Recurrent peripheral giant cell granuloma associated with cervical resorption

Capillary gingival hemangioma in a cat

A 12-year-old spayed female American short-haired cat presented with a palatal gingival mass located between the right maxillary third incisor and the canine teeth. The mass was dark red and had a narrow attachment to the gingival margin of the canine tooth. The mass was completely removed by marginal excision and the histopathological diagnosis was a capillary hemangioma. The mass did not relapse until 1 year later; however, the tooth was extracted because of cervical resorption of the right maxillary canine immediately adjacent to the mass resection site. This report presents a rare case of the gingival hemangioma in a cat and the possibility of a causal relationship between the occurrence of external cervical tooth resorption and hemangioma resection.

Peripheral Giant Cell Granuloma Associated With Periodontal Intrabony Defect

INTRODUCTION

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.

CASE PRESENTATION

A PGCG associated with loss of periodontal support is described. Following the lesion excision, a specific flap design outlining a surgical papilla in the adjacent area was proposed. The aim of this flap design was to obtain an optimal condition for periodontal regeneration, to treat the lesion excision associated with soft tissue defect, and to avoid a second surgical area. Complete periodontal defect resolution without soft tissue contraction or lesion recurrence was obtained at 2-year follow-up.

CONCLUSION

Early diagnosis and treatment are essential to prevent greater loss of periodontal attachment.

Recurrent Peripheral Giant Cell Granuloma: A Case Report

Objective:

This article describes a case of a Peripheral Giant Cell Granuloma (PGCG) in a girl.

Introduction:

PGCG is a relatively infrequent benign reactive lesion of the gingiva or alveolar ridge that develops in response to local irritation. Clinical appearance consists of a firm or soft smooth surface nodule in dissimilar colors of varying size with sessile or pedunculated implantation base. Radiographic features are generally nonspecific, thereby definitive diagnosis depends on microscopic examination to confirm the entity of PGCG.

Case Report:

A 6-year-old female patient was referred to the outpatient clinic of an Oral & Maxillofacial Surgery Department with the chief complaint of an intraoral swelling. The intraoral examination showed a painless sessile mass with exophytic growth similar to a tumorous lesion located on the mandibular alveolar ridge extending from distal aspect of right mandibular primary canine to mesial aspect of first permanent molar of the same side.

Conclusion:

Peripheral giant cell granuloma is a relatively uncommon lesion in children and potential for collaboration with the treatment in young patients should be considered for a successful therapeutic approach.

Peripheral giant cell granuloma recurring as an exclusively intra-osseous lesion: An unusual clinical presentation

Giant cell lesions of the jaws represent distinctive clinico-pathological spectrum. They manifest as peripheral and central lesions, occurring as solitary growths to involving multiple regions of the jaw. The present report presents a unique case of giant cell lesions of the jaws, wherein a peripheral giant cell granuloma recurred exclusively as a central giant cell lesion in a young patient. The recurrence was noted after a time-span of 3 years since the diagnosis and surgical excision of the peripheral lesion. Biochemical investigations were advised to rule out the possibility of hyperparathyroidism. Following a confirmed diagnosis of central giant cell granuloma, not associated with any other systemic conditions, an apt treatment plan was devised for an early rehabilitation of the patient.

A Review and Report of Peripheral Giant Cell Granuloma in a 4-Year-Old Child

Peripheral giant cell granuloma is a common benign and reactive gingival epulis in oral cavity. It is often difficult to make a clinical diagnosis; thereby definitive diagnosis depends on histopathologic features. We report a case of a 4-year-old Caucasian boy presenting with a five-month history a 20 × 15 × 12 mm pedunculated, lobular soft tissue mass of the left anterior maxilla gingiva which was misdiagnosed and maltreated before his referral. An excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed distinctive features of peripheral giant cell granuloma. Early detection and excision of this hyperplastic nodule especially in children are important to minimize potential dentoalveolar complications.

Clinical Management of a Peri-Implant Giant Cell Granuloma

Purpose. Implant therapy plays an important role in contemporary dentistry with high rates of long-term success. However, in recent years, the incidence of peri-implantitis and implant failures has significantly increased. The peripheral giant cell granuloma (PGCG) rarely occurs in peri-implant tissues and it is clinically comparable to the lesions associated with natural teeth. Therefore, the study of possible diseases associated with dental implants plays an important role in order to be able to diagnose and treat these conditions. Materials and Methods. This report described a 60-year-old Caucasian male who presented a reddish-purple pedunculated mass, of about 2 cm in diameter, associated with a dental implant and the adjacent natural tooth. Results. An excisional biopsy was performed and the dental implant was not removed. Histological examination provided the diagnosis of PGCG. After 19-month follow-up, there were no signs of recurrence of peri-implantitis around the implant. Conclusion. The correct diagnosis and appropriate surgical treatment of peri-implant giant cell granuloma are very important for a proper management of the lesion in order to preserve the implant prosthetic rehabilitation and prevent recurrences.

