ABSTRACT: 45–47. The overlying mucosa appeared pink to erythematous.

ABSTRACT:

Peripheral giant cell granuloma (PGCG) is a
reactive,

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proliferative,
exophytic lesion developing on the gingiva and alveolar ridge, originating from
the periosteum or periodontal membrane. The lesion develops mostly in adults,
commonly in the lower jaw, with slight femalePS1 .

 

INTRODUCTION

Theperipheral giant cell granuloma (PGCGPS2 ), also known as
peripheral giant cell epulis, peripheral gaint cell reparative granulomaPS3 . PGCL or giant
cell hyperplasia, is the most common giant cellPS4  lesion in the oral
cavity with the incidence rate varying fromPS5  5.1% to 43.6%.
Since its reparative effect has not been proved till date; the osteoclast
activity appears to be doubtful.1-3

 

CASE
REPORT

A female patient of age 40 years
reported to Department of Periodontology of Sardar Patel Post graduate
Institute of Dental Sciences. Chief complain of patient was painless swelling
in lower back right region of jaw since 6 months. History revealed swelling
started as small one and progressively increased to the present size over 6
months. The patient gave a history of mild localized intermittent pain in
relation to the same region while having meals and also slight bleeding on
brushing teeth. There was no history of trauma, neurological deficit, fever,
loss of appetite, loss of weight. There was no similar swelling present in any
parts of the body. Patient was systemically healthy. Past medical, family
histories were non-contributory.

Extraorally, there was no
abnormality detected. Intraorally, a solitary ovoid swelling was present in the
right lower buccal vestibule measuring approximately 2× 3 cm extending from
distal aspect of 45 to mesial aspect of 47 with significant vestibular obliteration
in relation to 45–47. The overlying mucosa appeared pink to erythematous. The
surface of the swelling was smooth. The swelling was firm in consistency,
showed no secondary changes. The swelling was covered by normal mucosa with
mild focal hyperpigmented areas and had a pedunculated base. On palpation, the
swelling was soft to firm in consistency, slightly tender, and blanched on
pressure. Orthopantomogram, intraoral periapical radiographs showed no bone
resorption.

 

Surgery
(exicisional biopsy) was planned under local anaesthesia. The overlying mucosa
was incised and undermined. Lesion was separated from adjacent tissue by blunt
dissection and removed in one piece. There is no signs of reoccurrence after 3
months follow up.

 

Histopathology
reveals it consists of nonencapsulated mass of tissue composed of a delicate
reticular and fibrillar connective tissue stroma containing tissue cells and
multinucleated gaint cells

 

DISCUSSION

 

A case of a PGCG is described,
which originally

appeared to be a gingival
overgrowth. The word epulis

derives from the Greek words
“epi” and “ulon” meaning

“on the gingiva”. Since the term
“epulis” indicates only

the location of a lesion, as an
insufficient term it is not

used
in diagnosis nowadays.5,6

 

PGCG is a localized tumor-like
hyperplastic gingival enlargement which usually evolves from the interdental
tissues(which may include the periosteum or periodontal membrane) as a consequence
of chronic irritation from local factors viz. subgingival plaque and calculus
or trauma.

Chronic local irritation of the
gingiva
is
responsible for the occurrence of most of the reactive lesions, one of which is
PGCG.

Although these lesions occur over
a varied age group? the peak incidence observed in males is the second decade
in contrast to the fifth decade for females. Moreover, PGCG lesions are more
common in mandible when compared to maxilla (2:1). Lesions are seen to arise
from anywhere on the gingiva or alveolar mucosa in either dentate or edentate
patients, but most occur anterior to the molar teeth. The interdental papilla
is mostly affected in dentate patients.7

 

Lesions can become large, sometimes
attaining a size upto 2 cm. The clinical appearance is similar to the more
common pyogenic granuloma, although the PGCG is often more bluish-purple as
compared with the bright-red colour of a typical pyogenic granuloma.

Recently, the PGCG associated
with dental implants has been reported (Hirshberg et al, 2003). Although the
PGCG develops within soft tissue, superficial resorption of the underlying
alveolar bony crest is sometimes seen. On occasion, it may be difficult to determine
whether the mass arose as a peripheral lesion or a central giant cell granuloma
eroding through the cortical plate into the gingival soft tissues (Chadwick et
al, 1989; Giansanti & Waldrom, 1969).

 

PGCG is most commonly a unifocal
lesion, so it must be differentially diagnosed among unifocal gingival
overgrowth8,9 Fibroma: it
differs from PGCG in consistency and Colour8,9.
Also, unlike PGCG, it typically causes

        irritation 9;Pyogenic
granuloma: it is usually softer, more bright

         red in colour and bleeds more readily
with minimal manipulation 8,9;

·       Peripheral
ossifying fibroma (POF): it may be

        similar to PGCG but it does not have
the bluish-red

        colouring, which is characteristic of a
PGCG 8,9.

        Also shows predominance in young women.

        X-ray typically reveals calcification
spots 9,10;

·       Pregnant tumour:
it is similar with pyogenic

        granuloma, and the diagnosis is
established due to

        pregnancy11;

·       Kaposi’s
sarcoma: where immunosuppression exists

        (characteristic lesion in patients with
HIV infection)

        and may provoke irregular bone
destruction below

        the exophytic lesion8, so it
can be easily diagnosed

        due to patient’s history;

·       Benign neoplasm
like haemangioma: it disappears

         under pressure 9;

·       Malignant
neoplasm like metastatic tumour: it

        may provoke irregular bone destruction
below the

        exophytic lesion 8,9 and
presents very rarely 12,13;

·       A brown tumour
of hyperparathyroidism can

        perforate the alveolus at the cervical
region of a tooth

       and it may mimic PGCG 8,9.

 

Differential diagnosis among
multifocal location, should be between leukaemia (it is characterized by
gingival swelling) and gingival hyperplasia due to medication (ie: nifedipine,
phenytoin and cyclosporine A).Surgery remains the mainstay of treating PGCG
wherein resection of the lesion with the elimination of its entire base is
performed. To prevent the recurrence after treatment, it is necessary to
correct or eradicate the underlying source of irritation.14

CONCULSION

 

This case report shows the
clinical presentation of PGCG involving the mandibular alveolar mucosa and
gingiva. The case report has substantiated the provisional diagnosis by means
of radiologic and histopathologic picture.

Most of the reactive oral lesions
including PGCG may

rapidly grow to reach a significant
size within several months of initial diagnosis. Radiographs are important to
show the origination of this particular giant cell lesion from th periphery
within the oral mucosa and thus help in its diagnosis.

If not managed timely, these soft
tissue growths may destroy the oral tissues; causing discomfort and tooth
movement by resorbing bone.