Surgical excision of peripheral giant cell granuloma of the maxilla: a case report.

Peripheral giant cell granuloma (PGCG) is described as an elevated lesion that is located mostly on the gingival mucosa and alveolar crest, consecutive to irritative factors and trauma. It predominantly occurs more in the mandible than the maxilla, and it is usually seen in the 4th to the 6th decades. The clinical appearance of this lesion is red-bluish in color, presenting a similar tissue to the one observed in the liver, usually measuring less than 2 cm. The treatment of the PGCG is the surgical excision. The recurrence of this lesion is rarely described in the literature. The present case highlights the importance of considering the traumatic extractions as one of the main uncommon etiologic factors, leading to the development of peripheral giant cell granuloma. It precisely describes the diagnosis, the treatment of a peripheral giant cell granuloma located in maxillary canine-premolar region, occurred consecutively after ancient traumatic extractions of the 13 and 14 since 1 year. This paper also reports a maxillary location of giant cell granuloma, while the literature reports more commonly the mandibular location. This lesion was excised surgically, and healed uneventually, and in which the follow-up didn´t show any sign of recurrence.

A rare case of a giant cell tumour caused by vitamin D deficiency.

Reparative giant cell granulomas are benign masses of multi-etiological nature, which account for 1%-7% of all benign lesions of the jaws. The objective of this case report is to present the relationship between isolated vitamin D deficiency and the development of reparative giant cell granuloma.Herein, we present the case of a 70-year-old female patient with a painless mass of increased mobility in the mandibular region, and pain in the involved teeth. After histological confirmation and laboratory screening, а reparative giant cell granuloma caused by serious deficiency of vitamin D3 - (25-OH)D was diagnosed. The treatment protocol included surgical removal of the lesion and vitamin D replacement therapy.In rare cases, this type of lesion can be a primary manifestation of vitamin D deficiency; therefore, it is extremely important to be aware of this pathology.

Peripheral giant cell granuloma associated with dental implants: Case-series.

PURPOSE: The objectives were to characterize clinico-pathologically a large series of peri-implant peripheral giant cell granuloma (PGCG), and investigate the role of foreign material as a possible etiological factor. MATERIAL AND METHODS: The study was retrospective, conducted on peri-implant specimens submitted for histology between 2005 and 2021. RESULTS: Three hundred and thirty-five peri-implant biopsies were retrieved, of which 52 (15.5%) were PGCG. The study population included 28 females and 24 males, age 35-92 years, mean 61. 51.2% reported bone involvement. The lesion involved the margins of the specimen in 65.3%, recurrence was reported in 46.1%. In 58.8% the implant was removed at the same time the specimen was submitted for histopathological analysis. Small foci of black granular foreign material were observed in 53.8% of cases of which 67.8% were birefringent under polarized light. The foreign material granules were not ingested inside multinucleated giant cells, but were scattered in the stromal compartment. CONCLUSIONS: Peri-implant PGCG is locally aggressive, with frequent bone involvement and high recurrence rate, resulting in implant loss in the majority of cases. The high recurrence rate may be related to conservative or inadequate surgery. Foreign material although common does not seem to have a role in its development.

Central odontogenic fibroma in association with brown tumor of hyperparathyroidism in a patient with neurofibromatosis type 1.

We present a patient with bone abnormalities and a myriad of lesions secondary to his redeveloping renal failure and neurofibromatosis type 1 (NF1). A 21-year-old male renal transplant recipient with NF1 presented with painless masses and large, irregular radiolucent lesions in the maxilla and mandible. After histologic examination, the lesion was diagnosed as a central odontogenic fibroma (COdF) in association with a central giant cell lesion, most consistent with brown tumor of hyperparathyroidism. The bone changes were interpreted to be highly suggestive of renal osteodystrophy. Around 30 cases of hybrid central giant cell granuloma-like lesion in association with central odontogenic fibroma have been reported. This, to our knowledge, is the first reported case of brown tumor in association with COdF. Our case provides further evidence of the giant cell component as the initiating entity in these hybrid lesions.

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)

KRAS mutations in implant-associated peripheral giant cell granuloma.

OBJECTIVES: To investigate the molecular pathogenesis of implant-associated peripheral giant cell granuloma (IA-PGCG). METHODS: A convenience sample of 15 IA-PGCG cases was selected. Hotspot mutations of KRAS, FGFR1, and TRPV4 genes, previously reported in conventional giant cell lesions of the jaws, were investigated by Sanger sequencing. As these mutations could activate MAPK/ERK pathway, the expression of phospho-ERK1/2 was also evaluated by immunohistochemistry. RESULTS: KRAS mutations were detected in 8/15 (53.4%) samples. Similar to conventional peripheral giant cell granuloma, the KRAS mutations most frequently occurred in codon 146 (p.A146V, n = 3), followed by codon 12 (p.G12A and p.G12D, n = 1 each) and codon 14 (p.V14L, n = 1). Variants of unknown significance (VUS) were also detected in two cases, affecting codons 37 (p.E37K) and 127 (p.T127I). All samples showed wild-type (WT) sequences for FGFR1 and TRPV4 genes. Consistent with MAPK/ERK pathway activation, all mononuclear cells of the lesion showed strong staining for phospho-ERK1/2 protein in the immunohistochemical analysis. CONCLUSIONS: KRAS mutations and activation of the MAPK-ERK signaling pathway occur in IA-PGCG. This is the first study to demonstrate cancer-associated gene mutations in a non-neoplastic reactive condition associated with dental implants.

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.

Reactive oral lesions associated with dental implants. A systematic review.

