Large cell granuloma is certainly a uncommon harmless entity but could be locally intense relatively. large cell reparative granuloma, but currently does not refer to him as reparative, because of its locally destructive. It is classified as peripheral if it affects the extremities and central if it develops in the midline (being the least common type). It is a rare entity relatively. Accounted for 7% from the maxillary tumors (his chosen area its the incisor area, and more often in the jaw compared to the maxilla) (2). It really 402957-28-2 is more 402957-28-2 prevalent in kids and adults, with hook predominance in females (2). As etiological elements (3) have already been related many factors, especially regional irritants (such as for example extractions or badly appropriate dentures) and hormonal (4) (actually, whenever we diagnose a GCGs, we have to discard the coexistence of principal hyperparathyroidism, because traditional brown tumors top features of this disease are practically indistinguishable in the histology of GCGs). Another theory pertains to its origins it really is an intraosseous vascular lesions comparable to angiomas of gentle tissues (5). Regardless affects bone tissue supported tissue. Case Survey Feminine individual 16 years of age without former background of curiosity who presents a lesion of almost a year, in the gingiva of the next quadrant, whose size, based on the patient, hasn’t increased in latest weeks (Fig. ?(Fig.1a).1a). It is asymptomatic clinically. On physical evaluation, the lesion is usually reddish, soft and fleshy. It causes a significant and bulging prominence, both lobby and palatal and mobility of the pieces 22 and 23. The analytical requested in its health center is completely normal. Orthopantomography shows the bone defect that coincides with lesion, pieces 18, 28, 38 and 48 included and root fragments of pieces 16 and 36, and periapical lesions in relation to pieces 36 and 37. When individual is attended in discussion, a facial, axial and coronal computed tomography (CT)-scan and 3D reconstructions are requested (Fig. ?(Fig.1b),1b), which shows the defect displayed around the Orthopantomography. In Hematoxylin-eosin staining appears intense SAPKK3 proliferation of fibroblasts and multinucleated giant cells, and it is reported as giant cell granuloma. Based on the age of the patient, in the absence of clinical and benign nature of the lesion, we opted for conservative treatment by six cycles of intralesional injection of triamcinolone, with the further implementation of regular radiological controls. However, due to the persistence and escalation of the lesion (Fig. ?(Fig.2),2), we completed treatment 402957-28-2 with resection of the granuloma and reconstruction 402957-28-2 of the defect with microvascular fibula free flap with skin paddle associated by anastomosis of the peroneal vessels to the facial vessels (Fig. ?(Fig.3a).3a). In a second procedure, two months after reconstruction, the flap was defatted (Fig. ?(Fig.33b). Open in a separate window Physique 1 a Initial clinical view of the lesion. b View of the defect produced by the lesion in 3D reconstruction CT-scan. Open in a separate window Physique 2 Appearance of the lesion after conservative treatment with intralesional triamcinolone. Open in a separate 402957-28-2 window Physique 3 a Adaptation of microvascular fibula free flap skin paddle associated to the resultant defect after excision. b Appearance of the flap once thinned two months after the reconstructive surgery. Discussion GCGs clinically manifests as a mass or nodule of reddish color (although it can sometimes be bluish) and occasionally ulcerated fleshy surface. Its range can be from asymptomatic, small and slow-growing to large and destructive lesions that grow rapidly. Imaging testing are essential, because show the true extent of GCGs and their behavior in the tissue in which it sits. Although, as a first approximation we can make use of the Ortopantomography, it is often necessary to perform CT, sometimes even three-dimensional reconstructions. Definitive diagnosis is determined by biopsy. Thus, histologically characterized (4) by the intense proliferation.