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Mei Z, Lei W, Huang D, Ma W, Pan G, Ni L, Han Z. Diagnosis and Treatment of Intraosseous Ganglion in the Ankle Region. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:143-148. [PMID: 36265495 DOI: 10.1055/a-1938-8449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the diagnosis and treatment of intraosseous ganglion cyst in the ankle region. METHODS A retrospective analysis was performed on the diagnosis and treatment of 18 patients with intraosseous ganglion in the ankle region from January 2005 to March 2016. There were 11 males and 7 females, with an average age of 40.4 years (22-74 years). Thirteen of these had mild intermittent localized pain in the ankle and five were asymptomatic and fortuitously found on images. According to the location of the intraosseous ganglion cyst, nine were located in the distal end of tibia, seven were in the distal end of the fibula, and two were in the talus. After curettage of intraosseous ganglion, 15 cases were filled with autogenous iliac bone and 3 cases with artificial bone. RESULTS Fifteen cases were diagnosed with radiographs and CT scans, two cases with MR images, and one case was confirmed by postoperative pathology. The cyst contents were jelly-like material with sclerotic bone margins. The mean size of the intraosseous ganglion cyst was 1.5 cm × 1.5 cm × 1 cm. Hematoxylin and eosin (H&E) staining of the tissue showed fibrous tissue, collagenous fiber, mucoid, and a few fibroblasts. Eighteen cases were followed up for 11 months to 10 years, with an average of 5.4 years. No recurrence was found. Sixteen patients were asymptomatic after surgery. Two cases of ankle pain occurred at 1 year and 6 months postoperatively, respectively. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the mean AOFAS ankle-hindfoot score improved from 78.2 ± 13.7 points preoperatively to 97.3 ± 4.5 points at the final follow-up. CONCLUSION For the intraosseous ganglion cyst in the ankle region, whether there are clinical symptoms or not, the cyst should be curettaged and the cavity should be filled with bone graft. The operation result is satisfactory.
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Affiliation(s)
- Zhengfeng Mei
- Orthopedics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Wentao Lei
- Orthopedics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Donghui Huang
- Orthopedics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei Ma
- Orthopedics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Guobiao Pan
- Orthopedics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Lingzhi Ni
- Orthopedics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiwei Han
- Orthopedics, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
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Jung KW, Yun JM, Lee JM, Choi IS. Sinonasal Manifestations of Severe Cherubism: A Case with 11-year Follow-up. EAR, NOSE & THROAT JOURNAL 2022:1455613221127588. [PMID: 36369646 DOI: 10.1177/01455613221127588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Cherubism, a type of fibroosteodysplasia, is a rare hereditary disease that causes variable degrees of facial deformity in children. Hypertrophy of the mandible is the most common symptom, but in severe cases, the disease affects the eyes, teeth, and sinonasal cavity. There have been few reports regarding sinonasal complications and no standard treatment has been established. This paper reports long-term treatment of severe cherubism that invaded the sinonasal cavity treated with consecutive endoscopic sinonasal surgeries.
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Affiliation(s)
- Keun-Woo Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Ji Min Yun
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Jeon Mi Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Ick Soo Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik hospital, Inje University College of Medicine, Goyang, Republic of Korea
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3
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Schreuder WH, van der Wal JE, de Lange J, van den Berg H. Multiple versus solitary giant cell lesions of the jaw: Similar or distinct entities? Bone 2021; 149:115935. [PMID: 33771761 DOI: 10.1016/j.bone.2021.115935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/27/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023]
Abstract
The majority of giant cell lesions of the jaw present as a solitary focus of disease in bones of the maxillofacial skeleton. Less frequently they occur as multifocal lesions. This raises the clinical dilemma if these should be considered distinct entities and therefore each need a specific therapeutic approach. Solitary giant cell lesions of the jaw present with a great diversity of symptoms. Recent molecular analysis revealed that these are associated with somatic gain-of-function mutations in KRAS, FGFR1 or TRPV4 in a large component of the mononuclear stromal cells which all act on the RAS/MAPK pathway. For multifocal lesions, a small group of neoplastic multifocal giant cell lesions of the jaw remain after ruling out hyperparathyroidism. Strikingly, most of these patients are diagnosed with jaw lesions before the age of 20 years, thus before the completion of dental and jaw development. These multifocal lesions are often accompanied by a diagnosis or strong clinical suspicion of a syndrome. Many of the frequently reported syndromes belong to the so-called RASopathies, with germline or mosaic mutations leading to downstream upregulation of the RAS/MAPK pathway. The other frequently reported syndrome is cherubism, with gain-of-function mutations in the SH3BP2 gene leading through assumed and unknown signaling to an autoinflammatory bone disorder with hyperactive osteoclasts and defective osteoblastogenesis. Based on this extensive literature review, a RAS/MAPK pathway activation is hypothesized in all giant cell lesions of the jaw. The different interaction between and contribution of deregulated signaling in individual cell lineages and crosstalk with other pathways among the different germline- and non-germline-based alterations causing giant cell lesions of the jaw can be explanatory for the characteristic clinical features. As such, this might also aid in the understanding of the age-dependent symptomatology of syndrome associated giant cell lesions of the jaw; hopefully guiding ideal timing when installing treatment strategies in the future.
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Affiliation(s)
- Willem H Schreuder
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek / Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Jacqueline E van der Wal
- Department of Pathology, Antoni van Leeuwenhoek / Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Henk van den Berg
- Department of Pediatrics / Oncology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
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4
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Early detection of cherubism with eventual bilateral progression: a literature review and case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:e77-e83. [PMID: 30287203 DOI: 10.1016/j.oooo.2018.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/09/2018] [Accepted: 08/22/2018] [Indexed: 01/08/2023]
Abstract
Cherubism is a rare familial disease of childhood that commonly affects the bilateral mandible and maxilla and typically resolves in adulthood. It has been shown to have a male predilection and has been mapped to the SH3 BP2 gene. Only 2 cases of unilateral cherubism have been documented in the literature; in the first case, the contralateral side was eventually affected. Although rare, unilateral cherubism presents a diagnostic dilemma. This case report describes a unique presentation of unilateral cherubism that progressed to affect the contralateral side and describes some of the considerations in the diagnosis and treatment of unilateral benign giant cell lesions of the jaws.
