Peripheral Giant Cell Lesions Research Articles

Concordância: impressão clínica vs. histologia oral pediátrica

ABSTRACT Several pathologies often lead to disagreements regarding their identification in clinical practice, particularly in the context of oral pathologies. The data obtained during anamnesis and physical examination frequently require revision to reach a diagnosis. Objective: The present study aimed to evaluate the agreement between clinical and histopathological diagnoses and report the frequency of completing forms for specimens submitted to histopathological examination, examined retrospectively. Methods: Data on 93,950 specimens submitted for histopathological examination were retrieved from medical records. Results: A total of 5,052 reports from patients aged 0 to 14 years were included. Agreement was defined based on categorizing the nature of the injury according to its diagnostic category. The highest agreement rate was observed for mucocele and papilloma (86%), followed by pyogenic granuloma (60%). Low rates of histopathological confirmation of clinical impressions were observed for hemangioma (17.5%) and peripheral giant cell lesion (35%). Among lesions related to dental tissues, odontoma showed the highest agreement (84%), followed by keratocyst (74%), while radicular cyst showed the most discordance (21%). Conclusion: This study found an acceptable level of agreement for the most frequent injuries. However, understanding the characteristics of oral lesions in children and their clinicopathological correlations is crucial for providing optimal treatment in each case.

Gingival and alveolar mucosal reactive hyperplastic lesions: a retrospective clinical and histological study of 996 cases.

gingival/alveolar mucosal reactive hyperplastic lesions (GRHL), including fibrous hyperplasia (FH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF) and peripheral giant cell lesion (PGCL), are a common group of oral diseases. The aim of the present study was to access the frequency and distribution of the clinical and histological features of these disorders in a Brazilian population. all specimens diagnosed as GRHL in three Oral Pathology laboratories were selected for the study. Clinical information was retrieved from the laboratory biopsy forms and hematoxylin and eosin stained histological slides were reviewed for analysis of the histological characteristics. final sample was composed of 996 specimens, including 463 FH (47%), 280 PG (28%), 183 POF (18%) and 70 PGCL (7%). Females were more affected by FH, PG, and POF, and most cases affected adults with mean ages ranging from 40 to 53 years. FH, PG, and POF were more common in the upper gingiva/alveolar mucosa. Most PG, POF and PGCL were pedunculated, in contrast with FH (p<0.001). PG, FH and POF were mostly red or normal mucosal in color, while PGCL were mostly red/purple (p<0.001). PGCL were larger, followed by POF, FH and PG (p<0.001). Some histological features were characteristically found in some conditions, but they were also encountered in other lesions with variable frequencies. Oral medicine specialists, oral pathologists and periodontists are usually the professionals in contact with patients presenting GRHL and it is of upmost relevance that they should be familiarized with their clinical and histological profile.

EXTENSIVE PERIPHERAL GIANT CELLS LESION: CASE REPORT

Peripheral giant cells lesion is a reactive injury caused by local irritation or trauma. Most injuries are small, although extensive injuries are seen occasionally. A 33-year-old woman sought care because of a volume increase in the right jaw that caused discomfort and facial asymmetry. The intraoral physical examination revealed an 8 cm nodular lesion in the inserted lower right gingiva with a purplish color, smooth surface, and hardened consistency. Computed tomography scan showed bone rarefaction in the region of teeth 45 and 47. An incisional biopsy was performed, and the histopathologic examination revealed a proliferation of cells, sometimes spindle-shaped, sometimes ovoid, permeated by numerous multinucleated giant cells. After diagnosis, a peripheral giant cell lesion was excised with safety margins and extraction of the teeth associated with the lesion was performed. The patient is being followed up, with no signs of recurrence of the lesion.

