Giant Cell Fibroma of Tongue: Understanding the Nature of an Unusual Histopathological Entity

Giant cell fibroma (GCF) is a rare case with unique histopathology. It belongs to the broad category of fibrous hyperplastic lesions of the oral cavity. It is often mistaken with fibroma and papilloma due to its clinical resemblance. Only its peculiar histopathological features help us to distinguish it from them. The origin of the giant cell is still controversial. Data available is very sparse to predict the exact behavior. Hence, we report a case of GCF of tongue in a 19-year-old male. Special emphasis is given to understand the basic process of development of the lesion, nature of giant cells, and also the need for formation of these peculiar cells. Briefly, the differential diagnosis for GCF is tabulated. 1. Background Giant cell fibroma (GCF) is an unusual fibrous mucosal mass with several unique features separating it from other oral fibrous hyperplasias [1]. First reported by Weathers and Callihan in 1974 [2], GCF is found predominantly in Caucasians in first three decades of life with slight female predilection. The etiology for GCF remains unknown and does not appear to be associated with chronic irritation [1]. It typically manifests as an asymptomatic sessile or pedunculated mass [1] that is commonly mistaken for other growths such as fibroepithelial polyp, pyogenic granuloma, and fibroma [3] and can be diagnosed accurately based only on its distinctive histopathology. Herewith, we report a case of GCF of tongue in a 19-year-old male, along with simultaneous comparison with irritation fibroma and retrocuspid papilla. Additionally, adding epidemiological data to the literature can help predict the exact nature of this relatively uncommon entity. 2. Case Presentation A 19-year-old male reported with a small growth on the tip of the tongue. The growth was round in shape, measuring approximately 1？mm × 0.5？mm, smooth surfaced, normal mucosal colour and sessile. It was nontender and firm in consistency with no history of trauma. A clinical diagnosis of fibroma was given and was subjected to excisional biopsy. Histopathological examination of the excised specimen revealed a relatively avascular fibrocellular connective tissue mass. The surface epithelium was hyperplastic stratified squamous with elongated and thin rete ridges (Figure 1). Characteristically, the stroma consisted of numerous giant cells especially near the surface epithelium (Figure 2). The giant cells were stellate shaped with dendritic process, containing moderate amount of basophilic cytoplasm and large vesicular nuclei with prominent nucleoli. Few giant cells were binucleated