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Amorós CM, Bascones AE, Leone RC, De la Sen Corcuera Ó, Barone S, De Pedro Marina M. Central giant cell granuloma: Off-label treatment with Denosumab in a patient with Noonan syndrome. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101640. [PMID: 37729965 DOI: 10.1016/j.jormas.2023.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023]
Abstract
This study aims to describe the utilization of Denosumabࣨ, a human monoclonal antibody against the RANK-L receptor, in a mandibular giant cell granuloma (GCG) with a significant local aggressiveness component that was unresponsive to surgical treatment. We present a case of a 19-year-old male patient diagnosed with Noonan syndrome, who presented a multifocal giant cell granuloma with aggressive behaviour resistant to surgical treatment. Due to the functional and aesthetic implications associated with a surgical procedure, a decision was made to initiate medical treatment using Denosumabࣨ. Throughout the treatment, the patient presented excellent clinical and analytical tolerance, with no reported adverse effects. Surgical intervention remains the preferred approach for GCG. Denosumabࣨ emerges as an alternative, either as neoadjuvant treatment or as definitive therapy for unresectable or resectable tumors associated with significant morbidity. It leads to size stabilization and regression of the tumour stage.
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Affiliation(s)
- Carlota Mazo Amorós
- Maxillofacial Surgery Department, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain.
| | | | - Roy Camacho Leone
- Maxillofacial Surgery Department, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain
| | - Óscar De la Sen Corcuera
- Maxillofacial Surgery Department, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain
| | - Simona Barone
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Maxillofacial Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Manuel De Pedro Marina
- Maxillofacial Surgery Department, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain
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2
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Mukdad M, Barut O, Sjöström M. Intralesional corticosteroid injections as first option for management of giant cell lesion of the lower jaw in a 56-year-old patient: A case report and brief literature review. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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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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Choe M, Smith V, Okcu MF, Wulff J, Gruner S, Huisman TAGM, Venkatramani R. Treatment of central giant cell granuloma in children with denosumab. Pediatr Blood Cancer 2021; 68:e28778. [PMID: 33089644 DOI: 10.1002/pbc.28778] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/09/2020] [Indexed: 11/09/2022]
Abstract
Central giant cell granuloma (CGCG) is a benign but locally aggressive intraosseous lesion of the mandible. Historically, it is treated by curettage or resection. Medical therapy is indicated when surgery is associated with increased morbidity or in adjuvant setting to decrease recurrence. Treatment of CGCG with denosumab, a receptor activator of nuclear factor kappa-beta (RANK) ligand inhibitor, is not well studied, especially in children. Here, we describe our experience with the use of denosumab in the treatment of six children with CGCG. All patients had a favorable response with manageable side effects, which suggests that denosumab is an effective treatment option without increased morbidity.
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Affiliation(s)
- Michelle Choe
- Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Valeria Smith
- Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - M Fatih Okcu
- Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jade Wulff
- Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Stephanie Gruner
- Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Texas
| | - Rajkumar Venkatramani
- Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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5
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de Arruda JAA, Martins AFL, Abreu LG, Mesquita RA, von Zeidler SV, Estrela C, Mendonça EF. Central giant cell granuloma of the maxilla: Long-term follow-up of a patient treated with an adjuvant corticosteroid. SPECIAL CARE IN DENTISTRY 2021; 41:399-407. [PMID: 33471401 DOI: 10.1111/scd.12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Central giant cell granuloma (CGCG) is one of the most intriguing lesions of the jaws and its nature has not yet been fully elucidated. Clinically, some CGCG behave more aggressively, while others have an indolent course. In cases of aggressive CGCG of the maxilla, effective personalized therapies are worth understanding. CASE REPORT We report here a challenging case of aggressive CGCG in a 15-year-old girl which was misdiagnosed as an endodontic lesion. Radiographically, a large osteolytic lesion involving the hard palate from the central incisor to the second premolar, extending into the nasal cavity, with loss of the lamina dura and cortical resorption was observed. The lesion expanded aggressively after extensive curettage. With possible mutilation and defects due to a more radical approach to the lesion, treatment with systemic prednisone and intralesional triamcinolone hexacetonide associated with a calcitonin nasal spray was instituted. The decision in favor of this therapeutic strategy was made after careful immunohistochemical analysis of calcitonin and glucocorticoid receptors. The H-score for the staining of glucocorticoid and calcitonin receptors in multinucleated giant cells was 222 and 153.6, respectively. The lesion reduced in size, and no adverse effects associated with medications were observed. Another curettage was performed, and only fibrous connective tissue was found. The patient is in follow-up for 11 years without evidence of recurrence. CONCLUSION Pharmacological agents hold clinical promise in cases of aggressive CGCG affecting the maxilla of pediatric patients. Investigating the expression of calcitonin and glucocorticoid receptors in order to plan treatment is very helpful in the decision to manage aggressive CGCG.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandra Ventorin von Zeidler
- Department of Pathology and Post-graduation Program in Biotechnology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Carlos Estrela
- Department of Stomatologic Sciences, School of Dentistry, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
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6
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Nilesh K, Dadhich A, Patil R. Management of recurrent central giant cell granuloma of mandible using intralesional corticosteroid with long-term follow-up. BMJ Case Rep 2020; 13:e237200. [PMID: 32928838 PMCID: PMC7490931 DOI: 10.1136/bcr-2020-237200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/04/2022] Open
Abstract
Central giant cell granuloma (CGCG) is an expansile osteolytic lesion of the jawbone. Conventional treatment of CGCG is surgical and vary from simple curettage to more aggressive resection of the jaw. However, surgical management is associated with drawbacks including requirement of hospitalisation and general anaesthesia, damage to vital anatomic structures and continuity defect of the mandible requiring reconstruction surgery. Use of intralesional injections of corticosteroid for the management of CGCG have been inconsistently used as an alternative non-surgical method of management of CGCG with varying success. While the use of such conservative modality over ablative surgery can significantly reduce postoperative morbidity, follow-up of such cases for a long period is important to study the possible recurrence. This paper reports successful treatment of a recurrent CGCG of posterior mandible by intralesional administration of triamcinolone acetonide in a 27-year old female patient, with long-term follow-up of 10 years.
