Recurrent peripheral giant cell granuloma in a 6-yr-old
A 6-year-old female patient was referred to the outpatient clinic of an Oral and Maxillofacial Surgery Department with a chief complaint of an intraoral swelling. First and second primary molars were extracted by a general dentist and after that, the reactive lesion has been progressively growing. It was reported that the patient had undergone a surgical procedure twice to excise the lesion in another dental service, with signs of recurrence.

The intraoral examination showed a painless sessile mass with exophytic growth similar to a tumorous lesion located on the mandibular alveolar ridge extending from distal aspect of right mandibular primary canine to mesial aspect of first permanent molar of the same side.

The lesion was light pink to purple colored, well defined and rounded, with approximately 3 cm in its largest diameter. On palpation, the lesion had a smooth surface and firm consistency with no tendency to bleed. No radiographic change was observed since there was no bony involvement of the lesion. Axial section of cone beam computed tomography revealed a nodular image with soft-tissue density, partially clear limits, measuring approximately 2.0 x 2.0 x 1.0 cm located in the soft tissues of the right side of the mandible.

These clinical and radiographic findings indicated a benign lesion and definitive diagnosis was confirmed after histopathologic examination of incisional biopsy specimen. Microscopic examination revealed abundant multinucleated giant cells organized in foci through dense fibrous connective tissue, which exhibited collagen fibers arranged in parallel bundles and bulky fibroblasts sometimes ovoid sometimes spindle-shaped. The presence of these features is indicative of Peripheral Giant Cell Granuloma (PGCG).

Key takeaways:-
- PGCG is a relatively uncommon lesion in children and potential for collaboration with the treatment in young patients should be considered for a successful therapeutic approach.

- The successive recurrences of the PGCG lesion, in this case, were attributed to inappropriate surgical technique induced by the child's lack of collaboration during the excision procedure.

-Therefore, general anesthesia was used to enable complete removal of the lesion, minimizing the risk of recurrence also talking into account the psychologically comfort of the young patient.

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