Diagnóstico e tratamento de granuloma periférico de células gigantes em mandíbula - relato de caso / Diagnosis and treatment of peripheral granuloma of giant cell in the jaw - case report

O granuloma periférico de células gigantes (GPCG) é uma lesão hiperplásica benigna causada por trauma local ou trauma crônico. Origina-se do ligamento periodontal ou mucoperiósteo. O objetivo deste trabalho é apresentar um caso de GPCG em mandíbula tratada com sucesso através de excisão cirúrgica, curetagem e ostectomia periférica.

Peripheral giant cell granuloma (PGCG) is a benign hyperplastic lesion caused by local trauma or chronic trauma. It originates from the periodontal ligament or mucoperiosteum. The objective of this work is to present a case of PGCG in the mandible successfully treated through surgical excision, curettage and peripheral ostectomy.

Granuloma periférico de células gigantes asociado a un implante: informe de un caso clínico con seguimiento a 5 años / Implant-associated peripheral giant cell granuloma: a case report with 5-year follow-up

Objetivo: Presentar la respuesta clínica a largo plazo del tratamiento de un granuloma periférico de células gigantes en un implante oseointegrado en el maxilar inferior. Caso clínico: Un paciente de 60 años, de sexo masculino, sin antecedentes sistémicos, concurrió por una lesión con márgenes definidos, de color rojizo morado y consistencia blanda sobre los tejidos blandos en la cara vestibular de un implante colocado en zona de 46. Se realizó la escisión quirúrgica de la lesión, se procesó el tejido extirpado y se envió al laboratorio. El estudio anatomopatológico confirmó el diagnóstico de granuloma periférico de células gigantes. La lesión recidivó dos veces. En la tercera extirpación se realizó la implantoplastía de la superficie del implante. La cicatrización no presentó inconvenientes. Hasta el último control, a los 5 años, no volvió a haber recidiva. Conclusión: En este caso clínico, se logró mantener la salud periimplantaria durante 5 años luego de la eliminación de un granuloma periférico de células gigantes. No obstante, este tuvo que ser removido en tres oportunidades debido a la alta recidiva (AU)

Aim: To evaluate the long-term clinical response to the treatment of a peripheral giant cell granuloma in an osseointegrated implant in the lower jaw. Clinical case: A 60-year-old male patient, with no systemic medical problems, presented a soft tissue lesion located at the buccal aspect of an implant placed in the 46 area. The lesion had defined reddish-purple margins and soft consistency. Surgical excision of the lesion was performed, processed and sent to the laboratory. The histopathology confirmed the diagnosis of peripheral giant cell granuloma. The lesion recurred twice. During the third surgical removal an mplantoplasty of the implant surface was performed. The healing was uneventful and there was no recurrence until the last control at 5 years. Conclusion: In this clinical case, perimplantar gingival health was maintained for 5 years after the surgical removal of a giant cell peripheral granuloma. However, it had to be removed three times, demonstrating a high recurrence (AU)

Constellation of Oral Inflammatory Hyperplastic Lesions: Case Series with Review of Literature

Oral cavity, when subjected to various forms of chronic insults or microtrauma, often results in a hyperplastic lesion, commonly referred to as inflammatory reactive hyperplasia. This category includes various lesions such as peripheral fibroma, peripheral ossifying/cementifying fibroma, pyogenic granuloma, and peripheral giant cell granuloma. They are primarily seen to develop in close proximity to the source of chronic irritant and have a close resemblance in terms of biological behavior and clinical presentation. Histopathologically, they display a common feature of hyperplastic fibrous tissue, but also have some variations like the presence of giant cells or aggregate of calcified mass depending on the histogenesis of the lesion. They were the most common tumor-like lesions to be seen in the oral cavity, familiarity with these lesions are of utmost importance. The present article portrays a series of 5 cases of different clinical forms of reactive hyperplasia with a brief literature review. The current manuscript is presented with an aim to enhance the knowledge about hyperplastic lesions.