Reactive lesion formation around dental implants a complication that has been given much consideration. These lesions can lead to marginal bone loss, and consequently, implant failure. In the present systematic review, all reported reactive lesions associated with dental implants in the literature were assessed. An electronic search was performed using PubMed Central, Scopus, Google Scholar, and Science Direct. The search strategy was limited to human studies (case reports and case series), full-text English language articles, published until May 2017. A total of 19 articles reporting 27 lesions in 25 cases were included. Peripheral giant cell granuloma and pyogenic granuloma were the most reactive lesions found around dental implants. The mean age of the patients was 51.28 ± 14.48 years, with a slight female predilection. Posterior mandibular gingiva was the most common location for these lesions. The recurrence rate of lesions was 33.33%, and the chance of implant removal was 29.62%. Due to the clinical significance of these lesions, early histopathologic examination is recommended to exclude the presence of such pathological lesions.

Foreign Body Reaction to Dialysis Chatheter and Peritoneal Fluid Eosinophilia in a Child on Continuous Ambulatory Peritoneal Dialysis.

Foreign body reaction is a tissue response against implanted materials. We described for the first time the eosinophilic peritonitis and foreign body giant cell reaction to dialysis catheter in a nonatopic child on continuous ambulatory peritoneal dialysis. We found tenderness, redness, and swelling without purulent discharge around the peritoneal catheter; increased eosinophil count in cloudy dialysis fluid; and blood and hyperechoic granulomatous formation appearance surrounding the peritoneal catheter on ultrasonography and foreign body giant cell reaction to dialysis catheter in pathologic examination of granulomatous lesionin in our patient. The peritoneal dialysis catheter was removed due to resistance to antibiotic and antihistamine treatments for suspected peritonitis and tunnel infection. Foreign body reaction and eosinophilic peritonitis with eosinophilic cloudy dialysis effluent can exist simultaneously. Foreign body reaction should be considered in the differential diagnosis of exit site and/or tunnel infection. Ultrasonography helps distinguish between foreign body reaction and exit-site or tunnel infection.

Multiple brown tumours from parathyroid carcinoma.

We report a case of a 29-year-old woman who suffered from severe bilateral inguinal pain and left mandibular mass. CT scan showed innumerable expansile osteolytic bone masses on the iliac wings, femur, ribs and vertebral bodies, diffuse skeletal osteopaenia, calyceal lithiasis on the right kidney and a left thyroid mass. Ionised calcium and intact parathyroid hormone (PTH) were elevated. Parathyroid sestamibi scan showed a hyperfunctioning left inferior parathyroid gland. Biopsy of the left mandibular mass was consistent with brown tumour. The patient underwent parathyroidectomy of the enlarged parathyroid gland. Final histopathology, however, revealed parathyroid carcinoma, 4.7 cm in widest dimension, with capsular and vascular space invasion. The patient underwent repeat surgery, specifically, left thyroid lobectomy, isthmectomy and central node dissection. Intact PTH decreased from 681.3 to 74 pg/mL (normal range: 10-65) 24 hours postoperatively. Follow-up at 6 months showed normal serum calcium levels, size reduction of bone lesions and improvement of quality of life.

Ectopic parathyroid adenoma presenting as facial expansile growths.

BACKGROUND: Giant cell reparative granuloma of the facial skeleton is a rare presentation of hyperparathyroidism. METHODOLOGY: A 17-year-old girl presented with progressive expansile bony growths of the mandible and maxilla. The case was investigated using biopsies, blood tests, imaging, and surgery. RESULTS: Biopsies confirmed giant cell reparative granuloma. Blood testing revealed very high parathyroid hormone levels, and brown tumours due to primary hyperparathyroidism weresuspected. Surgical removal of an ectopic adenoma led to correction of the endocrine condition. CONCLUSIONS: To our knowledge, this is the first reported case of multiple brown tumours of the facial skeleton due to an ectopic parathyroid adenoma. Diagnostic pitfalls and therapeutic challenges are described.

Mandibular mass in a child on hemodialysis.

We here with report a 13-year-old female patient on regular hemodialysis for the past five years who presented with a large mandibular mass. This was detected to be a brown tumor due to severe renal osteodystrophy as a complication of secondary hyperparathyroidism. The tumor did not regress even with intensive treatment with intravenous active vitamin D and needed surgical removal.

Peripheral Giant Cell Granuloma in a Dog.

Peripheral giant cell granuloma is considered rare in the dog with little known about the clinicopathologic features. There are few reports in the veterinary literature concerning this benign, reactive lesion, formerly known as giant cell epulis. In humans, the four most commonly described reactive epulides are focal fibrous hyperplasia (fibrous epulis), pyogenic granuloma, peripheral ossifying fibroma, and peripheral giant cell granuloma. This case report describes the diagnosis and surgical management of a peripheral giant cell granuloma in a dog.

Annular Elastolytic Giant Cell Granuloma and Temporal Arteritis Following Herpes Zoster.

A 70-year-old woman, who presented with pain and functional limitation of her right shoulder, without any previous traumatic incident, was evaluated in an emergency department. A shoulder x-ray was performed, and she received an intrajoint injection of an unspecified amount of triamcinolone. Forty-eight hours later, she noticed a papulovesicular and bullous eruption with a dermatomal distribution on her nape, supraclavicle, and left brachial and antebrachial regions (T1-T2-C5-C6-8). A diagnosis of herpes zoster (HZ) was made, for which she received valacyclovir 1 g every 8 hours for 10 days, pregabalin 75 mg every 8 hours, and topical acyclovir, with good response. The lesions and pain subsided, and results from general laboratory tests were normal or negative.