Rare nonsyndromic recurrent solitary gingival neurofibroma in an older adult

Background

Neurofibromas are benign peripheral nerve sheath tumors usually featured with neurofibromatosis type 1 syndrome. Recurrent gingival neurofibromas have been rarely reported in the periodontal literature, particularly affecting elderly patients.

Methods and Results

A 70-year-old man with a pale, rubbery, and painless thickening along the facial/buccal gingiva of the mandibular right canine and first premolar. Ten years prior, the patient had undergone excision of a neurofibroma within the same region. The patient denied a history of cutaneous disease or neurofibromatosis. Histopathologic and immunostaining of the excised lesion confirmed the diagnosis as a recurrent gingival neurofibroma.

Conclusions

With cases of suspected recurrent neurofibroma, attending practitioners should consult with an oral pathologist whether the primary lesion had exhibited tumor cells to the surgical specimen margin. Preoperative use of a cone beam computed tomography scan may enhance determination of tumor depth. Clinicians should also carefully weigh the decision for conservative excision of gingival neurofibromas and greater risk of recurrence versus performing a somewhat wider extirpation and possible formation of a mucogingival defect.

Key points

What are important clinical considerations when performing a gingival biopsy?

• Gingival neurofibromas may be associated with an increased risk for recurrence owing to decisions for tissue-sparing excision and prevention of a mucogingival defect; supplemental use of cone beam computed tomographic scans may provide greater appreciation of tumor depth.

What is a reasonable length of time of postoperative assessment for gingival neurofibromas?

• Patients who have undergone surgical removal of a gingival neurofibroma should undergo yearly surveillance for at least 10 years.

What is a key limitation to this case study?

• Preoperatively, attending clinicians should consult with an oral pathologist to ascertain whether a primary lesion had manifested tumor cells to the surgical margin. Conservative gingival resection of a neurofibroma may promote recurrence.