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

the current case, this association highlights the broad spec- as recurrence may occur several months after treatment, this
trum of local factors involved in the pathogenesis of PGCG. 9 short follow-up period does not allow assessment of long-term
Epidemiologically, PGCG shows a higher prevalence in stability, and continued monitoring is required. Proper man-
women between the third and sixth decades of life and affects agement of predisposing factors is also critical, as incomplete
the mandibular premolar region more often. 2,10,11 The present excision or persistent local irritation are important contribu-
case is consistent with this profile, although the patient’s age tors to lesion regrowth. 13,18
(62 years) places her at the upper end of the typical range. This This report has several limitations. First, the follow-up period
finding reinforces the importance of considering PGCG in old- is limited to one month, and no additional follow-up data are
er adults, especially when lesions exhibit features that may currently available. Therefore, long-term outcomes and recur-
mimic more aggressive processes. rence risk cannot be assessed, representing an important limita-
The lesion size in this case (approximately 20 mm) falls tion. Second, no comprehensive metabolic screening was per-
within the range reported in the literature, where PGCG typical- formed to rule out systemic conditions associated with giant cell
ly measures between 0.5 and 2 cm. 7,12 However, the rapid pro- lesions, such as hyperparathyroidism (brown tumor); only basic
gression described by the patient is noteworthy. Although PGCG laboratory tests were obtained. Although no clinical signs of en-
is classically described as slow growing, persistent irritation or docrine disorders were present and the laboratory results were
3,7
repeated trauma may lead to accelerated enlargement. This within normal limits, the absence of additional metabolic tests
clinical behavior, together with surface bleeding and a red- (serum calcium, phosphate, alkaline phosphatase, and parathy-
dish-violet appearance, may raise suspicion for more aggressive roid hormone) represents a limitation. Third, advanced imaging
lesions, highlighting the diagnostic relevance of this case. studies, such as periapical radiographs or cone-beam computed
Radiographically, PGCG is usually confined to soft tissues; tomography, were not performed; therefore, assessment of cor-
however, superficial bone resorption may occur in long-stand- tical bone involvement relied solely on panoramic radiography,
ing lesions or those associated with persistent chronic irrita- which has inherent limitations and may not accurately differen-
tion. 3,8,13 In the present case, panoramic imaging demonstrat- tiate between superficial cortical alteration, pressure remodeling,
ed superficial cortical alteration in the region of teeth 43–45. or projection artifacts. Finally, as a single case report, these find-
While this finding is consistent with existing literature, it is ings cannot be generalized, although they contribute to expand-
uncommon and may complicate the diagnostic approach. Doc- ing the clinical spectrum of PGCG. No financial, cultural, or lan-
umenting such presentations is clinically valuable, as evidence guage barriers were encountered during the diagnostic process.
of bone involvement may initially raise suspicion for central In conclusion, this uncommon presentation of PGCG in an
giant cell granuloma or other intraosseous pathologies. This older adult mimicked a more aggressive lesion, underscoring
underscores the importance of correlating radiographic find- the importance of comprehensive clinical, radiographic, and
ings with clinical and histopathological features to ensure histopathological correlation to avoid overtreatment. This case
accurate diagnosis and appropriate management. highlights relevant diagnostic challenges and provides educa-
The differential diagnosis included pyogenic granuloma, tional value for the management of reactive gingival lesions,
peripheral ossifying fibroma, peripheral odontogenic fibroma, supporting its relevance in clinical practice and justifying its
central giant cell granuloma, vascular lesions such as heman- publication. Complete excision with removal of local irritants
gioma, and brown tumor associated with hyperparathyroid- resulted in satisfactory short-term healing. However, the lim-
ism. 8,14 Pyogenic granuloma generally presents with a bright- ited follow-up does not allow assessment of recurrence, and
er, lobulated surface and greater vascularity. Peripheral long-term monitoring remains essential.
ossifying fibroma typically shows a firm consistency and may
contain calcifications or bone formation. Central giant cell
granuloma was excluded due to its characteristic radiolucent Appendices. Supplementary content
pattern and because the present case’s findings suggested the
bone alteration represented superficial remodeling secondary Supplementary data associated with this article can be found, in
to a soft tissue lesion, rather than a primary intraosseous pro- the online version, at https://administracao.spemd.pt/app/assets/
1,8
cess. Furthermore, the clinical findings supported superficial imagens/files_img/1_19_6a1415456d7e9.pdf.
vascularization rather than a true vascular lesion, such as
hemangioma. In this case, histopathological examination con-
firmed the diagnosis of PGCG by demonstrating multinucleat- Conflict of interest
ed giant cells within a fibrovascular stroma, accompanied by
hemorrhage and inflammatory infiltrate, in accordance with The authors have no conflicts of interest to declare.
classical descriptions. 15,16
Total excision with curettage of the underlying periosteum
or bone remains the treatment of choice and is essential to Ethical disclosures
reduce recurrence, which has been reported between 2% and
9%. 10,17 A large review including 2,824 cases reported an overall Protection of human and animal subjects. The authors
recurrence rate of approximately 9.5% after treatment, rein- declare that the procedures followed were in accordance with
forcing the importance of complete excision and elimination the regulations of the relevant clinical research ethics com-
18
of local irritative factors. In this case, clinical findings at one mittee and with those of the Code of Ethics of the World Med-
month indicated satisfactory postoperative healing. However, ical Association (Declaration of Helsinki).