Recurrent peripheric giant cell granuloma: literature review over a case report

Abstract

Introduction: Peripheral giant cell granuloma (PGCG) is a reddish, benign, nodular lesion of the oral mucosa. Its etiology is uncertain, but due to its association with local irritant factors, it is commonly labeled as a reactive lesion of the mucosa. Histologically, the PGCG is characterized by the presence of mononuclear spindle cells as well as multinucleated osteoclast-like cells in a fibrous-vascular stroma. Epidemiologically, it presents itself in most cases on the posterior part of the mandible, in women near their 4th decade of life. PGCG is most times asymptomatic and does not have a characteristic radiologic image, yet it can be associated with local bone resorption, where the lesion imprints itself on the bone. Classical treatment involves the surgical excision, with a recurrence rate being around 10%. With it, additional methods should be considered to lower the chance of reappearance. Case Report: In our case, we present a 25 year old woman with a PGCG on the anterior maxilla and a prior history of multiple cases of recurrence. The nodule was surgically removed and biopsied, where the histologic findings matched a PGCG diagnosis. Discussion: Even when PGCG is commonly called a reactive lesion, it’s more appropriate to consider the local irritant factors as adjuvants to the development of the lesion, given the differences between it and foreign body lesions. In spite of its benign and peripheric nature, damage to the underlying bone and dental tissues can still happen.  Conclusion: PGCG can compromise other structures of the oral cavity, and therefore requires proper identification and considerations on its surgical approach. The surgical excision should be accompanied with additional measures to diminish the chance of its recurrence. The reappearance of the lesion may happen years after the intervention, for which prolonged and periodic checkups should be held over time.