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Kadlub N, Sessiecq Q, Dainese L, Joly A, Lehalle D, Marlin S, Badoual C, Galmiche L, Majoufre-Lefebvre C, Berdal A, Deckert M, Vazquez MP, Descroix V, Coudert AE, Picard A. Defining a new aggressiveness classification and using NFATc1 localization as a prognostic factor in cherubism. Hum Pathol 2016; 58:62-71. [PMID: 27498064 DOI: 10.1016/j.humpath.2016.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/16/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
Cherubism is a rare genetic disease characterized by bilateral giant cell reparative granuloma of the jaws consisting of a fibrotic stroma with giant multinucleated cells (GMCs) and osteoclastic features. Cherubism severity is highly variable, and recurrence after surgery is the most important risk. Currently, there are no prognostic indicators. The aims of this study were to evaluate the osteoclastogenesis phenotype by histologic examination of nuclear factor of activated T cells 1 (NFATc1) localization and tartrate-resistant acid phosphatase (TRAP) activity and to correlate the results to disease aggressiveness to define prognostic indicators. Based on cherubism evolution 1 year after surgery, 3 classes of cherubism aggressiveness were identified: mild (group A), moderate (group B), and severe (group C). Histologically, in grade A and B cherubism lesions, GMCs were negative for both TRAP activity and NFATc1 nuclear localization. In contrast, in grade C cherubism lesions, GMCs were all positive for TRAP activity and NFATc1 nuclear localization and displayed osteoclast-like features. Other histopathologic findings were not different among the 3 groups. Our results establish that TRAP activity and NFTAc1 nuclear localization are associated with aggressive cherubism and therefore could be added to routine pathologic examination to aid in prognosis and management of the disease. The finding of NFATc1 nuclear localization in aggressive tumors supports the addition of anticalcineurin treatment to the therapeutic arsenal for cherubism.
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Affiliation(s)
- Natacha Kadlub
- INSERM, UMRS 1138, Centre de Recherche de Cordeliers, Molecular Oral Pathology, 75006 Paris, France; Université Paris Descartes, 75006 Paris, France; APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-Faciale et Plastique, 75015 Paris, France; APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015 Paris, France.
| | - Quentin Sessiecq
- CHU de Bordeaux, Service de Chirurgie Maxillo-Faciale, 33000 Bordeaux, France
| | - Linda Dainese
- APHP, Hôpital Armand Trousseau, Service d'Anatomopathologie et Cytologie, 75012 Paris, France; Université Pierre et Marie Curie, 75005 Paris, France
| | - Aline Joly
- INSERM, UMRS 1138, Centre de Recherche de Cordeliers, Molecular Oral Pathology, 75006 Paris, France; Université Paris Descartes, 75006 Paris, France; APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-Faciale et Plastique, 75015 Paris, France; APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015 Paris, France
| | | | - Sandrine Marlin
- APHP, Necker Enfants Malades, Service de Génétique, 75015 Paris, France
| | - Cecile Badoual
- Université Paris Descartes, 75006 Paris, France; APHP, Hôpital Européen Georges Pompidou, Service d'Anatomopathologie et Cytologie, 75015 Paris, France
| | - Louise Galmiche
- Université Paris Descartes, 75006 Paris, France; APHP, Necker Enfants Malades, Service d'Anatomopathologie et Cytologie, 75015 Paris, France
| | | | - Ariane Berdal
- INSERM, UMRS 1138, Centre de Recherche de Cordeliers, Molecular Oral Pathology, 75006 Paris, France; UFR Odontologie, Garancière, Université Paris Diderot, 75006 Paris, France
| | - Marcel Deckert
- INSERM, U1035, Université Nice Sophia-Antipolis, Microenvironment, Signaling and Cancer, 06000 Nice, France
| | - Marie-Paule Vazquez
- INSERM, UMRS 1138, Centre de Recherche de Cordeliers, Molecular Oral Pathology, 75006 Paris, France; Université Paris Descartes, 75006 Paris, France; APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-Faciale et Plastique, 75015 Paris, France; APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015 Paris, France