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5
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Tecco S, Caruso S, Nota A, Leocata P, Cipollone G, Gatto R, Cutilli T. Bilateral Central Giant Cell Granuloma of the mandibular angle in three females from the same family. Head Face Med 2018; 14:14. [PMID: 30180903 PMCID: PMC6122611 DOI: 10.1186/s13005-018-0171-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/20/2018] [Indexed: 12/28/2022] Open
Abstract
In literature there are few reports about multiple CGCG. But this is the first report of bilateral CGCG of the mandibular angles in three females from the same family.This report describes three cases of females from the same family - a mother and two young daughters - with bilateral CGCG in their jaw angles. All the lesions were surgically removed and the histopathologic diagnosis was always identical: giant cell central granulomas, with patterns that were absolutely superimposable between them and with that of the mother.The hypothesis is that this presentation of CGCG may be defined as hereditary bilateral CGCG of the mandibular angles (or also, cherubism-like lesions).
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Affiliation(s)
- Simona Tecco
- Dental School, Vita-Salute San Raffaele University, via Olgettina 58, Milan, Italy.
| | - Silvia Caruso
- School of Pediatric Dentistry, Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Lorenzo Natali 1: Località Coppito, 67100, L'Aquila, Italy
| | - Alessandro Nota
- Dental School, Vita-Salute San Raffaele University, via Olgettina 58, Milan, Italy.,School of Pediatric Dentistry, Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Lorenzo Natali 1: Località Coppito, 67100, L'Aquila, Italy
| | - Pietro Leocata
- Pathology Unit, Post-graduated school of Pathology, Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianluca Cipollone
- San Salvatore City Hospital L'Aquila, Unit of Pathology, Via Vetoio, 1, Coppito, 67100, L' Aquila, AQ, Italy
| | - Roberto Gatto
- School of Pediatric Dentistry, Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Lorenzo Natali 1: Località Coppito, 67100, L'Aquila, Italy
| | - Tommaso Cutilli
- Maxillo-Facial Surgery Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Lorenzo Natali 1: Località Coppito, 67100, L'Aquila, AQ, Italy
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6
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Gorsane I, Zammouri A, El Meddeb J, Younsi F, Bartkiz A, Abdelmoula J, Barbouch S, Ben Abdallah T. [Brown tumors in chronic hemodialysis patients]. Nephrol Ther 2016; 12:86-93. [PMID: 26907666 DOI: 10.1016/j.nephro.2015.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Brown tumors are rare and severe manifestations of secondary hyperparathyroidism. We propose in this study: to define and illustrate brown tumors observed in our hemodialysis center; to show the frequency for 20 years in our center; to identify risk factors compared to the rest of dialysis patients; and finally to offer improved support for reducing the incidence. PATIENTS AND METHODS We conducted a retrospective and descriptive study, over a period of 20 years (1993-2013), including 311 cumulative patients which are chronic hemodialysis in our unit. RESULTS Twenty-one patients had brown tumors (6.75%). The average age was 36.1 years and the sex ratio M/F is of 0.6. The average time between the start of hemodialysis and the diagnosis of brown tumor was 87.6 months. Clinical symptoms were dominated by bone pain, found in 76.1% of cases. The most frequent locations were costal (28.5% of cases), while spinal involvement was less frequent (4.76% of cases). The location was multifocal in 57.1% of cases. The mean serum calcium was of 2.08 mmol/L, the serum phosphate of 2.25 mmol/L, alkaline phosphatase of 1709 IU/L and the average value of parathyroid hormone of 1934 pg/mL. Radiography was the key of diagnostic. Resonance magnetic imaging and computed tomography had an interest in the exploration of spinal locations and maxillo-mandibular locations. All patients underwent parathyroidectomy and it was total in one patient. Tumorectomy was necessary in three patients (14.2% of cases). The outcome was favorable in 85.7% of cases. CONCLUSION Our work relates one of the most important series published of brown tumors and is characterized by the multifocal character of these tumors.
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Affiliation(s)
- Imen Gorsane
- Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie; Laboratoire de recherche d'immunologie de transplantation rénale et d'immunopathologie (LR03SP01), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie.
| | - Asma Zammouri
- Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie
| | - Jihede El Meddeb
- Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie
| | - Fathi Younsi
- Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie
| | - Ahlem Bartkiz
- Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie; Laboratoire de biochimie clinique, hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie
| | - Jouida Abdelmoula
- Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie; Laboratoire de biochimie clinique, hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie
| | - Samia Barbouch
- Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de néphrologie et de médecine A (M8), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie; Faculté de médecine de Tunis El Manar, rue Djebal Lakhdar, 1006 Tunis, Tunisie; Laboratoire de recherche d'immunologie de transplantation rénale et d'immunopathologie (LR03SP01), hôpital Charles Nicolle, boulevard du 9 Avril, 1006 Tunis, Tunisie
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7
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Case Report of Nonfamilial Cherubism in a Toddler: Description of Clinic-Radiographic Features and Osseous-Dental Treatments. Case Rep Med 2016; 2016:8795765. [PMID: 28105052 PMCID: PMC5220412 DOI: 10.1155/2016/8795765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/15/2016] [Indexed: 11/20/2022] Open
Abstract
Cherubism is a rare familial disease that occurs between the ages two and five years and regresses after puberty. Most of the cherubism cases show familial history, but there are some cases without familial histories of disorder. A two-year-old boy with a painless symmetrical progressive swelling of the jaws had visited maxillofacial radiology department. Panoramic radiograph revealed well-defined multilocular, radiolucent areas of both jaws. Computed tomography of the jaws showed well-defined, bilateral, multilocular, expansile lesions with thinning of cortical plate of maxilla and mandible and displacing the unerupted first molar anteriorly. Clinical, radiologic, and histopathologic characteristics confirmed the diagnosis of cherubism.
