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.^[1]See the image below.

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.

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Etiology

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.

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.^{[2, 3, 4, 5]}

Frequency

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.

Race

No known racial predilection is associated with peripheral giant cell granuloma.

Sex

One large recent study showed essentially no sex predilection (52% female vs. 48% male).

Age

A wide age range of patients can be affected, although most patients are in the fifth to seventh decades of life at the time of diagnosis of this lesion. One institutional biopsy service reported the mean age of 235 patients with peripheral giant cell granuloma to be 46 years, with a range from 6-88 years.

Prognosis

Peripheral giant cell granuloma has an excellent prognosis. A recurrence rate of 10-20% has been reported in most series; however, recurrences are typically managed easily with additional surgery. Some investigators have suggested that peripheral giant cell granulomas that develop in association with dental implants seem to have a higher risk for recurrence.^[6]

Clinical Presentation

Chrcanovic BR, Gomes CC, Gomez RS. Peripheral giant cell granuloma: An updated analysis of 2824 cases reported in the literature. J Oral Pathol Med. 2018 Mar 22. [QxMD MEDLINE Link].
Bischof M, Nedir R, Lombardi T. Peripheral giant cell granuloma associated with a dental implant. Int J Oral Maxillofac Implants. 2004 Mar-Apr. 19(2):295-9. [QxMD MEDLINE Link].
Hirshberg A, Kozlovsky A, Schwartz-Arad D, Mardinger O, Kaplan I. Peripheral giant cell granuloma associated with dental implants. J Periodontol. 2003 Sep. 74(9):1381-4. [QxMD MEDLINE Link].
Cloutier M, Charles M, Carmichael RP, Sandor GK. An analysis of peripheral giant cell granuloma associated with dental implant treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007. 103:618-622. [QxMD MEDLINE Link].
Etoz OA, Demirbas AE, Bulbul M, Akay E. The peripheral giant cell granuloma in edentulous patients: report of three unique cases. Eur J Dent. 2010 Jul. 4(3):329-33. [QxMD MEDLINE Link]. [Full Text].
Lester SR, Cordell KG, Rosebush MS, Palaiologou AA, Maney P. Peripheral giant cell granulomas: a series of 279 cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014 Oct. 118 (4):475-82. [QxMD MEDLINE Link].
Bodner L, Peist M, Gatot A, Fliss DM. Growth potential of peripheral giant cell granuloma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 May. 83(5):548-51. [QxMD MEDLINE Link].
Martins MD, Pires F, Daleck F, Myaki SI, Friggi MN, Martins MA. Peripheral giant cell granuloma in anterior maxilla: case report in a child. J Clin Pediatr Dent. 2005 Winter. 30(2):161-4. [QxMD MEDLINE Link].
Dereci Ö, Akgün Ş, Celasun B, Öztürk A, Günhan Ö. Histological evaluation of the possible transformation of peripheral giant cell granuloma and peripheral ossifying fibroma: A preliminary study. Indian J Pathol Microbiol. 2017 Jan-Mar. 60 (1):15-20. [QxMD MEDLINE Link].
Choi C, Terzian E, Schneider R, Trochesset DA. Peripheral giant cell granuloma associated with hyperparathyroidism secondary to end-stage renal disease: a case report. J Oral Maxillofac Surg. 2008 May. 66(5):1063-6. [QxMD MEDLINE Link].
Dayan D, Buchner A, Spirer S. Bone formation in peripheral giant cell granuloma. J Periodontol. 1990 Jul. 61(7):444-6. [QxMD MEDLINE Link].
Banthia R, Maheshwari S, Banthia P, Mantri K. Peripheral giant cell granuloma: a case report. Gen Dent. 2013 Jan-Feb. 61(1):e12-4. [QxMD MEDLINE Link].
Sahingur SE, Cohen RE, Aguirre A. Esthetic management of peripheral giant cell granuloma. J Periodontol. 2004 Mar. 75(3):487-92. [QxMD MEDLINE Link].
Said Ahmed W. Efficacy of Ethanolamine Oleate Sclerotherapy in Treatment of Peripheral Giant Cell Granuloma. J Oral Maxillofac Surg. 2016 Nov. 74 (11):2200-2206. [QxMD MEDLINE Link].

Media Gallery

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.
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.
This asymptomatic bluish-purple nodule developed on the edentulous mandibular alveolar ridge of a 76-year-old man.