The peripheral giant cell lesion is the gingival counterpart of the intrabony central giant cell granuloma. It is found almost exclusively in the mouth: two-thirds of all cases occurring in the mandibular gingiva, one-third in the maxillary gingiva. Peripheral giant cell lesions occur in both dentulous and edentulous alveolus. Approximately 8% occur in or adjacent to a recent dental extraction wound. It may be seen in children but occurs mainly in the midyears and is slightly more prevalent in females, although there is no increased incidence in pregnancy. The lesions range in size from millimeters to several centimeters. The red-to-purple color is accounted for by the percolation of blood through ill-defined, sinusoidal spaces and small areas of hemorrhage. The histomorphology is characterized by a proliferation of mono-nuclear cells with an overlay of multi-nucleated giant cells. Giant cells may be found within the lumen of thin-walled vascular channels. Foci of hemorrhage are found in almost 90% of cases and about 40% exhibit formation of osteoid and immature bone. Hemosiderin is plentiful and tends to concentrate at the superior pole of the lesion. The mononuclear cells and giant cells express vimentin, alpha 1-antichymo-trypsin, and CD-68, suggesting a mononuclear macrophage lineage. Birbeck-granule-positive dendritic cells are found in 65% of cases, evidence of the presence of Langerhans histiocytes, although the significance of this presence is unknown. Treatment consists of surgical excision, with a recurrence rate of 10%. The clinician should confirm that the peripheral lesion is not a central lesion that has perforated the cortex, masquerading as a peripheral lesion. Peripheral giant cell epulis occurring as a manifestation of neurofibromatosis is rare.
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