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Epulides 307

• Giant cell granuloma has also been called HISTORY, CHIEF COMPLAINT (intraosseous/central ameloblastoma) or
giant cell tumor or giant cell epulis. replaces • Gingival mass noticed by owner or at routine epithelial rests of Serres in gingival con-
ameloblastoma
VetBooks.ir the terms acanthomatous epulis and • Clinical complaints mostly absent with ameloblastoma) Diseases and Disorders
• Acanthomatous
oral examination
nective tissue (extraosseous/peripheral
adamantinoma.
peripheral odontogenic fibromas; dysphagia,
Epidemiology increased salivation, bloody oral discharge, DIAGNOSIS
and halitosis occasionally reported with
SPECIES, AGE, SEX giant cell granulomas and acanthomatous Diagnostic Overview
Dogs: ameloblastomas Diagnosis requires staging, including oral exami-
• Prevalence: common (except giant cell nation under anesthesia, thoracic radiographs,
granuloma, which is rare) PHYSICAL EXAM FINDINGS regional diagnostic imaging (dental radiographs,
• Distribution: peripheral odontogenic fibroma • Peripheral odontogenic fibroma computed tomography), lymph node palpa-
≈80%, acanthomatous ameloblastoma ≈18%, ○ Firm, rarely ulcerated gingival mass that tion and aspiration, and biopsy of the gingival
and giant cell granuloma ≈2% measures 0.5-3 cm in diameter mass.
• Breed: acanthomatous ameloblastoma more ○ Located near canine, premolar, and molar
commonly diagnosed in Shetland sheepdogs teeth (less commonly in the incisor tooth Differential Diagnosis
• Age: unknown for giant cell granuloma; area) and variably fixed to the gum line Dogs:
dogs with peripheral odontogenic fibroma ○ Covered by oral epithelium; ulceration • Gingival hyperplasia (often generalized)
usually > 5 years old; dogs with acantho- infrequent • Pyogenic granuloma (uncommon; usually
matous ameloblastoma usually > 7 years • Giant cell granuloma developing on gingiva/alveolar mucosa
old (but can affect dogs as young as 1 year ○ Soft, reddish purple caudobuccal to the mandibular first molar
of age) ○ Ulcerated and inflamed in cats)
• Sex: conflicting results; female dogs more • Acanthomatous ameloblastoma • Dentigerous cyst (around crown of an
often affected than males with acanthoma- ○ Cauliflower-like, red, ulcerated, easily unerupted tooth)
tous ameloblastoma, male dogs more often bleeding gingival mass that measures • Odontoma (not a neoplastic lesion, but a
affected than females with peripheral odon- 0.5-10 cm in diameter hamartoma, which is an accumulation of
togenic fibroma and giant cell granuloma ○ Most commonly located in the rostral normal cells in an abnormal manner)
Cats: lower jaw near incisor and canine teeth; • Viral papillomatosis (usually in puppies or
• Prevalence: uncommon less often in the rostral upper jaw (incisor immunocompromised adults)
• Distribution: peripheral odontogenic fibroma and canine tooth area), caudal lower jaw • Plasmacytoma (usually solitary, pink-red,
≈63%, giant cell granuloma ≈29%, and (near first molar), and caudal upper jaw well circumscribed)
acanthomatous ameloblastoma ≈8% (near fourth premolar) • Osteoma (slow-growing)
• Breed: no predisposition reported • Malignant melanoma (most common
• Age: cats with single peripheral odontogenic Etiology and Pathophysiology malignant oral tumor)
fibroma and giant cell granuloma usually • Peripheral odontogenic fibroma • Squamous cell carcinoma (second most
> 7 years old; acanthomatous ameloblastoma ○ Mixed or mesenchymal (depending on common oral malignant tumor)
and multiple feline epulides particularly in literature studied) odontogenic tumor • Fibrosarcoma (third most common malignant
young-adult cats ○ Arising from cells in the periodontal tumor)
• Sex: no predisposition reported ligament • Peripheral nerve sheath tumor (along major
• Giant cell granuloma: considered to be a nerves)
ASSOCIATED DISORDERS variant of the peripheral odontogenic fibroma • Osteosarcoma (usually osteolytic type;
Oral tumors, benign (p. 711). Hypercalcemia in which extensive ulceration and inflamma- variant: multilobular tumor of bone)
of malignancy has been reported in some dogs tion result in strongly increased osteoclastic • Lymphoma (also look for lesions on skin
with acanthomatous ameloblastomas (increased activity, but the real origin remains unknown around mouth and nasal plane, bilateral
serum concentrations of ionized calcium, total • Acanthomatous ameloblastoma enlargement of tonsils and regional lymph
calcium, and parathyroid hormone–related ○ Epithelial odontogenic tumor nodes)
peptide). ○ Debatable whether arising from epithelial • Amyloid-producing odontogenic tumor
rests of Malassez in periodontal ligament (rare)
Clinical Presentation
DISEASE FORMS/SUBTYPES
• Peripheral odontogenic fibroma
○ Slow growth; gingiva-like
○ Fibroblast is main component in mass
○ Slow recurrence after incomplete excision
○ Multiple feline epulides may not originate
from the periodontal ligament but may
represent reactive lesions arising from the *
periosteum.
• Giant cell granuloma *
○ Rapid growth; inflammatory and ulcerative
changes
○ Multinucleated giant cell is main com- A B
ponent in mass; osteoid and woven bone
formation EPULIDES A, Rostral upper jaw in a dog with peripheral odontogenic fibroma. Note smooth-surfaced and
○ Rapid recurrence after incomplete excision minimally ulcerated/inflamed gingival mass associated with palatally displaced right maxillary second incisor
(asterisk). B, Dental radiograph of rostral upper jaw in same patient (radiograph arranged in labial mounting;
• Acanthomatous ameloblastoma rostral toward bottom of image, and patient’s right side is on left of image). Note displaced right maxillary
○ Rapid growth; cauliflower-like second incisor (asterisk) and hard tissue (arrow) within tumor’s soft-tissue shadow. (Copyright Dr. Alexander
○ Basal cell is main component in mass M. Reiter, University of Pennsylvania.)

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