Peripheral giant cell granuloma pgcg is an uncommon pathology that affects gingival or alveolar mucosa. The case report is of a 30 year old male, who complained of a slowly expanding swelling in the maxilla in the left premolar region. It is often difficult to make a clinical diagnosis. Central giant cell granuloma cgcg is a benign, proliferative, intraosseous and nonodontogenic lesion of unknown etiology. Formerly called giant cell reparative granuloma giant cell lesion primarily of jaw, also other craniofacial bones and short tubular bones of hands and feet may be response to injury but some cases behave aggressively giant cells have features of macrophages and osteoclasts.
Clinical and histologic features of 26 cases of canine peripheral giant cell granuloma formerly giant cell epulis are reported. This study sought to report a rare case of pgcg associated with dental. The term giant cell reparative granuloma gcrg was first used by jaffe in 1953, to distinguish these lesions from giant cell tumor of long bones. Central and peripheral giant cell granulomas of jaws are uncommon, benign, reactive disorders that are characterized by the. Explanation for different behavior of peripheral and. Peripheral giant cell granuloma pgcg is a nonneoplastic, tumorlike reactive lesion occurring exclusively on gingivaalveolar crest. It is the most frequent giant cell lesion of the jaws, and originates from the connective tissue of the periosteum or from the periodontal. The most common treatment is curettage,which has a high recurrence rate, particularly in more.
Clinical presentation and management of peripheral giant. Peripheral giant cell granuloma pgcg is a relatively frequent benign reactive lesion of the oral cavity, originating from the periosteum or periodontal membrane following local irritation or. Peripheral giant cell granuloma pgcg is an infrequent exophytic lesion of the oral cavity, also known as giant cell epulis, osteoclastoma, giant cell reparative. We describe our experience in managing this lesion by intralesional triamci. It usually presents as a purplishred soft tissue nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells. Peripheral giantcell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. Reactive gingival mass resembling pyogenic granuloma, which pushes teeth aside and may erode alveolar bone or involve periodontal membrane arises from periodontal ligament enclosing root of tooth central giant cell granuloma. This case report describes three additional cases with clinical courses and outcomes.
This report describes the clinical and histopathological findings of a pgcg diagnosed in the maxilla of a 9yearold boy associated with a tooth erupting improperly. Peripheral giant cell granuloma or so called giant cell epulis is the most common oral giant cell lesion. The central giant cell granuloma is an uncommon lesion only seen in the toothbearing regions of the jaws, most commonly in the mandible and typically in the second and third decades. It is distinguishable from pyogenic granuloma and peripheral ossifying fibroma only on the basis of its unique histomorphology, which is the same as central giant cell granuloma 8, 9. Similarly, peripheral giant cell granuloma pgcg was first reported as fungus flesh in 1848, then reported as giant cell reparative granuloma by jaffe in 1953. The cause of peripheral giant cell granuloma is unknown, although local irritation due to dental plaque or calculus, periodontal disease, poor dental restorations, illfitting dental appliances, or dental extractions has been suggested to contribute to the development of the lesion.
Giant cell granuloma definition of giant cell granuloma by. Despite their histopathological similarity, unlike peripheral giant cell granuloma pgcg, central giant cell granuloma cgcg is an osteolytic lesion. A pgcg associated with loss of periodontal support is described. Central giant cell granuloma is a benign lesion of the jaws which is sometimes aggressive locally.
Esthetic management of peripheral giant cell granuloma. Jan 26, 2017 peripheral giant cell granuloma is a tumor like growth occurring relatively commonly in the oral cavity that represents a reactive process rather than a neoplasm. Due to these lesions often being symptomatic, active management is usua. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, pyogenic granuloma and peripheral ossifying fibroma. Central giant cell granuloma is an uncommon benign intraosseus lesion of jaws. Peripheral giant cell granuloma innovative journal. This report describes the clinical and histopathological findings of a pgcg diagnosed in the maxilla of a 9yearold boy associated with a tooth erupting improperly and a. Peripheral giant cell granuloma associated with a dental implant. This patient report describes a recurrent central giant cell granuloma involving the body of the mandible in a 48yearoldwoman. The most common type was the woven bone which appeared alone or in combination with lamellar bone in 82% of the lesions containing mineralized material. Aggressive central giant cell granuloma mimicking peripheral.
