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Abstract
PURPOSE To demonstrate the clinical, radiologic, and histopathologic features of a patient with orbital involvement in cherubism that prompted surgical treatment. DESIGN Single interventional case report. INTERVENTION Findings of the ophthalmic evaluation, computed tomography (CT) scans, intraoperative examination, and light microscopy of the specimens were analyzed. MAIN OUTCOME MEASURES Globe displacement, orbital bony lesions detected on CT scans, histopathology, and postoperative results were assessed. RESULTS A 27-year-old female was seen with a slowly progressive superonasal globe displacement and a temporal orbital mass bilaterally of 6 years' duration. She had a history of cherubism, but her cheeks and jaws had a normal appearance instead of the bilateral fullness of the lower half of the face typical of the disease. CT scans demonstrated multicystic bony lesions arising from the orbital floors bilaterally. The masses were excised using an anterior transcutaneous transseptal orbitotomy. Histopathology demonstrated numerous giant cells in a fibrovascular stroma, confirming the clinical diagnosis of cherubism. Postoperative recovery was complete. CONCLUSIONS Orbital involvement in cherubism may develop beyond puberty, after stabilization or regression of the lesions in the jaws. Patients with cherubism should be routinely evaluated by an ophthalmologist.
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Affiliation(s)
- F Colombo
- Department of Ophthalmology and Eye Hospital, University of Erlangen-Nürnberg, Erlangen, Germany
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52
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Affiliation(s)
- S Moss
- Department of Oral and Maxillofacial Surgery, Lincoln Medical and Mental Health Center, Bronx, NY, USA
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53
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Von Wowern N. Cherubism: a 36-year long-term follow-up of 2 generations in different families and review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:765-72. [PMID: 11113824 DOI: 10.1067/moe.2000.108438] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To clarify the relationships between the varying clinical or radiographic features of cherubism. STUDY DESIGN Nonparametric statistics were used in a long-term follow-up of 18 patients through 2 generations from 6 Danish families. RESULTS The radiographic grade of cherubism was significantly related to sex, maximal buccal bone expansion, course of cherubism, and number of aplasia or ectopic impacted teeth, but it was not related to families. Normal dentition in nonaffected regions was present or was obtained in 14 of 14 patients (age, >14 years). Surgical treatment did not provoke growth of lesional tissue in 22 of 22 cases. Radiographically, the bone structure in the lesional areas was related to age in all grades of cherubism: new bone formation in radiolucent areas (age, >20 years), normal bone structure with multilocular sketches (age, 32 to 39 years), and completely normal bone structure (age, >41 years), also found in 7 of 7 carriers of cherubism (age, >32 years). CONCLUSIONS This group analysis verifies the knowledge of cherubism previously based on cumulative reviews of findings in single-family and case reports.
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Affiliation(s)
- N Von Wowern
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Copenhagen, Denmark
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54
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Highly aggressive brown tumour of the maxilla as first manifestation of primary hyperparathyroidism. Int J Oral Maxillofac Surg 2000. [DOI: 10.1016/s0901-5027(00)80079-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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55
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Timoşca GC, Găleşanu RM, Cotuţiu C, Grigoraş M. Aggressive form of cherubism: report of a case. J Oral Maxillofac Surg 2000; 58:336-44. [PMID: 10716121 DOI: 10.1016/s0278-2391(00)90069-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G C Timoşca
- University of Medicine and Pharmacy, Iaşi, Romania.
