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Mohammadi F, Bashizadehfakhar H, Aliasghari S, Gholamhoseini Z. Aggressive Multiple Central Giant Cell Granulomas of the Jaws. Case Rep Dent 2023; 2023:5410229. [PMID: 38322589 PMCID: PMC10845258 DOI: 10.1155/2023/5410229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 02/08/2024] Open
Abstract
Central giant cell granuloma (CGCG) is considered a benign intraosseous lesion with a varied range of clinical features in two subtypes, including aggressive and non-aggressive lesions. This study presents a 9-year-old boy with multiple bilateral CGCG in the mandible without any systemic disease or specific syndrome. Clinical, radiographic, and histopathological findings demonstrated the aggressive lesions. It is discussed how the differential diagnosis and treatment can be determined based on the patient's age as well as the size and manner of the lesion.
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Affiliation(s)
- Farnoush Mohammadi
- Craniofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Oral and Maxillofacial Surgery Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoorieh Bashizadehfakhar
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Aliasghari
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Gholamhoseini
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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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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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: 4] [Impact Index Per Article: 0.7] [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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Patel D, Minhas G, Johnson P. A recurrent central giant cell granuloma in a young patient and orthodontic treatment: a case report. J Orthod 2016; 43:306-313. [DOI: 10.1080/14653125.2016.1226566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pattamparambath M, Sathyabhama S, Khatri R, Varma S, Narayanan NM. Benign Fibrous Histiocytoma of Mandible: A Case Report and Updated Review. J Clin Diagn Res 2016; 10:ZD24-6. [PMID: 27504429 DOI: 10.7860/jcdr/2016/19067.8056] [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: 01/24/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022]
Abstract
Benign Fibrous Histiocytoma (BFH) is a well recognised tumour of the soft tissue, developing entirely within the subcutaneous tissue, the deep soft tissues or in the parenchymal organs. However, BFH of bones is poorly defined. It has been rarely reported in the bones with femur, tibia and pelvic bone being the most commonly affected bones. Involvement of the jawbones is rare. Their clinical and radiographic features often simulate the common odontogenic and non-odontogenic lesions of the jaws. Hence, it is imperative for a dentist to have proper knowledge of various conditions affecting the jaws. Here we report a case of BFH which presented as an indolent swelling of the right mandibular posterior region for 15 years. The case emphasizes the need for considering BFH in the differential diagnosis of swellings of the jaws.
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Affiliation(s)
- Manjusha Pattamparambath
- Senior Resident, Department of Oral Pathology and Microbiology, Government Dental College , Calicut, Kerela, India
| | - Sudha Sathyabhama
- Professor and Head, Department of Oral Pathology and Microbiology, Government Dental College , Calicut, Kerela, India
| | - Rohitashwa Khatri
- Senior Resident, Department of Oral Medicine, Government Dental College , Alappuzha, Kerela, India
| | - Sujatha Varma
- Assistant Professor, Department of Oral Pathology and Microbiology, Government Dental College , Calicut, Kerela, India
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Araki M, Ishii T, Matsumoto N, Matsumoto K, Honda K, Nishimura S, Tanaka T. Extremely aggressive behavior of central giant cell granuloma after biopsy:a case report. Oral Radiol 2014. [DOI: 10.1007/s11282-014-0177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Moysich H, Neff A, Dhanuthai K, Pausch NC, Himpel M, Pitak-Arnnop P. Bilateral radiolucent lesions of the jaw in a generalized periodontitis patient. Central giant cell granuloma. ACTA ACUST UNITED AC 2014; 115:e13-6. [PMID: 24440029 DOI: 10.1016/j.revsto.2013.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 09/25/2013] [Indexed: 11/18/2022]
Affiliation(s)
- H Moysich
- Department of Oral and Maxillofacial Surgery, Research Group for Clinical and Psychosocial Research, Evidence-Based Surgery and Ethics in Oral and Maxillofacial Surgery, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany
| | - A Neff
- Department of Oral and Maxillofacial Surgery, Research Group for Clinical and Psychosocial Research, Evidence-Based Surgery and Ethics in Oral and Maxillofacial Surgery, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany
| | - K Dhanuthai
- Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - N C Pausch
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - M Himpel
- Department of Oral and Maxillofacial Surgery, Research Group for Clinical and Psychosocial Research, Evidence-Based Surgery and Ethics in Oral and Maxillofacial Surgery, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany
| | - P Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, Research Group for Clinical and Psychosocial Research, Evidence-Based Surgery and Ethics in Oral and Maxillofacial Surgery, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany.