Immunophenotype of dental implantassociated peripheral. Pdf peripheral giant cell granuloma is a benign reactive lesion of. Central giant cell granuloma is an uncommon benign proliferative lesion occurring more commonly in the anterior mandible. A solid swelling was observed in the area of the lower incisors. The lesion requires angiogenesis to grow which in turn may cause bone resorption. Initial treatment of lesion consisted of curettage and peripheral ostectomy.
The peripheral giant cell granuloma is a relatively common tumorlike growth that develops on the gingiva or alveolar ridge. It is a common giant cell lesion of the oral cavity whose histogenesis still continues to. An electronic search was undertaken in january 2018 in 5 databases, looking for. Central giant cell lesion cgcl is a benign lesion which has unpredictable biologic behaviour and is amenable to a plethora of treatment alternatives. Central giant cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings. Katsikeris n, kakarantzaangelopoulou e, angelopoulos a. Clinically, it appear as pyogenic granuloma, peripheral ossifying. Immunophenotype of dental implantassociated peripheral giant cell reparative granuloma in a representative case report. Peripheral giant cell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. From the radiographic exam, we observed a radiolucent image in the mandibular bone with welldefined limits extending from the apical region of tooth 33. Peripheral ossifying fibroma, also known as ossifying fibrous epulis, is a gingival nodule which is composed of a cellular fibroblastic connective tissue stroma which is associated with the formation of randomly dispersed foci of mineralised products, which consists of bone, cementumlike tissue, or a dystrophic calcification. The purpose of this study was to determine the ct characteristics and describe possible mr imaging features of gcg of the craniofacial bones. It is often impossible to make a clinical distinction between the two entities, thereby making definitive diagnosis dependent on histopathologic features. Intralesional corticosteroid injection for central giant cell.
Peripheral giant cell granuloma about more than 100 years ago, jaffe through his research affirmed that the giant cell tumors occurring at other areas of the body were poles apart from the giant cells found in the jaws and termed them as giant bernier cahn suggested that these lesions should be called as either a peripheral or central giant. Giant cell reparative granuloma, central the free dictionary. A peripheral giant cell granuloma with extensive osseous. Peripheral giant cell granuloma is a common benign and reactive gingival epulis in oral cavity. The clinical appearance is similar to that of pyogenic granuloma, that is, a fleshy, soft, sessile or pediculate mass with a color ranging from dark red to purple, located on the attached gums 1 or on the mucosa of the alveolar margin. Peripheral giantcell granuloma an overview sciencedirect. Peripheral giant cell granuloma article about peripheral. The peripheral giant cell granuloma pgcg was first described by jaffe in 1953. Gingival reactive lesions in orally rehabilitated patients by free revascularized flap. Peripheral giant cell granuloma pgcg is an infrequent exophytic lesion of the oral cavity, also known as giant cell epulis, osteoclastoma, giant cell reparative granuloma, or giant cell hyperplasia1,2,3. The true nature of these lesions is unknown but, as they are invariably destructive, the term reparative giant cell granuloma would appear to be inappropriate. We report an unusual case of giant cell reparative granuloma gcrg arising in the nasal cavity of a 7yearold girl. The peripheral giant cell granuloma has an unknown etiology, with some dispute as to whether this lesion represents a reactive or neoplastic process.
Diagnosis, granuloma giant cell, gingival overgrowth, mandible, biopsy, recurrence. An electronic search was undertaken in january 2018 in 5 databases, looking for publications reporting cases of pgcgs. Ct and mr imaging of giant cell granuloma of the craniofacial. Expression of cd34 and cd68 in peripheral giant cell granuloma and central giant cell granuloma. It is also known as giant cell epulis, osteoclastoma, giant cell reparative granuloma or giant cell hyperplasia. The peripheral giant cell granuloma in edentulous patients.
