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Suárez-Roa MDL, Reveiz L, Ruíz-Godoy Rivera LM, Asbun-Bojalil J, Dávila-Serapio JE, Menjívar-Rubio AH, Meneses-García A. Interventions for central giant cell granuloma (CGCG) of the jaws. Cochrane Database Syst Rev 2009:CD007404. [PMID: 19821413 DOI: 10.1002/14651858.cd007404.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Central giant cell granuloma (CGCG) of the jaws is a rare benign tumour with an unknown aetiology accounting for up to 7% of tumours in the mandible (lower jaw) and the maxilla (upper jaw). OBJECTIVES This systematic review focused on assessing the effects of primary non-surgical versus primary surgical interventions or any other treatment or placebo for treating central giant cell granuloma of the jaws. SEARCH STRATEGY Relevant randomised controlled trials (RCTs) were identified from the Cochrane Oral Health Group's Trials Register (July 2009); CENTRAL (The Cochrane Library 2009, Issue 3); MEDLINE (1950 to July 2009); EMBASE (1980 to July 2009); and LILACS (1982 to July 2009). We scanned bibliographies of relevant studies for possible references to additional trials as well as prospective clinical trial registries. Eligible RCTs were included regardless of the language of publication. SELECTION CRITERIA Randomised controlled trials involving a comparison of primary non-surgical interventions with primary surgical interventions or any other treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility, risk of bias and extracted data. The Cochrane Collaboration statistical guidelines were followed. MAIN RESULTS We did not find any study evaluating the effects of primary surgical versus primary non-surgical interventions for central giant cell granuloma of the jaws. However, we included and analysed one RCT with unclear risk of bias, evaluating the effects of calcitonin versus placebo for central giant cell granuloma of the jaws. No significant difference was found in the proportion of patients with increased volume of more than 10% of the lesion compared to the pretreatment measurement at 3 months of follow-up (one RCT, 14 participants; risk ratio (RR) 3.00, 95% confidence interval (CI) 0.40 to 22.30). AUTHORS' CONCLUSIONS We did not find RCTs evaluating the effects of primary surgical versus primary non-surgical interventions for central giant cell granuloma of the jaws. Although a number of non-surgical therapies have been proposed for treating central giant cell granuloma of the jaws, our review did not identify evidence from RCTs to support their use. More research is needed on this topic.
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Affiliation(s)
- María de Lourdes Suárez-Roa
- Section of Pathology, National Cancer Institute, Av. San Fernando, No. 22 Col. Seccion XVI, Mexico City, Mexico, 14080
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Tosco P, Tanteri G, Iaquinta C, Fasolis M, Roccia F, Sid Berrone, Garzino-Demo P. Surgical treatment and reconstruction for central giant cell granuloma of the jaws: A review of 18 cases. J Craniomaxillofac Surg 2009; 37:380-7. [DOI: 10.1016/j.jcms.2009.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 03/22/2009] [Accepted: 04/03/2009] [Indexed: 12/26/2022] Open
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Sun ZJ, Cai Y, Zwahlen RA, Zheng YF, Wang SP, Zhao YF. Central giant cell granuloma of the jaws: clinical and radiological evaluation of 22 cases. Skeletal Radiol 2009; 38:903-9. [PMID: 19582449 DOI: 10.1007/s00256-009-0740-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 06/03/2009] [Accepted: 06/06/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective was to investigate the clinical and radiological characteristics of central giant cell granulomas (CGCGs) of the jaws. METHODS A retrospective analysis of a 20-year database was performed regarding both clinical and radiological features of 22 patients affected with CGCGs of the jaws. RESULTS Fourteen women and 8 men were included with the age range of 7-81 years (mean 31.7 years). Among the 22 lesions, 16 were located in the mandible and 6 in the maxilla. Painless swelling was the most common clinical feature in 18 of all cases. Limited mouth opening was noted in 2 patients where the lesions involved the condyle. Radiographically, 13 lesions were homogeneously osteolytic and 9 lesions were trabeculated. Fifteen lesions were unilocular and 14 lesions presented with well-defined but not sclerotic margins. CT images in 5 patients clearly showed the trabeculation within the lesions. The follow-up ranged from 1.5 to 11 years with a mean period of 5 years. Three out of 9 aggressive and 1 out of 13 nonaggressive lesions developed recurrence. CONCLUSIONS Diagnosis of CGCGs of the jaws depends on both correct interpretation of clinical, radiographic and pathological data. Differentiation between aggressive and nonaggressive CGCGs should be considered to improve individual treatment planning.