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Affiliation(s)
- Kumar Nilesh
- Oral & Maxillofacial Surgery, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - Anuj Dadhich
- Department of Oral and Maxillofacial Surgery, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Rahul Patil
- Oral Pathology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
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7
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Candeiro GTDM, de Souza CVT, Chaves RSA, Ley AM, Feijão CP, Costa FWG, Barros Silva PG. Central giant cell granuloma mimicking a periapical lesion of endodontic origin: A case report. AUST ENDOD J 2020; 46:381-386. [PMID: 32820589 DOI: 10.1111/aej.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
This paper aims to report a case in which central giant cell granuloma (CGCG) mimicked a periapical lesion of endodontic origin. An 18-year-old female patient was referred for diagnosis and treatment of extensive radiolucent periapical lesion involving 31, 32, 33, 34 and 35 teeth. Clinically, the patient presented slight facial asymmetry and healthy teeth on the affected side with positive response to thermal vitality tests. Thus, an incisional biopsy was performed, which presented a histopathological picture characteristic of a CGCG. The endodontic treatment of the involved teeth was followed by surgical curettage of the lesion. After two years of follow-up, the patient was asymptomatic, with marked improvement in mandibular symmetry and adequate healing of the lesion. Therefore, the diagnosis of radiolucent periapical lesions must include lesions of endodontic and non-endodontic origin for better treatment planning and execution.
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Affiliation(s)
| | | | | | - Amanda Mourão Ley
- Post graduate program in Dentistry, Federal University of Ceará, Fortaleza, Brazil
| | - Camila Pontes Feijão
- Post graduate program in Dental Sciences, Christus University Center (Unichristus), Fortaleza, Brazil
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8
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Nogueira RLM, Osterne RLV, Lima Verde RMB, Azevedo NO, Teixeira RC, Cavalcante RB. Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant cell lesions: a prospective study. Br J Oral Maxillofac Surg 2020; 58:e283-e289. [PMID: 32792199 DOI: 10.1016/j.bjoms.2020.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022]
Abstract
The aim of this prospective study was to report on the response to treatment of central giant cell lesions (CGCL) with intralesional corticosteroid injections. Consecutive cases of CGCL were treated with a biweekly intralesional injection of 20mg/ml triamcinolone hexacetonide diluted in an anaesthetic solution of 2% lidocaine/epinephrine 1:200 000 at the proportion 1:1. All patients were monitored using cone beam computed tomography. Eleven patients were treated; their ages ranged from 15-34 (mean 22 years); and eight lesions were in the mandible, and three in the maxilla. Three cases were diagnosed as non-aggressive, and eight as aggressive. Six cases presented good results (four aggressive and two non-aggressive); three cases presented a moderate response (two aggressive and one non-aggressive); and two had a poor response to treatment (both aggressive). In four cases with a good response, osteoplasty was done. In all cases with a moderate response, the remaining lesion was curetted. Cases with a poor response were submitted to either curettage or denosumab injections. Corticotherapy, as main or neoadjuvant therapy, may be an option for treatment of CGCL.
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Affiliation(s)
- R L M Nogueira
- Department of Dental Clinic, Discipline of Oral and Maxillofacial Surgery and Stomatology, Federal University of Ceara School of Dentistry, Fortaleza, Brazil; Department of Oral and Maxillofacial Surgery, Memorial Batista Hospital, Fortaleza, Brazil
| | - R L V Osterne
- Department of Pathology, University of Fortaleza/Universidade de Fortaleza, School of Medicine, Fortaleza, Brazil
| | - R M B Lima Verde
- Christus University Center (Centro Universitário Christus), School of Dentistry, Fortaleza, Brazil; Federal University of Ceara School of Dentistry, Fortaleza, Brazil.
| | - N O Azevedo
- Federal University of Ceara School of Dentistry, Fortaleza, Brazil
| | - R C Teixeira
- Department of Oral Radiology, University of Fortaleza/Universidade de Fortaleza, School of Dentistry, Fortaleza, Brazil
| | - R B Cavalcante
- Department of Oral Pathology, University of Fortaleza/Universidade de Fortaleza, School of Dentistry, Fortaleza, Brazil
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Smriti K, John E, Pentapati KC, Gadicherla S, Bhagania M. Intra-Lesional Medicaments for the Management of Intra-Osseous Lesions of Maxilla and Mandible - Systematic Review. J Int Soc Prev Community Dent 2020; 10:36-45. [PMID: 32181219 PMCID: PMC7055339 DOI: 10.4103/jispcd.jispcd_295_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
Abstract
Aims and Objectives: This study aimed to review the success or remission of intralesional medicaments in the management of intraosseous lesions in the oral cavity. Materials and Methods: A comprehensive search was performed in two databases (PubMed and Scopus). Research articles, case reports, case series, and clinical trials were included. Review articles, lesions not involving the bone, incomplete reporting, any other treatment other than intralesional medicaments to treat intraosseous bone lesions, publications without any treatment, and letter to editor were excluded. Data on remission (complete, partial, or no remission), details and regimen of the intervention, number of participants, and follow-up in months were recorded. Results: A total of 653 publications were available for title and abstract screening after the removal of duplicates. Seven articles were excluded, which were not in English. After title and abstract screening, a total of 88 publications were available for full-text screening. Fifty-five articles were included in qualitative synthesis. A total of 168 patients from 55 publications were evaluated. Minimum follow-up was 1 month and maximum was 264 months. More than two-third (n = 38) of the publications were case reports on single patient. More than two-third (n = 38) of the publications had complete remission. Conclusion: Intralesional medications have shown variable success rates. Extensive lesions may undergo intralesional medications followed by surgical management.
