Peripheral giant-cell granuloma

Peripheral giant-cell granuloma (PGCG) is a benign oral pathologic condition that arises from the periodontal ligament or the periosteum of the alveolar ridge. It is often considered to be a reactive lesion, rather than a true neoplasm, in response to local irritation or trauma. The lesion is characterized by the presence of multinucleated giant cells in a background of proliferating connective tissue cells and is often associated with hemorrhage and hemosiderin deposits.

Etiology and Pathogenesis

The exact cause of PGCG is not well understood, but it is believed to be a reactive process to local irritants such as dental plaque, calculus, ill-fitting dentures, or trauma. It has also been associated with certain systemic conditions, such as hyperparathyroidism, suggesting a possible endocrine influence on its development.

Clinical Features

PGCG typically presents as a red to purplish, nodular mass located on the gingiva or alveolar ridge. It can occur at any age but is more commonly seen in adults, with a slight female predilection. The lesion is usually painless but can exhibit rapid growth, leading to cosmetic concerns or functional impairment.

Diagnosis

The diagnosis of PGCG is primarily based on clinical examination and confirmed by histopathological analysis. Radiographically, the lesion may cause superficial resorption of the underlying bone but does not invade the bone. Histologically, PGCG is characterized by the presence of numerous multinucleated giant cells, stromal cells, and a background of vascular connective tissue.

Treatment and Prognosis

The treatment of choice for PGCG is surgical excision, including removal of the lesion and thorough curettage of the surrounding tissues to eliminate any potential irritants. Recurrence is relatively common, reported in up to 10-15% of cases, necessitating close follow-up. The prognosis is generally good, with no malignant transformation reported.

Prevention

Preventive measures for PGCG focus on the control of local irritants, including maintaining good oral hygiene, regular dental check-ups, and the management of dental and periodontal diseases. Early detection and treatment of lesions can also help prevent recurrence.