Peripheral giant cell granuloma is a benign tumor of the connective tissue that originates in the periodontal membrane or mucoperiosteum of the alveolar bone. It presents as a vascular, red lesion ranging from 0.5 to 1.5 cm in diameter located on the gingiva or alveolar ridge. Histologically, it is characterized by a fibrous stroma containing multinucleated giant cells, spindle-shaped cells, hemorrhage, and new bone formation.

1. PERIPHERAL GIANT
CELL GRANULOMA
An benign tumour of connective tissue origin

2. SYNONYMS
•Peripheral giant cell epulis
•Peripheral giant cell reparative

3. ORIGIN
• Periodontal membrane / mucoperiosteum of the
alveolar bone
Aetiology:
Uknown
Contributing factors:
• Local irritation due to dental irritation / plaque / calculus
• Periodontal disease
• Poor dental restorations
• Ill fitting dental appliances
• Dental extractions
• Chronic infections

4. CLINICAL FEATURES
• Seen in very young children to edentulous old persons
• 4th to 6th decades of life are most affected
• Sex predilection: M:F=1:2 (M35% & F65%)
• Asymptomatic
• Relatively rapid growth rate
• Site: Occurs on gingival / alveolar surface, anterior to the molars
• Pedunculated / sessile that seems to be arising from deeper structures
• 0.5 to 1.5 cm in diameter
• Dark red, vascular / haemorrhagic in appearance, surface ulceration

5. Clinical features

6. CLINICAL FEATURES
• Appears as a vascular, ovoid / fusiform
swelling of the crest of the ridge
• Over 1 to 2 cm in diameter
• Grnular mass of tissue covering the slope of
the ridges
• Ulceration is less common
Edentulous patients

7. HISTOLOGIC FEATURES
• Non encapsulated mass of tissue composed of a delicate reticular and fibrillar
connective tissue stroma
• Conatining large no. of spindle shaped young connective tissue cells and
multinucleated GIANT CELLS
• GIANT CELLS: resemble osteoclast cells
• Giant cells contain few to several dozens of nucleus
• Nuclei are of may be large vesicular or small pyknotic
• Numerous capillaries around the periphery of lesion (giant cells also seen in the
lumen of these vessels)
• Foci of haemorrhage, liberation of hemosiderin pigment which is ingested by
mononuclear phagocytes
• Inflammatory cell infiltration
• Scatterd newly formed bone spicules
• Covering epithelium is mostly hyperplastic with ulceration

8. HISTOLOGICAL FEATURES
Spindle shaped cells

9. RADIOLOGICAL FEATURES
In edentulous area:
• superficial erosion the bone
• Pathognomonic peripheral ‘cuffing’ of the bone
In dentulous area
• Superficial destruction of the alveolar margin
/ crest of the interdental bone (not always)

10. TREATMENT & PROGNOSIS
• Conservative excision
• Complete removal of lesion is must to prevent
recurrence
• 10-15% of recurrence rate