| | - Vianney Descroix
- INSERM, UMRS 1138, Centre de Recherche de Cordeliers, Molecular Oral Pathology, 75006 Paris, France; UFR Odontologie, Garancière, Université Paris Diderot, 75006 Paris, France; APHP, Hôpital Pitié Salpétrière, Service d'Odontologie, 75013 Paris, France
| | - Amélie E Coudert
- INSERM, UMRS 1138, Centre de Recherche de Cordeliers, Molecular Oral Pathology, 75006 Paris, France; UFR Odontologie, Garancière, Université Paris Diderot, 75006 Paris, France
| | - Arnaud Picard
- INSERM, UMRS 1138, Centre de Recherche de Cordeliers, Molecular Oral Pathology, 75006 Paris, France; Université Paris Descartes, 75006 Paris, France; APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-Faciale et Plastique, 75015 Paris, France; APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015 Paris, France
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Wick MR, McDermott MB, Swanson PE. Proliferative, reparative, and reactive benign bone lesions that may be confused diagnostically with true osseous neoplasms. Semin Diagn Pathol 2014; 31:66-88. [DOI: 10.1053/j.semdp.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Ducours JL, Ducours M. [Cherubism: a case followed for 18 years]. ANN CHIR PLAST ESTH 2012; 58:152-8. [PMID: 23131902 DOI: 10.1016/j.anplas.2012.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 09/13/2012] [Indexed: 11/18/2022]
Abstract
Cherubism is a rare and benign bone disease affecting the bones of the face, mainly the mandible, sometimes the maxilla and exceptionally the whole skeleton. The physiopathology is briefly mentioned, especially the genetic aspect of the disease. Subsequently, we present the case of a patient suffering from cherubism, a case we have been following from the age of four and a half to the age of 22. Each step of the surgical treatment is illustrated through a wide iconography. The discussion analyses the intellectual process that leads to diagnosis. The clinical examination is fundamental, as well as the radiological check-up but the latter may not be feasible due to the young age of the patient. The definite diagnosis relies on the histological examination of the bone concerned. It will show an association of dense, abundant and highly vascularised conjunctive tissue together with giant plurinuclear cells, without any mitosis nor any cellular atypia. The other bone diseases affecting the bones of the face will have to be sought, of course, and eliminated through the clinical and radiological examinations and, above all, by the histological examination which is the basis of the definite diagnosis. The treatment of cherubism is still a controversial issue: some authors are in favour of therapeutic abstention while others support the recourse to surgery to deal with the functional and aesthetic dimensions of the disease. In conclusion, the authors insist that the diagnosis of cherubism is apparently easy. Cherubism must be envisaged in the case of a chubby-cheeked child and a sample of pathological bone should be taken in order to ascertain the diagnosis.
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Affiliation(s)
- J-L Ducours
- Service chirurgie plastique reconstructrice esthétique et maxillo-faciale, clinique Esquirol-Saint-Hilaire, 1, rue du Dr et Mme Delmas, BP 19, 47002 Agen cedex, France.
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Abstract
This article describes the clinical, radiographic, and pathologic features of tumors and tumorlike lesions affecting the bones of the head and neck region. Emphasis is placed on common bone lesions affecting the craniofacial skeleton, particularly those that occur with more frequency or those that are unique to this part of the skeleton. Several of these lesions pose a diagnostic challenge to the pathologist. To ensure that a correct diagnosis is rendered, it is of utmost importance that accurate and detailed clinical and radiographic information is available.