A Case of an Isolated Peripheral Giant Cell Granuloma in the Parotid Gland / 대한두경부종양학회지

Peripheral giant cell granuloma (PGCG) is an benign non-neoplastic lesion most commonly occurring in oral cavity but extraoral PGCG is extremely rare. Recently, we experienced a case of an isolated PGCG in the parotid gland in 59-year-old man. FNAB findings and radiologic findings including CT and US were suggestive of Warthin's tumor. Partial parotidectomy was performed. Pathologic findings showed fibrillar connective tissue stroma with spindled, ovoid, and round histiocytes-like cells mixed with uneven multinuclear giant cells, small capillaries, hemorrhage, hemosiderin-laden macrophages, and necrosis which were consistent with giant cell granuloma. We report a case of an PGCG in parotid with a review of literature.

Peripheral giant cell granuloma manifestation in pregnancy

The peripheral giant cell granuloma (PGCG) is a benign oral lesion occurring on the gingiva and alveolar ridge. It is the most common oral lesion and occurs at an average age of 30 years. The upsurge in the levels of estrogen and progesterone in pregnancy leads to a plethora of changes in various parts of human body, including the oral cavity. In the oral cavity, changes are commonly seen on the gingiva. These include pyogenic granuloma, PGCG and also peripheral ossifying fibroma, etc., The etiology of PGCG in our case might be related to hormonal alterations during the gestation period.

Evaluation of the osteopontin in oral peripheral and central giant cell granuloma

Aim: Peripheral giant cell granuloma (PGCG) and central giant cell granuloma (CGCG) of the jaws are benign proliferations of spindle-shaped mesenchymal cells and multinucleated giant cells. Despite the histopathologic similarities, they have markedly different clinical behavior. PGCG shows low recurrence rate whereas CGCG shows a variable clinical behavior ranging from nonaggressive lesions to aggressive lesions characterizing by pain, rapid growth, and high recurrence rate. Therefore, the aim of the study was to compare CGCG with PGCG by immunohistochemistry using Ki-67, osteopontin (OPN), and integrin ?vantibodies. Subjects and Methods: Twenty PGCG and 20 CGCG were selected for immunohistochemical evaluation of OPN, integrin ?v, and Ki-67 in multinucleated giant cells and mononucleated cells of PGCG and CGCG. Results: PGCG showed higher Ki-67 immunoreactivity in mononucleated cells compared to CGCG (P < 0.05). There was no reactivity with Ki-67 in multinucleated giant cells of both groups. Mononucleated cells in CGCGs demonstrated increased OPN and integrin ?vexpressions in comparison with PGCGs (P < 0.05). Conclusions: The clinic behavior of CGCG being more aggressive than PGCG might be explained by the high expression of OPN and integrin ?v. Further studies are necessary to evaluate the other OPN receptors and their role on the biologic behavior of these lesions.

Reactive hyperplastic lesions of the oral cavity: A retrospective survey study and literature review

The reactive lesions are relatively common in the oral cavity because of the frequency with which the tissues are injured. They often result from a known stimulus or injury such as dental plaque, calculus, or foreign material. Aims: The aim of this study was to review the clinicopathologic features of reactive hyperplastic lesions (RHLs) of the oral cavity at MIDSR, Dental College and Hospital, Latur, Maharashtra, and to compare these data with those of previously reported studies. Settings and Design: The patient case files from the Department of Oral and Maxillofacial Pathology from June 2010 to May 2016 were reviewed for cases of RHLs of the oral cavity. Subjects and Methods: Both clinical and histopathological diagnosis of reactive lesions was selected for the study. Data including the type of the lesion, age, gender, and the site involved were collected. Statistical Analysis Used: Descriptive statistics was applied to the data and differences in frequencies among groups were evaluated using SPSS (IBM Corporation) software. Results: A total of 155 histologically diagnosed cases of RHLs were obtained with a prevalence of 11.7%. The data consist of 56 (36.1%) males and 99 (63.9%) females. The most common lesion clinically was traumatic fibroma (36.5%) and histologically fibrous hyperplasia (37.4%). The reactive lesions clinically presented as either sessile (51%) or pedunculated (49%) lesions. Conclusions: The clinical features of reactive hyperplasia among our patients were similar to those reported previously with divergence in some analyzed data. The novelty in our study was the correlation between histopathology and clinical features which were not reported in literature till date.