Only five cases associated with dental implants have been reported. It may become aggressive leading to expansion and perforation of the cortex. This lesion is probably not present a true neoplasm but rather may be a reactive in nature. Peripheral giant cell granuloma associated with dental. Casereport munzenmayer j1, tapia p2, zeballos j2, martinez a3, compan a4, urra a5, spencer ml6 summary this case report describes a 19yearold female patient with a central giant cell granuloma in the left mandibular condyle, treated with en bloc resection and reconstruction with fibula graft.
Like pyogenic granuloma and peripheral ossifying fibroma, peripheral giant cell granuloma may represent an unusual response to tissue injury. Central giant cell granuloma cgcg is a localised benign condition of the jaws. There are few reports in the veterinary literature concerning this benign, reactive lesion, formerly known as giant cell epulis. Clinical and histologic features of 26 canine peripheral. Giant cell granuloma an overview sciencedirect topics. It can be considered an overexuberrant local response of tissue to. A 9yearold boy was complaining of swelling in the floor of the mouth. Both are included in clinical differential diagnoses of common benign and reactive gingival epulides in humans. Giant cell granulomas are benign intraosseous lesions, typically occurring in young females.
Central giant cell granuloma cgcg is defined by the world health organization as an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of hemorrhage, aggregations of multinucleated. As very, less is known about the histomorphometric differences between central giant cell granuloma and peripheral giant cell granuloma of jaws and the relation of histomorphometry with their behaviour, hence, this study provides a data for these two lesions, which could act as compliment data for establishing a baseline. Gcrg is an uncommon benign lesion that is most commonly found in the mandible and maxilla. The peripheral giant cell granuloma pgcg is a rare reactive exophytic lesion taking place on the gingiva and alveolar ridge usually as a result of local irritating factors such as trauma, tooth extraction, badly finished fillings, unstable dental prosthesis, plaque, calculus, chronic infections, and impacted food. Peripheral giant cell granuloma is, for all practical purposes, a sitespecific variant of pyogenic granuloma embedded with osteoclastlike multinucleated giant cells and arising exclusively from the periodontal ligament enclosing the root of a tooth. Pdf the peripheral giant cell granuloma in edentulous. Peripheral giant cell granuloma pgcg about more than a 100 years ago. Peripheral giant cell granuloma pgcg is a reactive lesion that occurs on the gingiva or alveolar mucosa and contains numerous giant cells.
Peripheral giant cell granuloma or the socalled giant cell epulis is the most common oral giant cell lesion. The peripheral giant cell granuloma pgcg is a reactive exophytic lesion of the gingiva and alveolar ridge that usually occurs as a result of local irritating factors such as plaque, calculus, chronic infections, chronic irritation, tooth extraction, improperly finished fillings, unstable dental prosthesis, and impacted food which originates from the periosteum or periodontal ligament. The peripheral giant cell reparative granuloma has been described for many years in literature under a great variety of names. Interestingly, clinically and on imaging followup up to 10 years, there has not been evidence of lesion recurrence as in figure 1f. It is microscopically similar to the central giant cell granuloma of bone, being characterized by a proliferation of multinucleated giant cells that resemble osteoclasts. It is also named with peripheral giant cell tumor and giant cell epulis1. The peripheral giant cell granuloma pgcg is an oral, non. Aggressive central giant cell granuloma of the mandible, a. Peripheral giant cell granuloma pgcg is a nonneoplastic lesion that may affect any region of the gingiva or alveolar mucosa of edentulous and toothed areas, preferentially in the mandible and rarely occurring in children. Hybrid peripheral giant cell granuloma and peripheral. Peripheral giant cell granuloma in a child associated with. Oct 31, 2012 central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior. Case report giant cell granuloma of the maxilla usman haider uzbek, iram mushtaq oral and maxillofacial unit, department of dentistry, ayub medical college, abbottabad. Peripheral giant cell granuloma is a tumor like growth occurring relatively commonly in the oral cavity that represents a reactive process rather than a neoplasm.