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Affiliation(s)
- Komal Smriti
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Evit John
- MPH Candidate, School of Public Health, University of Texas Health Sciences Centre, Houston, Texas, USA
| | - Kalyana-Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manish Bhagania
- Oral and Maxillofacial Surgery, Boston University, Boston, MA, USA
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10
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Stuepp RT, Marola LHG, Modolo F, Gondak R. Hybrid ameloblastoma and central giant cell lesion: Challenge of early diagnosis. J Clin Exp Dent 2020; 12:e204-e208. [PMID: 32071704 PMCID: PMC7018476 DOI: 10.4317/jced.56441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/09/2019] [Indexed: 12/03/2022] Open
Abstract
Hybrid lesions encompass the occurrence of different entities in one lesion. A 67-year-old woman was referred to the Oral and Maxillofacial Surgery Service for treatment of mandibular Central Giant Cell Lesion (CGCL) previously diagnosed. Intraoral examination revealed edentulism and a painless swelling extending from the alveolar ridge to the buccal vestibule with hard consistency covered by normal mucosae, with unknown duration. Panoramic radiograph revealed a large, multilocular and well-defined radiolucent lesion extending from the region of left mandibular lateral incisor teeth to right mandibular first molar with no evidence of osseous perforation. Initially, a treatment with intralesional injection of corticosteroids was performed. After 18 months of treatment, an increase in size of the osteolytic lesion was noted. An incisional biopsy was carried out and the microscopic examination revealed a unicystic ameloblastoma associated to CGCL. It was performed marsupialization and later the enucleation of residual lesion. The follow-up remains being performed. Key words:Hybrid lesion, central giant cell lesion, ameloblastoma.
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Affiliation(s)
- Rúbia-Teodoro Stuepp
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Luiz-Henrique-Godoi Marola
- Bucomaxillofacial Residence Program, University Hospital, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Filipe Modolo
- Department of Pathology, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Rogério Gondak
- Department of Pathology, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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11
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Gholizadeh N, Sadrzadeh-Afshar MS, Sheykhbahaei N. Intralesional corticosteroid injection as an effective treatment method for oral lesions: a meta-analysis. BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902019000418077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Abstract
Benign cysts and neoplasms of the maxillofacial region can vary in behavior, with some growing rapidly and resulting in destruction of surrounding structures. Despite their benign histology, many require often-morbid treatment to prevent recurrence of these lesions. Several less invasive and adjunctive medical treatments have been developed to lessen the morbidity of surgical treatment. As the molecular and genomic pathogenesis of these lesions is better understood, more directed treatments may lessen the burden for patients.
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Affiliation(s)
- Zachary S Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, 55 Fruit Street Warren 1201, Boston, MA 02421, USA.
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13
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Wang Y, Le A, El Demellawy D, Shago M, Odell M, Johnson-Obaseki S. An aggressive central giant cell granuloma in a pediatric patient: case report and review of literature. J Otolaryngol Head Neck Surg 2019; 48:32. [PMID: 31319877 PMCID: PMC6637537 DOI: 10.1186/s40463-019-0356-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/09/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Central giant cell granulomas are benign tumours of the mandible, presenting in children and young adults. Divided into non- and aggressive subtypes, the aggressive subtype is relatively rare and can occasionally progress rapidly, resulting in significant morbidity. CASE PRESENTATION We present a case of an aggressive central giant cell granuloma (CGCG) in a six year-old female. The lesion originated in the right mandibular ramus and progressed rapidly to involve the condyle. Diagnosis was made using a combination of imaging and pathology. A timely en bloc resection of the hemi-mandible was performed with placement of a reconstructive titanium plate and condylar prosthesis. CONCLUSION Our case demonstrates the importance of considering CGCG in the differential diagnosis of rapidly progressive mandibular lesions in the pediatric population. Prompt diagnosis and management can greatly improve long-term outcomes.
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Affiliation(s)
- Yiqiao Wang
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Andre Le
- Department of Otolaryngology – Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Dina El Demellawy
- Department of Pathology, Children’s Hospital of Eastern Ontario, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mary Shago
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Michael Odell
- Department of Otolaryngology – Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology – Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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14
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de Mendonça RP, Mitre GP, Real FH, da Silva Kataoka MS, de Melo Alves Júnior S, Vianna P, Da Silva Júnior NG, de Jesus Viana Pinheiro J. Central Giant Cell Granuloma Treated with Intralesional Corticosteroid Injections and Bisphosphonates: A Long-Term Follow-Up Case Study. Head Neck Pathol 2019; 14:497-502. [PMID: 31297738 PMCID: PMC7235135 DOI: 10.1007/s12105-019-01053-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/06/2019] [Indexed: 12/11/2022]
Abstract
Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the head and neck with potential for aggressive and locally destructive behaviour. Lesions of the maxilla tend to expand more than those of the mandible due to the thinner cortices and spongy tissue of this location. Surgical removal is the most common treatment; however, it may be disfiguring in aggressive cases, especially for lesions located in the maxilla. Alternative treatments, such as intralesional corticosteroid injections, have been performed with satisfactory results. We report a case of a 12-year-old female patient with a CGCG of the left maxilla that was treated with 40 doses of intralesional triamcinolone acetonide infiltrations combined with alendronate sodium and calcium carbonate. Clinical and imaging follow-up over 12 years demonstrates improvement in the patient's condition.
