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Dermatology > DISEASES OF THE ORAL MUCOSA
Peripheral Giant Cell Granuloma
Article Last Updated: Sep 15, 2006
AUTHOR AND EDITOR INFORMATION
Section 1 of 9  
Author: Carl Allen, DDS, Director, Oral and Maxillofacial Pathology, Professor, Department of Oral and Maxillofacial Surgery and Pathology, Ohio State University College of Dentistry; Professor, Department of Pathology, Ohio State University College of Medicine
Carl Allen is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental Association, American Society for Microbiology, and International Association for Dental Research
Editors: Terry L Barrett, MD, Director, Associate Professor, Department of Dermatology, Division of Dermatopathology and Oral Pathology, Johns Hopkins University School of Medicine; David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic; Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati; Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital; William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
Author and Editor Disclosure
Synonyms and related keywords:
peripheral giant cell epulis, peripheral giant cell reparative granuloma
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.
Frequency
United States
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.
Mortality/Morbidity
No mortality is associated with peripheral giant cell granuloma, and the lesion has minimal morbidity. Malignant transformation has never been reported.
Race
No known racial predilection is associated with peripheral giant cell granuloma.
Sex
Most reports describe a slight female predilection.
Age
A wide age range of patients can be affected, although most patients are in the fourth to sixth decades of life at the time of diagnosis of this lesion. The mean age of patients at the time of diagnosis is typically 38-42 years.
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.
Physical
- 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.
- 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.
Causes
- 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.
- Recent 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.
Kaposi Sarcoma
Metastatic Neoplasms to the Oral Cavity
Oral Malignant Melanoma
Oral Pyogenic Granuloma
Other Problems to be Considered
Peripheral ossifying fibroma
Peripheral odontogenic neoplasms
Gingival cyst of the adult
Brown tumor of hyperparathyroidism
Lab 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.
Surgical Care
Conservative excision is typically curative, although the lesion must be completely removed to prevent recurrence. 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.
Prognosis
- Peripheral giant cell granuloma has an excellent prognosis.
- A recurrence rate of 10-15% has been reported in most series; however, recurrences are typically managed easily with additional surgery.
| Media file 1:
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. |
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Media type: Photo
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| Media file 2:
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. |
 | View Full Size Image | |
Media type: Photo
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Peripheral Giant Cell Granuloma excerpt Article Last Updated: Sep 15, 2006
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