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8
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Piona C, Maines E, Morandi G, Gaudino R, Cavarzere P, Consolo U, Boner A. Painless bilateral swelling of the face: think about cherubism. Arch Dis Child 2015; 100:971-2. [PMID: 26245886 DOI: 10.1136/archdischild-2015-308914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Claudia Piona
- Department of Life and Reproduction Sciences, Pediatric Clinic, University of Verona, Verona, Italy
| | - Evelina Maines
- Department of Life and Reproduction Sciences, Pediatric Clinic, University of Verona, Verona, Italy
| | - Grazia Morandi
- Department of Life and Reproduction Sciences, Pediatric Clinic, University of Verona, Verona, Italy
| | - Rossella Gaudino
- Department of Life and Reproduction Sciences, Pediatric Clinic, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Life and Reproduction Sciences, Pediatric Clinic, University of Verona, Verona, Italy
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Attilio Boner
- Department of Life and Reproduction Sciences, Pediatric Clinic, University of Verona, Verona, Italy
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9
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Degala S, Mahesh KP, Monalisha. Cherubism: a case report. J Maxillofac Oral Surg 2015; 14:258-62. [PMID: 25861190 DOI: 10.1007/s12663-013-0474-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 01/14/2013] [Indexed: 11/28/2022] Open
Abstract
Cherubism is a benign, self-limiting fibro-osseous lesion characterized by bilateral symmetric painless expansion of jaw which is more prominent in mandible than in maxilla. Males are commonly affected (2:1) and with greater severity. It becomes noticeable in early childhood and gradually regresses after puberty. Although cherubism is considered as a familial/inherited disease but many sporadic cases have been reported in literature with no familial history. Osteoblastic and osteoclastic remodeling replaces normal bone by excessive amount of fibrovascular tissue containing multinucleated giant cells. Here, we present a case report of cherubism in a 10 year old boy describing the clinical, histological, biochemical and radiographic features.
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Affiliation(s)
- Saikrishna Degala
- Department of OMFS, JSS Dental College and Hospital, JSS University, Mysore, Karnataka India
| | - K P Mahesh
- Oral Medicine & Radiology, JSS University, Mysore, Karnataka India
| | - Monalisha
- Department of OMFS, JSS Dental College and Hospital, JSS University, Mysore, Karnataka India
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10
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Familial case of cherubism from South India: differential diagnosis and report of 2 cases. Case Rep Dent 2014; 2014:869783. [PMID: 25548687 PMCID: PMC4274864 DOI: 10.1155/2014/869783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/21/2014] [Indexed: 11/18/2022] Open
Abstract
Cherubism is a rare familial multilocular cystic lesion of the jaws. The condition clinically appears as a bilateral symmetric swelling of the cheeks in children and is the primary reason for referral. It is a rare lesion of the jaws that has a dominant pattern of inheritance. We report two cases of cherubism, that of a boy and his mother suggestive of a strong familial incidence. A variety of lesions of the jaw mimic this condition and hence the differential diagnosis has been emphasised.
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11
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Verma P, Verma KG, Verma D, Patwardhan N. Craniofacial brown tumor as a result of secondary hyperparathyroidism in chronic renal disease patient: A rare entity. J Oral Maxillofac Pathol 2014; 18:267-70. [PMID: 25328310 PMCID: PMC4196298 DOI: 10.4103/0973-029x.140779] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 07/25/2014] [Indexed: 11/04/2022] Open
Abstract
Brown tumors are erosive bony lesions caused by rapid osteoclastic activity and peritrabecular fibrosis due to primary or secondary hyperparathyroidism resulting in a local destructive phenomenon. The differential diagnosis based on histological examination is only presumptive. Clinical, radiological and laboratory data are necessary for definitive diagnosis. Here, we report a very rare case of brown tumor involving maxilla and mandible, which is the result of secondary hyperparathyroidism in 30-year-old female patient with chronic renal disease.
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Affiliation(s)
- Pradhuman Verma
- Department of Oral Medicine and Radiology, Surendra Dental College and Hospital, Sriganganagar, Rajasthan, India
| | - Kanika Gupta Verma
- Department of Pedodontics and Preventive Dentistry, Surendra Dental College and Hospital, Sriganganagar, Rajasthan, India
| | - Dinesh Verma
- Department of Oral and Maxillofacial Surgery, Surendra Dental College and Hospital, Sriganganagar, Rajasthan, India
| | - Nitin Patwardhan
- Department of Preventive and Community Dentistry, Vaidik Dental College and Hospital, Daman, Daman and Diu, India
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12
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Abstract
Cherubism is a self-limiting non-neoplastic autosomal dominant fibro-osseous disorder of the jaw usually found in children between 2-5 years of age. It occurs predominantly in boys and is characterized clinically by bilateral swelling of cheeks due to bony enlargement of the jaw that gives the patient a typical cherubic look. Cherubism may occur as solitary cases or in many members of family, often in multiple lesions. Radiographically the lesions appear as multilocular bilateral radiolucent areas. The present case report describes a 13-year-old female cherubic child with progressive swelling of cheeks.