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Affiliation(s)
- Raíssa Pinheiro de Mendonça
- Department of Oral Pathology, School of Dentistry, Federal University of Ceara, Rua Monsenhor Furtado, Fortaleza, Ceara 60430-355 Brazil
| | - Geovanni Pereira Mitre
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - Flavio Henrique Real
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Para, Avenida Augusto Correa, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - Maria Sueli da Silva Kataoka
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - Sérgio de Melo Alves Júnior
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | | | - Newton Guerreiro Da Silva Júnior
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Para, Avenida Augusto Correa, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - João de Jesus Viana Pinheiro
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
- Cell Culture Laboratory, Department of Oral Pathology, School of Dentistry, Federal University of Para - UFPA - Institute of Health Sciences, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
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15
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Abstract
This case report discusses a modified technique for treatment of a central giant cell lesion (CGCL) in children, where a recontouring procedure is performed prior to the treatment with intra lesional corticosteroid. We discuss the advantages of this less invasive technique, specially considering the early age of the patient and its bone growth, as well as the conservative approach for lesions in those cases. The treatment of an 8-year-old female patient exhibiting CGCL in anterior region of mandible with bone expansion is described. The procedure was performed using blade #15 and rongeur forceps, in order to obtain an adequate jaw contour. Two weeks later, drug treatment started with triamcinolone 10mg/ml diluted in 0.5% bupivacaine without vasoconstrictor agent, 1:1 ratio, for eight sessions. There were no complications in surgery and postoperative period. In 3-year follow-up, anatomical preservation is present with no signs of recurrence.
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16
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Yang H, Im GH, Nielsen GP, Kheterpal A, Schwab JH. Primary thoracic giant cell tumor of bone sensitive to steroids. Skeletal Radiol 2018; 47:1431-1435. [PMID: 29502130 DOI: 10.1007/s00256-018-2911-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 02/02/2023]
Abstract
Spinal giant cell tumor of bone (GCTB) is a rare benign, but locally aggressive, entity. We report the case of a 40-year-old man diagnosed with GCTB of the thoracic spine. The only symptom upon presentation was progressive back pain with pain radiating to the chest. Magnetic resonance imaging showed that the soft tissue mass extended posteriorly into the spinal canal, causing severe spinal cord compression. We initially treated this case with Decadron (Fresenius kabi, Bad Homburg vor der Hohe, Germany) for 1 week. This led to a reduction of tumor size and decompression of the spinal cord. To the best of our knowledge, there have been no prior reports of primary GCTB sensitive to steroid therapy within the existing literature.
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Affiliation(s)
- Huiliang Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Department of Orthopaedic Surgery, Orthopaedic Spine and Oncology Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gi Hye Im
- Department of Orthopaedic Surgery, Orthopaedic Spine and Oncology Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gunnlaugur Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arvin Kheterpal
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Spine and Oncology Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Batista Severo ML, Lopes MLDDS, Miguel MCDC, Germano AR, Nogueira RLM, Turatti E, Cavalcante RB, da Silveira ÉJD. Immunoexpression of calcitonin and glucocorticoid receptors in central giant cell lesions of the jaws. J Oral Pathol Med 2018; 47:907-913. [PMID: 30028524 DOI: 10.1111/jop.12766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study analyzed the immunoexpression of calcitonin receptor (CTR) and glucocorticoid receptor (GR) in central giant cell lesions (CGCLs) and verified potential associations with patient's response to clinical treatment with intralesional injection of triamcinolone. MATERIALS AND METHODS Fifty-four cases of CGCLs, including 22 non-aggressive, and 32 aggressive, were investigated by immunohistochemistry. RESULTS Surgery was the therapeutic choice for 53.1% of the aggressive CGCLs, and 46.9% were submitted to the conservative treatment with intralesional triamcinolone injections. Among patients submitted to conservative treatment, 60% (n = 9) showed favorable response. CTR expression was observed in 68.51%, and GR in 94.44% of the total sample. There were no differences in the expression of CTR, neither GR in mononucleated stromal cells (MSCs) or multinucleated giant cells (MGCs), in relation to aggressiveness, treatment performed for and the response to conservative treatment. Both markers showed a positive correlation between their expression in MSCs and MGCs in the total sample (P < 0.0001). CTR expression on MSCs showed a positive correlation with MGCs in the aggressive and non-aggressive groups (P < 0.0001). CONCLUSIONS Calcitonin receptor and GR expression were diffuse and similar in non-aggressive and aggressive cases, and it did not influence the response to clinical treatment with triamcinolone in the sample studied.
