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1</a>&#41;&#46; No other abnormalities were noted in the mouth&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology revealed a gingival mucosa formed of a stratified squamous epithelium with no significant abnormalities&#46; The superficial dermis was totally occupied by an inflammatory infiltrate characterized by a connective-tissue stroma containing numerous multinucleated giant osteoclastic cells&#44; immature mesenchymal cells&#44; and a mild&#44; predominantly mononuclear infiltrate&#46; Abundant capillaries with foci of extravasated red blood cells and hemosiderin deposits were also seen &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Orthopantomography showed no underlying bone abnormalities&#46; There were no significant alterations in the blood count and biochemistry&#44; and thyroid and parathyroid hormone studies were normal&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your diagnosis&#63;</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Peripheral giant cell granuloma &#40;PGCG&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lesion was excised by the maxillofacial surgery service and the patient remained asymptomatic 6 months after surgery&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">In 1953&#44; 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Vol. 102. Núm. 6.
Páginas 465-466 (agosto 2011)
Visitas
8186
Vol. 102. Núm. 6.
Páginas 465-466 (agosto 2011)
Case for diagnosis
Acceso a texto completo
A Rapidly Growing Gingival Nodule
Lesión nodular en encía de rápido crecimiento
Visitas
8186
A. Nuño-Gonzáleza,
Autor para correspondencia
anuno@fhalcorcon.es

Corresponding author.
, F.J. Vicente-Martína, F.J. Salamanca-Santamaríab
a Unidad de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
b Unidad de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Medical History

A 34-year-old man with no relevant past medical history attended the emergency department for a mildly painful tumor with occasional bleeding on the lower gum. The patient had developed periodontitis in the adjacent molar 2 months earlier that was treated with oral antibiotics (amoxicillin plus clavulanic acid) and the lesion developed following the treatment. He reported no fever, previous ingestion of other medication, or surgery in the area.

Physical Examination

Physical examination revealed a firm erythematous-violaceous tumor lesion of 20 mm in diameter on the gum adjacent to the lower second right molar (Fig. 1). No other abnormalities were noted in the mouth.

Figure 1
(0.07MB).
Histopathology

Histopathology revealed a gingival mucosa formed of a stratified squamous epithelium with no significant abnormalities. The superficial dermis was totally occupied by an inflammatory infiltrate characterized by a connective-tissue stroma containing numerous multinucleated giant osteoclastic cells, immature mesenchymal cells, and a mild, predominantly mononuclear infiltrate. Abundant capillaries with foci of extravasated red blood cells and hemosiderin deposits were also seen (Figs. 2 and 3).

Figure 2.

Hematoxylin-eosin, original magnification x20.

(0.11MB).
Figure 3.

Hematoxylin-eosin, original magnification x200.

(0.13MB).
Additional Tests

Orthopantomography showed no underlying bone abnormalities. There were no significant alterations in the blood count and biochemistry, and thyroid and parathyroid hormone studies were normal.

What Is Your diagnosis?

Diagnosis

Peripheral giant cell granuloma (PGCG).

Clinical Course

The lesion was excised by the maxillofacial surgery service and the patient remained asymptomatic 6 months after surgery.

Comment

In 1953, Jaffe1 used the term “giant cell reparative granuloma” to define a form of benign reactive tumor and to distinguish it from more aggressive giant-cell tumors that appear in the metaphyses of the long bones and that can metastasize in 2% of cases. PGCG is a giant-cell epulis or giant-cell granuloma that appears in the oral cavity and consists of a smooth-surfaced erythematous-violaceous gingival tumor of rapid growth adjacent to the bone. It typically arises in the mandibular mucosa, although it can also develop in the maxillary region; there have been very rare cases in other locations such as the nasal mucosa.2 This rare disease is most common in men of less than 30 years of age, with very occasional reports in children3; it has also been described in the elderly, related to friction from dental protheses.4 These lesions are thought to occur as a reaction to infection, trauma, or constant friction.1,3,4

Clinically, the differential diagnosis should include pyogenic granuloma (which tends to be softer and more prone to bleeding), irritation fibroma (slower growing and also found at other sites, including the cheek and lips), and venous malformations of the mouth (typically present from an early age).

Histologically, PGCG is characterized by osteoclast-like multinucleated giant cells surrounded by an inflammatory infiltrate in the stroma. The differential diagnosis must therefore include central giant cell granuloma as this disease presents the same histological characteristics with the added feature of underlying bone involvement, which appears as a radiolucent area on orthopantomography.1,5 Another similar lesion is the “brown tumor” (osteoclastoma) of hyperparathyroidism and it is therefore necessary to determine the calcium, phosphorous, and parathyroid hormone levels in these patients.1

Surgery is the most widely used treatment and outcomes are good, though with some recurrences.1,5,6 Medical treatments have been published in the form of anecdotal reports or case series, above all for central giant-cell granuloma. Intralesional injection of corticosteroids tends to reduce the size of the lesion.6 Oral or intranasal calcitonin has been used with excellent results.6 Other treatments include interferon alfa, imatinib, or a combination of the two. However, there have been no comparative studies of the various treatments to determine whether they are as effective as surgical excision.6

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References
[1]
J.M. Gándara, J.L. Pacheco, P. Gándara, A. Blanco, A. García, P. Madriñán, et al.
Granuloma periférico de células gigantes. Revisión de 13 casos clínicos.
MedOral, 7 (2002), pp. 254-259
[2]
S. Mohammadi, F. Hassannia.
Giant cell reparative granuloma of nasal cavity, a case report.
J Craniomaxillofac Surg, 38 (2010), pp. 145-147
[3]
E. Grand, E. Burgener, J. Samson, T. Lombardi.
Post-traumatic development of a peripheral giant cell granuloma in a child.
Dent Traumatol, 24 (2008), pp. 124-126
[4]
O.A. Etoz, A.E. Demirbas, M. Bulbul, E. Akay.
The peripheral giant cell granuloma in edentulous patients: report of three unique cases.
Eur J Dent, 4 (2010), pp. 329-333
[5]
A.J. Mighell, P.A. Robinson, W.J. Hume.
Peripheral giant cell granuloma: a clinical study of 77 cases from 62 patients, and literature review.
Oral Dis, 1 (1995), pp. 12-19
[6]
Biblioteca Cochrane Plus 2009, Número 4. [base de datos en Internet].Oxford: Update Software Ltd; 2009 [consultado el 14 de octubre de 2010]. Suárez-Roa ML, Reveiz L, Ruiz-Godoy Rivera LM, Asbun-Bojalil J, Dávila-Serapio JE, Menjívar-Rubio AH, et al. Intervenciones para el tratamiento del granuloma central de células gigantes (GCCG) de los maxilares. Disponible en: http://www.update-software.com. Citado en Cochrane Library CD007404.

Please cite this article as: Nuño-González A, et al. Lesión nodular en encía de rápido crecimiento. Actas Dermosifiliogr. 2011;102:465-466.

Copyright © 2010. Elsevier España, S.L. and AEDV
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