Case of Peripheral Cemento-ossifying Fibroma Mimicking Pyogenic Granuloma: A Diagnostic Challenge

Peripheral Cemento-ossifying Fibroma (PCOF) is a relatively common reactive gingival lesion that originates from the periodontal ligament. It often presents as a firm, nodular gingival overgrowth and is frequently misdiagnosed due to its clinical similarity to other benign lesions such as Pyogenic Granuloma (PG) and Peripheral Giant Cell Granuloma (PGCC). This case report highlights a diagnostic challenge in identifying PCOF in a 51-year-old female patient who presented with a slowly enlarging gingival growth in the maxillary anterior region. The lesion was reddish-pink, pedunculated, and measured 8×8 mm. It bleeds on slight provocation and clinically resembled a PG. Radiographic evaluation showed no alveolar bone involvement. A provisional diagnosis of PG was made, with differential diagnoses including fibrous hyperplasia, PGCC, and PCOF. The lesion was surgically excised using internal bevel gingivectomy, and the excised tissue was sent for histopathological examination. Microscopic analysis confirmed the diagnosis of PCOF, revealing Parakeratinised stratified squamous epithelium with ulceration, cellular fibrous stroma, bony trabeculae, and cementum-like calcifications. Postoperative healing was uneventful, and no recurrence was observed at 3-month follow-up. This case underscores the importance of histopathological evaluation in distinguishing PCOF from clinically similar lesions. Given the potential for recurrence, complete excision and regular follow-up are essential. Accurate diagnosis not only aids in appropriate management but also ensures optimal functional and aesthetic outcomes for the patient.