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

Table 1

Illustrating comparison between giant cell fibroma, irritation fibroma, retrocuspid papilla, and papilloma.

	Giant cell fibroma	Irritation fibroma	Retrocuspid papilla	Papilloma
Etiology	Unknown	Chronic irritation	Developmental	Human papilloma virus
Age	1st–3rd decade	4th–6th decade	Children and young adult	30–50 years
Sex	Slight female predilection	Slight male predilection	Female predilection	Equal sex distribution
Common site	Gingiva, tongue	Buccal, labial, and tongue mucosa	lingual gingiva adjacent to mandibular cuspids. Frequently bilateral	Tongue, lips, and soft palate
Histopathology	Moderate to dense fibrous connective tissue stroma containing numerous giant cells, concentrated mostly beneath the epithelium; giant cells are stellate fibroblasts with enlarged nuclei and few containing multiple nuclei; surface epithelium typically has very elongated, thin rete processes	Dense, minimally cellular stroma of collagen fibers; stromal cells are bipolar fibroblasts with plump nuclei and fibrocytes with thin, elongated nuclei with minimal cytoplasm; surface epithelium is usually atrophic and may show signs of continued trauma	Connective tissue stroma may exhibit large stellate fibroblasts and occasional epithelial rests.	Keratinized stratified squamous epithelium arrayed in finger-like projections with thin fibrovascular connective tissue cores; koilocytes (virus altered epithelial cells) are sometimes seen high in the prickle cell layer