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Latorre CG, Atalah CN, Marshall Baburizza M. Denosumab as treatment of central giant cell granuloma of the jaws. a scoping review. Oral Maxillofac Surg 2024; 28:1029-1045. [PMID: 38539018 DOI: 10.1007/s10006-024-01245-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/17/2024] [Indexed: 08/18/2024]
Abstract
Denosumab has been considered a treatment option for Central Giant Cell Granuloma (CGCG) a benign locally aggressive osteolytic lesion of the jaws. This study aimed to perform a scoping review of CGCG treated with Denosumab. The research question was: What is Denosumab's effectiveness in treating CGCG of the jaws? Studies that used Denosumab as a treatment for CGCGs in the jaws were selected following PRISMA-ScR guidelines, using Pubmed/Medline, Scopus, and Springer Link databases, among others. Demographics, clinical information, dosing, efficacy, adverse drug reactions (ADRs), and imaging tests used to assess the evolution of the lesions were extracted. Twenty-one studies were selected. Sixty patients with a mean age of 23.2 years were treated with Denosumab, 42% with 120 mg subcutaneously monthly, additional doses on days 1, 8, and 15 for month 1 in adults. In children, dosing was adjusted by weight to 60 or 70 mg. To avoid ADRs 500 mg of calcium and 400 IU of vitamin D orally were used. Initial effective response was reported after 1-3 months, with recurrence of 19.6% and ADRs in 74% of cases. Denosumab is effective for CGCG with monthly subcutaneous doses of 120 mg, 60 or 70 mg in patients < 45 or 50 kg for ≥ 12 months with calcium and vitamin D supplementation until remission changes are observed. Extensive or refractory lesions were the main indications. Common ADRs were hypo and hypercalcemia. Further studies are needed to define dose and supplementation protocols to avoid ADRs during and after therapy.
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Affiliation(s)
| | | | - Maureen Marshall Baburizza
- Faculty of Dentistry, Universidad Andres Bello, Viña del Mar, Chile.
- Oral Pathology and Oral Medicine Unit, Faculty of Dentistry, Universidad Andres Bello, Quillota 980, Viña del Mar, Chile.
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2
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Doshi A, Bhola N, Agarwal A. Giant Cells, Giant Impact: A Case of Aggressive Central Giant Cell Granuloma in the Mandible. Cureus 2024; 16:e58881. [PMID: 38800208 PMCID: PMC11117025 DOI: 10.7759/cureus.58881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Central giant cell granuloma (CGCG) is a bone lesion characterized by fibrous tissue containing areas of bleeding, giant cells with multiple nuclei, and trabeculae of woven bone. It is considered to be a local bone repair response, possibly triggered by inflammation, bleeding, or local injury. CGCG is more prevalent in females and can occur across a wide age range, typically diagnosed at a young age. Mandibular involvement is more common than maxillary involvement, with most lesions in the posterior region often extending into the ascending ramus. Management of aggressive CGCG can involve non-surgical (medical) and surgical treatment modalities. Surgical approaches vary from simple curettage to en bloc resection depending on various factors discussed in this case report.
