VASCULAR EXTENSION OF PERIPHERAL GIANT CELL LESION: A CASE REPORT WITH IMMUNOHISTOCHEMICAL ANALYSIS

Peripheral giant cell lesions shares microscopic similarities to other entities and their origin remains unclear. A 47-year-old woman was referred for management of a painful swelling in the canine region with recent history of tooth removal. A slight asymmetry in the upper lip was detected. Intraoral exam revealed a lesion that appeared as a purplish-red nodule, pediculate on the anterior right alveolar crest, and associated with an unstable dental prosthesis. Superficial bone resorption was detected. The lesion was curetted after excision biopsy. Microscopically, an ulcerative, nonencapsulated lesion composed of densely cellular lobules of round mononuclear cells, prominent multinucleated giant cells (MGCs), and hemorrhage was surrounded by fibrous tissue. Apoptotic MCGs were also seen. Interestingly, vessels in the periphery exhibited transendothelial migration of MGCs were positive for matrix metallopeptidase 9 (MMP-9) and macrophage fusion marker CD44. Neovascularization was detected within cellular lobules. Serum tests were normal. Clinical significance of vascular extension must be further clarified. No recurrence has occurred after 1 year.