Peripheral giant cell granuloma: This enormity is a rarity

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. Lesions vary in appearance from smooth, regularly outlined masses to irregularly shaped, multilobulated protuberances with surface indentations. Ulcerations of the margin are occasionally seen. The lesions are painless, vary in size, and may cover several teeth. It normally presents as a purplish-red nodule consisting of multinucleated giant cells in the background of mononuclear stromal cells and extravasated red blood cells. This case report describes the unusual appearance of a PGCG extending from left maxillary interdental gingiva to palatal area in 32-year-old female patient.

Immunoexpression of NF-ĸB and their inhibitory subunits IĸBα and IĸBβ in giant cell lesions of the jaws: implications for their clinical behavior

BACKGROUND

The unpredictable behavior of giant cell lesions (GCLs) of the jaws parallels its controversial histogenesis. This study evaluated a possible association between the immunohistochemical expression of NF-ĸB, the inhibitory subunits IĸBα/IĸBβ, and clinicopathological variables with the behavior of central and peripheral GCLs of the jaws.

MATERIALS AND METHODS

Paraffin-embedded samples of GCLs of the jaws (n = 68) were prepared for histological/immunohistochemical assessment. Demographic and clinicopathological parameters were assessed to determine the behavior of the lesions. A staining-intensity-distribution (SID) score was used to assess the immunomarkers reactivity. The association between significant candidate immunohistochemical predictor variables regarding clinical behavior was analyzed individually and adjusted for confounding using a binary logistic regression model.

RESULTS

While univariate analysis revealed a positive association of NF-ĸB SID score, NF-ĸB nuclear expression, IĸBα SID score, and NF-ĸB to inhibitors average ratio with the aggressive status of GCLs, after bivariate logistic regression analysis, only NF-ĸB nuclear expression, IĸBα SID score, and NF-ĸB to inhibitors average ratio remained as robust predictors of aggressiveness. Confounding and interaction effects regarding clinicopathological candidate predictor variables were also noted.

CONCLUSION

It looks that clinical behavior of GCLs of the jaws may be strong/independently linked to the increased nuclear expression of NF-ĸB, higher NF-ĸB to inhibitors average ratio, and decreased IĸBα SID score. Notwithstanding, there are simultaneously synergistic and opposing interactive effects with respect to age stratum, growth rate, multinucleated giant cells count, and mononuclear stromal cells density in the susceptible host that may increase the tissue destruction observed in aggressive GCLs.

Management of an unusual peripheral giant cell granuloma: A diagnostic dilemma

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. This article presents management of an unusual PGCG located on the partially edentulous mandible.

Non-syndromic multiple impacted supernumerary teeth with peripheral giant cell granuloma

Peripheral giant cell granuloma (PGCG) is a relatively frequent benign reactive lesion of the gingiva, originating from the periosteum or periodontal membrane following local irritation or chronic trauma. PGCG manifests as a red-purple nodule located in the region of the gingiva or edentulous alveolar margins. The lesion can develop at any age, although it is more common between the second and third decades of life, and shows a slight female predilection. PGCG is a soft tissue lesion that very rarely affects the underlying bone, although the latter may suffer superficial erosion. A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. These teeth may be single, multiple, erupted or unerupted and may or may not be associated with syndrome. 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 left permanent first molar with three supernumerary teeth in the mandibular arch but no associated syndrome.

Oral focal mucinosis associated with cervical external root resorption: a case report

BACKGROUND

Oral focal mucinosis (OFM) and cervical external root resorption are both rare lesions with an unknown etiology. In this article we report on a rare occurrence of OFM associated with cervical external root resorption.

METHODS

A 44-year-old female patient presented with sharp pain while drinking cold beverages and a firm localized gingival overgrowth adjacent to the buccal aspect of tooth #19. An excisional biopsy of the gingival lesion was taken and a deep cavity was found in the buccal aspect of the root. The cavity was restored with an amalgam filling.

RESULTS

The histological findings were of a well-circumscribed lesion composed of myxomatous connective tissue, which contained numerous stellate-shaped fibroblasts. Based on the findings, a diagnosis of OFM was made.

CONCLUSION

A rare case of OFM and cervical external root resorption occurring in the same site was described. A possible link between these 2 phenomena was hypothesized.

Peripheral and central giant cell granulomas of the jaws: A demographic study

OBJECTIVE

This study aimed to assess the demographic characteristics of peripheral giant cell granulomas (PGCGs) and central giant cell granulomas (CGCGs) in patients treated at our centers.

STUDY DESIGN

This 12-year retrospective study was based on existing data. Files of patients from 1993-2004 with a definite diagnosis of PGCGs and CGCGs from the oral pathology departments of our universities were assessed. Information regarding age distribution, gender, the jaw involved, the presenting area of the lesion, surgical treatment, and recurrence was documented.

RESULTS

During the study period, 204 patients with CGCGs were treated. The patients with CGCGs varied in age from 5 to 72 years, and the mean age patients was 23.72 years. Among these, 127 cases (62.87%) occurred in the second and third decades of life. One hundred thirty cases (63.75%) occurred in females and 74 (36.25%) in males. Ninety cases (44.1%) presented in posterior parts of the jaws. One hundred forty-four cases (70.58%) appeared in the mandible. Peripheral GCGs presented in 575 patients, who varied in age from 2 to 85 years with a mean age of 31.02 years. Among these, 297 cases (51.65%) occurred in females and 278 (48.34%) in males. Four hundred sixty-seven cases (81.2%) occurred in the first five decades of life, and 352 cases (61.21%) appeared in the mandible.