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Affiliation(s)
- Akash Doshi
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitin Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anchal Agarwal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Capucha T, Krasovsky A, Abdalla-Aslan R, Ginini JG, Noy D, Emodi O, Rachmiel A, Shilo D. Central giant cell granuloma of the jaws-long-term clinical and radiological outcomes of surgical and pharmacological management. Clin Oral Investig 2024; 28:200. [PMID: 38453790 PMCID: PMC10920455 DOI: 10.1007/s00784-024-05585-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To compare long-term results of different treatment modalities in central giant cell granuloma of the maxillofacial-skeleton. Primary resection may result in major defects. Alternative treatments include pharmacological agents. As yet there has been no consensus on the use of the variety of treatment options, and few studies have reported clarifying long-term results. MATERIALS AND METHODS This retrospective study on 22 patients with 25 lesions evaluated clinical, radiological and histological features, treatment preformed and lesion recurrence. Success was defined as regression/calcification and failure as recurrence, progression or un-responsiveness. RESULTS Of the presenting patients, 77% were under age 40. Lesion prevalence was higher in the anterior mandible and left posterior maxilla. Most cases exhibited pain, tooth-mobility or mucosal-expansion. The appearance was predominantly unilocular in the maxilla and multilocular in the mandible, which also exhibited higher prevalence of cortical perforation. Up to 80% of lesions were classified as aggressive. Intralesional steroids/calcitonin were used in 7 cases. Mean follow-up was 39.8 months. Two cases showed recurrence. In 71% of the cases treated pharmacologically, calcification/regression were observed. CONCLUSIONS Our analysis indicates better outcomes using a combined approach, including both pharmacological and surgical treatments in large aggressive lesions. Pharmacological treatment resulted in decreased size or well-defined lesions, thus reducing the need for extensive bone resection. Dual treatment with corticosteroids and calcitonin showed no superior outcomes, but a larger cohort should be assessed. CLINICAL RELEVANCE There are several protocols for treatment of central-giant-cell-granuloma lesions, but most are not fully established. It is important to report results that contribute to the establishment of proven protocols. This report attempts to establish the relevance of the combined approach: pharmacological treatment followed by surgical resection.
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Affiliation(s)
- Tal Capucha
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Andrei Krasovsky
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | | | | | - Dani Noy
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Omri Emodi
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Adi Rachmiel
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dekel Shilo
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel.
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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4
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Schreuder WH, Meijer EB, Cleven AHG, Edelenbos E, Klop C, Schreurs R, de Jong RT, van Maarle MC, Horsthuis RBG, de Lange J, van den Berg H. Efficacy and Toxicity of Calcitonin Treatment in Children with Cherubism: A Single-Center Cohort Study. J Bone Miner Res 2023; 38:1822-1833. [PMID: 37823782 DOI: 10.1002/jbmr.4922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
Cherubism is a rare autosomal dominant disease characterized by expansile osteolytic jawbone lesions. The effect and safety of off-label calcitonin treatment during the progressive phase of the disease are not well described. In this retrospective study, we present data on the radiological response and adverse effects of subcutaneously administered calcitonin in a cohort of nine cherubism children (three female, six male). Two of the nine patients underwent two separate treatment courses with a significant off-treatment interval in between; therefore, a total of 11 treatment courses with a mean duration of 17.9 months (range <1 to 35, SD 10.8) were studied. To measure the response, the cumulative volume of cherubism lesions was calculated from available three-dimensional imaging. The primary outcome was the change in the volume of lesions during calcitonin treatment and only assessed for the eight treatment courses with a minimal duration of 6 months. A statistically significant reduction in the mean cumulative volume of lesions was seen regardless of treatment duration. Average volume reduction was highest in the first half year of treatment, with a gradual, ongoing reduction thereafter. For the secondary outcome, the change in the cumulative volume of lesions after treatment cessation was assessed for the seven treatment courses with follow-up imaging available. After six of these seven treatment courses, the cumulative volume increased again but remained undoubtedly smaller than the initial volume at the start of therapy. Adverse effects were assessed for all 11 treatment courses and occurred in 73% of them. Most adverse effects were mild and low grade, with the most severe being one grade 3 symptomatic hypocalcemia requiring hospitalization and early treatment termination. Calcitonin treatment seems effective and tolerable in treating actively progressing cherubism in children. However, further research is required to better understand the pharmacological treatment of cherubism, including also other drugs, dosing, and protocols. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Willem H Schreuder