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Affiliation(s)
- Mara Luana Batista Severo
- Postgraduate Program in Oral Pathology, Dentistry Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | | | - Adriano Rocha Germano
- Oral and Maxillofacial Surgery Residence, Dentistry Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Renato Luiz Maia Nogueira
- Department of Dental Clinic, Discipline of Oral and Maxillofacial Surgery and Stomatology, Federal University of Ceara School of Dentistry, Fortaleza, CE, Brazil
| | - Eveline Turatti
- Department of Oral Pathology, School of Dentistry, University of Fortaleza, UNIFOR, Fortaleza, CE, Brazil
| | - Roberta Barroso Cavalcante
- Department of Oral Pathology, School of Dentistry, University of Fortaleza, UNIFOR, Fortaleza, CE, Brazil
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da Rosa MRP, de Sá JL, Martins VB, de Oliveira MV. Central giant cells lesion: Report of a conservative management. Eur J Dent 2018; 12:305-310. [PMID: 29988246 PMCID: PMC6004816 DOI: 10.4103/ejd.ejd_402_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Central giant cells lesion (CGCL) is defined as a benign intraosseous destructive pathology. It is classified as aggressive or nonaggressive, depending on their clinical, imaginologic, and histological behavior. The behavior, location, and extension of the lesion added to the patient's age will determine the choice of the treatment, either surgical or clinical. Thereby, the aim of this work is to review the literature related to the CGCL, as well as to present a clinical case report of a 22-year-old female patient, affected with an injury on the left side of her jaw. After the diagnosis, it was decided to carry out a conservative treatment with intralesional injections of triamcinolone (10 mg/ml). The injections were performed once a week for 6 weeks. The progress of the patient was satisfactory, and after 4 years, it has been observed through imaging and clinical bone formation examinations with complete remission of the injury and no signs of recurrence.
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Affiliation(s)
- Marina Rolo Pinheiro da Rosa
- Resident of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Amazon State University, Manaus, Brazil
| | - Juliana Lopes de Sá
- Dentistry Student, Department of Oral and Maxillofacial Surgery, Amazon State University, Manaus, Brazil
| | - Valber Barbosa Martins
- Professor at the Residence in Maxillofacial and Traumatology Surgery, Department of Oral and Maxillofacial Surgery, Amazon State University, Manaus, Brazil
| | - Marcelo Vinícius de Oliveira
- Professor at the Residence in Maxillofacial and Traumatology Surgery, Department of Oral and Maxillofacial Surgery, Amazon State University, Manaus, Brazil
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Bonolis A, Euvrard E, Meyer C, Louvrier A. Central giant-cell granuloma located in the mandibular symphyseal region of a child. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2017039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Central giant-cell granuloma (CGCG) is a rare mandibular tumor. The originality of this case lies in its clinical presentation, with a delay in treatment despite a significant aesthetic impact. Observation: An 8-year-old boy whose chin had been swelling for three (3) months was referred to have a consultation. The medical imaging examination revealed a well-defined osteolytic lesion of about 3 cm and round in shape. The lesion was surgically treated by enucleation. The anatomopathological examination provided evidence of a CGCG. Conclusion: Postoperative period was aesthetically acceptable, there were no nervous or dental lesions and no relapse at the 6-month follow-up.
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20
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Dos Santos B, Koth VS, Figueiredo MA, Salum FG, Cherubini K. Brown tumor of the jaws as a manifestation of tertiary hyperparathyroidism: A literature review and case report. SPECIAL CARE IN DENTISTRY 2018; 38:163-171. [PMID: 29603323 DOI: 10.1111/scd.12284] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Brown tumor of the jaws is a manifestation of hyperparathyroidism consisting of osteolytic lesions that show proliferation of multinucleated giant cells in the maxilla and/or mandible. Differential diagnosis of these lesions from local central giant-cell granuloma is mandatory for the correct treatment of the patient. Radiographic and histopathological exams of the jaw lesion are not sufficient to determine the diagnosis, which requires laboratory tests including serum levels of calcium, alkaline phosphatase, parathyroid hormone (PTH) and phosphate, and radiographic examination of other bones as well, such as hand-wrist, pelvis, and femur. We present here a brief literature review focusing on the clinical and radiographic features, diagnostic criteria and treatment of brown tumor and also report a case of the disease affecting the jaw.
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Affiliation(s)
- Bethina Dos Santos
- Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS
| | - Valesca Sander Koth
- Postgraduate Program, Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS
| | | | | | - Karen Cherubini
- Postgraduate Program, Dental College, Pontifical Catholic University of Rio Grande do Sul-PUCRS
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Peacock ZS. Controversies in Oral and Maxillofacial Pathology. Oral Maxillofac Surg Clin North Am 2017; 29:475-486. [DOI: 10.1016/j.coms.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Adjuvant Antiangiogenic Treatment for Aggressive Giant Cell Lesions of the Jaw: A 20-Year Experience at Massachusetts General Hospital. J Oral Maxillofac Surg 2017; 75:105-118. [DOI: 10.1016/j.joms.2016.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 01/08/2023]
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Schreuder WH, van den Berg H, Westermann AM, Peacock ZS, de Lange J. Pharmacological and surgical therapy for the central giant cell granuloma: A long-term retrospective cohort study. J Craniomaxillofac Surg 2016; 45:232-243. [PMID: 28087284 DOI: 10.1016/j.jcms.2016.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 10/01/2016] [Accepted: 11/10/2016] [Indexed: 01/10/2023] Open
Abstract
PURPOSE This is a retrospective cohort study of patients with a central giant cell granuloma (CGCG) treated at a single center to assess and compare the different surgical and non-surgical approaches. MATERIAL AND METHODS A cohort with a single histologically proven non-syndrome-related CGCG was selected and reviewed. Patients were allocated to group I (surgery), group II (pharmacotherapy), and group III (pharmacotherapy and surgery). The primary outcome was long-term radiologic response using computed tomography. Secondary outcomes were intermediate radiologic responses and occurrence and severity of side effects. RESULTS Thirty-three subjects were included in the study. The surgical group (n = 4) included 1 patient with progression during follow-up and a relatively high post-surgical morbidity. Twenty-nine patients started on various pharmacological treatment regimens (groups II and III). Fourteen patients could be managed without additional surgery. One of these lesions showed progression during follow-up. The other 15 lesions underwent additional surgery, and none showed progression during follow-up. Interferon treatment was associated with the most side effects. CONCLUSION Pharmacological agents have a role in the treatment of aggressive and non-aggressive CGCGs by limiting the renewed progression during long-term follow up and the extent and morbidity of surgical treatment.