ORAL LESIONS AROUND DENTAL IMPLANTS: A CRITICAL LITERATURE REVIEW

Objectives The aim of this critical literature review was to investigate the evidence and reports regarding oral lesions around dental implants (DI). Study Design This literature review was prepared in accordance with the PRISMA statement and based on the proposed focused question. Specific descriptors were organized according to the PICO strategy, and a literature search was performed for PubMed, Web of Science, and Embase databases. Results The most related pathologic diseases around DI were described as mucositis and peri-implantitis. However, other lesions can appear, such as nonneoplastic proliferative lesions (pyogenic granuloma, peripheral giant cell lesion, peripheral ossifying fibroma, and fibrous hyperplasia). Although rare, malignant neoplasms (squamous cell carcinoma) were reported. These pathologic changes in peri-implant tissue can negatively affect the implant success and survival rates of DI. The continuous care of DI with adequate control of the biofilm and the preservation of a sufficient amount of keratinized mucosa can prevent the development of most of these peri-implants lesions. Conclusions A wide variability of diseases can affect peri-implant tissues, a fact that demonstrates the necessity of a good clinical examination and complementary exams to determine a correct diagnosis. The aim of this critical literature review was to investigate the evidence and reports regarding oral lesions around dental implants (DI). This literature review was prepared in accordance with the PRISMA statement and based on the proposed focused question. Specific descriptors were organized according to the PICO strategy, and a literature search was performed for PubMed, Web of Science, and Embase databases. The most related pathologic diseases around DI were described as mucositis and peri-implantitis. However, other lesions can appear, such as nonneoplastic proliferative lesions (pyogenic granuloma, peripheral giant cell lesion, peripheral ossifying fibroma, and fibrous hyperplasia). Although rare, malignant neoplasms (squamous cell carcinoma) were reported. These pathologic changes in peri-implant tissue can negatively affect the implant success and survival rates of DI. The continuous care of DI with adequate control of the biofilm and the preservation of a sufficient amount of keratinized mucosa can prevent the development of most of these peri-implants lesions. A wide variability of diseases can affect peri-implant tissues, a fact that demonstrates the necessity of a good clinical examination and complementary exams to determine a correct diagnosis.

PERIPHERAL GIANT CELL LESION ASSOCIATED WITH PERIPHERAL OSSIFYING FIBROMA: A RARE CASE REPORT

Lesions formed by the combination of microscopic aspects of peripheral giant cell lesion (PGCL) and peripheral ossifying fibroma (POF) are rare. Whether they represent true hybrid lesions or part of a disease spectrum is debatable. A 38-year-old woman was referred for evaluation of a painless, slow-growing swelling on the mandible that had been identified 6 months earlier. Intraoral examination revealed a pinkish nodule with whitish, erythematous, and ulcerated areas located on the buccal gingiva of teeth #37 and #38. Computed tomography revealed hyperdense foci in the lesion and erosion of the underlying bone cortex. Under the diagnostic hypothesis of POF, an excisional biopsy was performed. Histopathologic analysis revealed proliferation of oval to spindle-shaped mononucleated mesenchymal cells, interspersed with multinucleated giant cells. Extensive deposition of trabecular bone intermixed by cellular fibroblastic tissue could also be observed. The definitive diagnosis was PGCL associated with POF. The patient remains under close follow-up. Lesions formed by the combination of microscopic aspects of peripheral giant cell lesion (PGCL) and peripheral ossifying fibroma (POF) are rare. Whether they represent true hybrid lesions or part of a disease spectrum is debatable. A 38-year-old woman was referred for evaluation of a painless, slow-growing swelling on the mandible that had been identified 6 months earlier. Intraoral examination revealed a pinkish nodule with whitish, erythematous, and ulcerated areas located on the buccal gingiva of teeth #37 and #38. Computed tomography revealed hyperdense foci in the lesion and erosion of the underlying bone cortex. Under the diagnostic hypothesis of POF, an excisional biopsy was performed. Histopathologic analysis revealed proliferation of oval to spindle-shaped mononucleated mesenchymal cells, interspersed with multinucleated giant cells. Extensive deposition of trabecular bone intermixed by cellular fibroblastic tissue could also be observed. The definitive diagnosis was PGCL associated with POF. The patient remains under close follow-up.

Multidisciplinary management of a central giant cell lesion: a case report

This case report describes the diagnosis and management of a central giant cell lesion in a young, healthy patient. The article outlines the differences between central giant cell lesions and their counterparts, peripheral giant cell lesions. More crucially, it highlights the challenge in distinguishing these lesions, which are almost identical histopathologically. CPD/Clinical Relevance: This case describes the difficulties that can be faced by clinicians in differentiating between peripheral giant cell lesions and central giant cell lesion. It also highlights the need for specialist multidisciplinary input in managing the surgical and orthodontic implications of these lesions.