Granuloma periférico de células gigantes: revisión de 87 casos / Peripheral giant-cell granuloma: a review of 87 cases

El granuloma periférico de células gigantes (GPCG) es una hiperplasiareactiva que se presenta sólo en la encía como respuesta a una irritación local o trauma crónico, sin predilección de género y edad variable. Objetivo: Identifi car las características demográfi cas e histopatológicas de 87 casos de GPCG en un servicio privado de patología bucal. Metodología: Se obtuvieron los datos de edad, género y diagnóstico clínico de 87 casos de GPCG. Se analizó la distribución por género y edad. Los cortes histológicos fueron examinados para confirmar el diagnóstico en 84 casos, ya que tres no presentaron las características del GPCG. Las características histopatológicas que se evaluaron fueron la presencia de estroma hipercelular, infi ltrado infl amatorio crónico, hemorragia, hemosiderina, tejidos mineralizados y úlcera. Resultados: De los 87 casos, tres fueron descartados por no corresponder al diagnóstico. En un periodo de 10 años se recibieron 6,696 biopsias, de las cuales 84 (1.2 por ciento) correspondieron a GPCG. Se presentó en un rango de edad de cinco a 90 años, con una media de edad de 42 años (± 19.9), siendomás frecuente en la quinta década de la vida y mostró predilección por el género femenino (58.5 por ciento). En los cortes histológicos se observó un estroma hipercelular con células de forma ovoide o fusiforme y células gigantes multinucleadas tipo osteoclasto, infi ltrado inflamatorio(66 por ciento), hemorragia (85 por ciento), hemosiderina (20 por ciento), tejidos mineralizados (11.9 por ciento) y úlcera (25 por ciento). Conclusión: El GPCG es una lesión exofítica reactiva de la encía que presenta características demográficas variables y que al examen microscópico se distingue por tener células gigantes multinucleadas tipo osteoclasto, además de otros componentes como tejidos mineralizados.

The peripheral giant-cell granuloma (PGCG) is a reactive hyperplasiathat occurs only in the gum, in response to local irritation orchronic trauma, with no predilection for either age or sex. Objective:To identify the demographic and histopathological characteristics of87 cases of PGCG in a private oral pathology service. Methodology:Data on the age, gender, and clinical diagnosis of 87 cases of PGCGwere obtained, which were analyzed to determine the distributionby sex and age. Histological sections were examined to confirm thediagnosis in 84 of the cases (three did not present any characteristicsof PGCG). The histopathologic features were evaluated for the presence of hypercellular stroma, chronic infl ammatory infi ltrate,hemorrhaging, hemosiderin, mineralized tissues, and ulcers. Results: of the 87 cases, 3 were eliminated as they did not match the requireddiagnosis. Over a 10-year period, 6,696 biopsies were received bythe pathology service, of which 84 (1.2%) were of PGCG. This was presented in patients ranging from 5 to 90 years old, the mean agebeing 42 years (± 19.9); it occurred most frequently in the 5th decadeof life and showed a predilection for females (58.5%). In the histologicsections, a hypercellular stroma with ovoid or fusiform cellsand multinucleated osteoclast-like giant cells was observed, as wellas infl ammatory infi ltrate (66%), hemorrhaging (85%), hemosiderin(20%), mineralized tissues (11.9%), and ulcers (25%). Conclusion:The PGCG is a reactive exophytic lesion of the gingiva that presentsvariable demographic features and which, under microscopic examination, is distinguished by multinucleated osteoclast-like giant cells, and other components as mineralized tissues.

Reactive Lesions Of Oral Cavity.

Oral mucosa is subjected constantly to external and internal stimuli that can give rise to reactive lesions. These lesions are non- neoplastic in nature. They manifest a spectrum of diseases that range from developmental, inflammatory, and reactive to neoplastic changes. Reactive lesions are typically gives response to chronic inflammation caused by various forms of low grade chronic irritations to the oral mucosa such as dental plaque and calculus, sharp edges of grossly carious teeth, faulty dental restorations, chronic biting habits, ill-fitting dental/oral appliances and food impactions. These lesions have a very similar appearance to benign neoplastic proliferations. This similarity is troublesome in differential diagnosis among them. Different types of localized reactive lesions of oral cavity are focal fibrous hyperplasia (FFH), pyogenic granuloma (PG), irritational fibroma, peripheral giant cell granuloma (PGCG), peripheral ossifying fibroma (POF), fibro-epithelial hyperplasia/polyp, inflammatory fibrous hyperplasia, and inflammatory gingival hyperplasia.