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Affiliation(s)
- Samir K El-Mofty
- Department of Pathology and Immunology, Washington University School of Medicine, 660 Euclid Avenue, Campus Box 8118, St Louis, MO 63110, USA
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Peñarrocha M, Bonet J, Mínguez JM, Bagán JV, Vera F, Mínguez I. Cherubism: a clinical, radiographic, and histopathologic comparison of 7 cases. J Oral Maxillofac Surg 2006; 64:924-30. [PMID: 16713807 DOI: 10.1016/j.joms.2006.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Cherubism is an uncommon fibro-osseous disorder of the jaws that presents with varying degrees of involvement and a tendency toward spontaneous remission. Lesions are characterized by replacement of bone with fibrovascular tissue containing abundant multinucleated giant cells. We attempted to study the relationships among the degree of cherubism, the radiographic extent of the jaw lesions, the histopathologic findings, and the clinical course of 7 patients. PATIENTS AND METHODS In 7 patients diagnosed with cherubism, we evaluated the degree of fibrosis and perivascular cuffing, the presence of focal hemosiderin deposits, and giant multinucleated cell density (absent, few, moderate, or severe). Clinical course and progression were also assessed using a 4-point scale (improvement, no changes, modest progression, and marked progression). RESULTS The patients were followed up for an average of 8.5 years. Two patients exhibited clinical and radiographic improvement, while 3 showed no changes, and 2 progressed despite surgical treatment in 1 of them. CONCLUSION The course of cherubism in 1 of our patients may represent evidence of an association between the presence of abundant multinucleated giant cells, an increased extent of the lesions, and a more aggressive behavior of the disease.
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Affiliation(s)
- Miguel Peñarrocha
- Oral Surgery, Faculty of Medicine and Dentistry, Valencia University, Valencia, Spain.
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Ozkan Y, Varol A, Turker N, Aksakalli N, Basa S. Clinical and radiological evaluation of cherubism: a sporadic case report and review of the literature. Int J Pediatr Otorhinolaryngol 2003; 67:1005-12. [PMID: 12907058 DOI: 10.1016/s0165-5876(03)00179-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many cases have been published on cherubism since Jones described it first time in three children of the same family [Am. J. Cancer 17 (1933) 946]. Cherubism is an autosomal-dominant disorder in which the normal bone is replaced by cellular fibrous tissue and immature bone. Extracranial skeletal involvement is rarely seen in hereditary and non-hereditary forms of the disorder. The mandible is the most severely affected craniofacial component, in which uncontrolled growth of the malady deteriorates the aesthetic balance of the face. Bilateral swelling of the cheeks, mandibular enlargement and maxillary spongious hypertrophy cause orbital manifestations and tendency of eyes looking up to the sky. Thus, the pathognomic clinical feature resembles the appearance of "raised to heaven" Renaissance cherubs. The sporadic case concerns a child affected by cherubism. Radiographic and clinical data of the patient are presented and brief review of the literature is included.
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Affiliation(s)
- Yasar Ozkan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Buyukciftlik Sok. No. 6, 80200 Nisantasi, Istanbul, Turkey.
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Schultze-Mosgau S, Holbach LM, Wiltfang J. Cherubism: clinical evidence and therapy. J Craniofac Surg 2003; 14:201-6; discussion 207-8. [PMID: 12621291 DOI: 10.1097/00001665-200303000-00012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cherubism is a hereditary childhood disease of autosomal dominant inheritance that is more common in the male sex. Some cases have also revealed a mutation of the gene FGF-RIII (fibroblast growth factor receptor III). The clinical picture of cherubism is characterized by painless symmetrical swelling of the mandible and polycystic destruction of the mandibular bone structure. Complications include delayed dentition, dental root resorption, malalignment of teeth, and impacted teeth. The disease progression comes to a halt of its own accord at the end of puberty. Spontaneous recoveries have been observed. Histologically, multinuclear giant cells with osteoclastic activity, which correspond to a giant cell granuloma, are found in fibrous stroma. It is generally agreed that decisions about surgical intervention should be considered carefully. A case report describes the course of the disease and therapy of a female patient with a periorbital manifestation of cherubism. The latero-orbital enlargement of the intraorbital and latero-orbital region of the zygomatic bone resulted in displacement of the orbital contents with a motility disorder of the eyes. The motility disorder was eliminated by reduction of the diseased hard tissue as well as by carrying out a modeling orbitotomy and by reconstructing an anatomically correct localized and irregular bilateral osseous structure of the zygomatic bone in the intraorbital and latero-orbital region.
