Case for diagnosis
A Rapidly Growing Gingival Nodule
Lesión nodular en encía de rápido crecimiento
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Nuño-González, F.J. Vicente-Martín, F.J. Salamanca-Santamaría" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Nuño-González" "email" => array:1 [ 0 => "anuno@fhalcorcon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F.J." "apellidos" => "Vicente-Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "F.J." "apellidos" => "Salamanca-Santamaría" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión nodular en encía de rápido crecimiento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 485 "Ancho" => 646 "Tamanyo" => 71360 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old man with no relevant past medical history attended the emergency department for a mildly painful tumor with occasional bleeding on the lower gum. The patient had developed periodontitis in the adjacent molar 2 months earlier that was treated with oral antibiotics (amoxicillin plus clavulanic acid) and the lesion developed following the treatment. He reported no fever, previous ingestion of other medication, or surgery in the area.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a firm erythematous-violaceous tumor lesion of 20 mm in diameter on the gum adjacent to the lower second right molar (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No other abnormalities were noted in the mouth.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology revealed a gingival mucosa formed of a stratified squamous epithelium with no significant abnormalities. The superficial dermis was totally occupied by an inflammatory infiltrate characterized by a connective-tissue stroma containing numerous multinucleated giant osteoclastic cells, immature mesenchymal cells, and a mild, predominantly mononuclear infiltrate. Abundant capillaries with foci of extravasated red blood cells and hemosiderin deposits were also seen (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Orthopantomography showed no underlying bone abnormalities. There were no significant alterations in the blood count and biochemistry, and thyroid and parathyroid hormone studies were normal.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Peripheral giant cell granuloma (PGCG).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lesion was excised by the maxillofacial surgery service and the patient remained asymptomatic 6 months after surgery.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">In 1953, Jaffe<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> used the term “giant cell reparative granuloma” to define a form of benign reactive tumor and to distinguish it from more aggressive giant-cell tumors that appear in the metaphyses of the long bones and that can metastasize in 2% of cases. PGCG is a giant-cell epulis or giant-cell granuloma that appears in the oral cavity and consists of a smooth-surfaced erythematous-violaceous gingival tumor of rapid growth adjacent to the bone. It typically arises in the mandibular mucosa, although it can also develop in the maxillary region; there have been very rare cases in other locations such as the nasal mucosa.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This rare disease is most common in men of less than 30 years of age, with very occasional reports in children<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>; it has also been described in the elderly, related to friction from dental protheses.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These lesions are thought to occur as a reaction to infection, trauma, or constant friction.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinically, the differential diagnosis should include pyogenic granuloma (which tends to be softer and more prone to bleeding), irritation fibroma (slower growing and also found at other sites, including the cheek and lips), and venous malformations of the mouth (typically present from an early age).