CONCLUSIONS

Giant cell granulomas comprised 9.29% of oral lesions. Peripheral GCG lesions occurred more than 2 times more frequently than CGCGs. Central GCGs occurred about 2 times more frequently in females, whereas PGCGs had an equal prevalence in both genders (P < .05). The mean age for patients with CGCGs was less than patients with PGCGs (P < .05). Central GCGs involved the mandible approximately 2 times more frequently than the maxilla (P < .05). However, when presenting in the maxilla, CGCGs most frequently presented in the area anterior to the canines (P < .05). Peripheral GCGs involved the mandible approximately 1.5 times more frequently than the maxilla (P < .05). Thorough curettage was the main treatment modality used. There were 9 cases (4.41%) of recurrence of CGCGs and 8 cases (1.39%) of recurrence of PGCGs documented during the follow-up period (ranging from 1-12 years).

An analysis of peripheral giant cell granuloma associated with dental implant treatment

This report discusses the management of a 21-year-old male who developed a peripheral giant cell granuloma (PGCG) associated with dental implant therapy, and reviews 4 previously reported cases of PGCGs developing in association with dental implant treatment. The patient described in this report was treated with multiple dental implants to manage severe oligodontia. Six years after implant placement, with the patient lost to follow-up, he presented to his dentist complaining of increasing swelling in the right mandibular vestibule. The patient was noted to have a large exophytic, ovoid-shaped, firm, smooth-surfaced, maroon-colored lesion. The lesion was found to be a PGCG associated with a dental implant. The lesion was treated successfully by explantation of the dental implant, complete excision of the lesion, and curettage of the underlying bony defect. No evidence of recurrence was seen over 12 months of follow-up.

External cervical root resorption involving multiple maxillary teeth in a patient with hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is an inherited syndrome characterized by mucocutaneous telangiectases that commonly involve the tongue, lips, fingers, and conjunctiva. While root resorption has been reported in association with central hemangiomas of bone, the association of HHT with external cervical root resorption has not been described to date. We report a case of a 57-year-old female with HTT who presented with advanced cervical root resorption involving multiple maxillary anterior teeth. Histologic examination of the gingival tissue adjacent to the area of root resorption demonstrated multiple thin-walled vascular elements as well as larger vascular channels surrounded by a thickened muscular layer. We hypothesize that the external root resorption seen in this case is the result of the HHT-related vascular process in the adjacent gingival tissue.

Peripheral giant cell granuloma of the mandibular condyle presenting as a preauricular mass

Preauricular mass is a common symptom for patients presenting to the otorhinolaryngologist with parotid disease. Some rare extraparotid lesions, originating from the temporomandibular joint and the mandible itself, also share the same localization and therefore are to be taken into consideration for the differential diagnosis with parotid lesions. Giant cell granuloma (GCG) was first described by Jaffe in 1953. Peripheral GCG (PGCG) is an exophytic soft tissue lesion originating from the periodontal ligament and periosteum. It is located only within the oral cavity. Central GCG (CGCG) is an uncommon benign fibro-osseous lesion generally presenting as an expansible mass with cortical bone defect. It is generally located in the mandible. The brown tumor of hyperparathyroidism and giant cell tumor must be ruled out because of the microscopic similarities of these lesions. The first case of PGCG of the mandible condyle is presented, and attention is drawn to mandibular diseases for the differential diagnosis of the preauricular mass.

Esthetic management of peripheral giant cell granuloma

BACKGROUND

Peripheral giant cell granuloma (PGCG) is a relatively rare hyperplastic lesion of the oral cavity. The lesion occurs in females more frequently than males and more often in the mandible than the maxilla. Although the precise etiology of PGCG is unknown, it might represent a local reaction to trauma or irritation.

METHODS

In general, treatment requires a wide excision of the lesion due to its possible recurrence.

RESULTS

This report describes the clinical and histopathological findings of PGCG diagnosed in the maxilla of a young male, as well as the successful treatment of a gingival defect that occurred following excision of the lesion, by placement of a subepithelial connective tissue graft concurrently with the biopsy procedure.

CONCLUSIONS

This report emphasizes the importance of having histopathological data to confirm the clinical diagnosis, and the importance of an adequate excision to prevent recurrence even in less extensive cases.

Multiple and synchronous peripheral giant cell granulomas of the gums

The presence of multiple giant cell lesions in the maxillofacial region is suggestive of hyperparathyroidism or neurofibromatosis. A case of synchronous, multiple peripheral giant cell granulomas is reported, bilaterally affecting the mandibular gums and also the upper right maxillary gingival mucosa, without concomitant systemic disease. Only 2 cases of central giant cell granulomas, and no cases of peripheral giant cell granulomas exhibiting similar characteristics, have been reported in the literature to date.