444
Bone Formation in Cell Granuloma* Dan
Dayan,
Peripheral
Amos Buchner, and Shoshana
Giant
Spirer
Mineralized products were analyzed in a series of 62 cases of peripheral giant cell granuloma of the gingiva or alveolar ridge of man. Histologie sections were examined by routine light microscopy and under polarized light to assess the extent and composition
of mineralized tissues in these lesions. In 35% of the cases, mineralized tissue was identified in the form of woven and/or lamellar bone and dystrophic calcification. The most common type was the woven bone which appeared alone or in combination with lamellar bone in 82% of the lesions containing mineralized material. Unlike peripheral ossifying fibroma, no cementum-like material was identified in peripheral giant cell granuloma. / Periodontol 1990;61:444-446.
Key Words: Grant cell granuloma; alveolar ridge neoplasms; gingival diseases.
The
peripheral giant cell granuloma is an exophytic lesion developing on the gingiva and alveolar ridge, and usually related to local irritating factors such as teeth extraction, poor restorations, food impaction, calculus, ill-fitting dentures, etc.1"6 Clinically, lesions vary in size (up to 3 cm), are sessile or pedunculated, usually deep red to reddish blue,
and bleed
easily.5
Histologically, the lesion consists of a non-encapsulated mass of tissue containing a large number of young connective tissue cells and multinucleated giant cells in an architectural pattern of focal nodules of giant cells separated by fibrous septa. In many cases, numerous capillaries are present in the lesion. Other possible features include hemorrhage, hemosiderin, inflammatory cells, and newly formed bone or calcified material.2'3'6-9 The lesion is usually covered by keratinized squamous epithelium, which can be ulcerated. The treatment is simple conservative excision of the lesion. Rate of recurrence is relatively low (around 10%), mainly because of the failure to eliminate the local irritating factors.9
All clinical and histopathologic studies on large series of peripheral giant cell granuloma'-3-7"11 report clinical features such as gender and age, location, size and general histopathologic findings, but only some2-3-7-9 mention the formation of mineralized material. The purpose of this study was to analyze a new series of peripheral giant cell granuloma focusing on mineralized tissue formation in the lesion.
"'Section of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
MATERIALS AND METHODS Sixty-two cases of peripheral giant cell granuloma were retrieved from the files of the Section of Oral Pathology and Oral Medicine, Tel Aviv University School of Dental Medicine. Clinical data were reviewed for age, gender, location, and symptoms. The location of the lesion was recorded as mandibular or maxillary, anterior or posterior region. The anterior region consisted of the incisors, canine, and premolar areas, while the posterior region included the molar areas. The histologie slides were 6 µ paraffin sections stained with hematoxylin and eosin. The sections were examined for the presence of mineralized material, such as lamellar bone, woven bone, cementum, and dystrophic calcification. The mineralized material was also examined with polarized-
light microscopy. RESULTS Lesions were found in all age groups with peaks at the 4th, 5th, and 6th decades (Fig. 1). The mean age was 42, with females slightly more affected (53%) than males (47%). The mandible was slightly more affected (53%) than the maxilla (47%). In both jaws, most of the lesions were present in the anterior region (71%) (Table 1). The histologie features were typical of a peripheral giant cell granuloma. Generally, the lesion was covered with epithelium and consisted of a non-encapsulated high cellular mass with abundant giant cells dispersed throughout, numerous capillaries, inflammatory infiltrate in slight or moderate intensity, hemorrhage, and hemosiderin. The surface of the lesion was partially or completely ulcerated in 25 cases (40%), whereas in 37 cases (60%), the surface was intact and covered with stratified squamous epithelium. In 81% of the cases, the epithelial covering was of parakeratin
Volume 61 Number 7
DAYAN, BUCHNER, SPIRER
Giant cells
25-
C/3
20-
a
Bone Formation in Cell Granuloma* Dan
Dayan,
Peripheral
Amos Buchner, and Shoshana
Giant
Spirer
Mineralized products were analyzed in a series of 62 cases of peripheral giant cell granuloma of the gingiva or alveolar ridge of man. Histologie sections were examined by routine light microscopy and under polarized light to assess the extent and composition
of mineralized tissues in these lesions. In 35% of the cases, mineralized tissue was identified in the form of woven and/or lamellar bone and dystrophic calcification. The most common type was the woven bone which appeared alone or in combination with lamellar bone in 82% of the lesions containing mineralized material. Unlike peripheral ossifying fibroma, no cementum-like material was identified in peripheral giant cell granuloma. / Periodontol 1990;61:444-446.
Key Words: Grant cell granuloma; alveolar ridge neoplasms; gingival diseases.
The
peripheral giant cell granuloma is an exophytic lesion developing on the gingiva and alveolar ridge, and usually related to local irritating factors such as teeth extraction, poor restorations, food impaction, calculus, ill-fitting dentures, etc.1"6 Clinically, lesions vary in size (up to 3 cm), are sessile or pedunculated, usually deep red to reddish blue,
and bleed
easily.5
Histologically, the lesion consists of a non-encapsulated mass of tissue containing a large number of young connective tissue cells and multinucleated giant cells in an architectural pattern of focal nodules of giant cells separated by fibrous septa. In many cases, numerous capillaries are present in the lesion. Other possible features include hemorrhage, hemosiderin, inflammatory cells, and newly formed bone or calcified material.2'3'6-9 The lesion is usually covered by keratinized squamous epithelium, which can be ulcerated. The treatment is simple conservative excision of the lesion. Rate of recurrence is relatively low (around 10%), mainly because of the failure to eliminate the local irritating factors.9
All clinical and histopathologic studies on large series of peripheral giant cell granuloma'-3-7"11 report clinical features such as gender and age, location, size and general histopathologic findings, but only some2-3-7-9 mention the formation of mineralized material. The purpose of this study was to analyze a new series of peripheral giant cell granuloma focusing on mineralized tissue formation in the lesion.
"'Section of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
MATERIALS AND METHODS Sixty-two cases of peripheral giant cell granuloma were retrieved from the files of the Section of Oral Pathology and Oral Medicine, Tel Aviv University School of Dental Medicine. Clinical data were reviewed for age, gender, location, and symptoms. The location of the lesion was recorded as mandibular or maxillary, anterior or posterior region. The anterior region consisted of the incisors, canine, and premolar areas, while the posterior region included the molar areas. The histologie slides were 6 µ paraffin sections stained with hematoxylin and eosin. The sections were examined for the presence of mineralized material, such as lamellar bone, woven bone, cementum, and dystrophic calcification. The mineralized material was also examined with polarized-
light microscopy. RESULTS Lesions were found in all age groups with peaks at the 4th, 5th, and 6th decades (Fig. 1). The mean age was 42, with females slightly more affected (53%) than males (47%). The mandible was slightly more affected (53%) than the maxilla (47%). In both jaws, most of the lesions were present in the anterior region (71%) (Table 1). The histologie features were typical of a peripheral giant cell granuloma. Generally, the lesion was covered with epithelium and consisted of a non-encapsulated high cellular mass with abundant giant cells dispersed throughout, numerous capillaries, inflammatory infiltrate in slight or moderate intensity, hemorrhage, and hemosiderin. The surface of the lesion was partially or completely ulcerated in 25 cases (40%), whereas in 37 cases (60%), the surface was intact and covered with stratified squamous epithelium. In 81% of the cases, the epithelial covering was of parakeratin
Volume 61 Number 7
DAYAN, BUCHNER, SPIRER
Giant cells
25-
C/3
20-
a
