Diagnosis of a case of ligneous gingivitis in a patient with moderate plasminogen deficiency

Ligneous Gingivitis: A Systematic Review

“…Searches identified a total 59 papers, and after final analysis according to the inclusion criteria 27 papers were acceptable (Figure 1). There were 21 case reports [10,[14][15][16][17][18][19][20][21]23,24,26,27,[30][31][32][33][38][39][40][41], and six were case series [1,2,8,9,34,35] Case report 1 3a Turkey Pierro VS 17 Case report 1 3a Brazil Suresh L 39 Case report 1 3a USA Günhan O 9 Case series 3 3a Turkey Gokbuget AY 1 Case series 5 3b Turkey Fine G 16 Case report 1 3a USA Baykul T 27 Case report 1 4 Turkey Chi AC 14 Case…”

“…Histopathologically, sub-epithelial fibrin deposition was the most common histological description with 23.7% cases [15,16,19,21,26,31,32,35,40], interestingly only described in females, followed by epithelial disorganization and amyloid like material, and acute and chronic inflammation [9,10,14,20,23,31] seen in both sexes with 18.4% (n=7) of cases; this is an important fact to mention, according to Günhan Ö et al in 2012, there are histological early and late changes of ligneous disease, where PMN exudation, immunoreactivity to fibrinogen, keratin positivity and amorphous accumulation, occurs at early stage principally, and sub-epithelial amorphous accumulation occurs at late stage with chronic inflammation cells [13] (Figure 2). This is key to allow accuracy in the diagnosis, where the differentiation between amyloid and other proteins like fibrin, with a similar histologic appearance [29], could be excluded with a Congo red positively for amyloid and using special stains such as Fibrin and MSB to confirm fibrin deposition, which in this study was found in 22.4% of the cases [1,9,10,38].…”

“…For differential diagnosis, this study found only 7 studies describing other possible presumptive diagnoses. These included necrotizing ulcerative periodontal disease, desquamative gingivitis [18,20,40], hormonal hyperplasia [39]. Systemic causes linked to medication and hematologic malignancies like leukemia producing gingival enlargement must also be considered in the differential diagnosis [1].…”