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Affiliation(s)
- Babita Niranjan
- Department of Pedodontics and Preventive Dentistry, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Nd Shashikiran
- Department of Pedodontics and Preventive Dentistry, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Shilpy Singla
- Department of Pedodontics and Preventive Dentistry, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Sowmya Kasetty
- Department of Oral Pathology, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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13
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Yoshitaka T, Ishida S, Mukai T, Kittaka M, Reichenberger EJ, Ueki Y. Etanercept administration to neonatal SH3BP2 knock-in cherubism mice prevents TNF-α-induced inflammation and bone loss. J Bone Miner Res 2014; 29:1170-82. [PMID: 24978678 PMCID: PMC4131552 DOI: 10.1002/jbmr.2125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 09/30/2013] [Accepted: 10/14/2013] [Indexed: 12/19/2022]
Abstract
Cherubism is a genetic disorder of the craniofacial skeleton caused by gain-of-function mutations in the signaling adaptor protein, SH3-domain binding protein 2 (SH3BP2). In a knock-in mouse model for cherubism, we previously demonstrated that homozygous mutant mice develop T/B cell-independent systemic macrophage inflammation leading to bone erosion and joint destruction. Homozygous mice develop multiostotic bone lesions whereas cherubism lesions in humans are limited to jawbones. We identified a critical role of tumor necrosis factor α (TNF-α) in the development of autoinflammation by creating homozygous TNF-α-deficient cherubism mutants, in which systemic inflammation and bone destruction were rescued. In this study, we examined whether postnatal administration of an anti-TNF-α antagonist can prevent or ameliorate the disease progression in cherubism mice. Neonatal homozygous mutants, in which active inflammation has not yet developed, were treated with a high dose of etanercept (25 mg/kg, twice/week) for 7 weeks. Etanercept-treated neonatal mice showed strong rescue of facial swelling and bone loss in jaws and calvariae. Destruction of joints was fully rescued in the high-dose group. Moreover, the high-dose treatment group showed a significant decrease in lung and liver inflammatory lesions. However, inflammation and bone loss, which were successfully treated by etanercept administration, recurred after etanercept discontinuation. No significant effect was observed in low-dose-treated (0.5 mg/kg, twice/week) and vehicle-treated groups. In contrast, when 10-week-old cherubism mice with fully active inflammation were treated with etanercept for 7 weeks, even the high-dose administration did not decrease bone loss or lung or liver inflammation. Taken together, the results suggest that anti-TNF-α therapy may be effective in young cherubism patients, if treated before the inflammatory phase or bone resorption occurs. Therefore, early genetic diagnosis and early treatment with anti-TNF-α antagonists may be able to prevent or ameliorate cherubism, especially in patients with a mutation in SH3BP2.
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Affiliation(s)
- Teruhito Yoshitaka
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
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14
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Tsodoulos S, Ilia A, Antoniades K, Angelopoulos C. Cherubism: a case report of a three-generation inheritance and literature review. J Oral Maxillofac Surg 2013; 72:405.e1-9. [PMID: 24280174 DOI: 10.1016/j.joms.2013.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/15/2022]
Abstract
Cherubism is a rare, non-neoplastic pathologic entity first described by Jones in 1933. It affects mostly younger individuals and is usually inherited. Cherubism presents as a painless jaw enlargement that affects both the maxilla and the mandible and is characterized by replacement of the osseous tissue by fibrous connective tissue. Radiologically, the lesions appear as multiple, multilocular radiolucent spaces with distinct borders divided by bony septations, which often dramatically alter the shape and size of the jaw structures. These often result in marked facial abnormalities. Cervical lymphadenopathy is not uncommon in those affected. The disease is self-limited and can reverse itself with time. Approximately 250 cases have been reported in published studies, mostly affecting males. The purpose of our report was to present a case of cherubism diagnosed in a young girl and the long-term (3 generations) follow-up evaluation of her mother and grandmother, both of whom had been diagnosed with the same pathologic entity.
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Affiliation(s)
- Spyridon Tsodoulos
- Associate Professor, Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Ilia
- Dentist, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos Antoniades
- Professor, Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Angelopoulos
- Consultant, Department of Maxillofacial Radiology, Bronx Veterans Affairs Hospital, Bronx, NY
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Eley KA, Wheeler K, Tiam RN, Watt-Smith SR. An unusual mandibular mass in a child. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:386-91. [DOI: 10.1016/j.oooo.2012.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/08/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
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Amaral FR, Diniz MG, Bernardes VF, Souza PEA, Gomez RS, Gomes CC. WWOX expression in giant cell lesions of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:210-3. [DOI: 10.1016/j.oooo.2013.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 05/07/2013] [Accepted: 05/13/2013] [Indexed: 11/25/2022]
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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
PURPOSE OF REVIEW Giant cell tumor (GCT) of bone is a benign, osteolytic neoplasm of bone. The receptor activator of NF-KB ligand (RANKL) pathway has recently been shown to play a key role in the pathogenesis of GCT. RECENT FINDINGS Treatment for refractory, recurrent, or metastatic GCT remains challenging. The recent development of a monoclonal antibody to RANKL, denosumab, offers promise in the management of these patients. A recent phase 2 study suggested denosumab offers disease and symptom control for patients with advanced or refractory disease. In this population, denosumab appears to be well tolerated. There are key questions which remain to be addressed, including patient selection, optimal scheduling, use as an adjuvant, and application to other giant cell-rich disorders. SUMMARY Denosumab offers a new treatment option for a subset of patients with previously untreatable GCT. The role of denosumab in curative treatment is the subject of ongoing studies.
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Kumar VV, Ebenezer S, Narayan T, Wagner W. Clinicopathologic conference: Multiquadrant expansile fibro-osseous lesion in a juvenile. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:286-92. [DOI: 10.1016/j.tripleo.2011.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 07/07/2011] [Accepted: 08/07/2011] [Indexed: 10/14/2022]
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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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Li K, Chen Z, Zhao X, Zhou Y, Zhang D, Yang G, Tang X. Secondary hyperparathyroidism associated with multiple brown tumor: a case report. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1000-1948(12)60032-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Chrcanovic BR, Gomez RS, Freire-Maia B. Neurofibromatosis type 1 associated with bilateral central giant cell granuloma of the mandible. J Craniomaxillofac Surg 2010; 39:538-43. [PMID: 21071237 DOI: 10.1016/j.jcms.2010.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 05/26/2010] [Accepted: 10/04/2010] [Indexed: 11/27/2022] Open
Abstract
Neurofibromatosis type 1, or von Recklinghausen disease, is one of the most common hereditary neurocutaneous disorders in humans. Clinically, Neurofibromatosis type 1 is characterized by café-au-lait spots, freckling, skin neurofibroma, plexiform neurofibroma, bony defects, Lisch nodules and tumors of the central nervous system. Central giant cell granuloma is a benign central lesion of bone, primarily involving the jaws, of variably aggressive nature characterized by aggregates of multinucleated giant cells in a background of cellular vascular fibrous connective tissue and spindle-shaped mononuclear stromal cells. The association between neurofibromatosis and central giant cell granuloma has been reported in the literature. A case of mandibular bilateral central giant cell granuloma in a patient with Neurofibromatosis type 1 was conservatively but successfully treated by adequate surgical curettage of mandibular bone lesions.
