Journal of Dental Sciences 17 (2022) 1056e1057

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Correspondence

Retrocuspid papilla presenting as a giant

cell fibroma

KEYWORDS
Retrocuspid papilla;
Attached gingiva;
Giant cell fibroma

The retrocuspid papilla (RCP) is a soft tissue nodule located
at the lingual attached gingiva of the mandibular cuspid.1e4
Here, we reported a case of RCP at the lingual attached
gingiva of the left mandibular cuspid of a 33-year-old fe-
male 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 mandib-
ular cuspid for an unknown duration. The papule measured
approximately 0.3  0.2  0.2 cm in size. It is asymptom-
atic 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 examina-
tion. 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 pre-
senting as a giant cell fibroma.1e4
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).2 The RCP is present significantly more often among
females in the Honduras group. Moreover, a unilateral dis-
tribution is more frequent than a bilateral distribution,
except for the Nicaragua group, where a bilateral distri-
bution prevails. Furthermore, the RCP is most frequently
located on the attached gingiva as compared to free gingiva
and mucosa.2 In another study, the RCP is discovered in
9.1% of 232 adults (age range, 20e63 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.3 On the whole, the RCPs are quite com-
mon and have been reported in 25%e99% of children and
young adults. The prevalence drops to 6%e19% in older
adults.1 Buchner et al.4 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 simu-
late 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.1e4 Thus, if the dentist is familial with this lesion
and can make a clinical diagnosis with confidence based on

https://doi.org/10.1016/j.jds.2021.12.012
1991-7902/ª 2021 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 Journal of Dental Sciences 17 (2022) 1056e1057

Figure 1 Histopathological microphotographs of our case of the retrocuspid papilla. (A and B) Low- and medium-power micro-
photographs 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  ).

its morphology and its specific location, it requires no bi-
opsy and treatment.1e4
Declaration of competing interest
The authors have no conflicts of interest relevant to this
article.
References
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2. D’Aoust P, Landry R, Ganske R, Carrier J. The prevalence of the
retrocuspid papilla among three indigenous groups of patients.
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Dent 1991;68. 39, 43, 45 passim.
3. Brannon RB, Pousson RR. The retrocuspid papillae: a clinical
evaluation of 51 cases. J Dent Hyg 2003;77:180e4.
4. Buchner A, Merrell PW, Hansen LS, Leider AS. The retrocuspid
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Chia-Yu Li
Po-Tang Lai
Department of Dentistry, Hualien Tzu Chi Hospital,
Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
Yang-Che Wu**
School of Dentistry, College of Oral Medicine, Taipei
Medical University, Taipei, Taiwan
Department of Dentistry, Taipei Medical University-Shuang
Ho Hospital, Ministry of Health and Welfare, New Taipei
City, Taiwan
Chun-Pin Chiang*
Department of Dentistry, Hualien Tzu Chi Hospital,
Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
Department of Dentistry, National Taiwan University
Hospital, College of Medicine, National Taiwan University,
Taipei, Taiwan
Graduate Institute of Oral Biology, School of Dentistry,
National Taiwan University, Taipei, Taiwan
**Corresponding author. School of Dentistry, College of Oral
Medicine, Taipei Medical University, No. 250, Wu-Xing
Street, Taipei 11031, Taiwan.
E-mail address: lmarch19791004@gmail.com (Y.-C. Wu)
*Corresponding author. Department of Dentistry, Hualien
Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.
707, Section 3, Chung-Yang Road, Hualien 970, Taiwan.
E-mail address: cpchiang@ntu.edu.tw (C.-P. Chiang)
Received 9 December 2021
Available online 23 December 2021

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