed rete ridges (original magnification × 25, Hematoxylin & eosin). c, High-power view of the papillary chorion in a GCF. Note: the presence of multiple plump, stellate-shaped multinuclated fibroblasts (original magnification × 200, Hematoxylin & eosin). (from Non-HPV Papillary Lesions of the Oral Mucosa: Clinical and Histopathologic Features of Reactive and Neoplastic Conditions)
GCF is a benign fibrous tumor with distinct clinical and pathological features. Unlike a traumatic fibroma, it is not induced by chronic low-grade trauma. GCF represents approximately 4.7% of all oral benign fibrous growths submitted for biopsy. The lesion predominantly affects Caucasians, has a slight female predilection, and a peak incidence in the second decade of life. In a study of 434 cases, 60% occurred before the age of 30.
GCF presents as a small, asymptomatic, pale pink, pedunculated or sessile fibrous nodule. Most lesions measure less than 1 cm in diameter and have limited growth potential – the average size being 4 mm. The gingiva, tongue, palate, buccal mucosa and lip are the sites of predilection. The lesion can be present for years before being noticed by the patient. The surface of the lesion can be smooth and dome-shaped, finely bosselated or papillary. Smooth lesions will inspire a clinical differential diagnosis including traumatic fibroma, peripheral ossifying fibroma, pyogenic granuloma, and peripheral giant cell granuloma. Papillary lesions often lead to a clinical diagnosis of squamous papilloma or verruca vulgaris.
Histopathologically, GCF presents as a nodular mass with a smooth or pebbly surface. The body of the nodule is composed of fibro-vascular connective tissue surfaced by a thin keratotic stratified squamous epithelium. The rete ridges are often elongated and narrow. The distinguishing characteristic is the presence of multiple plump, stellate, bi- or multinucleated fibroblasts in the superficial connective tissue. Melanin incontinence and melanophages are occasionally present below the basement membrane. Other lesions involving the skin and mucous membranes have a similar microscopic appearance. These include the fibrous papule of the nose, ungual fibroma, acral fibrokeratoma and fibroblastoma. Mucosal lesions include the retrocuspid papillae (RCP) (discussed below) and pearly penile papules.
A conservative excision is usually curative. Recurrences have been documented but are rare.