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Affiliation(s)
- Stefan Schultze-Mosgau
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany.
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9
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Petschler M, Stiller M, Hoffmeister B, Witkowski R, Opitz C, Bill JS, Peters H. [Clinical and molecular genetic observations on families with cherubism over three generations]. MUND-, KIEFER- UND GESICHTSCHIRURGIE : MKG 2003; 7:83-7. [PMID: 12664252 DOI: 10.1007/s10006-002-0444-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cherubism is a rare fibro-osseous disorder that almost exclusively affects the maxilla and mandible. CASE REPORT We report on three affected males in three generations in family A, and ten affected patients in family B. The youngest affected relative in family A also had craniosynostosis. His father and grandfather had cherubism and clubbed fingers. RESULTS AND DISCUSSION Cherubism was mapped to region 4p16.3. Because of the associated craniosynostosis, we excluded the FGFR3 gene as a candidate gene for cherubism. The inheritance pattern is autosomal dominant with variable expression. The penetrance is 100% in males and 50-70% in females. We found incomplete penetrance in males, which does not conform with all publications.
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MESH Headings
- Adolescent
- Adult
- Cherubism/diagnosis
- Cherubism/genetics
- Child
- Child, Preschool
- Chromosome Aberrations
- Chromosomes, Human, Pair 4
- Combined Modality Therapy
- Craniosynostoses/diagnosis
- Craniosynostoses/genetics
- Craniosynostoses/therapy
- Female
- Follow-Up Studies
- Genes, Dominant
- Genetic Predisposition to Disease/genetics
- Humans
- Infant
- Male
- Orthodontics, Corrective
- Osteoarthropathy, Secondary Hypertrophic/diagnosis
- Osteoarthropathy, Secondary Hypertrophic/genetics
- Pedigree
- Protein-Tyrosine Kinases
- Receptor, Fibroblast Growth Factor, Type 3
- Receptors, Fibroblast Growth Factor/genetics
- Tooth Abnormalities/diagnosis
- Tooth Abnormalities/genetics
- Tooth Abnormalities/therapy
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Affiliation(s)
- M Petschler
- Abteilung für Zahnärztliche Chirurgie und Röntgenologie, Klinik für Kieferchirugie und plastische Gesichtschirurgie, Universitätsklinikum Benjamin Franklin, Berlin.
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White DK, Street CC, Jenkins WS, Clark AR, Ford JE. Panoramic radiograph in pathology. Atlas Oral Maxillofac Surg Clin North Am 2003; 11:1-53. [PMID: 12725098 DOI: 10.1016/s1061-3315(02)00012-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dean K White
- Division of Oral and Maxillofacial Pathology, College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0298, USA.
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11
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Cherubism. Indian J Otolaryngol Head Neck Surg 1995. [DOI: 10.1007/bf03048000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Koury ME, Stella JP, Epker BN. Vascular transformation in cherubism. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 76:20-7. [PMID: 7688886 DOI: 10.1016/0030-4220(93)90287-e] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cherubism is a well-known disease entity that was first described by Jones in 1933. A case is presented in which the usual course of the lesion changed dramatically during treatment. The lesion demonstrated unilateral growth with a vascular proliferation after surgical recontouring. Vascular transformation and surgical activation of cherubism, as well as treatment considerations, are discussed.
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Affiliation(s)
- M E Koury
- Oral and Maxillofacial Surgery, Parkland Memorial Hospital
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13
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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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14
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Katz JO, Dunlap CL, Ennis RL. Cherubism: report of a case showing regression without treatment. J Oral Maxillofac Surg 1992; 50:301-3. [PMID: 1542075 DOI: 10.1016/0278-2391(92)90333-u] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J O Katz
- Department of Oral Diagnosis, School of Dentistry, University of Missouri-Kansas City 64108-2795
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Kaugars GE, Niamtu J, Svirsky JA. Cherubism: diagnosis, treatment, and comparison with central giant cell granulomas and giant cell tumors. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1992; 73:369-74. [PMID: 1545971 DOI: 10.1016/0030-4220(92)90137-f] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
An extensive case of cherubism in a 17-year-old girl with no apparent familial history is presented. The rationale for treatment is presented and is compared with previous reports that have advocated nontreatment. The clinical and histologic similarities of cherubism to central giant cell granuloma and the giant cell tumor of bone are also discussed.