Peripheral odontogenic myxoma: Clinical case with a literature review

Peripheral odontogenic myxoma (POM) is a rare and extra-osseous variant of odontogenic myxoma (OM), classified as a relatively rare benign odontogenic tumor, yet presenting locally aggressive behavior. The objective this manuscript is to report a case of POM in a 75-year-old patient, located in the right maxilla, and in addition, to perform a literature review of the data in relation to clinical, radiographic aspects, hypothesis of diagnosis, and treatment. A male patient, 75 years old, clinical examination constact the presence of a nodule, with a smooth surface, on the right upper alveolar ridge, measuring 20 x 25 mm, with a color similar to the mucosa, a softened consistency, involving teeth 14 and 15, and with an undetermined time of evolution was observed. The diagnostic hypothesis was a peripheral ossifying fibroma and differential diagnosis of peripheral giant cell lesion. An excisional biopsy was performed together with extraction of the involved teeth. Histopathological examination and histochemical reaction was confirm the histopathological diagnosis of POM. The reported case is extremely rare due to the clinical presentation of the lesion, causing bone resorption with tooth mobility. In addition, the age range of involvement is very different from that presented in the literature, between the second and fourth decade of life. The final diagnosis was very important, as it is a lesion with a great potential for recurrence, long-term follow-up should be more careful, and in case of recurrence, a new intervention must be performed.

Periodontal initial therapy combined with laterally positioned flap in gingival plasma cell granuloma treatment: a case report

Background: Gingival plasma cell granuloma (GPCG) is a rare benign, reactive, non-neoplastic lesion characterized by the predominance of polyclonal plasma cells. Clinical diagnosis is often confused with peripheral giant cell lesion, plasmacytoma, lymphoma, and fibroma. Surgery resection predominates the treatment methods. Routine resection extends to adjacent normal tissue, causing postoperative aesthetic and soft tissue defects.

THE BENEFITS OF LASER SURGERY FOR THE TREATMENT OF PERIPHERAL GIANT CELL LESION. A CASE REPORT

A 47-year-old male patient was referred to an oral surgeon complaining of a nodular lesion associated with the alveolar ridge of tooth 34 and 35. At the clinical examination, a nodular, sessile, smooth-textured, fibrous consistency lesion of approximately 6 mm was observed, and radiographically bone resorption was noticed. The treatment performed was excisional biopsy using a high-level diode laser (Thera Lase Surgery, DMC, São Carlos, São Paulo, Brazil) following parameters of the manufacturer (GaAlAs, 980 nm, 2.5 W, pulsatile, 60 Hz). The specimen was sent for histopathologic examination, confirming the diagnosis of peripheral giant cell lesion. This approach resulted in a nonstressful procedure, no intensive blood bleeding, and postsurgical course with rapid healing in 7 days and completed healing in 15 days. At 1 year follow-up, no recurrence was observed. The use of a laser surgery allowed beneficial effects to the patient as a prompt recovery. A 47-year-old male patient was referred to an oral surgeon complaining of a nodular lesion associated with the alveolar ridge of tooth 34 and 35. At the clinical examination, a nodular, sessile, smooth-textured, fibrous consistency lesion of approximately 6 mm was observed, and radiographically bone resorption was noticed. The treatment performed was excisional biopsy using a high-level diode laser (Thera Lase Surgery, DMC, São Carlos, São Paulo, Brazil) following parameters of the manufacturer (GaAlAs, 980 nm, 2.5 W, pulsatile, 60 Hz). The specimen was sent for histopathologic examination, confirming the diagnosis of peripheral giant cell lesion. This approach resulted in a nonstressful procedure, no intensive blood bleeding, and postsurgical course with rapid healing in 7 days and completed healing in 15 days. At 1 year follow-up, no recurrence was observed. The use of a laser surgery allowed beneficial effects to the patient as a prompt recovery.

