Peripheral Giant Cell Granuloma Research Articles

Peripheral giant cell granuloma of orbit: A case report

Giant cell reparative granuloma (GCRG) is a rare locally aggressive benign lesion of orbit with a total of less than 15 reported cases worldwide. A 35-year-old male presented with a left upper eyelid mass. Contrast-enhanced computed tomography orbit revealed a soft-tissue density lesion of the extraconal compartment of the left orbit. Wide local excision was done. Histopathology showed peripheral giant cell granuloma of the orbit with fibroosseous component. No recurrence has been seen after eight months. Definite diagnosis of GCRG is only possible by excision biopsy. Early intervention is important to differentiate from malignant lesion.

Evaluation of the relationship between the expression of AgNOR and Ki67 with the recurrence rate in central granulomatous giant cell lesions: A case-control.

Giant cell granuloma is a local nonneoplastic lesion that is divided into two categories, based on its site of occurrence: Central and peripheral giant cell granuloma. Central giant cell granuloma is an intraosseous lesion that has a tendency to recure even in surgically treated cases. Several studies have proven that there is an association between different lesions clinical behavior and their histological features. The aim of this study was to evaluate the expression of AgNOR and Ki67 in lesions with and without recurrency. Files and records of 35 patients who had been histologically diagnosed with central giant cell granuloma were investigated. Histological features were studied after performing AgNOR staining and Ki67 marker. The data were analyzed by chi-square, Fisher, and T-test. Acquired data indicated that the count of AgNOR staining and Ki67 marker was significantly higher in lesions with recurrency than the lesions with no recurrency. The same results were attained from Ki67 intensity. The current study indicated that AgNOR staining and Ki67 marker have prognostic value in predicting recurrency of central giant cell granuloma lesions.

Incidence, treatment method and recurrence rate in giant cell granulomas: Retrospective study

Central and peripheral giant cell granulomas are benign entities mostly seen in mandibular anterior region at female individuals, usually with observed recurrence. Their etiology is still unclear, as is the optimal method for treating them. The aim of this study was to evaluate the incidence, treatment methods, recurrence rates, and initial and definitive correlation of central and peripheral giant cell granulomas.Patients who were referred to our clinic between 2013 and 2023 and who had the lesions’ definitive diagnosis as “central giant cell granuloma” (CGCG) or “peripheral giant cell granuloma” (PGCG) were included in the study. Demographic data, recurrence rates, treatment methods, lesion location, clinical behaviors, and sizes were noted on the reports.A total of 30 lesions in 23 patients (14 PGCG and 9 CGCG) were evaluated in this study. The mean follow-up time was 62.6 months; 8 of 23 patients had systemic disease. While only 1 patient was observed to have cortical bone destruction in PCGC, all patients were found to have cortical bone destruction in CGCG (p < 0.05). In both lesions, the correlation of preliminary and definitive diagnosis was evaluated, and it was found to be 50% in PGCG while it was 77.7% in CGCG. The recurrence rates were 21.4% in PGCG and 33.3% in CGCG. Curettage was applied in all patients. Additional treatments (intralesional steroid injections, denasumab applications, resection, and graft application) were performed in 5 patients who were found to have CGCG (p = 0.004). However, there was no significant relation between treatment method and recurrence in CGCG (p > 0.05).Various peripheral lesions could mimic PGCG; thus, curettage therapy could be appropriate in the treatment of PGCG. Nevertheless, in some cases of CGCG, additional treatment methods could be more effective for preventing recurrence and any other complications.

10,600 nm High Level-Laser Therapy Dosimetry in Management of Unresponsive Persistent Peripheral Giant Cell Granuloma to Standard Surgical Approach: A Case Report with 6-Month Follow-Up.

