Treatment

Under general anesthesia, the lesion was completely excised along with teeth # 19-21 in one en bloc mass.   Iodoform gauze packing was sutured into the defect for 10 days (Figure 4).  His postoperative regimen included wound care and observation only.  Post-operative healing was unremarkable. After a period of one month, the site appears well healed.  The patient will continue to be followed, and planned in the future (after completion of growth) for bone grafting and eventually for implant prothesis.

Incisional and excisional biopsy

Histological examination revealed a highly cellular fibrous lesion with focal myxoid background.  The fibroblasts are eosinophilic with plump and vesicular nuclei and are arranged in elongated fascicles with focal areas of storiform pattern (Figures 5 & 6).  Mitotic figures are present but are scant.  There is no evidence of pleomorphism.  The immunohistochemistry markers are positive with smooth muscle marker HHF35, but negative with desmin, myogenin, and S-100 proteins. 

 

Figure 4 Surgical site packed with iodoform gauze and sutured for ten days.

 

Figure 5 Low power (x100) histology shows short bundles of spindle-shaped fibroblasts criss-crossing each other, some in a storiform pattern. There was no evidence of atypia and mitotic figures were occasional to absent.

 

Figure 6 High power (x200) histology shows short bundles of spindle-shaped fibroblasts criss-crossing each other.  The neoplastic cells show no evidence of atypia.