STUDY OF THE CELLULAR CANNIBALISM OF CENTRAL AND PERIPHERAL LESIONS OF THE JAWS

Objective: This study analyzed the role of cellular cannibalism in the pathogenesis of peripheral giant cell lesions (PCGLs) and central giant cell lesions (CGCLs). Study Design: This is a retrospective and quantitative study of 42 cases of PCGLs and 43 cases of CGCLs (24 aggressive and 19 nonaggressive). It was analyzed by hematoxylin-eosin staining of the number of cannibalistic cells in the giant cells (GC) of this lesions. Results: Cannibalistic GCs were seen in 17 cases of CGCLs (39.5%) and in 34 cases of PCGLs (80.9%). The quantity of cannibalistic GCs ranged from 1.0 to 142.0 with a total mean ± standard deviation (SD) of 12.15 ± 24.87. The cannibalistic GCs was higher in PCGLs (19.5 ± 28.2) than CGCLs (5.04 ± 18.8) with statistical significance (P

IMMUNOHISTOCHEMICAL COMPARATIVE STUDY OF PERIPHERAL, PERI-IMPLANT, AND CENTRAL GIANT CELL LESIONS

Central giant cell lesions (CGCL) and peripheral giant cell lesions (PGCL) are reactive lesions of unknown etiopathogenesis and similar histologic features. PGCL affects the gingiva and alveolar mucosa, but some rare cases can be associated with dental implants. Objective: In the present study, we compared the expression of smooth muscle actin, Bcl-2, GLUT-1, CD68, OPG, RANK, Ki67, and CD34 in a series of CGCL and conventional and peri-implant PGCL. Study Design: Clinical data were retrieved from the laboratory records and histologic analysis was performed in hematoxylin and eosin (H&E)-stained sections. Immunohistochemical reactions for detecting the above mentioned antibodies were performed and digitally scored. Results: The digital scores for CD68 and Bcl-2 were higher in conventional PGCL and CGCL than in peri-implant PGCL (P = .033 for CD68 and P Conclusions: The current results demonstrated some differences in microvessel density, proliferative activity, and expression of CD68 and Bcl-2 among conventional PGCL, peri-implant PGCL and CGCL. Further studies are encouraged to better understanding of these early findings.

PERIPHERAL CALCIFYING ODONTOGENIC CYST: DIAGNOSTIC CHALLENGE

A 62-year-old male patient with light brown skin color sought the stomatology clinic with complaint of cyst in the inferior alveolar ridge for 2 months without symptoms. Extraoral examination showed no alterations. Intraoral examination presented nodular sessile lesion with delimited boundary and the same color of the adjacent mucosa that measured approximately 10 mm in the left inferior alveolar ridge, on canine tooth area, without trauma history association. Periapical radiography was requested that evidenced a cup-shaped resorption area. With a diagnostic hypotheses of peripheral giant cell lesion and peripheral ossifying fibroma, an excisional biopsy was performed, and treatment of the bone resorption was started. The anatomopathologic analysis showed a fragment of cystic lesion coated by stratified squamous epithelium with arch projections, ghost cells, and amorphous lobular mass, confirming the diagnosis of peripheral calcifying odontogenic cyst. The patient remains on clinic and image control during 8 months without signs of recurrence.

VASCULAR EXTENSION OF PERIPHERAL GIANT CELL LESION: A CASE REPORT WITH IMMUNOHISTOCHEMICAL ANALYSIS

Peripheral giant cell lesions shares microscopic similarities to other entities and their origin remains unclear. A 47-year-old woman was referred for management of a painful swelling in the canine region with recent history of tooth removal. A slight asymmetry in the upper lip was detected. Intraoral exam revealed a lesion that appeared as a purplish-red nodule, pediculate on the anterior right alveolar crest, and associated with an unstable dental prosthesis. Superficial bone resorption was detected. The lesion was curetted after excision biopsy. Microscopically, an ulcerative, nonencapsulated lesion composed of densely cellular lobules of round mononuclear cells, prominent multinucleated giant cells (MGCs), and hemorrhage was surrounded by fibrous tissue. Apoptotic MCGs were also seen. Interestingly, vessels in the periphery exhibited transendothelial migration of MGCs were positive for matrix metallopeptidase 9 (MMP-9) and macrophage fusion marker CD44. Neovascularization was detected within cellular lobules. Serum tests were normal. Clinical significance of vascular extension must be further clarified. No recurrence has occurred after 1 year.

SOFAT as a Putative Marker of Osteoclasts in Bone Lesions.