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Affiliation(s)
- Bruno Ramos Chrcanovic
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500 Prédio 45, Coração Eucarístico, Belo Horizonte, MG, Brazil.
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23
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Amaral FR, Brito JAR, Perdigão PF, Carvalho VM, de Souza PEA, Gomez MV, De Marco L, Gomez RS. NFATc1 and TNFα expression in giant cell lesions of the jaws. J Oral Pathol Med 2010; 39:269-74. [DOI: 10.1111/j.1600-0714.2009.00855.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE To report three new retinal findings in a patient with cherubism. PARTICIPANT An 18-year-old male patient. METHODS Clinical examination and retinal scanning with spectral domain optical coherence tomography. RESULTS The spectral domain optical coherence tomography revealed inner retinal striae in the posterior pole of both eyes and a subfoveal vitelliform deposit in the left eye. There was an inferior retinoschisis in the left eye. CONCLUSIONS The inner retinal striae, subretinal vitelliform deposit, and retinoschisis extend the scale of retinal findings associated with orbital (facial) cherubism.
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Affiliation(s)
- Shira Robbins
- From the *Ratner's Children's Eye Center and †Jacobs Retina Center, Department of Ophthalmology, University of California San Diego, La Jolla, California
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Lima GDMG, Almeida JD, Cabral LAG. Cherubism: clinicoradiographic features and treatment. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2010; 1:e2. [PMID: 24421967 PMCID: PMC3886048 DOI: 10.5037/jomr.2010.1202] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 03/15/2010] [Indexed: 11/19/2022]
Abstract
Objectives Cherubism is a congenital childhood disease of autosomal dominant
inheritance. This disease is characterized by painless bilateral
enlargement of the jaws, in which bone is replaced with fibrous tissue.
The condition has sui generis clinical, radiographic and
histological features, of which the clinician should be aware for a
better differential diagnosis in the presence of a fibro-osseous lesion
affecting the bones of the maxillomandibular complex. The purpose of
present paper was to review the literature and to report the most
important aspects of cherubism in order to facilitate the study of this
disease Material and Methods Literature was reviewed about cherubism, emphasizing the relevant
clinicoradiographic features and treatment. Literature was selected
through a search of PubMed and Scielo electronic databases. The keywords
used for search were adolescent, cherubism, cherubism/physiopathology,
cherubism/treatment, cherubism/radiography. A manual search of the
reference lists of the identified articles and the authors' article
files and recent reviews was conducted to identify additional
publications. Those studies that described new features about cherubism
were included in this review. Results In total 44 literature sources were obtained and reviewed. Studies that
described new features about cherubism physiopathology, diagnostics and
treatment were reviewed. Conclusions Despite the exceptions, cherubism is a clinically well-characterized
disease. In cases of a suspicion of cherubism, radiographic examination
is essential since the clinical presentation, the location and
distribution of the lesions may define the diagnosis. Histopathological
examination is complementary. Nowadays, genetic tests should be used for
final diagnosis of cherubism.
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Affiliation(s)
- Gabriela de Morais Gouvêa Lima
- Postgraduation Program in Oral Biopathology, São José dos Campos Dental School, São Paulo State University - UNESP, São José dos Campos, São Paulo Brazil
| | - Janete Dias Almeida
- Postgraduation Program in Oral Biopathology, São José dos Campos Dental School, São Paulo State University - UNESP, São José dos Campos, São Paulo Brazil
| | - Luiz Antonio Guimarães Cabral
- Department of Biosciences and Oral Diagnosis, São José dos Campos Dental School, São Paulo State University - UNESP, São José dos Campos, São Paulo Brazil
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Landesberg R, Eisig S, Fennoy I, Siris E. Alternative indications for bisphosphonate therapy. J Oral Maxillofac Surg 2009; 67:27-34. [PMID: 19371812 DOI: 10.1016/j.joms.2008.12.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 12/16/2008] [Indexed: 12/22/2022]
Abstract
Bisphosphonates are currently used in the treatment of osteoporosis (postmenopausal and steroid-induced), hypercalcemia of malignancy, Paget's disease of bone, multiple myeloma, and skeletally related events associated with metastatic bone disease in breast, prostate, lung, and other cancers. There are, however, numerous other conditions where a decrease in bone remodeling by bisphosphonates might aid in disease management. The focus of this review will be to discuss a select group of conditions for which bisphosphonate therapy may be efficacious. In this review we present several cases where bisphosphonates have been used as a primary or adjunctive treatment for giant cell lesions of the jaws. Use of bisphosphonate therapy for giant cell tumors of the appendicular skeleton, pediatric osteogenesis imperfecta, fibrous dysplasia, Gaucher's disease, and osteomyelitis will be discussed. Finally, we will review previous in vivo studies on the use of bisphosphonates to augment integration and to treat osteolysis surrounding failing orthopedic implants.
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Affiliation(s)
- Regina Landesberg
- Division of Oral and Maxillofacial Surgery, University of Connecticut Health Center, School of Dental Medicine, Farmington, CT 06032, USA.
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Abstract
Fibrous dysplasia is a relatively common disorder of bone. It may affect the bones of the face and skull and, in so doing, produce a wide variety of clinical presentations. Plain film assessment of craniofacial fibrous dysplasia may be difficult because of varying appearances and complex, overlapping structures. The MRI appearances of fibrous dysplasia are often non-specific and may be confusing. Findings on CT are also variable, but more commonly lead to a specific diagnosis. This is because of the characteristic ground-glass appearance of woven bone, seen on CT in most if not all cases of craniofacial fibrous dysplasia.
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Affiliation(s)
- D A Lisle
- Department of Medical Imaging, Redcliffe District Hospital, Brisbane, Queensland, Australia.
