Diagnostic delay due to COVID-19 pandemic: a case of uncontrolled growth of peripheral giant cell granuloma

ABSTRACT

COVID-19 pandemic had several consequences including reduced access to public health care service that led to significant delays in screenings, diagnosis, and treatments. Peripheral giant cell granuloma (PGCG) is a benign exophytic lesion of reactive nature, affecting gingiva and alveolar ridge. Recent studies report its highest prevalence in 5th-6th decade of age, occurring mainly in mandible with an average size of 1.3-1.7 cm. We aimed to show the impact of pandemic on diagnosis delay in a patient with peripheral giant cell granuloma that reached unusual dimensions. ACaucasian 61-year-old male referred to our observation for the presence of an exophytic lesion on edentulous alveolar crest of the mandible. He was an edentulous patient, that developed a lesion of unusual dimensions of 7x4.5x3.5 cm. The soft consistency, slow exophytic growth and bluish-red color suggested an inflammatory hyperplastic nature of the lesion. An excisional biopsy was performed in association with curettage of underlying periosteum. Histological examination revealed presence of spindle-shaped mononuclear cells and multiple multinucleated giant cells in a well vascularized stromal tissue. No calcifications were found. Clinical and histological features suggested the diagnosis of PGCG. This case is clinical evidence of the delays induced by the COVID-19 emergency, which negatively affected all health care and suggests that the PGCG, albeit benign in nature, may have an uncontrolled and non-self-limiting growth, making its surgical removing and healing process more complicated. Copyright © 2022 Edizioni Minerva Medica. All rights reserved.