Oral Neurofibroma: An Integrative Retrospective Analysis of Clinicopathological Data

BACKGROUND: Neurofibromas are benign proliferations of Schwann cells, perineural cells, and endoneural fibroblasts. They are uncommon peripheral nerve sheath tumors that display a broad spectrum of histopathologic features. OBJECTIVES: To evaluate the clinical and histopathologic features of oral neurofibromas (ONs) diagnosed in the Oral Pathology Laboratory, College of Dentistry, the University of Baghdad (Baghdad, Iraq). STUDY DESIGN: A retrospective clinicopathologic study of ONs was performed (2010-2025). All cases were revised by 2 previously trained oral pathologists using light microscopy, and clinicopathologic data were collected. RESULTS: Demographic analysis revealed a high frequency of females (59.0%), with a mean age of 40.5 years. Four patients had NF-1 (n=4, 6.6%). The predominant clinical presentation consisted of asymptomatic masses, most frequently involving the gingiva (16.4%), buccal mucosa (14.8%), and palate (14.8%). Microscopically, the conventional neurofibroma subtype was most prevalent (65.6%), and the stroma was predominantly collagenous (62.3%), with significant mast cell infiltration (83.6%). Tumor size ranged from 0.4 to 8.0 cm, with lesions larger than 3.0 cm observed only in plexiform variants or recurrent tumors. The overall recurrence rate was 9.7%, mainly attributed to infiltrative growth patterns, including plexiform and diffuse morphologies. CONCLUSION: Oral neurofibromas are clinicopathologically heterogeneous. These neoplasms may occur as single or multiple lesions, with or without an association with neurofibromatosis type 1. Furthermore, the presence of mast cells and stromal maturation patterns is critical for accurate diagnosis. Neoplasms larger than 3 cm, or those with plexiform or diffuse growth patterns, should raise clinical suspicion for underlying syndromes.