PERIPHERAL GIANT CELL GRANULOMA: CLINICAL FEATURES, HISTOLOGY AND TREATMENT
Author: Sanketh DS, MDS
INTRODUCTION AND ETIOLOGY
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. The cause for this lesion appears to be local irritating factors like dental plaque, calculus, ill-fitting prostheses, poorly made dental restorations and periodontal disease and is believed to arise from the periodontal ligament or the mucoperiosteum. Some pathologists regard this lesion to be the soft tissue counterpart of central giant cell granuloma.
This lesion has a predilection for the middle aged and the elderly with most lesions occurring in the 4th – 6th decades and the mean age being 38-42 years. Approximately 52% – 60% of the cases occur in females. This lesion is usually asymptomatic, has a rapid growth and can attain a size of 1 cm in a few months.
Peripheral giant cell granulomas always occur on the gingiva, sometimes on edentulous alveolar ridges, frequently anterior to the molars and have a slight predilection for the mandible as compared to the maxilla. The clinical appearance is similar to pyogenic granuloma and its colour may range from deep red to red-blue or blue-purple although it more often has a bluish tinge. The lesion is either sessile or pedunculated and is not greater than 2cm in size. The surface of the lesion is smooth and may sometimes be ulcerated.
Though this lesion is a soft tissue tumor, radiographs may sometimes reveal an underlying “cupping” resorption of bone.
Microscopy shows proliferation of numerous giant cells in a background of oval or spindle shaped plump mesenchymal cells interspersed in a loose or dense fibrous stroma with numerous capillaries and sinusoidal spaces filled with red blood cells.
The giant cells may contain a few to a dozen nuclei. Abundant haemorrhage with hemosiderin pigments is usually found throughout the tissue. The overlying epithelium is hyperplastic and may be missing in focal areas corresponding to the area of ulceration.
Mitotic figures are common in the background mesenchymal cells and focal areas of metaplastic bone and dystrophic calcification may be observed.
Remember that peripheral giant cell granuloma exclusively occurs on the gingiva. And the first set of differentials to be considered when diagnosing a soft tissue lump on the gingiva are the 3 “P”s i.e – Pyogenic granuloma, Peripheral giant cell granuloma and Peripheral ossifying fibroma. An irritational fibroma could also be considered although fibromas are mostly pink in appearance as compared to the deep red to red-blue appearance of the other lesions.
Metastatic tumors, mesenchymal tumors like hemangioma and squamous cell carcinoma could also be considered.
Local surgical exicison is the treatment of choice and care must be taken to scale the adjacent teeth and to remove any source of local irritation to prevent recurrence. A recurrence of approximately 10% to 18% has been reported.
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