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CPC 12
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This 13 year old boy presents with a recurrent friable granular lesion of the anterior maxilla. It had been excised several months earlier and this represents the recurrence. At surgery it was found to be attached by a broad stalk to the underlying tissue. There was no apparent underlying bone involvement.

Differential Diagnosis:

  1. Pyogenic Granuloma
  2. Peripheral Odontogenic (Ossifying) Fibroma
  3. Peripheral Giant Cell Granuloma
  4. Squamous Cell Carcinoma
  5. other soft tissue malignancies

Note: The first three lesions in the above differential diagnosis usually are the initial considerations in the diagnosis of peripheral soft tissue lesions. Because of the size, recurrent nature, and surface irregularity of this particular lesion, a more aggressive tumor can also be considered in this case.


Slide 1 (low power, H&E). This lesion demonstrates an intact mucosa composed of stratified squamous epithelium. The underlying stroma is cellular and contains spotty calcifications. Surgical hemorrhage is seen in the lower portion of this field.

Slide 2 (high power, H&E). These calcifications resemble bone rather than cementum and are surrounded by vascularized cellular connective tissue.

Diagnosis: Peripheral Odontogenic (ossifying) Fibroma