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Jaffe-Campanacci syndrome, revisited: detailed clinical and molecular analyses determine whether patients have neurofibromatosis type 1, coincidental manifestations, or a distinct disorder. Genet Med 2013; 16:448-59. [PMID: 24232412 DOI: 10.1038/gim.2013.163] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 09/10/2013] [Indexed: 01/02/2023] Open
Abstract
PURPOSE "Jaffe-Campanacci syndrome" describes the complex of multiple nonossifying fibromas of the long bones, mandibular giant cell lesions, and café-au-lait macules in individuals without neurofibromas. We sought to determine whether Jaffe-Campanacci syndrome is a distinct genetic entity or a variant of neurofibromatosis type 1. METHODS We performed germline NF1, SPRED1, and GNAS1 (exon 8) mutation testing on patients with Jaffe-Campanacci syndrome or Jaffe-Campanacci syndrome-related features. We also performed somatic NF1 mutation testing on nonossifying fibromas and giant cell lesions. RESULTS Pathogenic germline NF1 mutations were identified in 13 of 14 patients with multiple café-au-lait macules and multiple nonossifying fibromas or giant cell lesions ("classical" Jaffe-Campanacci syndrome); all 13 also fulfilled the National Institutes of Health diagnostic criteria for neurofibromatosis type 1. Somatic NF1 mutations were detected in two giant cell lesions but not in two nonossifying fibromas. No SPRED1 or GNAS1 (exon 8) mutations were detected in the seven NF1-negative patients with Jaffe-Campanacci syndrome, nonossifying fibromas, or giant cell lesions. CONCLUSION In this study, the majority of patients with café-au-lait macules and nonossifying fibromas or giant cell lesions harbored a pathogenic germline NF1 mutation, suggesting that many Jaffe-Campanacci syndrome cases may actually have neurofibromatosis type 1. We provide the first proof of specific somatic second-hit mutations affecting NF1 in two giant cell lesions from two unrelated patients, establishing these as neurofibromatosis type 1-associated tumors.
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Redfors M, Jensen JL, Storhaug K, Prescott T, Larheim TA. Cherubism: panoramic and CT features in adults. Dentomaxillofac Radiol 2013; 42:20130034. [PMID: 24048692 DOI: 10.1259/dmfr.20130034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To describe the panoramic radiographic and CT features of cherubism in an unselected series of 15 adults. METHODS In this cross-sectional study, 15 individuals aged 29-84 years with familial non-syndromal molecularly confirmed cherubism were examined with panoramic radiography and CT. Bone abnormalities were analysed and described. RESULTS 11 (73%) of the 15 adults had mandibular abnormalities. These abnormalities ranged from subtly detectable to severe, and were less prevalent and expansive but could be rather similar to the characteristic image features in children. Unilocular radiolucencies were more common than multilocular radiolucencies, and a specific feature of these abnormalities was that they were exclusively found in the anterior mandible. CONCLUSIONS The radiographic and CT abnormalities of cherubism in adults were frequent and extremely heterogeneous, with some distinct features.
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Affiliation(s)
- M Redfors
- Department of Maxillofacial Radiology, Faculty of Dentistry, University of Oslo, Blindern, Oslo, Norway
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Borges BBP, Fornazieri MA, Bezerra APCDA, Martins LAL, Pinna FDR, Voegels RL. Giant cell bone lesions in the craniofacial region: a diagnostic and therapeutic challenge. Int Forum Allergy Rhinol 2012; 2:501-6. [PMID: 22566483 DOI: 10.1002/alr.21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 03/01/2012] [Accepted: 03/31/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Giant cell tumors of bone (GCTs) are common in the long bones, but rare in the craniofacial region, with only 1% of cases occurring in the latter. Clinical, radiological, and anatomical diagnosis of this locally aggressive disease, which occurs in response to trauma or neoplastic transformation, poses a major challenge in clinical practice. METHODS The present study describes a series of 4 cases and highlights the main features of the differential diagnosis and treatment of these lesions: GCT, giant cell reparative granuloma (GCRG), and the brown tumor of hyperparathyroidism. RESULTS GCT presents as a benign neoplasm, most typically affecting the knees, and rarely in the temporal and sphenoid bones. It is radiologically indistinguishable from GCRG due to its lytic, poorly defined appearance. The distinction can only be made microscopically, as the presence of multinucleated giant cells scattered throughout the stroma and the absence of a history of trauma favor a diagnosis of GCT. The brown tumor of hyperparathyroidism occurs with rapid, localized osteoclast activity secondary to the effects of increased parathyroid hormone (PTH) levels; parathyroid examination is indispensable. CONCLUSION The diagnosis and treatment of these lesions poses a major challenge due to their similar clinical presentation and radiological appearance. Accurate diagnosis is essential for definition of appropriate management, as complete resection is the goal in GCT and GCRG to avoid recurrence, whereas the brown tumor often yields to treatment of the underlying hyperparathyroidism.
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