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56
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Ekim M. A swollen face in a girl on haemodialysis. Nephrol Dial Transplant 2000; 15:283. [PMID: 10648688 DOI: 10.1093/ndt/15.2.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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57
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Stiller M, Urban M, Golder W, Tiziani V, Reichenberger E, Frege J, Opitz C, Peters H. Craniosynostosis in cherubism. ACTA ACUST UNITED AC 2000. [DOI: 10.1002/1096-8628(20001211)95:4<325::aid-ajmg6>3.0.co;2-r] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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58
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59
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Mangion J, Rahman N, Edkins S, Barfoot R, Nguyen T, Sigurdsson A, Townend JV, Fitzpatrick DR, Flanagan AM, Stratton MR. The gene for cherubism maps to chromosome 4p16.3. Am J Hum Genet 1999; 65:151-7. [PMID: 10364527 PMCID: PMC1378085 DOI: 10.1086/302454] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cherubism is a rare familial disease of childhood characterized by proliferative lesions within the mandible and maxilla that lead to prominence of the lower face and an appearance reminiscent of the cherubs portrayed in Renaissance art. Resolution of these bony abnormalities is often observed after puberty. Many cases are inherited in an autosomal dominant fashion, although several cases without a family history have been reported. Using two families with clinically, radiologically, and/or histologically proved cherubism, we have performed a genomewide linkage search and have localized the gene to chromosome 4p16.3, with a maximum multipoint LOD score of 5. 64. Both families showed evidence of linkage to this locus. Critical meiotic recombinants place the gene in a 3-cM interval between D4S127 and 4p-telomere. Within this region a strong candidate is the gene for fibroblast growth factor receptor 3 (FGFR3); mutations in this gene have been implicated in a diverse set of disorders of bone development.
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Affiliation(s)
- J Mangion
- Section of Cancer Genetics, Institute of Cancer Research, Sutton, Surrey, United Kingdom
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60
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Tiziani V, Reichenberger E, Buzzo CL, Niazi S, Fukai N, Stiller M, Peters H, Salzano FM, Raposo do Amaral CM, Olsen BR. The gene for cherubism maps to chromosome 4p16. Am J Hum Genet 1999; 65:158-66. [PMID: 10364528 PMCID: PMC1378086 DOI: 10.1086/302456] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cherubism is an autosomal dominant disorder that may be related to tooth development and eruption. It is a disorder of age-related bone remodeling, mostly limited to the maxilla and the mandible, with loss of bone in the jaws and its replacement with large amounts of fibrous tissue. We have used a genomewide search with a three-generation family and have established linkage to chromosome 4p16. Three other families affected with cherubism were also genotyped and were mapped to the same locus. The combined LOD score is 4.21 at a recombination fraction of 0, and the locus spans an interval of approximately 22 cM.
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Affiliation(s)
- V Tiziani
- Department of Cell Biology, Harvard Medical School and Harvard-Forsyth Boston, MA, USA.
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61
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Kalantar Motamedi MH. Treatment of cherubism with locally aggressive behavior presenting in adulthood: report of four cases and a proposed new grading system. J Oral Maxillofac Surg 1998; 56:1336-42. [PMID: 9820222 DOI: 10.1016/s0278-2391(98)90618-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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62
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Southgate J, Sarma U, Townend JV, Barron J, Flanagan AM. Study of the cell biology and biochemistry of cherubism. J Clin Pathol 1998; 51:831-7. [PMID: 10193324 PMCID: PMC500977 DOI: 10.1136/jcp.51.11.831] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To establish whether the multinucleate cells in lesions of patients with cherubism are also osteoclasts and if this is the case whether they were responsive to calcitonin; to carry out cytogenetic studies on two members of the same family affected by cherubism in an attempt to identify any major chromosomal defects; and to perform an in-depth modern biochemical study of four children in the same family. SUBJECTS AND METHODS Four related children with cherubism were studied. Tissue taken from one of the children at elective decompression of an optic nerve was submitted to in vitro bone resorption studies. Cytogenetic studies were done on two of the children and biochemical studies on all four. RESULTS The multinucleate cells in the cherubic lesions were shown to be osteoclasts since they synthesised tartrate resistant acid phosphatase, expressed the vitronectin receptor, and resorbed bone. Bone resorption by the cultured multinucleate cells was significantly inhibited by calcitonin. High resolution cytogenetic studies failed to detect any chromosomal abnormalities in two children with cherubism. The biochemistry profile of all four children with cherubism showed that serum calcium, parathyroid hormone, parathyroid related hormone, calcitonin, and alkaline phosphatase were within normal levels. Urine analysis of pyridinium and deoxypyridinium cross links, hydroxyproline, and calcium in relation to urine creatinine were measured to assess bone resorption in these children, and the values were at the upper end of the normal range in all four. CONCLUSIONS Further studies are required to determine whether calcitonin treatment will control this grossly deforming disease until the time when the physiological changes that occur at puberty rectify the pathology. It is not recommended that biochemical markers of bone resorption are used in isolation to monitor the activity of cherubism in individuals because the results are based on a small number of children and because of reports of marked interindividual variation in the levels of these markers, particularly in children.
