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Pregnancy tumor mimicking a neoplasm - A case report

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 Oral Medicine, Oral Diagnosis

Pregnancy tumor mimicking a neoplasm—

A case report
Deepak Kumar Chopra, BDS, MDS   n  Premdeep Gandhi, BDS, MDS   n  Deepak Kochar, BDS, MDS

Pregnancy brings about a complex series of physiological changes
for women. A tumor-like gingival enlargement can occur during
pregnancy. The size of the tumor generally increases gradually
over a few months as the pregnancy progresses, then shrinks
spontaneously after delivery. This case report describes a case
of gingival swelling in a 26-year-old woman at five months of
gestation. The lesion was not painful and grew very rapidly over
a three-week period. The histopathological examination revealed
granulation tissue with non-neoplastic proliferation of endothelial
cells, suggestive of pregnancy tumor.
Received: February 10, 2011
Accepted: May 10, 2011

P
regnancy is a complex condi-
tion involving what can be con-
sidered extreme physical and
physiological changes.1 Modification
of metabolism and immunological
status, and higher levels of hormones,
make it possible for the fetus to grow
and develop. Hormones can cause
changes to the skin and oral mucosa
that progress due to increased levels
of sex hormones found in blood and
saliva.2 These hormones are thought
to be the reason for the occurrence
of the specialized inflammatory pro-
cess and gingival enlargement.3
Progesterone and estrogen recep-
tors are situated in the basal and
spinous stratum of the epithelium
and in connective tissue, which is
why those cells could be influenced
by a high level of pregnancy hor-
mones.4 Progesterone dilates blood
vessels, making them more perme-
able and increasing the proliferation
of capillary vessels. Estrogen regu-
lates the proliferation, differentia-
tion, and keratinization of gingival
tissue. These hormones increase
gingival bleeding, cause gingival
growth, and lead to deepening of
periodontal pockets.5
Pregnancy tumor is a quite rare
gingival disorder, occurring in
1.8–5% of pregnant women; it
more commonly affects the anterior
region of the maxilla.6 The tumor
is a smooth or lobulated exophytic
lesion and manifests as a pink, red,
or purple erythematous papule on
a pedunculated or sessile base.1 It
usually arises during the second
trimester, grows gradually over
several months, and tends to bleed.
After delivery, the tumor can
regress and disappear entirely.7 The
current case report describes a case
of gingival swelling in a woman
who was five months pregnant
and presented with a tumor that
grew very rapidly and mimicked a
malignant neoplasm.

Fig. 1. Clinical presentation of gingival overgrowth. Fig. 2. Tissue recovered after excisional biopsy.

e182 May/June 2012 General Dentistry www.agd.org

 Fig. 4. Photomicrograph showing hyperplastic squamous
epithelium with inflammatory cells and proliferated
Fig. 3. Gingival overgrowth corrected and sutures placed. endothelial cells (H&E stain, magnification 40X).

Case report
A 26-year-old pregnant woman
was referred to the Inderprastha
Dental College Ghaziabad (UP)
Department of Periodontology with
the chief complaint of an extensive
gingival enlargement on the man-
dibular right side. The lesion was of
negligible size when the patient first
noticed it three weeks earlier, but it
had grown rapidly over the past 20
days. The patient’s medical history
revealed that she was at five months
of gestation with no systemic disease. Fig. 5. Healthy gingiva three months postsurgery.
Clinical examination revealed an
isolated, exophytic, pedunculated
lesion on the mandibular right
buccal side between the interdental
gingiva of the lateral incisor and granulation tissue with non-neoplas- appearance had returned to normal
canine. It measured approximately tic proliferation of endothelial cells at the site of the lesion (Fig. 5).
2.5 cm in diameter with some areas and enlargement of blood capillar-
of erythema. The lesion was rough ies. Infiltration of acute and chronic Discussion
and firm in consistency and bled inflammatory cells in a collagenous Pregnancy tumor is also known
minimally on palpation (Fig. 1). matrix was also present. The as pyogenic granuloma, which is
The swelling also interfered with surface of the lesion demonstrated something of a misnomer in that
eating and speech. The patient’s oral a hyperplastic, parakeratinized, the lesion does not produce pus, as
hygiene was otherwise good. stratified squamous epithelium with “pyogenic” would imply. However,
Excisional biopsy of the swelling areas of atrophy and ulcer. These it is a tumor of granulation tissue,
with a wide margin was performed findings were consistent with a his- as “granuloma” implies.1 This lesion
(Fig. 2) and sutures were placed topathological diagnosis of pyogenic has been called an epulis because
(Fig. 3). The histopathological granuloma. After three weeks of it is located more frequently in
examination (Fig. 4) revealed young postoperative follow-up, the clinical the gingiva. Other terms used

www.agd.org General Dentistry May/June 2012 e183

 Oral Medicine, Oral Diagnosis  Pregnancy tumor mimicking a neoplasm—A case report
include granuloma telangiectaticum
and epulis gravidarum. The term
hemangiomatous granuloma was
suggested by Angelopoulos to
accurately reflect the characteristic
histopathologic picture (heman-
gioma-like) and the inflammatory
nature (granuloma) of the lesion.8
Clinically, the lesion will be
pedunculated or broad-based,
highly vascularized, smooth, edema-
tous, hemorrhagic, and soft and
red with a glossy surface; it will also
harden when longstanding. It could
be located in single or multiple well-
localized outgrowths and be painless
or dully painful. It usually does not
measure more than 2.0 cm in diam-
eter.9 Differential diagnosis includes
peripheral giant cell granuloma,
epulis, peripheral ossifying fibroma,
metastatic cancer, hemangioma,
conventional granulation tissue,
hyperplastic gingival inflammation,
angiosarcoma, Kaposi sarcoma, and
non-Hodgkin lymphoma.10
Summary
Pregnancy tumor represents an
important differential diagnosis
of oral masses and can behave in
e184 May/June 2012 General Dentistry
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a very aggressive fashion, mimick-
ing a malignant tumor. Excised
specimens should be sent for his-
topathological analysis to exclude
malignancy. It is an acceptable
practice to excise aggressive variants
of this lesion during pregnancy to
avoid distressing side effects.
Author information
Dr. Chopra is a reader, Depart-
ment of Periodontics, Inderprastha
Dental College and Hospital,
Ghaziabad, Utter Pradesh, India.
Dr. Gandhi is a senior lecturer,
Department of Oral Pathology,
Jan Nayak Chaudhari Devi Lal
Dental College, Sirsa, Haryana.
Dr. Kochar is an assistant professor,
Department of Periodontics, Gov-
ernment Dental College, Rohtak,
Haryana.
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Published with permission by the Academy of
General Dentistry. © Copyright 2012 by the
Academy of General Dentistry. All rights reserved.