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Affiliation(s)
- Willem Hans Schreuder
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. de Lange), Academic Medical Center, Academic Center Dentistry Amsterdam and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Henk van den Berg
- Department of Pediatric Oncology, Academic Medical Center, Emma Children Hospital and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Anne Marie Westermann
- Department of Medical Oncology, Academic Medical Center and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Zachary Scott Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Fruit Street 55, MA, 02114, Boston, United States.
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. de Lange), Academic Medical Center, Academic Center Dentistry Amsterdam and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Surgical Treatment, Oral Rehabilitation, and Orthognathic Surgery After Failure of Pharmacologic Treatment of Central Giant Cell Lesion: A Case Report. J Oral Maxillofac Surg 2016; 74:2567.e1-2567.e10. [DOI: 10.1016/j.joms.2016.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 11/21/2022]
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Dolanmaz D, Esen A, Mihmanlı A, Işık K. Management of central giant cell granuloma of the jaws with intralesional steroid injection and review of the literature. Oral Maxillofac Surg 2016; 20:203-209. [PMID: 26481917 DOI: 10.1007/s10006-015-0530-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE We report the results of the intralesional steroid injections for the management of central giant cell granuloma (CGCG) of the jaws. METHODS Seven CGCGs were treated with intralesional injection of corticosteroids. To accomplish this, 3.5 mL of triamcinolone and 3.5 mL of 0.5 % marcaine with 1/200,000 epinephrine (total 7 mL) were mixed. An adequate amount of steroid was injected into different areas of the lesion. This procedure was repeated on a weekly basis for 6 weeks. RESULTS Clinical and radiological examination showed complete resolution and ossification of the lesions in four patients. Partial recovery was achieved in two patients. One patient did not respond to the treatment and underwent surgical curettage. CONCLUSIONS We suggest that intralesional steroid injection is safe and effective for the treatment of CGCG, especially in non-aggressive lesions.
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Affiliation(s)
- Doğan Dolanmaz
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Selçuk University, Konya, Turkey
| | - Alparslan Esen
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Ankara Cd. No:75/A, Konya, Turkey.
| | - Ahmet Mihmanlı
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Bezmialem University, Istanbul, Turkey
| | - Kubilay Işık
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Konya, Turkey
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Abstract
Most pathologic lesions of the jaws or of oral mucosa are treated successfully by surgical interventions. For treatment of the central giant cell lesion, aneurysmal bone cysts, histiocytosis of the mandible, hemangioma, odontogenic keratocyst, Paget disease, oral submucous fibrosis, and oral lichen planus, medical management consisting of intralesional injections, sclerosing agents, and systemic bisphosphonates is as successful as surgical procedures with fewer complications. Pharmacology of agents used and protocols are presented.
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Affiliation(s)
- Orrett E Ogle
- Mona Dental Program, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica; Oral and Maxillofacial Surgery, Woodhull Medical Center, Brooklyn, NY, USA.
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27
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Pham Dang N, Longeac M, Picard M, Devoize L, Barthélémy I. [Central giant cell granuloma in children: Presentation of different therapeutic options]. ACTA ACUST UNITED AC 2016; 117:142-6. [PMID: 26907517 DOI: 10.1016/j.revsto.2016.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/23/2015] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
Central giant cell granuloma (CGCG) is a benign tumor that may be subdivided in a non-aggressive form and an aggressive form. In aggressive forms, tumor size and high recurrence risk need large surgical resections. In order to minimize surgical morbidity, especially in children, medical treatments acting on the tumor proliferation are currently being assessed: steroids (triamcinolone), anti-osteoclastic drugs (calcitonine, alendronate, denosumab), anti-angiogenic drugs (interferon α). However to date, there is no evidence for any superiority of medical over surgical treatment. Complete response is rarely obtained and additional surgery is often necessary to remove the tumor in case of tumor progression, to remove a remnant or to remodel bone. Moreover, these drugs have frequent local or systemic side effects such as osteonecrosis and growth deficiencies.
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Affiliation(s)
- N Pham Dang
- Service de chirurgie maxillo-faciale, stomatologie et chirurgie plastique de la face, université d'Auvergne, NHE, CHU de Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; UMR Inserm/UdA, U1107, neuro-dol, trigeminal pain and migraine, faculté de chirurgie dentaire, BP 10448, 63000 Clermont-Ferrand, France.