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Affiliation(s)
- J Southgate
- Department of Maxillofacial Surgery, St Richard's Trust, Chichester, West Sussex, UK
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63
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Hernandez HN, Lewiss RE, Yousem DM, Clerico DM, Weinstein GS. Central giant cell granuloma of the hard palate. Otolaryngol Head Neck Surg 1998; 118:871-3. [PMID: 9627255 DOI: 10.1016/s0194-5998(98)70287-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- H N Hernandez
- Department of Otorhinolaryngology--Head and Neck Surgery, University of Pennsylvania, Philadelphia, USA
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64
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65
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Tiffee JC, Aufdemorte TB. Markers for macrophage and osteoclast lineages in giant cell lesions of the oral cavity. J Oral Maxillofac Surg 1997; 55:1108-12; discussion 1112-3. [PMID: 9331235 DOI: 10.1016/s0278-2391(97)90291-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Giant cell lesions of the oral cavity are a well recognized entity. However, the histogenesis of these lesions is still the subject of controversy, with support for both histiocyte/macrophage and osteoclast origins being found in the literature. This study evaluated a set of peripheral giant cell lesions (PGCLs) and central giant cell lesions (CGCLs) for characteristics of both cell types to address this dilemma. MATERIALS AND METHODS Detection of histiocyte/macrophage characteristics was accomplished immunohistochemically by evaluating for markers specific for this cell type, namely alpha-1 -antichymotrypsin (1 -ACT) and factor XIIIa antibodies. Detection of osteoclast characteristics made use of the fact that osteoclasts possess a unique enzyme, tartrate-resistant acid phosphatase, which can be appreciated by histochemical procedures. RESULTS A large percentage of the multinucleated cells stained with the 1-ACT (38.08% in PGCLs and 15.84% in CGCLs), while only isolated cells stained for factor XIIIa (1.20% PGCLs, 0.99% CGCLs). Isolated stromal cells also were stained. Virtually all multinucleated cells reacted with the tartrate-resistant acid phosphatase stain (99.26% PGCLs, 98.34% CGCLs), as did a number of the mononuclear stromal cells. CONCLUSIONS This study supports the contention that GCLs of the oral cavity may arise from precursor cells related to the granulocyte/macrophage line, and may originate from mononuclear cells that express markers for both macrophages and osteoclasts.
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Affiliation(s)
- J C Tiffee
- Department of Oral Medicine/Pathology, University of Pittsburgh--School of Dental Medicine, PA 15261, USA
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66
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Abstract
This report reviews the literature involving the central giant cell granuloma. Diagnosis and treatment is presented. The article reports the case of a child who was initially seen in her general dentist's office, then referred to an oral and maxillofacial surgeon. Differential diagnoses of both benign and malignant lesions related to the central giant cell tumor are discussed.
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Affiliation(s)
- J B Roberson
- Division of Oral and Maxillofacial Surgery, University of Cincinnati Medical Center, Ohio 45267-0558, USA
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67
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Betts NJ, Stewart JC, Fonseca RJ, Scott RF. Multiple central giant cell lesions with a Noonan-like phenotype. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 76:601-7. [PMID: 8247501 DOI: 10.1016/0030-4220(93)90069-g] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A small number of patients with the phenotypic features of Noonan syndrome have also developed giant cell lesions of the jaws similar to those seen in cherubism. This case report describes an individual with the features of the recently described Noonan-like/multiple giant cell lesion syndrome. Previously reported cases and issues relative to diagnosis and management are considered.
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Affiliation(s)
- N J Betts
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia
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68
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Ayoub AF, el-Mofty SS. Cherubism: report of an aggressive case and review of the literature. J Oral Maxillofac Surg 1993; 51:702-5. [PMID: 8492214 DOI: 10.1016/s0278-2391(10)80276-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A F Ayoub
- Oral Surgery Department, Faculty of Medicine, University of Glasgow, UK
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