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Di Daniele N, Condò S, Ferrannini M, Bertoli M, Rovella V, Di Renzo L, De Lorenzo A. Brown tumour in a patient with secondary hyperparathyroidism resistant to medical therapy: case report on successful treatment after subtotal parathyroidectomy. Int J Endocrinol 2009; 2009:827652. [PMID: 20011058 PMCID: PMC2778191 DOI: 10.1155/2009/827652] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 02/26/2009] [Indexed: 11/17/2022] Open
Abstract
Brown tumour represents a serious complication of hyperparathyroidism. Differential diagnosis, based on histological examination, is only presumptive and clinical, radiological and laboratory data are necessary for definitive diagnosis. Here we describe a case of a brown tumour localised in the maxilla due to secondary hyperparathyroidism in a young women with chronic renal failure. Hemodialysis and pharmacological treatment were unsuccessful in controlling secondary hyperparathyroidism making it necessary to proceed with a subtotal parathyroidectomy. The proper timing of the parathyroidectomy and its favourable effect on regression of the brown tumor made it possible to avoid a potentially disfiguring surgical removal of the brown tumor.
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Affiliation(s)
- Nicola Di Daniele
- Department of Internal Medicine, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy
| | - Stefano Condò
- Nephrology and Dialysis Unit, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy
| | - Michele Ferrannini
- Nephrology and Dialysis Unit, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy
| | - Marta Bertoli
- Genetic Unit, Department of Biopathology and Imaging Diagnostic, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy
| | - Valentina Rovella
- Department of Internal Medicine, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy
| | - Laura Di Renzo
- Department of Neuroscience, Division of Human Nutrition, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy
| | - Antonino De Lorenzo
- Department of Neuroscience, Division of Human Nutrition, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy
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30
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Genetic Disorders and Bone Affecting the Craniofacial Skeleton. Oral Maxillofac Surg Clin North Am 2007; 19:467-74, v. [DOI: 10.1016/j.coms.2007.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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van Capelle CI, Hogeman PHG, van der Sijs-Bos CJM, Heggelman BGF, Idowu B, Slootweg PJ, Wittkampf ARM, Flanagan AM. Neurofibromatosis presenting with a cherubism phenotype. Eur J Pediatr 2007; 166:905-9. [PMID: 17120035 DOI: 10.1007/s00431-006-0334-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 10/05/2006] [Indexed: 11/28/2022]
Abstract
We report on a child who presented clinical manifestations of both neurofibromatosis type 1 (NF1) and cherubism. With genetic testing, we found a mutation in the NF-1 gene, confirming the neurocutaneous disorder. Histology when correlated with radiological evaluation of a mandibular biopsy was consistent with cherubism. This is the first report in the literature of a child with proven neurofibromatosis type 1 and cherubism without extragnathic lesions. This emphasises that cherubism is a clinical phenotype that can be associated with a number of germline mutations involving SH3BP2, PTPN11 and NF1.
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Affiliation(s)
- C I van Capelle
- Department of Pediatrics, Meander Medisch Centrum, Amersfoort, The Netherlands
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32
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Lietman SA, Prescott NL, Hicks DG, Westra WH, Levine MA. SH3BP2 is rarely mutated in exon 9 in giant cell lesions outside cherubism. Clin Orthop Relat Res 2007; 459:22-7. [PMID: 17545756 DOI: 10.1097/blo.0b013e31804b4131] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Giant cell tumor of bone and giant cell reparative granuloma are benign lesions with prominent giant (multinucleated) cells, and an understanding of the molecular biology and genetics of these lesions will likely aid in more effective treatment. Cherubism is a benign lesion of the maxilla and mandible histologically similar to giant cell tumor of bone and giant cell reparative granuloma. Germline mutations in exon 9 of the gene encoding Src homology 3 binding protein 2 (SH3BP2) occur in most patients with cherubism. We therefore hypothesized SH3BP2 and its putative downstream effector nuclear factor of activated T cells c1 isoform (NFATc1) are highly expressed in sporadic nonsyndromic giant cell lesions and associated with somatic SH3BP2 mutations. We analyzed giant cell lesions for SH3BP2 and NFATc1 expression by RNA blot and/or immunohistochemistry and for exon 9 SH3BP2 mutations. We found the SH3BP2 transcripts and protein were abundantly expressed in giant cell tumors of bone, as well as NFATc1 protein. Sequencing of exon 9 of SH3BP2 was normal in all sporadic nonsyndromic giant cell lesions. Although many multinucleated giant cell lesions of bone share histologic features, the primary genetic defect in cherubism and these other giant cell lesions appears different.
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Affiliation(s)
- Steven A Lietman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
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Carvalho Silva E, Carvalho Silva GC, Vieira TC. Cherubism: Clinicoradiographic Features, Treatment, and Long-Term Follow-Up of 8 Cases. J Oral Maxillofac Surg 2007; 65:517-22. [PMID: 17307601 DOI: 10.1016/j.joms.2006.05.061] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 02/14/2006] [Accepted: 05/31/2006] [Indexed: 11/17/2022]
Affiliation(s)
- Edgard Carvalho Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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34
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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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35
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Kruse-Lösler B, Diallo R, Gaertner C, Mischke KL, Joos U, Kleinheinz J. Central giant cell granuloma of the jaws: A clinical, radiologic, and histopathologic study of 26 cases. ACTA ACUST UNITED AC 2006; 101:346-54. [PMID: 16504869 DOI: 10.1016/j.tripleo.2005.02.060] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Revised: 02/09/2005] [Accepted: 02/10/2005] [Indexed: 01/10/2023]
Abstract
The clinical behavior of central giant cell granuloma (CGCG) of the jaws is variable and difficult to predict. Clinical data and follow-up information of 26 patients with CGCG were analyzed. Histologic features were correlated with the clinical course of the disease. In 16 patients the CGCGs were asymptomatic; 10 lesions presented with aggressive growth, pain, massive swelling, root resorption, cortical perforation, and/or recurrence. These patients were younger and the lesions were larger than in the nonaggressive group. The histomorphometric analysis proved a significant increase in large giant cells, fractional surface area, and mitotic activity in aggressive CGCG lesions. Immunohistologic investigation (Ki-67 and p53 stain) revealed no significant differences. After surgical treatment, 3 patients with aggressive lesions developed a recurrence. The data show that clinical and histomorphometric features may be reliable indicators for the differentiation between aggressive and nonaggressive CGCG. This should be accounted for to improve the individual planning of the treatment and follow-up.
