ArticleInternational journal of surgery case reports2026
Peripheral ossifying fibroma mimicking oral Kaposi's sarcoma in an immunosuppressed patient with Behçet's disease: a case report.
Article in International journal of surgery case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction and importance: Kaposi's sarcoma (KS) is an HHV-8-associated angioproliferative neoplasm occurring preferentially in immunosuppressed individuals, with oral involvement documented in up to 65% of HIV/AIDS patients. Several benign reactive gingival lesions, including peripheral ossifying fibroma (POF), may clinically mimic oral KS, creating a significant diagnostic challenge. In patients with established systemic KS, newly detected oral lesions carry a high risk of diagnostic anchoring bias, making HHV-8 (LANA-1) immunohistochemistry indispensable for definitive diagnosis. Presentation of case: A 57-year-old male with Behçet's disease under long-term corticosteroid therapy (15 mg/day) and histologically confirmed cutaneous KS was referred for a painless gingival nodule evolving over 6 years. Intraoral examination revealed a well-demarcated, firm, pink, non-bleeding nodular lesion on the lingual mandibular gingiva, without bone involvement on panoramic radiography. The atypical clinical presentation prompted complete surgical excision under local anesthesia. Histopathology demonstrated a benign fibrocellular proliferation with focal mineralized deposits consistent with POF. HHV-8 LANA-1 immunohistochemistry, performed on the Autostainer Link 48 DAKO platform using the EnVision K5007 system, showed absent HHV-8 expression, definitively excluding oral KS. Healing was uneventful with no recurrence at 6 months. Clinical discussion: The coexistence of systemic KS and iatrogenic immunosuppression introduced a powerful cognitive prior - diagnostic anchoring bias - directing clinical reasoning toward mucosal KS despite four atypical features: pink coloration, firm consistency, absence of spontaneous bleeding, and 6-year indolent evolution. Negative HHV-8 immunostaining was decisive, confirming that oral lesions in KS patients are not necessarily mucosal disease. This case reinforces the principle that histopathological and immunohistochemical analysis must systematically override clinical gestalt in this setting. Conclusion: Early biopsy combined with HHV-8 (LANA-1) immunohistochemistry is essential when evaluating oral nodular lesions in immunosuppressed patients with established KS, to prevent diagnostic anchoring bias and avoid unnecessary oncologic investigations.
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