# Peripheral Giant Cell Granuloma in Pregnancy: A Case Report
## 3 Discussion
On the other hand, [PERSON] et al. (2018) reported a clinical case involving the surgical removal of a PGCG in a patient who manifested the lesion during the last trimester of pregnancy. The patient presented generalized gingival inflammation, bleeding on probing, and calculus during clinical examination. Additionally, radiographic examination identified bone resorption in the molar region. In the present case report, no alterations were observed in the soft or hard tissues of the oral cavity. In a descriptive study involving 26 patients with PGCG, [PERSON] (1998) identified the presence of estrogen and progesterone receptors using the immuno-peroxidase technique [23]. Estrogen receptor positivity was found in stromal cells in fourteen patients, and in ten of these patients the osteoclast-like giant cells exhibited estrogen receptor immunostaining. Based on these results, it was concluded that the cells forming the peripheral giant cell granuloma might be potential targets for estrogens and that the lesion might be influenced by hormonal conditions. In contrast, [PERSON] (2008) carried out a descriptive study in 20 patients to determine the relationship between PGCG and circulating levels of sex hormones (testosterone, estrogen, and progesterone) [24]. However, no significant association was found between PGCG and sex hormones, and it was concluded that PGCG does not directly depend on testosterone, estrogen, and progesterone studies [25]. Therefore, it was suggested that the role of sex hormones in the development of PGCG might be secondary to local factors such as trauma and poor oral hygiene. In the clinical case described here, we believe that the changes in the oral cavity caused by hormones during pregnancy may be considered as factors that contribute to the onset and progression of PGCG, as no other local triggering conditions for this lesion were present. However, further studies are needed to clarify this association. Generally, PGCGs occur in soft tissue without affecting the bone, as was observed in the present study, which is consistent with findings from other studies [13; 26]. However, giant cells may be activated as an inflammatory response, making them participate as osteoclasts and leading to the resorption of alveolar bone [3]. Osteoclastic activity may be associated with exuberant stromal cell proliferation and bone remodeling [21]. Resorptivefunctions may be modulated by estrogen receptors on osteoclasts. On the other hand, the proliferation of osteoclasts in the pathology may be related to other factors. The treatment of choice for PGCG is surgical excision, as implemented in the present clinical case and in previous studies [1; 7; 14; 27]. This surgical removal method involves excising the lesion along with extensive curettage of the periosteum at the base of the lesion. The associated teeth do not need to be extracted if they are healthy. In fact, it has even been suggested that extraction is contraindicated [2; 27]. In addition, it is advisable to remove local irritants. Various treatment modalities have been suggested for PGCG, including intralesional steroids, subcutaneous or nasal calcitonin, subcutaneous injections of alpha-interferon, and the protein tyrosine kinase inhibitor imatinib. However, there is insufficient evidence to support the efficacy of these methods [27]. Using a CO\({}_{2}\) laser or laser resection is another viable treatment option for granuloma removal [27]. The CO\({}^{2}\) laser provides advantages, including reduced bleeding risk and superior coagulation properties. However, it may not be suitable when the lesion affects adjacent bone, in which case thorough surgical curettage becomes necessary [27]. In a study by [PERSON] (2005), CGCG excision and biopsy was performed via CO\({}_{2}\) laser in an operation involving two cases and with a cold scalpel in three cases [15]. Laser resection is a technique that allows wound sterilization, causes less intraoperative bleeding, does not require sutures, and provides greater postoperative comfort.