Peripheral giant cell granuloma (PGCG) is a non-neoplastic, tumour-like reactive lesion that exclusively involves the gingiva and/or the alveolar crest. The surgical approach with a scalpel has been the golden standard of treatment for PGCG, but the scientific literature reports a high rate of lesion recurrence. Hence, this unique case report aimed to evaluate the efficacy of λ 10,600 nm high-level laser therapy (HLLT) in eradicating persistent, aggressive, and recurrent PGCG that failed to respond to standard surgical treatment. A fit and healthy thirty-four-year-old Caucasian male presented with a two-month history of recurrent episodes of an oral mucosal lesion involving the buccal and lingual interdental papillae between the lower right second premolar (LR5) and lower right first molar (LR6), which was surgically excised with a scalpel three times previously. A λ 10,600 nm-induced HLLT was chosen as a treatment modality at a lower peak power of 1.62 W, measured with a power metre, emitted in gated emission mode (50% duty cycle), whereby the average output power reaching the target tissue was 0.81 W. The spot size was 0.8 mm. Ninety seconds was the total treatment duration, and the total energy density was 7934.78 J/cm2. Patient self-reporting outcomes revealed minimal to no post-operative complications. Initial healing was observed on the 4th day of the post-laser treatment, and a complete healing occurred at two-weeks post-operatively. The histological analysis revealed PGCG. This unique case report study demonstrated the efficacy of λ 10,600 nm-induced HLLT and its superiority to eradicate persistent aggressive PGCG over the standard surgical approach with minimal to no post-operative complications, accelerating wound healing beyond the physiological healing time associated with no evidence of PGCG recurrence at the six-month follow-up timepoint. Based on the significant findings of this unique study and the results of our previous clinical studies, we can confirm the validity and effectiveness of our standardised λ 10,600 nm laser dosimetry-induced HLLT and treatment protocol in achieving optimal outcomes. Randomised controlled clinical trials with large data comparing λ 10,600 nm with our dosimetry protocol to the standard surgical treatment modality at long follow-up timepoints are warranted.

Peripheral Giant Cell Granuloma in Pregnancy: A Case Report

Peripheral giant cell granuloma (PGCG) is an asymptomatic, non-neoplastic, and proliferative lesion of unknown etiology. Possible pre-disposing factors, such as hormonal changes during pregnancy, have been suggested. However, the association between PGCG and pregnancy is controversial. There are few reported clinical cases of pregnancy-associated PGCG in the literature, and they occurred only in the lower jaw. The present report is on a 35-year-old female patient at 36 weeks of gestation who presented with a PGCG in the central and lateral incisors of the upper jaw. Management consisted of complete surgical excision of the lesion along with a margin of healthy tissue under local anesthesia, followed by curettage of the adjacent fibers of the affected bony wall. The patient experienced adequate healing without complications. The diagnosis of PGCG was based on clinical characteristics, imaging examinations, and histopathological confirmation. The patient underwent postoperative follow-up evaluations at 3, 6, and 12 months, and there were no signs of recurrence.

Peripheral Ossifying Fibroma: A Case Report and Review

Gingival enlargement, especially reactive hyperplasia lesions such as pyogenic granuloma, peripheral giant cell granuloma, irritational/traumatic fibroma and peripheral ossifying fibroma are frequently encountered in the oral cavity. They are usually of benign nature, rarely presenting with aggressive clinical features.[1] We present in this article a case of peripheral ossifying fibroma originating from an interdental papilla distal to mandibular premolars.

Morphological analysis of cell cannibalism: An auxiliary tool in the prediction of central giant cell granuloma clinical behavior

Central giant cell granuloma (CGCG) is a benign jaw lesion with variable clinical behavior. Cell cannibalism is a cellular process associated with aggressiveness and invasion in malignant neoplasms. Here, we morphologically investigated cell cannibalism as an auxiliary method to predict CGCG clinical behavior. Cell cannibalism was quantitatively evaluated in 19 cases of peripheral giant cell granuloma (PGCG), 38 cases of CGCG (non-aggressive and aggressive), and 19 cases of giant cell tumor of bone (GCT) stained with hematoxylin and eosin. T-test was performed to assess the differences between the variables analyzed (p ≤ 0.05). Cell cannibalism was identified in 21% of non-aggressive CGCGs and 68.4% of aggressive CGCGs. A significantly higher amount of cannibal multinucleated giant cells (CMGC) was observed in aggressive CGCG compared to PGCG and non-aggressive CGCG (p = 0.042; p = 0.044, respectively). There were no significant differences in the CMGC index between non-aggressive CGCG and PGCG (p = 0.858) and between aggressive CGCG and GCT (p = 0.069). CGGC cases that exhibited rapid growth and tooth displacement and/or root resorption had a higher amount of CMGC (p = 0.035; p = 0.041, respectively). Cell cannibalism can be identified in CGCG through routine anatomopathological examination. The quantification of CMGC can help to predict the clinical behavior of central giant cell granuloma.

DNA methylation profile discriminates sporadic giant cell granulomas of the jaws and cherubism from their giant cell-rich histological mimics.