Secreted osteoclastogenic factor of activated T cells (SOFAT) is a novel activated human T-cell-secreted cytokine that induce osteoclastogenesis in a RANKL-independent manner. The aim of this study was to evaluate the immunohistochemical expression of SOFAT in intraosseous and extraosseous lesions. Thirty-two oral biopsies were divided into 2 groups: (1) intraosseous lesions-4 cases of cherubism, 5 central giant cell lesions, 3 osteoblastomas, 3 cementoblastomas, 2 periapical lesions and (2) extraosseous lesions-5 peripheral giant cell lesions, 5 cases of oral paracoccidioidomycosis, and 5 foreign body reactions. Immunohistochemistry was performed for SOFAT and tartrate-resistant acid phosphatase. Image analysis consisted of a descriptive evaluation of the immunohistochemical staining pattern observed. Tartrate-resistant acid phosphatase-positive lesions included those containing multinucleated giant cells (MGC) from both groups. SOFAT was positive in MGC of the intraosseous lesions group, except in periapical foreign body reactions as well as extraosseous lesions. SOFAT was shown to be a putative marker of osteoclasts, which proved useful to differentiate them from multinucleated macrophages. Osteoclast induction may be both dependent and independent from the RANK/RANKL/OPG pathway and independent from the bone microenvironment.

Profile evaluation of patients diagnosed with non-neoplastic proliferative lesions in a dentistry clinic

Non-neoplastic proliferative lesions (NNPLs) are alterations that affect oral mucosal tissues. The etiology of these lesions is associated with local irritant processes, principally inflammation, infections and mechanical irritants. NNPLs are classified into four groups: inflammatory fibrous hyperplasia, pyogenic granuloma, peripheral ossifying fibroma, and peripheral giant cell lesion. Aim: This cross-sectional, quantitative, retrospective, analytical, informative and educational study aimed to evaluate the profiles of patients who were diagnosed with any non-neoplastic proliferative lesion in the Unimontes Stomatology Clinic, Brazil. Methods: From January 2001 to June 2012, 1505 patients were counted who underwent anatomopathological examination, in addition to evaluations for other conditions. Results: Of these 1505 patients, 223 were diagnosed with some type of non-neoplastic proliferative lesion, and statistical analysis showed that 76% were female and 24% male and that 23.3% were between 41 and 50 years of age. Inflammatory fibrous hyperplasia was the most common NNPL (86.5%). Conclusion: Due to the high frequency of these lesions in the dental clinic, this type of survey has significant relevance for informing health professionals about these proliferative processes. This information is necessary, since the dentist is intimately involved in both the etiology, treatment and prevention of these lesions.

Peripheral odontogenic fibroma in the mandibular gingiva: case report

ABSTRACT Peripheral odontogenic fibroma (POF) is a rare benign neoplasm of odontogenic mesenchymal origin that accounts for approximately 4.7% of all odontogenic tumors. This article reports the case of a 29-year-old woman who presented with a painless, reddish mass in the right vestibular mandibular gingiva between the second premolar and the first molar. Radiographic examination revealed small crestal bone loss in the region. Microscopic analysis revealed a tumor composed of cellular fibroblastic connective tissue intermingled with conspicuous islands and strands of apparently inactive odontogenic epithelium. The final diagnosis was POF. No clinical signs of recurrence were observed 22 months after surgical excision. POF may be clinically mistaken for other common gingival lesions, such as pyogenic granuloma, peripheral giant cell lesion, and peripheral ossifying fibroma. Conservative local excision has been suggested as the treatment of choice for POF. However, in view of the paucity of information on the biological behavior and recurrence rate of this tumor, long-term follow-up of patients is mandatory.

Peri-implant peripheral giant cell lesions: report of 13 new cases and comparative histological and immunohistochemical analysis with peripheral and central giant cell lesions.