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Affiliation(s)
- Birgit Kruse-Lösler
- Department of Craniomaxillofacial Surgery, University of Münster, Münster, Germany.
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36
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Martínez-Tello FJ, Manjón-Luengo P, Martin-Pérez M, Montes-Moreno S. Cherubism associated with neurofibromatosis type 1, and multiple osteolytic lesions of both femurs: a previously undescribed association of findings. Skeletal Radiol 2005; 34:793-8. [PMID: 16096755 DOI: 10.1007/s00256-005-0938-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 03/30/2005] [Accepted: 03/31/2005] [Indexed: 02/08/2023]
Abstract
We present a patient with neurofibromatosis type 1, with the clinical, radiological and histological features of cherubism mandibular lesions, and multiple osteolytic, geographic lesions in both femurs, consistent with multiple non-ossifying fibromas. We have been unable to find a similar case in the world literature. We discuss our findings in relationship with a number of syndromes that present clinical, radiological or pathological similarities.
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Affiliation(s)
- Francisco J Martínez-Tello
- Departamento de Anatomía Patológica, Hospital Universitario "12 de Octubre", Carretera de Andalucía Km. 5400, 28041, Madrid, Spain.
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37
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Gomes MF, de Souza Setúbal Destro MF, de Freitas Banzi EC, dos Santos SH, Claro FA, de Oliveira Nogueira T. Aggressive behaviour of cherubism in a teenager: 4-years of clinical follow-up associated with radiographic and histological features. Dentomaxillofac Radiol 2005; 34:313-8. [PMID: 16120883 DOI: 10.1259/dmfr/32866350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cherubism is a rare hereditary fibro-osseous childhood disease characterized by bone degradation and fibrous tissue replacement at the angles of the mandible and at the tuberosity areas of the maxilla that leads to prominence of the lower face and an appearance reminiscent of the cherub's portrayal in Renaissance art. This disease has an autosomal dominant hereditary characteristic. The purpose of this report is to analyse laboratory tests, clinicopathological and radiographic features of cherubism and its intraoral manifestations in a patient during 4-years of follow-up, correlating the features observed in this case with those of the literature. Also discussed is the atypical and aggressive behaviour of this case during puberty.
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Affiliation(s)
- M F Gomes
- Faculdade de Odontologia de São José dos Campos, UNESP, Departamento de Biociências e Diagnóstico Oral, São Paulo, Brasil.
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38
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Meng XM, Yu SF, Yu GY. Clinicopathologic study of 24 cases of cherubism. Int J Oral Maxillofac Surg 2005; 34:350-6. [PMID: 16053841 DOI: 10.1016/j.ijom.2004.09.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2004] [Indexed: 12/13/2022]
Abstract
The authors reviewed 24 cases of familial or nonfamilial cherubism. The age at onset was between 6 and 10 years. It was characterized by bilateral painless swelling of jaws and eyes-to-heaven appearance was visible when the maxillae were affected as well. Radiographs showed well-defined multilocular radiolucencies and with age, thick sclerotic borders were visible. A malocclusive and abnormal dentition, worse in the mandible can be seen. Histopathologically, numerous randomly distributed multinucleated giant cells and vascular spaces within a fibrous connective tissue stroma with or without eosinophilic collagen perivascular cuffing were apparent. Multinucleated giant cells were positive for osteoclastic specific markers, tartrate-resistant acid phosphatase and human alphaV beta3 integrin, 23C6. Results after follow-up were available for 14 cases. Of these, no treatment was carried out in five cases, cherubism resolved (three cases) or grew slowly (two cases); curettage or surgical contouring was performed in seven cases, during the rapid growth of the lesions. This not only gave good immediate results, but also arrested active growth of remnant cherubic lesions and even stimulated bone regeneration. Segmental mandibulectomy followed by reconstruction was performed in two cases with extensive lesion and the risk of pathologic fracture of the mandible, and excellent results were obtained.
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Affiliation(s)
- X-M Meng
- Department of Oral Pathology, Peking University School of Stomatology, Haidian District, Beijing 100081, PR China.
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39
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Sarkozy A, Obregon MG, Conti E, Esposito G, Mingarelli R, Pizzuti A, Dallapiccola B. A novel PTPN11 gene mutation bridges Noonan syndrome, multiple lentigines/LEOPARD syndrome and Noonan-like/multiple giant cell lesion syndrome. Eur J Hum Genet 2004; 12:1069-72. [PMID: 15470362 DOI: 10.1038/sj.ejhg.5201290] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Noonan (NS) and multiple lentigines/LEOPARD syndromes (LS) have proved to be associated with distinct PTPN11 mutations. Noonan-like/multiple giant cell lesion syndrome (NLS) is a rare disease, characterised by short stature, facial dysmorphisms, congenital heart defect (CHD) and central giant cell lesions. PTPN11 gene mutations have been reported in a single NLS family and two sporadic patients. Here we report a patient with a complex phenotype progressing throughout the years from NS at birth towards LS and NLS. PTPN11 gene analysis disclosed a novel missense mutation (Ala461Thr) in exon 12, affecting the consensus sequence of the SHP2-active site. This observation joins together NS and LS to NLS into a unique genetic defect, broadening the clinical and molecular spectrum of PTPN11-related disorders.