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC 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 Center, Amsterdam, the Netherlands
| | - Ethan B Meijer
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjen H G Cleven
- Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands
| | - Esther Edelenbos
- Department of Pediatric Oncology, Amsterdam University Medical Centers Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Renate T de Jong
- Department of Internal Medicine, Endocrine section, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Merel C van Maarle
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Roy B G Horsthuis
- Department of Oral and Maxillofacial Surgery, Ziekenhuisgroep Twente, Almelo and Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Henk van den Berg
- Department of Pediatric Oncology, Amsterdam University Medical Centers Location AMC, University of Amsterdam, Amsterdam, the Netherlands
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5
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Niada S, Varazzani A, Giannasi C, Fusco N, Armiraglio E, Di Bernardo A, Cherchi A, Baj A, Corradi D, Tafuni A, Parafioriti A, Ferrero S, Bianchi AE, Giannì AB, Poli T, Latif F, Brini AT. Significant association between FGFR1 mutation frequency and age in central giant cell granuloma. Pathology 2023; 55:329-334. [PMID: 36428107 DOI: 10.1016/j.pathol.2022.09.003] [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: 06/10/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022]
Abstract
Central giant cell granulomas (CGCG) are rare intraosseous osteolytic lesions of uncertain aetiology. Despite the benign nature of this neoplasia, the lesions can rapidly grow and become large, painful, invasive, and destructive. The identification of molecular drivers could help in the selection of targeted therapies for specific cases. TRPV4, KRAS and FGFR1 mutations have been associated with these lesions but no correlation between the mutations and patient features was observed so far. In this study, we analysed 17 CGCG cases of an Italian cohort and identified an interesting and significant (p=0.0021) correlation between FGFR1 mutations and age. In detail, FGFR1 mutations were observed frequently and exclusively in CGCG from young (<18 years old) patients (4/5 lesions, 80%). Furthermore, the combination between ours and previously published data confirmed a significant difference in the frequency of FGFR1 mutations in CGCG from patients younger than 18 years at the time of diagnosis (9/23 lesions, 39%) when compared to older patients (1/31 lesions, 0.03%; p=0.0011), thus corroborating our observation in a cohort of 54 patients. FGFR1 variants in young CGCG patients could favour fast lesion growth, implying that they seek medical attention earlier. Our observation might help prioritise candidates for FGFR1 testing, thus opening treatment options with FGFR inhibitors.
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Affiliation(s)
| | - Andrea Varazzani
- Maxillo-Facial Surgery, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Chiara Giannasi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology, University of Milan, Italy
| | | | - Andrea Di Bernardo
- Pathology Department, ASST Istituto Ortopedico Gaetano Pini - CTO, Milan, Italy
| | - Alessandro Cherchi
- Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Baj
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Domenico Corradi
- Department of Medicine and Surgery, Unit of Pathology, University of Parma, Parma, Italy
| | - Alessandro Tafuni
- Department of Medicine and Surgery, Unit of Pathology, University of Parma, Parma, Italy
| | | | - Stefano Ferrero
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; Division of Pathology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Edoardo Bianchi
- Istituto Stomatologico Italiano, Milan, Italy; Unicamillus, Saint Camillus Medical University, Rome, Italy
| | - Aldo Bruno Giannì
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; Maxillo-Facial and Dental Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Tito Poli
- Maxillo-Facial Surgery, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Farida Latif
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences University of Birmingham, Edgbaston, Birmingham, UK
| | - Anna Teresa Brini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
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6