We use your linkedin profile and activity data to personalize ads and to show you more relevant ads. A size increase of the gingiva can be a manifestation of gingival disease. Nov 02, 2011 we use your linkedin profile and activity data to personalize ads and to show you more relevant ads. Pdf expression of cd34 and cd68 in peripheral giant cell. Central giant cell granulomas are more common in the anterior mandible, often crossing the. Giant cell granulomas occurring within the bone are called central giant cell granuloma cgcg and. Although pgcg can be associated with dental implants, little is known about this lesion and implant osseointegration as well as its etiopathogenesis and the treatments available. Also called giant cell epulis resembles pyogenic granuloma but may erode alveolar bone or involve periodontal membrane usually women, mean age 30 years, although may involve children or elderly patients without teeth. Journal of oral and maxillofacial surgery, medicine, and pathology. Peripheral giant cell granuloma in a dog lorraine a.
Is it a peripheral ossifying fibroma or a pyogenic granuloma. Peripheral giant cell granuloma and peripheral ossifying fibroma are clinicopathologically distinct gingival lesions. It normally presents as a soft tissue purplishred nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells. This study indicates that there are some differences between these groups in age and sex distribution as well as in location and size of the lesion.
Subsequent reports also featured a constellation of terminology such as osteoclastoma, giant cell epulis, and myeloid epulis. It is microscopically similar to the central giant cell granuloma of bone, being characterized by a proliferation of multinucleated giant. The ethiology of peripheral giant cell granuloma pgcg is not clear. However, most authorities believe peripheral giant cell granuloma is a reactive lesion. Traditional treatment has been local curettage, although aggressive subtypes have a high tendency to recur. Peripheral giant cell granuloma pgcg is an infrequent exophytic lesion of the oral cavity, also known as giant cell epulis, osteoclastoma, giant cell reparative granuloma, or giant cell hyperplasia. Jun 19, 2018 the peripheral giant cell granuloma has an unknown etiology, with some dispute as to whether this lesion represents a reactive or neoplastic process. Bone formation in peripheral giant cell granuloma dayan. Hybrid peripheral giant cell granuloma and peripheral ossifying fibroma lesion.
The peripheral giant cell granuloma pgcg is associated with periodontal bony lesions in several situations and excision results in a soft papilla defect and an intrabony defect without soft tissue protection. It is often impossible to make a clinical distinction between the two entities, thereby making definitive diagnosis dependent on. The peripheral giant cell granuloma pgcg is a rare reactive exophytic lesion taking place on the gingiva and alveolar ridge usually as a result of local irritating factors such as trauma, tooth. They result from a local inflammatory process, thought to be secondary to trauma. Peripheral giant cell granuloma pgcg is a benign reactive softtissue lesion of the anterior mandible. To integrate the available data published on peripheral giant cell granuloma pgcg into a comprehensive analysis of its clinicalradiological features. Central giant cell granuloma of the mandibular condyle. Peripheral giant cell granuloma is considered rare in the dog with little known about the clinicopathologic features. Pdf on aug 1, 20, varsha vk and others published peripheral giant cell granuloma. Giant cell reparative granuloma the free dictionary. Management of an unusual peripheral giant cell granuloma. Giant cell reparative granuloma of the nasal cavity.
Nagargoje department of oral and maxillofacial surgery midsr dental college latur, maharashtra, india corresponding author a b s t r a c t. Abstract the peripheral giant cell granuloma pgcg is a benign hyperplastic gingival lesion of unknown aetiology occurring mostly in adults. Our case was that of a very aggressive peripheral giant cell granuloma in the maxilla involving the maxilla sinus, extending into the orbit, nasal cavity, and masticator space. Expression of cd34 and cd68 in peripheral giant cell granuloma. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Peripheral giant cell granuloma pubmed central pmc. Recurrent central giant cell granuloma in the mandible. Central giantcell granuloma cgcg is a localised benign condition of the jaws. These three diseases are associated because they appear. Peripheral giant cell granuloma is an infrequent reactive, exophytic lesion of the oral cavity, also known as giant cell epulis, osteoclastoma, giant cell reparative granuloma, or giant cell hyperplasia. It is twice as common in females and is more likely to occur before age 30. Pathology outlines peripheral giant cell granuloma.