| | - M Longeac
- Service de chirurgie maxillo-faciale, stomatologie et chirurgie plastique de la face, université d'Auvergne, NHE, CHU de Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - M Picard
- Service de chirurgie maxillo-faciale, stomatologie et chirurgie plastique de la face, université d'Auvergne, NHE, CHU de Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - L Devoize
- Service d'odontologie, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - I Barthélémy
- Service de chirurgie maxillo-faciale, stomatologie et chirurgie plastique de la face, université d'Auvergne, NHE, CHU de Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; UMR Inserm/UdA, U1107, neuro-dol, trigeminal pain and migraine, faculté de chirurgie dentaire, BP 10448, 63000 Clermont-Ferrand, France; Faculté de médecine, université d'Auvergne, Clermont université, BP 10448, 63000 Clermont-Ferrand, France
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Cavalcante RB, Turatti E, Daniel APB, de Alencar GF, Chen Z. Retrospective review of oral and maxillofacial pathology in a Brazilian paediatric population. Eur Arch Paediatr Dent 2015; 17:115-22. [DOI: 10.1007/s40368-015-0217-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
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Noya Maiz N, de la Rosa-García E, Irigoyen Camacho ME. Immunohistochemical expression of alpha-smooth muscle actin and glucocorticoid and calcitonin receptors in central giant-cell lesions. J Oral Pathol Med 2015; 45:289-94. [DOI: 10.1111/jop.12377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Nancy Noya Maiz
- Department of Health Care; Universidad Autónoma Metropolitana; Xochimilco México City México
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30
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Fonseca FP, Ribeiro ACP, Santos-Silva ARD, Vargas PA, Lopes MA. Fine needle aspiration cytology and intralesional steroid injection in a central giant cell granuloma affecting the gingiva: a new clinical approach. Braz Dent J 2015; 24:420-7. [PMID: 24173268 DOI: 10.1590/0103-6440201302196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/06/2013] [Indexed: 01/02/2023] Open
Abstract
Central giant cell granuloma (CGCG) is a benign jaw lesion predominantly found in the mandible of young female patients with a variable clinical behavior. Although surgical management is regarded as the main treatment modality for this lesion, the use of intralesional injections of steroids has been recently advocated for its treatment. In addition to this conservative management, the use of fine needle aspiration cytology (FNAC) for diagnosing CGCGs has been proven a safe and efficient approach, especially useful in cases with lesions located in esthetic regions. Herein, it is described a case of CGCG extending to the overlying gingiva of a 15-year-old male patient diagnosed by FNAC and subsequently treated with intralesional injections of a solution of triamcinolone acetonide and ethanolamine oleate that led to an important clinical remission, allowing a more conservative surgical procedure for preservation of gingival esthetics. Therefore, both procedures can be considered as management options for CGCG of the jaws.
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Martins AFL, Souza POC, Rege ICC, Morais MO, Mendonça EF. Glucocorticoids, calcitonin, and osteocalcin cannot differentiate between aggressive and nonaggressive central giant cell lesions of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:386-95. [DOI: 10.1016/j.oooo.2015.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/15/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
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Central giant cell granuloma of the mandibular condyle: a case report, literature review, and discussion of treatment. ORAL AND MAXILLOFACIAL SURGERY CASES 2015. [DOI: 10.1016/j.omsc.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Abstract
Oral and maxillofacial surgeons are often involved in the diagnosis and treatment of vascular neoplasms of the head and neck. An incorrect diagnosis may lead to improper or unnecessary treatment. This article reviews the diagnosis and management of vascular tumors.
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Esen A, Işık K, Dolanmaz D. Treatment of mouth and jaw diseases with intralesional steroid injection. World J Stomatol 2015; 4:87-95. [DOI: 10.5321/wjs.v4.i2.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/11/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Many lesions of the oral region are treated with surgical methods such as curettage and resection. Chemotherapy and radiation therapy with or without surgical intervention can be used as an adjunct in some cases. Intralesional steroid injection is a conservative procedure which is already used in various regions of the body and joints. This technique is used also for a number of mouth and jaw lesions. Localized langerhans cell histiocytosis, central giant cell granuloma, oral submucous fibrosis, oral lichen planus, lichen sclerosus of the oral mucosa, lymphatic malformations and orofacial granulomatosis can be considered among these diseases. The purpose of this review is to investigate the effects of intralesional steroid injections in the treatment of oral diseases.
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Abstract
Central giant cell granuloma (CGCG) is an intraosseous lesion consisting of fibrous cellular tissue that contains multiple foci of hemorrhage, multinucleated giant cells, and occasional trabeculae of woven bone. An 8-year-old boy presented himself complaining of a painless swelling in the left maxilla that had started 1 year. Computed tomography (CT) scan confirmed a poorly defined multilocular radiolucent lesion in the left maxilla crossing the midline. The patient underwent enucleation through an intraoral approach of the lesion. The biopsy revealed multinucleated giant cells in a fibrous stroma. A CT was taken approximately 1 year postoperatively. There was no clinical or radiographic evidence of recurrence. Therefore, surgical treatment of CGCG can be performed, trying to preserve the surrounding anatomic structures, which can be maintained in case the lesion does not show an aggressive clinical behavior, avoiding large surgical defects which are undesirable in children.
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Goyal P, Narula R, Bansal S, Bansal S, Garg P. Conservative nonsurgical treatment of mandibular central giant cell granuloma in an adolescent: A case report. PEDIATRIC DENTAL JOURNAL 2014. [DOI: 10.1016/j.pdj.2013.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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da Silva Sampieri MB, Yaedú RYF, Santos PSS, Gonçales ES, Santa'ana E, Consolaro A, Cardoso LB. Central giant cell granuloma: treatment with calcitonin, triamcinolone acetonide, and a cystic finding 3 years and 6 months after the primary treatment. Oral Maxillofac Surg 2013; 17:229-234. [PMID: 23111768 DOI: 10.1007/s10006-012-0370-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 10/18/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior. CASE REPORT A 9-year-old boy was complaining of swelling in the floor of the mouth. A solid swelling was observed in the area of the lower incisors. From the radiographic exam, we observed a radiolucent image in the mandibular bone with well-defined limits extending from the apical region of tooth 33 to the apical region of tooth 42. DISCUSSION Due to the diagnosis and the age of the patient, we chose a conservative treatment, administering subcutaneous injections of calcitonin. During this treatment, no reduction to the lesion was observed. Therefore, we chose to treat the lesion with triamcinolone acetonide. Monthly follow-ups demonstrated good lesion reduction and the absence of any clinical symptoms during the first 2 years. After a 3-year follow-up, the patient returned, presenting mobility of the lower incisors. A significant increase in the size of the lesion was observed. After a biopsy, with the removal of tissue which had the appearance of a cyst capsule, microscopic analyses were found to be compatible with a secondarily infected cyst. Two months following this procedure, the patient did not present tooth mobility anymore and the oral mucosa presented a normal aspect. Following a radiographic exam, full lesion repair was observed. These conservative treatments should be the first option in cases of central giant cell granuloma and the patient must be observed for a long period of time, until no further clinical or radiographic signs of lesions are observed.