Rare Case of Peripheral Ossifying Fibroma in Maxillary Anterior Region: A Clinical Experience.

Peripheral ossifying fibroma (POF) is rare pathology and its appearance in maxillary anterior is very rare. It occurs due to irritants such as trauma, microorganisms, plaque, calculus, restorations, and dental appliances. It is also called by other names like epulis, peripheral fibroma with calcification, POF, calcifying fibroblastic granuloma, peripheral cementifying fibroma, peripheral fibroma with cementogenesis, and peripheral cemento-ossifying fibroma. POF may present as a pedunculated swelling, or it may have a broad attachment base. The lesion is usually red to pink with areas of ulceration, and their surface may be smooth or irregular. We are presenting one case of POF in the maxillary anterior region.

Recurrent Peripheral Giant Cell Granuloma: A Case Report.

Abstract: Peripheral Giant Cell Granuloma is a non-neoplastic, tumor-like, reactive lesion occurring exclusively on gingiva/alveolar crest. It is thought to arise from the periodontal ligament or periosteum. Clinically, it bears resemblance to pyogenic granuloma, peripheral ossifying fibroma and many other peripheral soft tissue lesions seen in the oral cavity, thereby making histopathology mandatory for the diagnosis of this lesion. The lesion although being relatively common still carries a lot of ambiguity. The ambiguity is in terms of its etiology, growth potential, biological behavior (recurrence), histogenesis of its cells as well as its treatment. The entity further holds significance because of its notorious behavior and its high tendency to recur. The present paper describes a case report on recurrent peripheral giant cell granuloma with a comprehensive insight of the literature on its clinical and histological aspects. Special attention has been given on the histogenesis of its cells and treatment of this lesion.

Presentación de una paciente con granuloma periférico de células gigantes / Presentation of a Patient with Peripheral Giant Cell Granuloma

Se presentó una paciente femenina de 37 años de edad, sin antecedentes generales de interés, con hábito de onicofagia desde la niñez, que presentaba aumento de volumen localizado en la papila interdentaria entre incisivo lateral y canino maxilar derecho, de aproximadamente dos años de evolución, que le ocasionaba molestias y sangramiento durante el cepillado dentogingival. La lesión se presentó con aspecto de una pieza dentaria, de coloración rosa a rojo, superficie lisa, base sésil, no doloroso a la palpación, rebasaba el borde incisal, sin interferir con la oclusión y sobrepasaba el ancho vestíbulo lingual de los dientes contiguos en aproximadamente dos milímetros. Radiográficamente se observó reabsorción superficial de la cresta del tabique interdentario entre ambos dientes y espaciamiento del trabeculado óseo. Se realizó la escisión quirúrgica y posterior examen anatomopatológico, el cual confirmó la presencia de granuloma periférico gigante celular completamente resecado, lo cual corroboró el diagnóstico presuntivo. Se apreció una satisfactoria evolución postquirúrgica.

A female patient of 37 years old with no history of general interest, nail biting habit from childhood, which had increased volume within the interdental papilla between lateral incisor and maxillary right canine about two years of evolution was presented, which caused discomfort and bleeding during dentogingival brushing. The lesion appeared with appearance of a tooth, pink color to red, smooth, sessile base, not painful on palpation, exceeded the incisal margin, without interfering with the occlusion and surpassing the broad lingual hall of the contiguous teeth in approximately two millimeters. The radiographic exam evidenced superficial reabsorption of the crest of the interdental partition between both teeth and bone-like spacing of the trabeculate. The lesion was eliminated by surgical excision. The histologic test confirmed the presence of peripheral giant cell granuloma completely eliminated. A satisfactory post-surgical evolution was observed.