Sporadic giant cell granulomas (GCGs) of the jaws and cherubism-associated giant cell lesions share histopathological features and microscopic diagnosis alone can be challenging. Additionally, GCG can morphologically closely resemble other giant cell-rich lesions, including non-ossifying fibroma (NOF), aneurysmal bone cyst (ABC), giant cell tumour of bone (GCTB), and chondroblastoma. The epigenetic basis of these giant cell-rich tumours is unclear and DNA methylation profiling has been shown to be clinically useful for the diagnosis of other tumour types. Therefore, we aimed to assess the DNA methylation profile of central and peripheral sporadic GCG and cherubism to test whether DNA methylation patterns can help to distinguish them. Additionally, we compared the DNA methylation profile of these lesions with those of other giant cell-rich mimics to investigate if the microscopic similarities extend to the epigenetic level. DNA methylation analysis was performed for central (n = 10) and peripheral (n = 10) GCG, cherubism (n = 6), NOF (n = 10), ABC (n = 16), GCTB (n = 9), and chondroblastoma (n = 10) using the Infinium Human Methylation EPIC Chip. Central and peripheral sporadic GCG and cherubism share a related DNA methylation pattern, with those of peripheral GCG and cherubism appearing slightly distinct, while central GCG shows overlap with both of the former. NOF, ABC, GCTB, and chondroblastoma, on the other hand, have distinct methylation patterns. The global and enhancer-associated CpG DNA methylation values showed a similar distribution pattern among central and peripheral GCG and cherubism, with cherubism showing the lowest and peripheral GCG having the highest median values. By contrast, promoter regions showed a different methylation distribution pattern, with cherubism showing the highest median values. In conclusion, DNA methylation profiling is currently not capable of clearly distinguishing sporadic and cherubism-associated giant cell lesions. Conversely, it could discriminate sporadic GCG of the jaws from their giant cell-rich mimics (NOF, ABC, GCTB, and chondroblastoma).

Peripheral giant cell granuloma: a case series and brief review.

We report three varied presentations of peripheral giant cell granuloma and provide an up-to-date summary on the diagnosis, treatment and prognosis of this everyday swelling, including lessons learned.

Histopathological correlation in oral biopsies in clinically diagnosed pediatric oral lesions: A 12-year institutional archival study

: The present study was aimed to determine the histopathological correlation in lesions of oral cavity in children aged 14 years and below received for diagnosis in the Oral Pathology Department of the Indira Gandhi Government Dental College Jammu, J&amp;K. : The archives of the Department of Oral Pathology and Microbiology were retrospectively analyzed. Biopsy records of all oral lesions from pediatric patients, aged 0–14 years, from Department Of Oral and Maxillofacial Pathology &amp; Oral Microbiology, Indira Gandhi Government Dental College Jammu, J&amp;K, from 2011 to 2022 were considered. Descriptive statistical analysis and using computer software Pearson’s Chi‑square test was performed.: 36 biopsies (4.9%) belonged to pediatric population out of the total 727 biopsies that were received during the period. Females (64%) showed greater prevalence compared to males (36%). Affected age group seen were between10–14 years. The most common category of lesions diagnosed were cysts and the odontogenic tumors were the least seen. Mandible showed more predilection compared to maxilla in jaws which was most common location involved, followed by the gingiva, palate, lower lip and labial mucosa. On comparing the histopathological diagnosis, dentigerous cysts (22%) were the most common followed by radicular cysts (17%), fibrous hyperplasia (14%), pyogenic granuloma (11%), central giant cell granuloma (8%), hyperplasia of minor salivary glands (5.6%) and percentage of aneurysmal bone cyst, peripheral giant cell granuloma, peripheral ossifying fibroma, central ossifying fibroma, juvenile ossifying fibroma, cementoblastoma, ameloblastoma and necrotic bone all was equal (2.8%). A statistically significant association of age and gender was seen with the category of the lesion.:The lesions were more common in the mandible with a female predilection and in age group &amp;#62;10 years. The majority of oral and maxillofacial lesions detected in pediatric population were benign similar to the previous reports.

