The is not used in diagnosis nowadays.5,6 PGCG is

The peripheral
giant cell granuloma (PGCG), also known as peripheral giant cell epulis. PGCG
or giant cell hyperplasia, is the most common giant cell lesion in the oral
cavity with the incidence rate varying from 5.1% to 43.6%. Since its reparative
effect has not been proved till date; the osteoclast activity appears to be
doubtful.1-3

 

CASE
REPORT

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!


order now

 

 A 40 years old female patient with a chief complain of painless
swelling in lower back right region of jaw since 6 months. The
swelling was initially small in size and then gradually increased up to the
present size.

 

The patient gave
a history of mild localized intermittent pain in relation to the same region
while having meals and also slight bleeding on brushing teeth. There was no
history of trauma, neurological deficit, fever, loss of appetite, loss of
weight. There was no similar swelling present in any parts of the body. Patient
was systemically healthy. Past medical, family histories were non-contributory.

 

Extra-orally,
there was no abnormality detected. Intra-orally, a solitary ovoid swelling was
present in the right lower buccal vestibule measuring approximately 2× 3 cm
extending from distal aspect of 45 to mesial aspect of 47 with significant
vestibular obliteration in relation to 45–47. The overlying mucosa appeared
pink to erythematous.

 

The surface of
the swelling was smooth, showed no secondary changes,& was covered by
normal mucosa with mild focal hyper pigmented areas and had a pedunculated
base. On palpation, the swelling was soft to firm in consistency, slightly
tender, and blanched on pressure. Orthopantomogram, intraoral periapical radiographs
showed no bone resorption.

 

Fig 1. A firm, smooth
swelling, extending from mandibular premolar to mesial aspect of mandibular 2nd
molar.

 

Surgery (excisional biopsy) was planned
under local anaesthesia. The overlying mucosa was incised and undermined.
Lesion was separated from adjacent tissue by blunt dissection and removed in
one piece. There is no sign of reoccurrence after 6 months follow up.

 

 Fig
2. After surgical exicision of lesion

 

Histopathology reveals it consists of
non-encapsulated mass of tissue composed of a delicate reticular and fibrillar
connective tissue stroma containing tissue cells and multinucleated giant cells,
containing 8-15 nuclei. Area of haemorrhage and acute and chronic inflammatory
cells are frequently present. Microscopic examination of the section shows the
presence of hyperplastic parakertinized stratified squamous epithelium.
Presence of numerous young proliferating fibroblasts. (Fig 3&4)

 

 

Fig 3&4. Histological
appearance of the PGCG lesion (in various magnifications) showing features of
hyperplastic granulation tissue, and proliferation of multinucleated giant
cells within haemorrhagic background(H&E stains20X & 10X)

 

Fig 5. Exicised
tissue                            Fig 6. 1 week post operatively

 

 

 

DISCUSSION

 

A case of a PGCG
is described, which originally

appeared to be a
gingival overgrowth. The word epulis

derives from the
Greek words “epi” and “ulon” meaning

“on the
gingiva”. Since the term “epulis” indicates only

the location of
a lesion, as an insufficient term it is not

used in diagnosis nowadays.5,6

 

PGCG is a
localized tumor-like hyperplastic gingival enlargement which usually evolves
from the interdental tissues (which may include the periosteum or periodontal
membrane) as a consequence of chronic irritation from local factors viz. sub-gingival
plaque and calculus or trauma.

Chronic local
irritation of the gingiva
is
responsible for the occurrence of most of the reactive lesions, one of which is
PGCG.

Although these
lesions occur over a varied age group? the peak incidence observed in males is
the second decade in contrast to the fifth decade for females. Moreover, PGCG
lesions are more common in mandible when compared to maxilla (2:1). Lesions are
seen to arise from anywhere on the gingiva or alveolar mucosa in either dentate
or edentate patients, but most occur anterior to the molar teeth. The
interdental papilla is mostly affected in dentate patients.7

 

Lesions can
become large, sometimes attaining a size upto 2 cm. The clinical appearance is
similar to the more common pyogenic granuloma, although the PGCG is often more
bluish-purple as compared with the bright-red colour of a typical pyogenic
granuloma.

Recently, the
PGCG associated with dental implants has been reported (Hirshberg et al, 2003).
Although the PGCG develops within soft tissue, superficial resorption of the
underlying alveolar bony crest is sometimes seen. On occasion, it may be
difficult to determine whether the mass arose as a peripheral lesion or a
central giant cell granuloma eroding through the cortical plate into the
gingival soft tissues (Chadwick et al, 1989; Giansanti & Waldrom, 1969).

 

Differential
diagnosis among multifocal location, should be between leukaemia (it is
characterized by gingival swelling) and gingival hyperplasia due to medication
(ie: nifedipine, phenytoin and cyclosporine A).Surgery remains the mainstay of
treating PGCG wherein resection of the lesion with the elimination of its
entire base is performed. To prevent the recurrence after treatment, it is
necessary to correct or eradicate the underlying source of irritation.8

 

CONCULSION

 

of PGCG involving
the mandibular alveolar mucosa and gingiva. The case report has substantiated
the provisional diagnosis by means of radiologic and histopathologic picture.

Most of the
reactive oral lesions including PGCG may rapidly grow to reach a significant
size within several months of initial diagnosis. Radiographs are important to
show the origin of this particular giant cell lesion from the periphery within
the oral mucosa and thus help in its diagnosis. PGCG is not an aggressive
lesion.

If not diagnosed
early & properly managed, these soft tissue growths may cause discomfort
while performing daily routine such as eating, speaking, etc and also destroy
oral tissues.