Background Few cases or peri-implant peripheral giant cell lesions (PGCL) have been reported in the literature. The aim of this study was to report 13 new cases of peri-implant PGCL and compare the expression of smooth muscle actin, Bcl-2 protein, GLUT-1, CD68, osteoprotegerin, receptor activator of nuclear factor kappa-B, Ki-67 and CD34 in these cases with PGCL and central giant cell lesions (CGCL). Material and Methods Clinical data were retrieved from the laboratory records and histological analysis was performed using HE-stained slides. Immunohistochemical reactions for the above mentioned antibodies were performed and digitally scored. Results Peri-implant PGCL mostly affected the posterior mandible of adult females. CD68 and Bcl-2 expressions were higher in conventional PGCL and CGCL than in peri-implant PGCL (p=0.033 for CD68 and p<.0001 for Bcl-2). Microvessel density was higher in conventional peripheral than in central and peri-implant PGCL (p=0.002). Proliferative index of the mononuclear cells showed no statistically significant differences comparing the three groups but it was higher in peri-implant PGCL. Conclusions The current study demonstrated that peri-implant PGCL is more common in the posterior mandible of adult females. There were some differences in microvessel density, proliferative activity and expression of CD68 and Bcl-2 among conventional PGCL, peri-implant and CGCL. Further studies are encouraged to better understand these early findings. Key words:Giant cell lesion, giant cell granuloma, peripheral, dental implants, immunohistochemistry.

Immunohistochemical expression of RANKL in oral giant cell lesions is predictive of aggressiveness.

The aim of this study was to evaluate the immunohistochemical expression of receptor activator of nuclear factor kappa-B ligand (RANKL) and of osteoprotegerin (OPG), important proteins correlated with osteoclastogenesis, in central giant cell lesions (CGCL) and peripheral giant cell lesions (PGCL) and to compare their expression with the histological and clinical parameters for quantification of multinucleated giant cells (MGC) and their nuclei, lesion size, and recurrences. Twenty cases of each lesion type were selected to quantify the number of MGCs and nuclei/mm2 of connective tissue. The immunoreactivity of RANKL and OPG was expressed as a percentage of the marked area in the stroma. Clinical data were collected from pathoanatomical and medical reports. No statistical differences were found for the number of MGCs (p = 0.24) between PGCL and CGCL, but the number of nuclei within the MGCs was higher in CGCL (p = 0.01). RANKL expression was higher in CGCL than in PGCL (p = 0.04) and all recurrent lesions showed higher RANKL and OPG expressions than nonrecurrent lesions. We report higher RANKL expression and a greater number of nuclei in CGCL, which may explain the difference in clinical behaviour between these lesions and their pathogenesis.

Peripheral Odontogenic Fibroma in the Mandibular Gingiva: a Case Report

Peripheral odontogenic fibroma (POF), a rare benign neoplasm of odontogenic ectomesenchymal origin, represents approximately 4.7% of all odontogenic tumors. A 29-year-old white woman was referred for evaluation of a painless, slow-growing swelling in the gingiva, identified 2 years earlier. Her medical history was unremarkable. Intraoral examination showed a reddish, soft nodule, measuring approximately 1.5 × 0.8 cm, in the right vestibular mandibular gingiva between the second premolar and the first molar. Radiographic examination revealed small crestal bone loss in the region. In view of a provisional diagnosis of pyogenic granuloma or peripheral giant cell lesion, excisional biopsy was performed. Histopathologic analysis confirmed a tumor composed of cellular, fibroblastic connective tissue intermixed with abundant islands and strands of apparently inactive odontogenic epithelium. The final diagnosis was epithelium-rich POF. Nine months after surgical excision, clinical signs of recurrence were not detected. The patient remains under clinical follow-up.

Concomitant Peripheral Giant Cell Lesion and Traumatic Bone Cyst in the Mandible: a Rare Case Report

Synchronous lesions of the jaws are reported here. A 14-year-old girl presented with a reddish sessile nodule in the mandibular left premolar gingival region. Radiographically, a well-defined radiolucent area involving the left mandibular body was observed. Incisional biopsy of the extraosseous lesion was performed, and a giant cell lesion was histopathologically diagnosed. Another surgical intervention was planned. However, the patient returned 2 years later with both intra- and extraosseous lesions with increased sizes. A surgical exploratory procedure in the bone lesion revealed an empty cavity; curettage to stimulate bleeding was performed, in addition to excision of the extraosseous lesion. The final diagnosis was synergistic peripheral giant cell lesion and traumatic bone cyst. The 12 month follow-up did not show any relapse. Besides, neoformation of the entire bone was observed. The pathogenesis of both the lesions remains uncertain; one hypotheses is local trauma leading to development of a reactive disease.