Rapidly progressive angiomatous epulis: How to differentiate a benign gingival lesion from malignancy?

Abstract

Angiomatous epulis, also known as vascular epulis or gingival pyogenic granuloma, is a benign reactive gingival lesion characterized by marked capillary proliferation. It typically develops in response to chronic local irritation, trauma, inflammatory stimuli, or hormonal influences. Clinically, it presents as a rapidly growing erythematous to violaceous gingival mass with a marked tendency to bleed, which may mimic malignant gingival tumors and raise diagnostic concern. Although the diagnosis is primarily based on clinicopathological correlation, imaging plays an important complementary role. Radiological evaluation, particularly computed tomography (CT), is useful to assess lesion extent, confirm its superficial localization, and exclude aggressive features such as bone erosion or deep tissue invasion. Imaging also contributes to the differential diagnosis by helping distinguish angiomatous epulis from other gingival lesions, including peripheral giant cell granuloma, peripheral ossifying fibroma, vascular malformations, and malignant tumors. We report the case of a 15-year-old patient presenting with a rapidly progressive gingival mass evolving over two months. Periapical radiography demonstrated preserved alveolar bone architecture, while CT imaging confirmed a well-circumscribed soft-tissue lesion confined to the gingiva, without cortical bone destruction, periodontal ligament alteration, or extension to adjacent structures. Given the rapid growth and bleeding tendency, imaging was essential to exclude malignancy and guide management. Complete surgical excision was performed, and histopathological examination confirmed the diagnosis of angiomatous epulis. This case highlights the added value of imaging in the diagnostic workup of vascular gingival lesions, particularly in differentiating benign entities from malignant conditions and in supporting appropriate therapeutic decision-making.