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Affiliation(s)
- Zhi-Jun Sun
- Key Laboratory for Oral Biomedical Engineering of Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237# Luo Yu Road, Wuhan, 430079, Hubei, China.
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Crusoé-Rebello I, Torres MGG, Burgos V, Oliveira C, Santos JND, Azevedo RA, Campos PSF. Hybrid lesion: central giant cell granuloma and benign fibro-osseous lesion. Dentomaxillofac Radiol 2009; 38:421-5. [PMID: 19700537 DOI: 10.1259/dmfr/44753298] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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105
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Spontaneous Resolution of a Central Giant-Cell Granuloma After Incisional Biopsy: A Case Report. J Oral Maxillofac Surg 2009; 67:1543-7. [DOI: 10.1016/j.joms.2008.12.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 10/15/2008] [Accepted: 12/19/2008] [Indexed: 11/21/2022]
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Bilodeau E, Chowdhury K, Collins B. A case of recurrent multifocal central giant cell granulomas. Head Neck Pathol 2009; 3:174-8. [PMID: 19644538 PMCID: PMC2715452 DOI: 10.1007/s12105-009-0119-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 05/08/2009] [Indexed: 10/27/2022]
Abstract
One case of recurrent multifocal central giant cell granulomas (CGCG) is presented. Initially, the lesions presented concurrently in the maxilla and mandible with subsequent recurrence in the mandible. Now, two recurrences are seen in the maxillary sinus and ethmoid region. The literature regarding multifocal CGCG is reviewed.
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Affiliation(s)
- Elizabeth Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA USA
| | - Khalid Chowdhury
- Center for Craniofacial & Skull Base Disorders/Department of Otolaryngology, University of Colorado, Denver, CO USA
| | - Bobby Collins
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA USA
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107
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Susarla SM, August M, Dewsnup N, Faquin WC, Kaban LB, Dodson TB. CD34 Staining Density Predicts Giant Cell Tumor Clinical Behavior. J Oral Maxillofac Surg 2009; 67:951-6. [DOI: 10.1016/j.joms.2008.12.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Revised: 10/09/2008] [Accepted: 12/19/2008] [Indexed: 11/16/2022]
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108
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Wong YK, Cheng JCF. Central giant cell granuloma in palate associated with orthodontic treatment. ACTA ACUST UNITED AC 2008; 15:135-9. [PMID: 18826766 DOI: 10.1308/135576108785891105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A case report of a central giant cell granuloma in the palate, which arose after orthodontic treatment, is presented with a review of relevant literature. Treatment options and clinical implications are also discussed.
