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Peripheral giant cell granuloma - Oral Mucosal Lesion
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Peripheral giant cell granuloma - Oral Mucosal Lesion

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Contributors: Belinda Tan MD, PhD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
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Synopsis

The peripheral giant cell granuloma is a fairly common nodule on the gingiva caused by a proliferation of giant cells. It is likely caused by gingival and/or periodontal inflammation that results in differentiation of pluripotent cells into osteoclast-like or monocyte-like cells.

It tends to occur in older individuals in the fifth and sixth decades with a slight female predilection. The mandibular gingiva is more often involved than the maxillary. It is usually non-painful. Biting on it may induce bleeding since it is contains many blood vessels. It often occurs in the edentulous ridge. The lesion may lie in a cup-shaped depression in the underlying bone. Sometimes it may be difficult to tell if this is a purely extra-osseous process that has cupped the bone or whether it is an intra-osseous central giant cell granuloma that has broken through the bone and now has an extra-osseous or "peripheral" presentation. Unlike the central giant cell granulomas, these are not usually associated with hyperparathyroidism.

Codes

ICD10CM:
K13.4 – Granuloma and granuloma-like lesions of oral mucosa

SNOMEDCT:
89722009 – Giant cell peripheral granuloma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Lobular capillary hemangioma (pyogenic granuloma) may appear identical although they tend to occur in younger individuals (some who are pregnant) and tends to be brighter red.
  • Peripheral ossifying fibroma may appear similar if inflamed.
  • The gingival fibroma is firm, fibrous looking and may be located on the attached rather than marginal gingiva.
  • Some odontogenic cysts and tumors may occur on the gingiva but they are generally not located on the marginal gingiva. However, they may be seen on the attached or non-attached gingiva.
  • The parulis (dental sinus tract) is usually located near the apices of teeth.
  • Metastatic tumors do occur as gingival nodules but these are generally rapidly growing and tend to occur in older individuals with a history of such a tumor.
  • Granulomatosis with polyangiitis

Best Tests

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Therapy

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References

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Last Updated: 10/31/2017
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Peripheral giant cell granuloma - Oral Mucosal Lesion
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Peripheral giant cell granuloma : Gingival-alveolar mucosa, Purple color, Oral nodule
Clinical image of Peripheral giant cell granuloma
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