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Histologically, PGCG is characterized by osteoclast-like multinucleated giant cells surrounded by an inflammatory infiltrate in the stroma. The differential diagnosis must therefore include central giant cell granuloma as this disease presents the same histological characteristics with the added feature of underlying bone involvement, which appears as a radiolucent area on orthopantomography.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a> Another similar lesion is the “brown tumor” (osteoclastoma) of hyperparathyroidism and it is therefore necessary to determine the calcium, phosphorous, and parathyroid hormone levels in these patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Surgery is the most widely used treatment and outcomes are good, though with some recurrences.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,6</span></a> Medical treatments have been published in the form of anecdotal reports or case series, above all for central giant-cell granuloma. Intralesional injection of corticosteroids tends to reduce the size of the lesion.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Oral or intranasal calcitonin has been used with excellent results.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Other treatments include interferon alfa, imatinib, or a combination of the two. However, there have been no comparative studies of the various treatments to determine whether they are as effective as surgical excision.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Nuño-González A, et al. Lesión nodular en encía de rápido crecimiento. Actas Dermosifiliogr. 2011;102:465-466.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 485 "Ancho" => 646 "Tamanyo" => 71360 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 792 "Ancho" => 344 "Tamanyo" => 116807 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification x20.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 410 "Ancho" => 547 "Tamanyo" => 131178 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification x200.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma periférico de células gigantes. 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Hume" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Oral Dis" "fecha" => "1995" "volumen" => "1" "paginaInicial" => "12" "paginaFinal" => "19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7553374" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Biblioteca Cochrane Plus 2009, Número 4. [base de datos en Internet].Oxford: Update Software Ltd; 2009 [consultado el 14 de octubre de 2010]. Suárez-Roa ML, Reveiz L, Ruiz-Godoy Rivera LM, Asbun-Bojalil J, Dávila-Serapio JE, Menjívar-Rubio AH, et al. Intervenciones para el tratamiento del granuloma central de células gigantes (GCCG) de los maxilares. Disponible en: <a class="elsevierStyleInterRef" href="http://www.update-software.com/">http://www.update-software.com</a>. Citado en Cochrane Library CD007404." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010200000006/v1_201304241225/S1578219011000059/v1_201304241225/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010200000006/v1_201304241225/S1578219011000059/v1_201304241225/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011000059?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 12 | 21 |
| 2024 Octubre | 69 | 36 | 105 |
| 2024 Septiembre | 87 | 26 | 113 |
| 2024 Agosto | 114 | 53 | 167 |
| 2024 Julio | 88 | 29 | 117 |
| 2024 Junio | 101 | 43 | 144 |
| 2024 Mayo | 72 | 34 | 106 |
| 2024 Abril | 81 | 21 | 102 |
| 2024 Marzo | 85 | 30 | 115 |
| 2024 Febrero | 61 | 34 | 95 |
| 2024 Enero | 64 | 28 | 92 |
| 2023 Diciembre | 72 | 12 | 84 |
| 2023 Noviembre | 76 | 33 | 109 |
| 2023 Octubre | 55 | 24 | 79 |
| 2023 Septiembre | 74 | 31 | 105 |