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Affiliation(s)
- Anna Sarkozy
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Rome, Italy
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Petkovska L, Ramadan S, Aslam MO. Cherubism: Review of four affected members in a Kuwaiti family. ACTA ACUST UNITED AC 2004; 48:408-10. [PMID: 15344997 DOI: 10.1111/j.0004-8461.2004.01329.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cherubism is a rare autosomal dominant fibro-osseous disorder of childhood, mostly limited to the maxilla and mandible. Extra-cranial skeletal involvement is rare. Post-pubertal involution of the process and jaw remodeling occurs in adulthood. The aim of this case report is to present four cherubs, a father and his three daughters, in whom the diagnosis was made based on history, physical examination, laboratory tests and typical radiological features. The imaging characteristics are discussed and the published literature is reviewed.
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Affiliation(s)
- L Petkovska
- Radiology Department, Al-Adan Hospital, Safat 5326, Kuwait.
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Imai Y, Kanno K, Moriya T, Kayano S, Seino H, Matsubara Y, Yamada A. A missense mutation in the SH3BP2 gene on chromosome 4p16.3 found in a case of nonfamilial cherubism. Cleft Palate Craniofac J 2004; 40:632-8. [PMID: 14577811 DOI: 10.1597/1545-1569_2003_040_0632_ammits_2.0.co_2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Cherubism is a rare hereditary multilocular cystic disease of the jaws, characterized by its typical appearance. Although nonfamilial cases have been reported, it is difficult to distinguish nonfamilial cherubism from central giant cell granuloma. Recent studies have revealed the point mutations in the SH3BP2 gene on chromosome 4p16.3 in cherubism families. In this article, the SH3BP2 gene in nonfamilial cherubism was examined. PATIENT A 21-year-old Japanese woman with nonfamilial cherubism. INTERVENTIONS Genomic DNA was purified from a blood sample obtained from the patient and used for direct sequencing. In addition, a sample of the lesion, resected during surgery, was used for histologic and immunohistochemical purposes. RESULTS Genomic DNA sequencing found a Pro418Arg mutation in the SH3BP2 gene of the patient. In a histochemical analysis, the multinucleated giant cells proved to be strongly positive for PGM-1, KP-1, and tartrate-resistant acid phosphatase and faintly positive for osteopontin. CONCLUSIONS The missense mutation Pro418Arg was identified in the SH3BP2 gene from a nonfamilial case of cherubism. DNA diagnosis may play a significant role in the identification of cherubism.
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Affiliation(s)
- Yoshimichi Imai
- Department of Plastic and Reconstructive Surgery at Tohoku University Graduate School of Medicine, Sendai, Japan.
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Imai Y, Kanno K, Moriya T, Kayano S, Seino H, Matsubara Y, Yamada A. A Missense Mutation in the SH3BP2 Gene on Chromosome 4p16.3 Found in a Case of Nonfamilial Cherubism. Cleft Palate Craniofac J 2003. [DOI: 10.1597/1545-1569(2003)040<0632:ammits>2.0.co;2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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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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Lo B, Faiyaz-Ul-Haque M, Kennedy S, Aviv R, Tsui LC, Teebi AS. Novel mutation in the gene encoding c-Abl-binding protein SH3BP2 causes cherubism. Am J Med Genet A 2003; 121A:37-40. [PMID: 12900899 DOI: 10.1002/ajmg.a.20226] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cherubism is a rare autosomal dominant inherited condition caused by mutations in the c-Abl-binding protein SH3BP2. It is characterized by multiple cystic giant cell lesions of the jaw appearing in early childhood with stabilization and remission after puberty. In the present study, we used direct sequence analysis of the SH3BP2 gene of several individuals from a family with cherubism to search for additional SH3BP2 mutations resulting in cherubism. In affected relatives, we found a previously unreported G to A transition in exon 9 leading to a Gly to Arg substitution at amino acid position 420. G420R has been reported previously with a G to C transversion. To date there have been no disease causing mutations outside exon 9. Therefore, the amino acid sequence from positions 415 to 420 may represent a specific protein domain which, when disrupted, leads to the cherubism phenotype.
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Affiliation(s)
- Bryan Lo
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
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45
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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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46
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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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47
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Affiliation(s)
- H Greess
- Institut für Diagnostische Radiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg.
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48
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Gupta N, Singh PP, Singh UR. Cherubism. Indian J Otolaryngol Head Neck Surg 2002; 54:229-31. [PMID: 23119899 PMCID: PMC3450443 DOI: 10.1007/bf02993110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cherubum is a benign. fanilial giant cell lesion characterised by gradually prirgeesive panless swelling of the jaws. A study involving, suffering from this rare disarder is preunted. The differentdal dingnosis ON bath clincal charcteristics and hisioktical ftvltitgs is disussed. The conficting treatmem policlm with respect to non-treatment and surgirai recentouring with curenage, are also reviewed.
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Affiliation(s)
- Neelima Gupta
- Department of Pathology, G. T. B. Hospital and University College of Medical Sciences, Delhi
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49
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Silva EC, de Souza PEA, Barreto DC, Dias RP, Gomez RS. An extreme case of cherubism. Br J Oral Maxillofac Surg 2002; 40:45-8. [PMID: 11883969 DOI: 10.1054/bjom.2001.0654] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe an 8-year-old boy who presented with severe facial swelling. This progressed rapidly and 17 months later he died of gastrointestinal and pulmonary infections. The diagnosis was initially brown tumour associated with hyperparathyroidism, but this was revised in the light of laboratory investigations that were within the reference ranges, and normal appearance of the parathyroids on exploration to that of an extreme case of cherubism that behaved in a locally aggressive manner.
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Affiliation(s)
- E C Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil
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50
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Abstract
Cherubism is a rare hereditary condition characterised by progressive cystic proliferation of the mandible and maxilla in childhood, followed by post-pubertal involution of the process and jaw remodelling in adulthood. Its name is derived from the cherubic appearance that results from the jaw hypertrophy. Here, we present the case of a young boy with cherubism, in the context of his pedigree, to illustrate the clinical characteristics and their variable expression. We also seek to distinguish cherubism from central giant cell granuloma and giant cell tumour of the jaws, with which it holds a false synonymity.
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Affiliation(s)
- D A Lannon
- The Craniofacial and Plastic Surgery Department, Temple Street Children's Hospital, Dublin, Ireland
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