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Affiliation(s)
- Yiu-Kai Wong
- Oral-Maxillofacial Surgery and Dental Unit, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
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109
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Immunohistochemical evaluation of giant cell tumors of the jaws using CD34 density analysis. J Oral Maxillofac Surg 2008; 66:928-33. [PMID: 18423282 DOI: 10.1016/j.joms.2008.01.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 12/13/2007] [Accepted: 01/05/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare CD34 expression in both aggressive and nonaggressive giant cell lesions of the jaws and identify any associations between tumor vascular density and biologic behavior. MATERIALS AND METHODS This was a retrospective study of subjects treated for giant cell lesions of the jaws at Massachusetts General Hospital from 1992 to 2006. The primary predictor variable was tumor classification (aggressive or nonaggressive); tumors were considered aggressive if they were greater than 5 cm in size, recurred after treatment, or exhibited 3 of the following: presence of root resorption, tooth displacement, or cortical bone thinning or perforation. Secondary predictor variables, recorded for each patient, were demographic, anatomic, and clinical measures. The outcome variable was the average CD34 staining density of histologic specimens quantified in 2 different areas. Descriptive and bivariate statistics were computed to identify predictors associated with vascular density. RESULTS The study sample was composed of 32 subjects with a mean age of 24.4 +/- 19.77 years (range: 2-83); 23 subjects (71.8%) were female. Of the tumors included, 11 (34.4%) were located in the maxilla, 21 (65.6%) in the mandible. Twenty-six tumors (81.2%) were classified as aggressive; the remainder (18.8%) were nonaggressive. There were no statistically significant differences between subjects with aggressive versus nonaggressive tumors with regard to age, gender, or location. Subjects with aggressive tumors had a significantly higher CD34 staining density (P = .02). None of the secondary predictors was associated with vascular density. CONCLUSION Vascular density of giant cell tumors of the jaws is significantly increased in aggressive tumors.
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Flórez-Moreno GA, Henao-Ruiz M, Santa-Sáenz DM, Castañeda-Peláez DA, Tobón-Arroyave SI. Cytomorphometric and immunohistochemical comparison between central and peripheral giant cell lesions of the jaws. ACTA ACUST UNITED AC 2008; 105:625-32. [DOI: 10.1016/j.tripleo.2007.08.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 08/01/2007] [Accepted: 08/27/2007] [Indexed: 11/24/2022]
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Oral rehabilitation of a 12-year-old patient diagnosed with a central giant cell granuloma using a fibula graft and an implant-supported prosthesis: A clinical report. J Prosthet Dent 2008; 99:257-62. [DOI: 10.1016/s0022-3913(08)60057-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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112
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Vered M, Nasrallah W, Buchner A, Dayan D. Stromal myofibroblasts in central giant cell granuloma of the jaws cannot distinguish between non-aggressive and aggressive lesions. J Oral Pathol Med 2007; 36:495-500. [PMID: 17686009 DOI: 10.1111/j.1600-0714.2007.00541.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate correlations between myofibroblast density (MFD) and biological behavior of a large series of non-aggressive and aggressive central giant cell granuloma lesions (CGCGs). METHODS Twenty-four non-aggressive and 17 aggressive lesions were immunohistochemically stained with alpha smooth muscle actin. MFD was assessed using the point counting method in the lesions' core tissue and in control areas that consisted of non-involved, connective tissue surrounding the lesion. RESULTS All CGCGs contained myofibroblasts among the stromal cells. No significant differences were found in the mean percentage of MFD (%MFD) of non-aggressive (20.8 +/- 15.7%) and aggressive (23.7 +/- 22.9%) lesions (P > 0.05) or in the mean %MFD of the respective control areas (1.4 +/- 2.2% and 1.7 +/- 4.1%; P > 0.05). The mean core tissue %MFD of both lesion types was significantly higher than that of the control areas (P < 0.001). CONCLUSION Myofibroblasts were an integral component of CGCG stromal cells, but their density could not distinguish between non-aggressive and aggressive lesions.
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Affiliation(s)
- Marilena Vered
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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Temporal bone central giant-cell granuloma presenting as a serous otitis media. Eur Arch Otorhinolaryngol 2007; 265:587-91. [PMID: 18004584 DOI: 10.1007/s00405-007-0460-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
Abstract
Central giant cell granuloma is a benign intraosseous lesion that most commonly occurs in the facial bones. Its location in the temporal bone is extremely rare and only 20 cases have been reported in the literature. We report a case of an adult female patient presenting with a right serous otitis media and mastoiditis associated with a mixed hearing loss during 6 months. CT-scan and MRI revealed a temporal bone tumor involving the mastoid, and surrounding the right temporo-mandibular joint. Tumor was totally removed after a canal-wall-down mastoidectomy and middle ear exclusion. Pathology revealed a central giant cell granuloma. Seven months following the surgery there was no evidence of recurrence. Central giant cell granuloma is a rare temporal bone lesion, with non specific clinical and imaging signs but characteristic pathological features. Today, a total surgical removal and regular MRI follow-up is the best management option.