| 2023 Agosto | 39 | 23 | 62 |
| 2023 Julio | 55 | 30 | 85 |
| 2023 Junio | 76 | 27 | 103 |
| 2023 Mayo | 61 | 31 | 92 |
| 2023 Abril | 48 | 16 | 64 |
| 2023 Marzo | 36 | 22 | 58 |
| 2023 Febrero | 52 | 29 | 81 |
| 2023 Enero | 39 | 23 | 62 |
| 2022 Diciembre | 51 | 30 | 81 |
| 2022 Noviembre | 16 | 27 | 43 |
| 2022 Octubre | 26 | 26 | 52 |
| 2022 Septiembre | 29 | 40 | 69 |
| 2022 Agosto | 18 | 30 | 48 |
| 2022 Julio | 34 | 37 | 71 |
| 2022 Junio | 21 | 25 | 46 |
| 2022 Mayo | 37 | 36 | 73 |
| 2022 Abril | 48 | 15 | 63 |
| 2022 Marzo | 44 | 41 | 85 |
| 2022 Febrero | 34 | 27 | 61 |
| 2022 Enero | 33 | 70 | 103 |
| 2021 Diciembre | 27 | 40 | 67 |
| 2021 Noviembre | 41 | 43 | 84 |
| 2021 Octubre | 51 | 54 | 105 |
| 2021 Septiembre | 35 | 69 | 104 |
| 2021 Agosto | 68 | 48 | 116 |
| 2021 Julio | 42 | 33 | 75 |
| 2021 Junio | 52 | 36 | 88 |
| 2021 Mayo | 45 | 35 | 80 |
| 2021 Abril | 84 | 28 | 112 |
| 2021 Marzo | 76 | 22 | 98 |
| 2021 Febrero | 89 | 15 | 104 |
| 2021 Enero | 53 | 11 | 64 |
| 2020 Diciembre | 43 | 13 | 56 |
| 2020 Noviembre | 26 | 10 | 36 |
| 2020 Octubre | 18 | 4 | 22 |
| 2020 Septiembre | 31 | 13 | 44 |
| 2020 Agosto | 23 | 16 | 39 |
| 2020 Julio | 14 | 11 | 25 |
| 2020 Junio | 35 | 26 | 61 |
| 2020 Mayo | 30 | 18 | 48 |
| 2020 Abril | 30 | 17 | 47 |
| 2020 Marzo | 31 | 20 | 51 |
| 2020 Febrero | 5 | 6 | 11 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 1 | 5 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 1 | 3 | 4 |
| 2019 Agosto | 6 | 0 | 6 |
| 2019 Julio | 4 | 3 | 7 |
| 2019 Junio | 4 | 8 | 12 |
| 2019 Mayo | 6 | 17 | 23 |
| 2019 Abril | 2 | 1 | 3 |
| 2019 Marzo | 2 | 6 | 8 |
| 2019 Febrero | 0 | 3 | 3 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 1 | 3 | 4 |
| 2018 Noviembre | 0 | 1 | 1 |
| 2018 Octubre | 5 | 1 | 6 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 5 | 4 | 9 |
| 2018 Febrero | 68 | 4 | 72 |
| 2018 Enero | 136 | 7 | 143 |
| 2017 Diciembre | 80 | 5 | 85 |
| 2017 Noviembre | 75 | 5 | 80 |
| 2017 Octubre | 73 | 6 | 79 |
| 2017 Septiembre | 68 | 4 | 72 |
| 2017 Agosto | 88 | 9 | 97 |
| 2017 Julio | 79 | 3 | 82 |
| 2017 Junio | 75 | 3 | 78 |
| 2017 Mayo | 76 | 3 | 79 |
| 2017 Abril | 81 | 5 | 86 |
| 2017 Marzo | 69 | 11 | 80 |
| 2017 Febrero | 43 | 7 | 50 |
| 2017 Enero | 37 | 7 | 44 |
| 2016 Diciembre | 44 | 8 | 52 |
| 2016 Noviembre | 68 | 4 | 72 |
| 2016 Octubre | 68 | 16 | 84 |
| 2016 Septiembre | 47 | 3 | 50 |
| 2016 Agosto | 44 | 6 | 50 |
| 2016 Julio | 36 | 5 | 41 |
| 2016 Junio | 10 | 5 | 15 |
| 2016 Mayo | 6 | 7 | 13 |
| 2016 Abril | 6 | 6 | 12 |
| 2016 Marzo | 11 | 5 | 16 |
| 2016 Febrero | 6 | 3 | 9 |
| 2016 Enero | 8 | 0 | 8 |
| 2015 Diciembre | 11 | 1 | 12 |
| 2015 Noviembre | 50 | 1 | 51 |
| 2015 Octubre | 41 | 5 | 46 |
| 2015 Septiembre | 9 | 4 | 13 |
| 2015 Agosto | 12 | 2 | 14 |
| 2015 Julio | 70 | 7 | 77 |
| 2015 Junio | 56 | 8 | 64 |
| 2015 Mayo | 99 | 9 | 108 |
| 2015 Abril | 90 | 7 | 97 |
| 2015 Marzo | 47 | 10 | 57 |
| 2015 Febrero | 50 | 6 | 56 |
| 2015 Enero | 35 | 9 | 44 |
| 2014 Diciembre | 36 | 11 | 47 |
| 2014 Noviembre | 34 | 16 | 50 |
| 2014 Octubre | 51 | 15 | 66 |
| 2014 Septiembre | 41 | 15 | 56 |
| 2014 Agosto | 41 | 14 | 55 |
| 2014 Julio | 81 | 24 | 105 |
| 2014 Junio | 62 | 14 | 76 |
| 2014 Mayo | 74 | 15 | 89 |
| 2014 Abril | 68 | 15 | 83 |
| 2014 Marzo | 72 | 12 | 84 |
| 2014 Febrero | 60 | 11 | 71 |
| 2014 Enero | 65 | 21 | 86 |
| 2013 Diciembre | 67 | 14 | 81 |
| 2013 Noviembre | 40 | 14 | 54 |
| 2013 Octubre | 53 | 16 | 69 |
| 2013 Septiembre | 43 | 14 | 57 |
| 2013 Agosto | 51 | 17 | 68 |
| 2013 Julio | 50 | 41 | 91 |
| 2013 Junio | 11 | 6 | 17 |
| 2013 Mayo | 18 | 7 | 25 |
| 2013 Abril | 12 | 12 | 24 |
| 2013 Marzo | 19 | 19 | 38 |
| 2013 Febrero | 44 | 6 | 50 |
| 2013 Enero | 14 | 5 | 19 |
| 2012 Diciembre | 11 | 3 | 14 |
| 2012 Octubre | 1 | 1 | 2 |
| 2012 Septiembre | 0 | 1 | 1 |
| 2012 Agosto | 1 | 1 | 2 |
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