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The Case of the Hemorrhagic Gingival Mass

Case Challenge Number: 6

Diagnostic Information

Clinical Findings Clinical examination revealed a non-tender, bright-red pedunculated mass which arose from the buccal interdental papilla between teeth #19 and #20. (Figure 1) The mass tended to bleed easily upon manipulation. Generalized marginal gingivitis was seen throughout the mouth.

buccal view of gingival mass

Figure 1. Buccal view of lesion.

Bitewing Radiograph

A bitewing radiograph revealed slight bone loss at the crest of the alveolar bone between #19 and #20. (Figure 2) However, no obvious intrabony lesion was observed.

bitewing xray showing slight bone loss

Figure 2. Bitewing radiograph showing only slight alveolar bone bone loss between #19 and #20.

Additional Clinical History

During the review of the patient’s medical history, she stated she currently was five months pregnant.


Because the large size of the lesion was creating problems with eating and speaking, it was decided to excise the mass and submit it to the Oral Pathology Laboratory. Microscopic examination showed an ulcerated mass of granulation tissue that was covered by a thick fibrinopurulent membrane. (Figure 3)

image showing photomicrograph of tissue

Figure 3. Low-power photomicrograph showing a mass of highly vascular granulation tissue. The epithelial surface is ulcerated and replaced by a fibrinopurulent membrane.

This tissue was characterized by numerous capillaries which were engorged with red blood cells. (Figure 4)

image showing photomicrograph of blood vessels

Figure 4. Medium-power photomicrograph showing dilated blood vessels engorged with red blood cells.

There was an associated mixed inflammatory infiltrate which included polymorphonuclear leukocytes, lymphocytes, and plasma cells. (Figure 5)

image showing photomicrograph of capillaries

Figure 5. High-power photomicrograph showing capillaries with adjacent polymorphonuclear leukocytes, lymphocytes and plasma cells.