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Nogueira RLM, Faria MHG, Osterne RLV, Cavalcante RB, Ribeiro RA, Nonaka CFW, Rabenhorst SHB. Central giant cell lesion of the jaws: study of CCND1 gene amplification and p16INK4a protein levels. J Mol Histol 2013; 44:527-34. [DOI: 10.1007/s10735-013-9494-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/07/2013] [Indexed: 01/01/2023]
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Osterne RLV, Araújo PM, de Souza-Carvalho ACG, Cavalcante RB, Sant'Ana E, Nongueira RLM. Intralesional corticosteroid injections in the treatment of central giant cell lesions of the jaws: a meta-analytic study. Med Oral Patol Oral Cir Bucal 2013; 18:e226-32. [PMID: 23385503 PMCID: PMC3613330 DOI: 10.4317/medoral.18345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/13/2012] [Indexed: 12/02/2022] Open
Abstract
Objective: The aim of this study was to evaluate the response of treatment of central giant cell lesion to intralesional corticosteroid injections.
Study Design: Review of articles indexed in PubMed on the topic between the years 1988 and 2011, and development of a descriptive meta-analysis of the results.
Results: Sample of 41 patients primarily treated with intralesional corticosteroid injections was obtained, with a male female ratio of 1:0.95, being 23 aggressive and 18 non-aggressive central giant cell lesions. Triamcinolone acetonide and triamcinolone hexacetonide were the drugs used, and 78.0% cases were considered as good result, 14.6% were considered as moderate response and 7.3% were considered as negative result to treatment. Considering the aggressiveness, 88.9% of non-aggressive lesions presented a good response to treatment, in aggressive central giant cell lesions, 69.6% presented a good response to intralesional corticosteroid injections.
Conclusion: In view of the results analyzed, intralesional corticosteroid injections could be considered as first treatment option for central giant cell lesion.
Key words:Central giant cell lesion, corticosteroids injections, triamcinolone hexacetonide, triamcinolone acetonide.
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Treatment of central giant cell lesions using bisphosphonates with intralesional corticosteroid injections. Head Face Med 2012; 8:23. [PMID: 22913518 PMCID: PMC3489779 DOI: 10.1186/1746-160x-8-23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/18/2012] [Indexed: 01/13/2023] Open
Abstract
Central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness. Nonsurgical treatment methods, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. Recently, bisphosphonates have been used to treat central giant cell lesions. A case of a 36-year-old male with a central giant cell lesion crossing the mandibular midline was treated with intralesional corticosteroids combined with alendronate sodium for the control of systemic bone resorption. The steroid injections and the use of bisphosphonates were stopped after seven months when further needle penetration into the lesion was not possible due to new bone formation. After two years, the bony architecture was near normal, and only minimal radiolucency was present around the root apices of the involved teeth. The patient was followed up for four years, and panoramic radiography showed areas of new bone formation. Thus far, neither recurrence nor side effects of the medication have been detected.
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Nogueira R, Faria M, Osterne R, Cavalcante R, Ribeiro R, Rabenhorst S. Glucocorticoid and calcitonin receptor expression in central giant cell lesions: implications for therapy. Int J Oral Maxillofac Surg 2012; 41:994-1000. [DOI: 10.1016/j.ijom.2012.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 11/08/2011] [Accepted: 01/20/2012] [Indexed: 11/17/2022]
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Cyclooxygenase-2 expression in central giant cell lesion of the jaws: an immunohistochemical study. J Mol Histol 2011; 43:59-62. [PMID: 22042094 DOI: 10.1007/s10735-011-9369-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 10/16/2011] [Indexed: 10/16/2022]
Abstract
Central Giant Cell Lesion (CGCL) is an uncommon benign jaw lesion, with uncertain etiology, and a variable clinical behavior. Studies of molecular markers of CGCL, may help understanding better the nature and behavior of this lesion, and eventually may represent a definitive target to pharmacological approach in the treatment of CGCL. Chronic inflammation has been found to mediate a wide variety of diseases including neoplasms. Among the gene products involved in the induction of the inflammatory process, Cyclooxygenase 2 (COX-2) has been shown to have a close relationship with tumorigenesis, however COX-2 expression has never been evaluated in CGCL. The aim of the study was to investigate the expression of COX-2 in CGCL. Immunohistochemical assessment for COX-2 expression was performed in 18 patients previously diagnosed with CGCL. Multinucleated giant cells (MGC) and mononucleated stromal cells (MSC) were used in the slide analysis. Among the patients studied, 10 were male and 8 were female, with a median age of 15.4 years. Lesions in the mandible were observed in 11 cases and 7 were found in the maxilla. There were 9 aggressive and 9 non-aggressive CGCLs. COX-2 immunopositivity was present in only 3 cases stained in both MGC and MSC. All 3 cases presented with ulcerations in the mucosa lesion, suggesting that the COX-2 expression is due to the presence of inflammation. This study does not support the involvement of COX-2 in the etiophatogenesis of CGCL.
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