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de Lange J, van den Akker HP, van den Berg H. Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options. ACTA ACUST UNITED AC 2007; 104:603-15. [PMID: 17703964 DOI: 10.1016/j.tripleo.2007.04.003] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Accepted: 04/10/2007] [Indexed: 01/10/2023]
Abstract
Central giant cell granuloma (CGCG) is a benign lesion of the jaws with an unknown etiology. Clinically and radiologically, a differentiation between aggressive and non-aggressive lesions can be made. The incidence in the general population is very low and patients are generally younger than 30 years. Histologically identical lesions occur in patients with known genetic defects such as cherubism, Noonan syndrome, or neurofibromatosis type 1. Surgical curettage or, in aggressive lesions, resection, is the most common therapy. However, when using surgical curettage, undesirable damage to the jaw or teeth and tooth germs is often unavoidable and recurrences are frequent. Therefore, alternative therapies such as injection of corticosteroids in the lesion or subcutaneous administration of calcitonin or interferon alpha are described in several case reports with variable success. Unfortunately, randomized clinical trials are very rare or nonexistent. In the future, new and theoretically promising therapy options, such as imatinib and OPG/AMG 162, will be available for these patients.
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Affiliation(s)
- Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center and Academic Center for Dentistry (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
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Gleason BC, Kleinman PK, Debelenko LV, Rahbar R, Gebhardt MC, Perez-Atayde AR. Novel karyotypes in giant cell-rich lesions of bone. Am J Surg Pathol 2007; 31:926-32. [PMID: 17527082 DOI: 10.1097/pas.0b013e31802fb498] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Giant cell-rich lesions of bone, including giant cell tumor of bone, giant cell reparative granuloma (GCRG), and aneurysmal bone cyst (ABC), may have overlapping clinical, radiologic, and histopathologic features. In fact, GCRG and solid ABC are currently differentiated solely based on skeletal location. Prior cytogenetic studies have reported that telomeric associations are present in the majority of giant cell tumors of bone, whereas translocations involving 16q22 and/or 17p13 are characteristic of ABCs. There is only one previously published karyotype of a GCRG, which revealed a reciprocal translocation, t(X;4)(q22;q31.3). We report 3 cases of giant cell-rich bone lesions with novel karyotypes: one lesion located in the first metacarpal, a typical location for GCRG, was histologically consistent with a giant cell tumor and showed the following karyotype [46,XX,inv(2)(p13q21),t(inv2;11)(q21;q13)]; the second lesion, also a giant cell tumor of bone, in the sacrum showed the following karyotype [46,XX,r(9)(p24q34)[cp7]/46,idem,?r(16)(p13.3q24)[cp10]/46,XX]. The third lesion, a hard palate mass, had the histopathologic features of a GCRG and a karyotype showing a reciprocal translocation, 46,XY,t(2;10)(q23;q24). These findings suggest that at least a subset of GCRGs may be neoplastic and that these lesions differ cytogenetically from classic giant cell tumors of bone or solid ABC, although the latter entity is otherwise indistinguishable from reparative granuloma. Further cytogenetic characterization of giant cell-rich bone lesions may improve the utility of karyotyping as a tool in their differential diagnosis and may shed light on the pathogenetic relationship between these lesions.