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Affiliation(s)
- G E Kaugars
- Department of Oral Pathology, Medical College of Virginia, Richmond
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16
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Faircloth WJ, Edwards RC, Farhood VW. Cherubism involving a mother and daughter: case reports and review of the literature. J Oral Maxillofac Surg 1991; 49:535-42. [PMID: 2019904 DOI: 10.1016/0278-2391(91)90185-o] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- W J Faircloth
- Department of Oral and Maxillofacial Surgery, David Grant USAF Medical Center, Travis Air Force Base, CA
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Dunlap C, Neville B, Vickers RA, O'Neil D, Barker B. The Noonan syndrome/cherubism association. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1989; 67:698-705. [PMID: 2740093 DOI: 10.1016/0030-4220(89)90012-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Noonan syndrome is characterized by short stature, unusual facies, congenital heart disease, chest deformity, mild mental retardation, and cryptorchidism in males. It may be sporadic or inherited as an autosomal dominant trait and occurs between 1 in 1000 and 1 in 2500 live births. Cherubism is a giant cell lesion of the jaws thought to be transmitted as an autosomal dominant trait. It is usually recognized by age 7 years, follows a variable course, and is not known to be related to other genetic disorders. We herein report on four patients with Noonan syndrome, all of whom had cherubism. Two other probable cases are cited in the literature for a total of six known cases.
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Affiliation(s)
- C Dunlap
- Department of Oral Pathology, University of Missouri, School of Dentistry, Kansas City
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Abstract
A case of nonfamilial cherubism and a review of literature have been reported. A diagnosis of cherubism was based on clinical and histopathologic examinations.
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Abstract
A retrospective review of experience with jaw tumors in 48 children over a ten-year period was made. These were predominantly benign, nonodontogenic, mesenchymal tumors. Clinical behavior was variable and often did not correspond to the histologic patterns. The clinically aggressive variants displayed rapid growth usually with associated pain. Resection rather than curettage is appropriate therapy when there has been earlier treatment failure by local tumor removal or rapid tumor expansion, or when tumor extensively invades the jaw. When resection is carried out, facial growth is not adversely affected if early reconstruction with autogenous bone is performed.
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Zachariades N, Papanicolaou S, Xypolyta A, Constantinidis I. Cherubism. INTERNATIONAL JOURNAL OF ORAL SURGERY 1985; 14:138-45. [PMID: 3920157 DOI: 10.1016/s0300-9785(85)80085-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cherubism is a benign, hereditary giant cell lesion of the jaws, that appears in children as a bilateral painless swelling, between the ages of 2 and 5 years and progresses until puberty, when it spontaneously regresses. It normally requires no treatment. We had the chance to operate on a 5-year-old boy with cherubism 8 years ago, and used homogenous bone grafts to replace the diseased tissue to avoid pathological fracture of the mandible. Since then we have been following the patient, witnessing the gradual involvement of other sites in the jaws and the displacement of teeth and tooth germs.
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Abstract
Three cases of cherubism not previously recorded in the literature are described. They are three members of a Greek Cypriot family; the mother aged 49 years had residual mandibular deformity; the first daughter aged 17 years had facial swelling and anterior rib lesions; the second daughter aged 14 years presented with a unilateral giant-cell granuloma in the mandible.
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Gorlin RJ, Boggs WS. The genetic aspects of facial abnormalities. ADVANCES IN HUMAN GENETICS 1977; 8:235-346. [PMID: 410236 DOI: 10.1007/978-1-4615-8267-0_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Jones AE, Pelton DA. An index of syndromes and their anaesthetic implications. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1976; 23:207-26. [PMID: 1252977 DOI: 10.1007/bf03005693] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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