A case of large fibrous epulis with difficult diagnosis

Epulis is a clinical term for a hyperplastic lesion of the gingiva. We describe a case of a 71-year-old male who was finally diagnosed as fibrous epulis. The tumorous lesion was huge (6×3×3.5cm), and showed fast papillary growth with ulceration. We therefore suspected the lesion as a malignant tumor, especially a verrucous carcinoma, although biopsied specimens showed no malignancy. The lesion was surgically excised along with an upper margin of mandible, and the defect was reconstructed with a free rectus abdominis musculocutaneous flap. Histopathological examination of the specimen revealed proliferation of fibrous tissue and no malignancy, which led to the diagnosis as fibrous epulis. It was suggested that an epulis often shows a variety of clinical and histopathological characteristics, and is therefore sometimes difficult to diagnose.