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The Case of the Hemorrhagic Gingival Mass
DIAGNOSTIC INFORMATION

Case Author(s): Brad W. Neville, DDS; Tariq Javed, DMD, MSD, MS

Clinical Findings

Clinical examination revealed a non-tender, bright-red pedunculated mass which arose from the buccal interdental papilla between teeth #19 and #20. (Figure 1) The mass tended to bleed easily upon manipulation. Generalized marginal gingivitis was seen throughout the mouth.

buccal view of gingival mass
Figure 1. Buccal view of lesion.

Bitewing Radiograph

A bitewing radiograph revealed slight bone loss at the crest of the alveolar bone between #19 and #20. (Figure 2) However, no obvious intrabony lesion was observed.

bitewing xray showing slight bone loss
Figure 2. Bitewing radiograph showing only slight alveolar bone bone loss between #19 and #20.
Figure 2. Bitewing radiograph showing only slight alveolar bone bone loss between #19 and #20.
image showing photomicrograph of tissue
Figure 3. Low-power photomicrograph showing a mass of highly vascular granulation tissue. The epithelial surface is ulcerated and replaced by a fibrinopurulent membrane.
This tissue was characterized by numerous capillaries which were engorged with red blood cells. (Figure 4)
image showing photomicrograph of blood vessels
Figure 4. Medium-power photomicrograph showing dilated blood vessels engorged with red blood cells.
There was an associated mixed inflammatory infiltrate which included polymorphonuclear leukocytes, lymphocytes, and plasma cells. (Figure 5)
image showing photomicrograph of capillaries
Figure 5. High-power photomicrograph showing capillaries with adjacent polymorphonuclear leukocytes, lymphocytes and plasma cells.
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