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Affiliation(s)
- Briana C Gleason
- Department of Pathology, Children's Hospital, Boston, MA 02115, USA
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Motamedi MHK, Eshghyar N, Jafari SM, Lassemi E, Navi F, Abbas FM, Khalifeh S, Eshkevari PS. Peripheral and central giant cell granulomas of the jaws: A demographic study. ACTA ACUST UNITED AC 2007; 103:e39-43. [PMID: 17428697 DOI: 10.1016/j.tripleo.2006.12.022] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 12/13/2006] [Accepted: 12/21/2006] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to assess the demographic characteristics of peripheral giant cell granulomas (PGCGs) and central giant cell granulomas (CGCGs) in patients treated at our centers. STUDY DESIGN This 12-year retrospective study was based on existing data. Files of patients from 1993-2004 with a definite diagnosis of PGCGs and CGCGs from the oral pathology departments of our universities were assessed. Information regarding age distribution, gender, the jaw involved, the presenting area of the lesion, surgical treatment, and recurrence was documented. RESULTS During the study period, 204 patients with CGCGs were treated. The patients with CGCGs varied in age from 5 to 72 years, and the mean age patients was 23.72 years. Among these, 127 cases (62.87%) occurred in the second and third decades of life. One hundred thirty cases (63.75%) occurred in females and 74 (36.25%) in males. Ninety cases (44.1%) presented in posterior parts of the jaws. One hundred forty-four cases (70.58%) appeared in the mandible. Peripheral GCGs presented in 575 patients, who varied in age from 2 to 85 years with a mean age of 31.02 years. Among these, 297 cases (51.65%) occurred in females and 278 (48.34%) in males. Four hundred sixty-seven cases (81.2%) occurred in the first five decades of life, and 352 cases (61.21%) appeared in the mandible. CONCLUSIONS Giant cell granulomas comprised 9.29% of oral lesions. Peripheral GCG lesions occurred more than 2 times more frequently than CGCGs. Central GCGs occurred about 2 times more frequently in females, whereas PGCGs had an equal prevalence in both genders (P < .05). The mean age for patients with CGCGs was less than patients with PGCGs (P < .05). Central GCGs involved the mandible approximately 2 times more frequently than the maxilla (P < .05). However, when presenting in the maxilla, CGCGs most frequently presented in the area anterior to the canines (P < .05). Peripheral GCGs involved the mandible approximately 1.5 times more frequently than the maxilla (P < .05). Thorough curettage was the main treatment modality used. There were 9 cases (4.41%) of recurrence of CGCGs and 8 cases (1.39%) of recurrence of PGCGs documented during the follow-up period (ranging from 1-12 years).
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Kotru M, Singh N. The value of recognizing suspect diagnoses in the triple diagnosis of giant cell tumor of bone. Indian J Orthop 2007; 41:97-100. [PMID: 21139759 PMCID: PMC2989148 DOI: 10.4103/0019-5413.32038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Giant cell tumor (GCT) of bone is the most frequently over-diagnosed neoplasm in orthopedic pathology because giant cells are a common component of many neoplastic and nonneoplastic conditions of bone. Triple diagnosis, requiring substantial individual and collective inputs by orthopedic surgeons, radiologists and pathologists, is the preferred method for the workup of patients with suspected bone neoplasms. At each stage in triple diagnosis, deviations from the typical must be regarded as clues to alternate diagnoses: the greater the deviation, the more a diagnosis of GCT must be considered suspect. A suspect diagnosis must trigger renewed analysis of the available data and a diligent search to exclude alternate diagnoses.This review lists suspect diagnoses of GCT with a brief overview of each.
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Affiliation(s)
- Mrinalini Kotru
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi - 110 095, India
| | - Navjeevan Singh
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi - 110 095, India,Correspondence: Dr. Navjeevan Singh, Professor of Pathology University College of Medical Sciences and GTB Hospital, Delhi - 110 095, India. E-mail:
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Yazici N, Yalçin B, Yilmaz T, Akyüz C, Karli Oguz K, Sungur A, Büyükpamukçu M. Surgery and calcitonin therapy in childhood central giant cell granuloma. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.pedex.2006.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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