Surgical treatment of peripheral giant cell granuloma: a case report

Surgical treatment of peripheral giant cell granuloma: a case report

Unexpected first finding in primary hyperparathyroidism; peripheral giant cell granuloma in the mandibula

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Hybrid odontogenic lesions: A case series of a rare entity

BackgroundThe occurrence of hybrid odontogenic lesions with two or more morphologically distinct components is a rare phenomenon and poses a diagnostic challenge. We aimed to study the clinical, radiological, and pathological features and behavior of hybrid odontogenic lesions, to enhance awareness about these rare lesions. MethodHematoxylin and Eosin slides of hybrid odontogenic lesions diagnosed between January 01, 2012 and December 31, 2020, were reviewed. Demographic and radiological information were obtained from the patient's medical records. Results8 cases were diagnosed with a mean age of 19.1 years and male to female ratio of 1:1.7. Involvement of mandible was more common (n = 5) as compared to maxilla (n = 3). All patients presented with swelling for an average of 9.75 months (3–25 months) duration. Bleeding, loose teeth, pain and facial asymmetry were reported in 5,3, 3, and 2 cases, respectively. Radiologically, 7 cases were well demarcated, 75% cases (n = 6) were radiolucent, and average radiological size was 4.8 cm. All patients were managed with surgery alone. 5 cases (62.5%) underwent enucleation and curettage, while local excision, en-block resection and segmental mandibulectomy were performed in 1 case each. Histologically, ossifying fibroma/cemento-ossifyiong fibroma were the most lesion, occurring in 5 cases (62%), followed by giant cell granuloma like lesions (GCG) i.e., central and peripheral giant cell granuloma (n = 3), Adenomatoid Odontogenic tumor (AOT) (n = 2), and DC (n = 2), ameloblastic fibroma (AF) (n = 1), Ameloblastoma (n = 1), calcifying odontogenic cyst (COC) (n = 1), and complex odontoma (n = 1). No evidence of recurrence was noted after 4–99 months of surgery (mean: 32.9) in cases with available data (n = 7). Long-term complaints included facial asymmetry (n = 2) and pain (n = 1). ConclusionMost hybrid odontogenic lesions affect young females in the second decade of life and commonly show COF and OF as hybrid components. A conservative approach to management appears adequate.

A large-cohort study of 2971 cases of epulis: focusing on risk factors associated with recurrence

BackgroundTo analyze the clinicopathological features of different histological subtypes of epulis, and evaluate the risk factors associated with recurrence.Materials and methodsA retrospective study including 2971 patients was performed. The patients’ sex, age, location, size, histological subtypes, recurrence information, oral hygiene habits, periodontitis symptoms and smoking history were retrieved from the patient medical records and follow-up information.ResultsAmong the 2971 cases, focal fibrous hyperplasia (FFH) was the most common lesion (60.92%), followed by peripheral ossifying fibroma (POF) (29.32%), pyogenic granuloma (PG) (8.08%) and peripheral giant cell granuloma (PGCG) (1.68%). The peak incidence of epulis was in the third and fourth decade of life, with a mean age of 45.55 years. Female predominance was found in all types of lesions with a female to male ratio of 1.71:1. PG had the highest recurrence rate (17.18%), followed by POF (12.98%), FFH (9.55%) and PGCG (8.82%). Histological subtypes were significantly correlated with the recurrence of epulis (P = 0.013). Regular supportive periodontal therapy (P = 0.050) had a negative correlation with recurrence, whereas symptoms of periodontitis (P < 0.001) had a positive correlation with the recurrence of epulis.ConclusionsControlling the periodontal inflammation and regular supportive periodontal therapy might help reduce the recurrence of epulis.

AN UNUSUAL PRESENTATION OF SOFT TISSUE FIBRO-OSSEOUS LESION: A CASE REPORT

Diagnosis of peripheral oral exophytic lesion is quite challenging. Pathologic growth protruding above the normal contour of the oral mucosa is referred to as an oral exophytic lesion. The most frequent lesions found in patients are gingival lesions, and the majority of these are reactive hyperplasia's linked to a variety of persistent irritant stimuli. Nodules of inammatory brous hyperplasia are very common. Irritation broma, pyogenic granuloma, peripheral ossifying broma, and peripheral giant cell granuloma are some of the reactive lesions of the gingiva. The lesions are typically mucosal in colour but can occasionally include localised ulceration. Presenting a case of 30-year-old female with swelling in the anterior Maxillary gingiva, the clinical presentation of which differs from the usual presentation with no radiographic changes

Peripheral Giant Cell Granuloma-A Reactive Lesion: Case Report

Gingival overgrowth commonly seen in clinics can be categorized as generalized or localized. Peripheral giant cell granuloma (PGCG) is tumor like, non-neoplastic reactive intra-osseous lesion occurring in the gingiva or alveolar mucosa and is characterized by an un-encapsulated proliferation of mononuclear polygonal cells which are spindle-shaped with osteoclast-type multinucleated giant cells in a vascular background. This is a case report of 28 year old female with peripheral giant cell granuloma in mandibular anterior region. The lesion was completely excised to the periosteum level and no recurrence was seen in 1 month follow up.

