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rev port estomatol med dent cir maxilofac . 2026;67(1):34-39 35

havior may occur, and some cases may mimic more aggressive Intraoral examination showed an exophytic, reddish-vio-
conditions. In particular, rapid enlargement and radiographic let lesion of approximately 20 mm in diameter with a bleeding
signs suggestive of cortical involvement are uncommon fea- surface, a relatively fluctuant consistency, and a pedunculat-
tures that may complicate the diagnostic approach. ed base on the vestibular gingiva extending from tooth 43 to
Histopathologically, PGCG is characterized by an unen- 45 (FDI World Dental Federation notation) (Fig. 1). Although
capsulated proliferation of spindle-shaped and polygonal the lesion showed superficial bleeding on manipulation, di-
mesenchymal cells, with multinucleated osteoclast-like gi- ascopy (blanching test) was negative, and aspiration using a
ant cells embedded in a vascular stroma containing hemo- 25-gauge needle at the lesion base did not yield blood. Clinical
siderin deposits and extravasated red blood cells. 1,4,5 The palpation indicated a soft tissue lesion without evidence of
differential diagnosis includes pyogenic granuloma, periph- intraosseous expansion. Periodontal evaluation of the in-
eral ossifying fibroma, peripheral odontogenic fibroma, cen- volved teeth (43–45) revealed no deep periodontal pockets or
tral giant cell granuloma, vascular lesions such as heman- clinical attachment loss suggestive of periodontal bone de-
gioma, and giant cell lesions associated with systemic struction. Periodontal probing around teeth 43–45 showed
conditions, particularly hyperparathyroidism (brown tu- probing depths within normal limits (≤3 mm), without clinical
mor). These entities may share similar clinical features but attachment loss. Oral hygiene was poor, with multiple carious
differ in histology and biological behavior. 4,5 Histopatholog- lesions. Residual roots were identified in the posterior man-
ic examination is essential for diagnosis, while radiograph- dibular region adjacent to the lesion, associated with dental
2,4
ic assessment helps rule out bone involvement. Treatment plaque accumulation and calculus deposits. No defective res-
consists of surgical excision with curettage of the underly- torations or prosthetic appliances were observed. These find-
ing periosteum or bone and elimination of local irritants to ings were considered relevant local irritative factors. The ad-
reduce recurrence, which ranges from 2% to 9% depending jacent teeth were preserved, with no significant mobility
on the completeness of curettage and control of etiological (grade 0) and no signs of occlusal trauma. Thus, extraction of
factors. 1,3,4 adjacent teeth was not required.
The aim of this report is to describe the clinical course, Panoramic radiography revealed a localized superficial cor-
diagnosis, treatment, and early postoperative follow-up of a tical alteration in the region of teeth 43–45, associated with
patient with PGCG presenting with atypical features. This re- residual roots and extensive carious lesions in both arches.
6
port was prepared in accordance with the CARE guidelines There was no evidence of a well-defined intraosseous radio-
and the corresponding checklist was used during manuscript lucency or cortical expansion (Fig. 2). Laboratory tests, includ-
preparation (Appendix 1). The present case is noteworthy be- ing complete blood count, coagulation profile, and fasting
cause of the combination of accelerated growth, bleeding glucose, were within normal limits.
tendency, and superficial cortical erosion in an older patient, A differential diagnosis was established based on the ob-
which raised suspicion for more aggressive or intraosseous served clinical and radiographic findings: rapid growth, bleed-
lesions. Reporting such presentations helps refine the clinical ing tendency, radiographic evidence of cortical alteration, neg-
spectrum of PGCG and highlights the importance of careful ative aspiration findings, and normal periodontal parameters.
clinicoradiographic and histopathological correlation. There- Differential diagnoses included pyogenic granuloma, periph-
fore, this case is relevant to clinical practice and warrants eral ossifying fibroma, peripheral odontogenic fibroma, central
publication. giant cell granuloma, vascular lesions such as hemangioma,
and giant cell lesions associated with systemic conditions,
particularly hyperparathyroidism (brown tumor), as summa-
Case report rized in Table 1.
Three days after the first visit, surgical excision was con-
A 62-year-old female homemaker attended the Dentistry Ser- ducted under local anesthesia with 2% lidocaine and epi-
vice of the Regional Teaching Hospital of Trujillo for evalua- nephrine (1:100,000), administered by infiltration using one
tion of an oral swelling that had increased in size for three cartridge (1.8 mL). An elliptical incision was made extending
months. She reported numbness and pain on contact in the to the periosteum, including a margin of 2–3 mm of clinical-
right mandibular region. Her medical history was unremark- ly healthy surrounding tissue, without flap elevation. The
able; she denied trauma, endocrine disorders, and regular lesion and its pedicle were removed en bloc using a #15 scal-
medication use. No relevant psychosocial risk factors were pel blade (Fig. 3). Subsequently, thorough curettage of the
identified. underlying periosteum and superficial cortical bone was per-
The lesion had begun approximately three months prior, formed using a Lucas-type surgical curette until firm, bleed-
with a progressive increase in the volume of the mandibular ing bone was reached. Bone margins were then smoothed
gingiva. Two months before the consultation, the patient began with a sterile round bur to ensure complete removal of any
experiencing episodes of bleeding and discomfort on contact. residual reactive tissue.
One month prior, she noted accelerated growth of the lesion Local irritative factors were carefully identified and man-
accompanied by increased superficial ulceration. aged during the same surgical session, immediately after le-
On the day of clinical evaluation (day 0), extraoral exam- sion excision and prior to wound closure. This sequence aimed
ination revealed reduced vertical dimension associated with to prevent contamination of the surgical site and to ensure
the loss of posterior dental support. There was no facial asym- closure over a field free of chronic irritants. Factors addressed
metry, swelling, or palpable lymphadenopathy. included residual roots and local plaque accumulation in the