Spongiotic gingival hyperplasia: a systematic review of histopathologic features

Objectives Spongiotic gingival hyperplasia (SGH) is a rare inflammatory gingival condition that exhibits characteristic histopathologic features. The aim of this study was to systematically summarize the reported histopathologic features of SGH. Study design A systematic review of SGH literature following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement was performed. PubMed, Wiley, and Web of Science were searched for publications of biopsy-proven SGH cases. Results In total, 25 articles were included (289 patients). SGH occurred mostly in the first two decades with equal sex distribution. Multifocal lesions were reported in 13.5% of patients. A predilection for the maxillary anterior gingiva was noted. The majority of lesions were covered by non-keratinized epithelium (73.6%). Acanthosis/hyperplasia was noted in 88.4% of cases, and neutrophilic transmigration was noted 62.0% of cases. Highly vascular lamina propria was a common feature. Moreover, 99% of cases stained for cytokeratin 19 demonstrated positivity throughout the full epithelial thickness. Excision was the most common treatment, and the majority of cases resolved. Conclusions SGH is a reactive gingival pathology that primarily occurs in adolescents. The histopathologic features of SGH consistently reported were hyperplastic non-keratinized stratified squamous epithelium with spongiosis and prominent vascular stroma. Surgical excision was curative in the majority of cases. Systematic Review Registration PROSPERO CRD420251170524.