Treatment

Under local anesthesia, the lesion was excised sharply and the roots of teeth #s 5 and 6 were scaled to ensure complete removal of any local irritants. It was allowed to heal by secondary intention

Excisional Biopsy

Histologic examination reveals a hemisected piece of soft tissue composed of keratinized and ulcerated surface epithelium with an underlying granulation tissue mass with many giant cells (Figure 3). The surface also shows a large area of ulceration covered by fibrin and neutrophils. The underlying granulation tissue mass is loose and vascular and contains numerous giant cells of variable shapes and sizes (Figure 4). The giant cells are haphazardly arranged. The granulation tissue mass contains clusters of extravasated erythrocytes as well as clusters of hemosiderin pigment (Figure 5). This mass and the surrounding connective tissue are infiltrated by lymphocytes, plasma cells, and neutrophils.

Figure 3 Low power (x40) H & E stained histology shows a mass of vascular granulation tissue with many multinucleated giant cells and ulcerated surface epithelium.

Figure 4 Higher power (x100) H & E stained histology shows sheets of multinucleated giant cells suspended on a background of vascular granulation tissue.

Figure 5 High power (x200) H & E stained histology shows small clusters of hemosiderin pigment and clusters of extravasated erythrocytes in a background of granulation tissue and giant cells.