CLINICAL

Peripheral giant cell granuloma is characterized by a swelling of the boundary is clear, loud, and often ulcerated. Basically not stemmed, smooth surface or slightly bergranula and pink to red purple. Nodules are usually a few mm to 1 cm in diameter, although the rapid enlargement can create a disturbing growth of the teeth beside it. Females are more pften affected (male:female = 1:1.5) especially between 20-60 years of age. (Laura Mitchell. 2006) Lesions are usually asymptomatic, but at because it is aggressive, then the underlying alveolar bone is often involved and make a radiolucency "peripheral cuff" superficial pathognomonic and the nodular mass that may be pedunculated or closely adherent to the surface. Upon palpation, one may note a lesion that is either soft or hard, depending upon the composition of collagen and/or inflammatory components. Usually a massive area in maxilla or mandibula. (Peter A. 2005) Lesion begins with a dome-shaped swelling colored reddish or purplish in the interdental papilla or alveolar ridge. In the dentulous patients often look more reddish lesions caused by the presence of ulceration that occurs when food is chewed and the thin epithelium of the protruding mass. Larger lesions are usually around one or more teeth, often involving the periodontal ligament, including the apex of the tooth. These lesions lead to the loss and movement of the teeth. In the edentulous area, dome-shaped lesions, purple, and usually have an intact surface. Periapical radiographs typically show a loss of superficial layers of cortical bone, and the remaining bones in the middle who are not involved. (Peter A. 2005) Peripheral giant cell granuloma comprises a nodule oof cellular mesenchyme filled with numerous giant cells. Serologic tests for levels of calcium, phosphate, and parathyroid hormone are advisable to exclude hyperparathyroidism. It is important to exclude, by radiography, the presence that may have undergone extension into the soft tissues. (Chaparro Avendano AV. 2005) Clinical of Peripheral Giant Cell Granuloma : 1. Lesions originated from marginal gingiva or interdental papilla.

2. These lesions most commonly occur in labial surface 3. These lesions can be stemmed or not stemmed 4. These lesions are soft, regular or irregular shape 5. Theres many lobes on the surface 6. Ulceration often occurs in marginal gingiva 7. Varies size between 1 4cm 8. Colored reddish or purplish

HISTOLOGY
Peripheral giant cell granuloma are multinucleated giant cells within the granulation tissue. Extravascular erythrochytes and hemosiderin granules are usually observed. The peripheral giant cell granuloma occurs as an exophytic lesion in the region of the gingival or the edentulous alveolar mucosa. The lesion is found on the gingival or edentulous ridge, and it is usually forward on the molar region. The lesion can be in the range of 1 cm and usually more than 2 cm. They are usually deep red or bluish purple. They can be soft to somewhat firm and smooth in texture. Depending upom the degree of ulceration, they may bleed. The lesion is distinguished by the multinucleated guant cells that make up the tissue when seen microscopically. (Peter A.2001) Peripheral giant-cell granulomas appear microscopically as a large number of multinucleated giant cells, which can have up to dozens of nuclei. Additionally, there are mesenchymal cells that are ovoid and spindle-shaped. Near the borders of the lesion, deposits of hemosiderin and hemorrhage is often found. The histology shows nodular arrangement of giant cell tissue separated by fibrous septum. Giant cell network consisting of a mixture of mononuclear and giant cell multinukleasi underlying extravasation of red blood cells. There are a few capillaries and sinusoid spaces. Thinned or thickened fibrous stroma, and contains an extensive network of vascular wall structure and thin. Hemosiderin content in bulk generally found in giant cell and tissue surrounding the fibrous components. The lesion can be found many giant cells and fibroblast-fibroblast multiple throughout the specimen. Histologically, these

lesions are indistinguishable from central giant cell granuloma and brown tumor of hyperparathyroidism. (Kahn, Michael A. 2001) Peripheral giant cell granuloma consists of fibers bundled subepithelial which coated epithelial flattenes layered and accompanied infiltration giant cells which multinucleated with resemble osteoclast and stroma which contains vessel blood and giant cells.

The giant cells is multinucleated and varies in form,size,and number. They separated by the fibers fibrous and also found a number of vessel blood with diameter which varies and sometimes giant cells can seen or localized in vessel blood. (Laura Mitchell. 2006) Histology of Peripheral Giant Cell Granuloma : 1. Giant cell granuloma has several focal multinucleated giant cell and hemosiderin particles in
the connective with stroma.

2. There is chronic inflammatory lesion scaterred throughout in the presence of acute

inflammation that occurs on the surface.

3. Usually a layer of epithelial hyperplasia with ulceration experienced at the base. 4. Sometimes accompanied by the formation of bone lesions

RONTGEN

Fig.1 : Smooth surfaced peripheral giant cell granuloma arising from marginal gingiva

Fig.2 : Radioghraphy of Peripheral giant cell granuloma

Fig 3 : Intraoral swelling in relation to the left permanent lower first molar

DAFTAR PUSTAKA Oral Pathology Oleh Peter A. Reichart,Hans Peter Philipsen Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001. Oxford Handbook of Clinical Dentistry. Laura Mitchell,David A. Mitchell,Lorna McCaul. 2006
Chaparro Avendano AV, Berini Aytes L, Gay Escoda C. Perioheral giant cell granuloma: A report of five cases and review of literature. Med Oral Pathol Oral Cir Bucal 2005

GAMBAR Figure 1 : Chaparro Avendano AV, Berini Aytes L, Gay Escoda C. Perioheral giant cell granuloma: A
report of five cases and review of literature. Med Oral Pathol Oral Cir Bucal 2005

Figure 2 : Regezi, Sciubb. Oral pathology.WB Saunders Co.; 2nd ed. 2000 Figure 3 : Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.