History of Present Illness
Jimmy is a 38-year-old patient of record who has just returned home from a two year overseas assignment in Costa Rica. He reports that while out of the country, he had his teeth cleaned once and now needs a comprehensive check-up. He has no complaints and relates no problems in the past two years.
Extraoral examination reveals normal TMJ function, no facial muscle tenderness, and no cervical lymphadenopathy. Intraoral examination reveals an intact dentition in good repair with no evidence of caries or periodontal disease. There is well-defined, firm, smooth surfaced papule noted on the lingual alveolar ridge interproximal to #22/23 (Figure 1). The lesion is broadly attached and blanches with pressure (Figure 2). A periapical radiograph of the area is within normal limits, with no evidence of alveolar bone loss or osseous involvement. The lesion is excised and submitted for histologic assessment.
The biopsy of the gingival mass shows a submucosal proliferation of nests, cords and islands of odontogenic epithelium. The epithelium displays peripherally palisaded columnar epithelial cells with nuclear polarization away from the basement membrane, nuclear hyperchromasia, subnuclear cytoplasmic clearing, and central keratinization. A supporting fibrovascular connective tissue stroma is present. There is a patchy acute and chronic inflammatory infiltrate. No bone involvement is identified.