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Schreuder WH, Lipplaa A, Cleven AHG, van den Berg H, Bisschop PH, de Jongh RT, Witjes MJH, Kessler PAWH, Merkx MAW, Edelenbos E, Klop C, Schreurs R, Westermann AM, Tromp JM, Levenga H, Gelderblom H, de Lange J. RANKL inhibition for giant cell lesions of the jaw: A retrospective cohort analysis. Eur J Cancer 2022; 175:263-273. [PMID: 36174298 DOI: 10.1016/j.ejca.2022.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In all giant-cell-rich lesions (GCRL) occurring in bone, a common underlying excessive RANKL expression is held responsible for the osteolytic activity. Apart from giant cell tumour of bone (GCTB), systematic outcome analysis of RANKL inhibition in other GCRL is unavailable. The aim of this study is to assess the efficacy and safety of a 1-year denosumab protocol in giant cell lesions of the jaw (GCLJ). METHODS A retrospective cohort study was conducted compromising patients treated with a 1-year protocol of monthly subcutaneously administered 120 mg denosumab. Objective tumour response based on histology and imaging was used to calculate objective tumour response rate, progression-free survival (PFS) and time to progression. Type, severity and frequency of adverse events were recorded in a standardised way to assess safety. RESULTS Twenty patients, predominantly female (90%), were included. Fifty-five per cent of lesions were located in the mandible; most classified as aggressive lesions (90%). Thirty-five per cent (7/20) of cases were either recurrent after prior treatment or progressive, while on other drug treatment. Objective tumour response rate was 100% after 12 months of treatment. Median PFS was 50.4 months (95% CI 38.0-62.8) with a cumulative PFS rate of 22.6% (95% CI 1.8-43.4) at 5 years follow-up. Median time to progression was 38.4 months (95% CI 26.0-50.8). Treatment was well tolerated, and none of the patients had to interrupt therapy for toxicity. CONCLUSION High-dose denosumab is effective and safe in achieving a complete response in GCLJ within 12 months. The high long-term relapse rate after treatment cessation is the main obstacle for denosumab to become standard treatment for GCLJ.
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Affiliation(s)
- Willem H Schreuder
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC (Location AMC) and Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands; Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Astrid Lipplaa
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjen H G Cleven
- Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Henk van den Berg
- Department of Pediatric Oncology, Amsterdam University Medical Centers Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine, Endocrine section, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter A W H Kessler
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery and IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands; Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Esther Edelenbos
- Department of Pediatric Oncology, Amsterdam University Medical Centers Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC (Location AMC) and Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC (Location AMC) and Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands
| | - Anneke M Westermann
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jacqueline M Tromp
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Henriette Levenga
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC (Location AMC) and Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands
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7
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Camarini C, de Souza Tolentino E. Non-surgical treatment as an alternative for the management of central giant cell granuloma: a systematic review. Clin Oral Investig 2022; 26:2111-2132. [PMID: 34599398 DOI: 10.1007/s00784-021-04193-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/21/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of non-surgical treatment as an alternative in the management of central giant cell granuloma (CGCG). MATERIAL AND METHODS A literature search was carried out in accordance with the PRISMA statement in order to answer the question "Are non-surgical treatments effective as an alternative in the treatment of CGCG?". Two examiners independently assessed eligibility, risk of bias, and extracted data, which included therapeutic protocol, side effects, and need for surgical supplementation. RESULTS Among 1712 studies, 15 were included, totaling 145 patients. Calcitonin, intralesional corticosteroids, and denosumab were the medications used. For calcitonin (n = 61), complete remission was found in 30 cases. For intralesional triamcinolone (n = 68), reduction in size was observed in most cases (n = 39). Four cases received subcutaneous denosumab and showed absence of active bone metabolism in the region, of which three presented ossification. Combination of drug therapies (n = 29) was reported in one study and included subcutaneous interferon and oral imatinib. More and less side effects were found for interferon and corticosteroids, respectively. Forty percent of patients required additional surgical treatment. CONCLUSION Despite the side effects presented and the need for additional surgery in some patients, in general, all non-surgical treatments could provide positive results as an alternative for the management of CGCG, especially with regard to reducing the size of the lesion. CLINICAL RELEVANCE CGCG is a benign bone lesion that mainly affects young individuals. Although the most common therapy is surgery, its contraindication in some patients, the large extension, and high recurrence rate of the aggressive variant have led the search for non-surgical therapies.