Giant Cell Fibroma in an Elderly Woman: A Report of a Rare, Late and Unusually Large Presentation

BackgroundGiant cell fibroma (GCF) is a rare benign oral fibrous lesion which is predominantly found in the mandible of Caucasians but rarely in the maxilla and black population above the third decade of life.&#x0D; Objective: To draw the attention of clinicians to a rare, late and unusually large presentation of Giant Cell Fibroma&#x0D; Case report: The index case was a 68-year-old fisherwoman with a ten-year-old slow-growing painless swelling occupying the left anterior maxilla. The lesion crossed the midline to the right causing incompetent lips and teeth displacement leading to aesthetics and functional problems. Upon clinical examination, a provisional diagnosis of peripheral giant cell granuloma was made. Radiological essentially revealed a soft tissue mass, histopathological evaluations confirmed the diagnosis of GCF and the patient was prepared for surgical excision. A surgical excision of the soft tissue mass and peripheral ostectomy was performed.&#x0D; Conclusion: GCF has distinct histopathologic features occurring in any age, race, site and decades of life; growing very large causing aesthetics and functional problems. Immunohistochemistry if available is an additional resource to unequivocally establish the diagnosis.

INFLAMMATORY/REACTIVE HYPERPLASIA'S: A REVIEW

The reactive lesions are comparatively common in the oral cavity that dentist face during routine examination because of the frequency with which the tissues are injured. They frequently result from a well-known provocation or injury such as plaque, calculus, or foreign bodies. Diagnosis and development of a treatment plan is difficult if dentists are not aware of the prevalence and clinical symptoms of these lesions. The aim of this article was to review the clinical features of various reactive hyperplastic lesions of the oral cavity. The most commonly found lesions are irritational fibroma, pyogenic granuloma, epulis fissuratum, peripheral giant cell granuloma.

Tacrolimus-Induced Gingival Hyperplasia.

A 66-year-old man with a history of an orthotopic heart transplant and rheumatoid arthritis presented to the clinic for a routine follow-up appointment. The patient reported swelling in his gums that started after his heart transplant surgery. He underwent gingival laser excision twice in the past, but the swelling recurred. Since his heart transplant surgery, he has taken daily tacrolimus, mycophenolic acid, and prednisone. Gingival hyperplasia (Figure, A) affecting the alignment of the teeth was notable on physical examination. His laboratory workup, including complete blood cell count, was within normal limits. The patient has had no cardiac complications since his surgery and chose to continue taking tacrolimus despite its adverse effect.FIGURE: A and B, Gingival hyperplasia affecting the alignment of the teeth.Tacrolimus is an immunosuppressant used in organ transplants. It has been replacing cyclosporine as it showed it is associated with a lower prevalence and severity of gingival overgrowth. Differential diagnosis: Vitamin C deficiency (scurvy) Gingival plaques Acute myeloid leukemia Peripheral giant cell granuloma Sarcoidosis

Rare presentation of localized gingival overgrowth with osseous defect – Case report

Gingival overgrowth is one of the most undesirable consequences that often lead to impaired esthetics and masticatory functions, compromised oral hygiene maintenance often requiring surgical excision of the excessive tissue. Gingival overgrowth belongs to a common group of lesions designated as focal reactive overgrowths. These growths are reactive in nature. A definitive diagnosis will then enable an appropriate management strategy. Peripheral giant-cell granuloma (PGCG) is a reactive focal overgrowth, ordinarily presents as an epulis-like growth. This is of a reactive rather than neoplastic nature and its pathogenesis is uncertain. It is widely considered to originate from the cells of the periodontal ligament, occurring as a response to irritants such as dental calculus, plaque, microorganisms, dental appliances, and restorations. The purpose of this article is to report the clinical, histopathological features and treatment of a case with PGCG arising from mandibular posterior alveolus in a 34-year-old female. The overgrowth was well defined along with the bone defect, involving the buccal aspect of the mandibular gingiva. The tooth was endodontically treated, the lesion was completely excised, and the osseous defect was filled with regenerative material. The 12-month follow-up radiograph revealed successful healing with no more recurrence.