Peripheral Giant Cell Granuloma 

Updated: Jun 19, 2018
Author: Carl M Allen, DDS, MSD; Chief Editor: Jeff Burgess, DDS, MSD 

Overview

Background

The peripheral giant cell granuloma has an unknown etiology, with some dispute as to whether this lesion represents a reactive or neoplastic process. However, most authorities believe peripheral giant cell granuloma is a reactive lesion.[1] See the image below.

This peripheral giant cell granuloma involved the This peripheral giant cell granuloma involved the maxillary gingiva associated with an erupting central incisor of a 6-year-old girl. The referring doctor had suggested a diagnosis of eruption cyst; however, an eruption cyst would immediately collapse once the tooth had disrupted its roof.

Etiology

The cause of peripheral giant cell granuloma is unknown, although local irritation due to dental plaque or calculus, periodontal disease, poor dental restorations, ill-fitting dental appliances, or dental extractions has been suggested to contribute to the development of the lesion.

Reports have described the development of the peripheral giant cell granuloma in association with dental implants. This appears to represent an uncommon complication of implant placement, developing from a few months to several years after placement of the dental implant.[2, 3, 4, 5]

Epidemiology

Frequency

Peripheral giant cell granuloma is uncommon but not rare. Precise estimates of its incidence and prevalence in the general population have not been definitively determined.

Race

No known racial predilection is associated with peripheral giant cell granuloma.

Sex

One large recent study showed essentially no sex predilection (52% female vs. 48% male).

Age

A wide age range of patients can be affected, although most patients are in the fifth to seventh decades of life at the time of diagnosis of this lesion. One institutional biopsy service reported the mean age of 235 patients with peripheral giant cell granuloma to be 46 years, with a range from 6-88 years.

Prognosis

Peripheral giant cell granuloma has an excellent prognosis. A recurrence rate of 10-20% has been reported in most series; however, recurrences are typically managed easily with additional surgery.  Some investigators have suggested that peripheral giant cell granulomas that develop in association with dental implants seem to have a higher risk for recurrence.[6]

 

Presentation

History

Peripheral giant cell granuloma has a relatively rapid growth rate, often attaining a size of 1 cm within a few months. Lesions are generally asymptomatic. See image below.

This asymptomatic bluish-purple nodule developed o This asymptomatic bluish-purple nodule developed on the edentulous mandibular alveolar ridge of a 76-year-old man.

Physical Examination

Clinical examination shows a dusky purple, sessile or pedunculated, smooth-surfaced, dome-shaped papule or nodule. Most lesions are less than 1.5 cm in diameter, though infrequently, a peripheral giant cell granuloma may grow as large as 5 cm in greatest dimension.[7]

The lesion is always located on the alveolar mucosa or the gingiva, and 70% are found in the anterior segments of the jaws, such as in the premolar, canine, and incisor regions. A slight predilection for the mandible is observed in most reported series. Surface ulceration is often present.

See the image below.

A 10-year-old boy developed this painless purple p A 10-year-old boy developed this painless purple papule of the maxillary facial alveolar process over a 3-month period. Biopsy helped confirm the diagnosis of peripheral giant cell granuloma.
 

DDx

Diagnostic Considerations

Also consider the following[8] :

  • Peripheral ossifying fibroma [9]
  • Peripheral odontogenic neoplasms
  • Gingival cyst of the adult
  • Brown tumor of hyperparathyroidism [10]

Differential Diagnoses

 

Workup

Laboratory Studies

Laboratory studies are generally not necessary, although a serum calcium level or a parathyroid hormone assay may be indicated to rule out the rare possibility of brown tumor for lesions that are particularly large, recurrent despite adequate surgery, multiple, or associated with systemic signs suggestive of hyperparathyroidism.

Imaging Studies

Periapical radiographs typically demonstrate a cupping out or saucerization of the alveolar bone that underlies a peripheral giant cell granuloma.

Histologic Findings

Intact or ulcerated surface epithelium covers peripheral giant cell granulomas. The underlying connective tissue contains a benign proliferation of granulationlike tissue that supports numerous benign multinucleated giant cells. Abundant extravasated blood is typically noted, and deposits of hemosiderin are seen at the periphery of the lesional tissue. Spicules of woven or lamellar bone may be observed in approximately 35% of peripheral giant cell granulomas.[11]

 

Treatment

Surgical Care

Conservative excision is typically curative, although the lesion must be completely removed to prevent recurrence.[12] In areas such as the maxillary gingivae where surgical removal may have a negative esthetic impact, the clinician may want to consider a gingival graft in conjunction with the excision of the lesion.[13, 14]