Retrocuspid papilla presenting as a giant cell fibroma.

The retrocuspid papilla (RCP) is a soft tissue nodule located at the lingual attached gingiva of the mandibular cuspid.1, 2, 3, 4 Here, we reported a case of RCP at the lingual attached gingiva of the left mandibular cuspid of a 33-year-old female patient.

This 33-year-old female patient came to our dental clinic for evaluation and treatment of an elevated sessile papule at the lingual attached gingiva of the left mandibular cuspid for an unknown duration. The papule measured approximately 0.3 × 0.2 × 0.2 cm in size. It is asymptomatic and not tender on palpation. The clinical diagnosis was a fibroma or a papilloma. After discussing with the patient and obtaining the signed informed consent, the papule was totally excised under local anesthesia. The removed soft tissue specimen was sent for histopathological examination. Microscopically, it showed a fibrotic mass covered by the parakeratotic and acanthotic stratified squamous epithelium with a smooth surface. The main mass was composed of dense fibrous collagenous tissues (Fig. 1A and B). The most characteristic feature was the presence of several mononucleated or multinucleated stellate giant cells in the subepithelial fibrous connective tissue (Fig. 1C and D). The above-mentioned characteristic findings finally confirmed the histopathological diagnosis of a RCP presenting as a giant cell fibroma.1, 2, 3, 4

Figure 1

Histopathological microphotographs of our case of the retrocuspid papilla. (A and B) Low- and medium-power microphotographs showing a fibrotic mass covered by the parakeratotic and acanthotic stratified squamous epithelium with a smooth surface. The main mass was composed of dense fibrous collagenous tissues. (C and D) High-power microphotographs exhibiting a characteristic finding of several mononucleated or multinucleated stellate giant cells in the subepithelial fibrous connective tissue. (Hematoxylin and eosin stain; original magnification; A, 4 × ; B, 10 × ; C, 20 × ; and D, 40 × ).

The RCP is observed more frequently in young children and regresses or disappears with age. It is found in 25% of children under 5 years of age among three groups of Latin American patients (Ecuador, Honduras, and Nicaragua groups). The RCP is present significantly more often among females in the Honduras group. Moreover, a unilateral distribution is more frequent than a bilateral distribution, except for the Nicaragua group, where a bilateral distribution prevails. Furthermore, the RCP is most frequently located on the attached gingiva as compared to free gingiva and mucosa. In another study, the RCP is discovered in 9.1% of 232 adults (age range, 20–63 years). Moreover, 57% of the RCPs are unilateral and 43% are bilateral. Clinically, the RCPs are usually a sessile nodule with or without a papillary surface. On the whole, the RCPs are quite common and have been reported in 25%–99% of children and young adults. The prevalence drops to 6%–19% in older adults. Buchner et al. assessed histomorphologic features of 30 RCPs and found that in most cases (80%) the RCP is composed of loosely-arranged delicate fibrous connective tissue with stellate and multinucleated fibroblasts. These findings indicate that the RCPs are predominantly observed to be a giant cell fibroma microscopically.

The clinical significance of the RCP is that it may simulate pathological gingival conditions from which it must be differentiated. The RCP is considered to be a “normal anatomical structure” or an “anatomic variation” of the gingiva.1, 2, 3, 4 Thus, if the dentist is familial with this lesion and can make a clinical diagnosis with confidence based on its morphology and its specific location, it requires no biopsy and treatment.1, 2, 3, 4

Declaration of competing interest

The authors have no conflicts of interest relevant to this article.