Peripheral giant cell granuloma: a case report

Peripheral giant cell granuloma (PGCG) is a non neoplastic reactive lesion of the gingiva, originating from the periosteum or periodontal membrane following local irritation or chronic trauma. PGCG manifests as a red-purple growth located in the gingiva or edentulous alveolar margins. The lesion can develop at any age, shows a slight female predilection. Usually, they cause one or the other problem in eruption or alignment of teeth, but may also present without disturbing the normal occlusion or eruption pattern. Management of these teeth depends on the symptoms. Presented here is a case of PGCG in relation to the lower right first premolar in a 10 year old child.

Peripheral Giant Cell Granuloma: A Case Report and Review of Literature.

Peripheral Giant Cell Granuloma or so called “Giant cell epulis” is the most common oral giant cell lesion.It usually presents as a purplish-red soft tissue nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells. This lesion probably does not represent a true neoplasm but it may be a reactive in nature which is believed to be stimulated by local irritation or trauma, but the cause is not known with certainty. A case of peripheral giant cell granuloma arising at the left maxillary premolar region in a 18 year old boy is being reported here. The lesion was completely excised upto the periosteum level; there was no residual or recurrence of swelling or bony defect apparent in the area of biopsy after a follow-up period of 1 year.

Granuloma periférico de células gigantes: reporte de un caso / Peripheral giant cells granuloma: a clinical case report

El granuloma periférico de células gigantes (GPCG) es una lesión pseudotumoral exofítica poco frecuente en cavidad oral, localizado principalmente en el maxilar inferior en zona de premolares y molares, sangrante y de crecimiento rápido, asociado a factores irritativos o agresión (extracción, traumatismo, placa, sarro, obturación desbordante, infección crónica, impactación alimentaria, etc.). Su tratamiento es la excisión quirúrgica, retirando los factores irritativos. Dentro de sus diagnósticos diferenciales se encuentran el tumor pardo del hiperparatiroidismo, el querubismo y el quiste óseo aneurismático, que tienen el mismo patrón histológico del granuloma periférico de células gigantes. Se reporta caso clínico de paciente femenino de 52 años de edad que acudió a consulta odontológica en la Facultad de Odontología de la Universidad de Cartagena, por presentar una lesión tumoral ubicada en encía vestibular y lingual zona de anteroinferiores asociada con abundante placa bacteriana y cálculos subgingivales. Se le realizó la escisión quirúrgica de la lesión, exodoncia de los dientes involucrados por la marcada pérdida ósea, curetaje y se envió a patología donde se confirmó diagnóstico de granuloma periférico de células gigantes.

The peripheral giant cell granuloma (PGCG) is a pseudotumoral exophytic lesion, very rare in oral cavity, it is primarily located in the premolar and molar area of the mandible, it usually presents bleeding and rapid growth, also, is associated with aggression or irritating factors (extraction, trauma, plaque, tartar, faulty restorations, chronic infection, food impaction, among others). Its treatment consists of surgical excision, removing the irritating factors. Within its differential diagnosis are the hyperparathyroidism brown tumor, cherubism and aneurysmal bone cyst, which have the same histological pattern as the peripheral giant cell granuloma. This is a description of a clinical case of a female patient, age 52 who attended the College of Dentistry of the University of Cartagena because she presented a tumor located in the vestibular and lingual gingival area of anterior and lower zone associated with abundant bacterial plaque and subgingival calculus. The surgeon made the surgical excision of the lesion, extraction of teeth affected by the marked bone loss, and curettage. The sample was sent to the pathology lab which confirmed the diagnosis of peripheral giant cell granuloma.

Lesão periférica de células gigantes: relato de caso / Peripheral lesion in giant cells

A lesão periférica de células gigantes é um processo proliferativo não neoplásico. Considerada uma lesão reacional, parece ter origem no periósteo ou ligamento periodontal, relacionada a trauma, irritação local e mais recentemente aos implantes dentais. Neste trabalho apresentamos as principais características clínicas, radiográficas e microscópicas da lesão fundamentados em recente revisão de literatura.

Peripheral giant cell granuloma is a non-neoplasic tumorous proliferationthat occurs in all age groups, and this condition can be more aggressive in child. The etiological factors it is not exactly known, althogh local irritating factors, trauma, and actually dentalimplants are related. There is a high predilection for the mandible anda slight one for women. After surgical treatment the tissue must besubmitted for histopathological evaluation to a correct diagnosis.