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Affiliation(s)
- Camila Camarini
- Department of Dentistry, Maringá State University, Avenida Mandacaru, Maringá, Paraná, 87080-000, Brazil.
| | - Elen de Souza Tolentino
- Department of Dentistry, Maringá State University, Avenida Mandacaru, Maringá, Paraná, 87080-000, Brazil
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8
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Lima BC, Pinheiro GL, Pinto LAPF, Cavalcante MADA. Treatment of a central giant cell lesion in the mandible. Natl J Maxillofac Surg 2021; 12:414-417. [PMID: 35153441 PMCID: PMC8820298 DOI: 10.4103/njms.njms_227_20] [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: 10/15/2020] [Revised: 02/19/2021] [Accepted: 03/22/2021] [Indexed: 11/04/2022] Open
Abstract
Central giant cell lesion (CGCL) is a benign intraosseous lesion that usually accompany the gnathic bones in the anterior region, mostly crossing the midline. Its clinical features involve cortical expansion, tooth displacement, and root resorption. Pain may occur in 20% of cases. Histopathological characteristics are like other pathological entities, being necessary discarding them. In this case, a 53-year-old female presented an expansive legion in the anterior mandible with tooth displacement and pain. After incisional biopsy, the result was CGCL. Surgical planning involved manufacturing a biomodel, bending the reconstruction plate to give the correct mandibular arch perimeter. After that, it was performed a segmental resection and installation of a reconstruction plate using a cervical approach. The patient is under follow-up with no signs of recurrence or complications.
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Affiliation(s)
- Bernardo Correia Lima
- Department of Oral Surgery, Oral Surgery Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giulianna Lima Pinheiro
- Department of Oral Surgery, Oral Surgery Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Augustus Peral Ferreira Pinto
- Department of Oral Surgery, Oral Surgery Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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9
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Anand S, Kv A. An Aggressive Central Giant Cell Granuloma of Mandible in an Older Patient Managed Successfully With Marginal Mandibulectomy and Reconstruction With Submental Island Flap. Cureus 2021; 13:e15414. [PMID: 34249561 PMCID: PMC8254205 DOI: 10.7759/cureus.15414] [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] [Accepted: 06/03/2021] [Indexed: 11/05/2022] Open
Abstract
The Central giant cell granuloma (CGCG) is a non-odontogenic, osteolytic lesion of unknown aetiology, which affects the craniofacial region, particularly the anterior mandible. The age group commonly affected is below 30 years, with a distinct female predilection. Histopathological analyses show fibro cellular stroma consisting of evenly distributed multinucleated giant cells, multiple foci of haemorrhage, and focal areas of spicules of newly formed bone. Depending upon the extent, behaviour, and characteristics management varies from non-surgical to surgical approaches. Since CGCG is associated with a higher rate of recurrence, excision by curettage with the removal of peripheral bone margins is the gold standard and radical surgical intervention in aggressive lesions is associated with low recurrences. Reconstruction of the resulting surgical defect is extremely important to restore aesthetics and function. This case report reviews presentation along with currently used therapies for CGCG while describing an uncommon case of locally aggressive CGCG occurring in a 50-year-old female involving the posterior mandibular region, successfully managed with marginal mandibulectomy, curettage and reconstructed with submental island flap with no recurrence during follow up.
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Affiliation(s)
- Sumit Anand
- Oral and Maxillofacial Surgery, Teerthanker Mahaveer Dental College and Research Centre, Teerthanker Mahaveer Hospital, Teerthanker Mahaveer University, Moradabad, IND
| | - Arunkumar Kv
- Oral and Maxillofacial Surgery, Teerthanker Mahaveer Dental College and Research Centre, Teerthanker Mahaveer Hospital, Teerthanker Mahaveer University, Moradabad, IND
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10
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Ahmed A, Naidu A. Towards better understanding of giant cell granulomas of the oral cavity. J Clin Pathol 2021; 74:483-490. [PMID: 33858937 DOI: 10.1136/jclinpath-2020-206858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/08/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022]
Abstract
Giant cell granulomas are enigmatic lesions of the oral cavity characterised by a peculiar combined proliferation of mononuclear and multinucleated giant cells in a mesenchymal stromal background. Central and peripheral giant cell granulomas may have similar pathogenesis and histology but differ in their location and biological behaviour. It is important to differentiate them from other giant cell lesions that can occur in the oral cavity, such as giant cell tumour of the bone, aneurysmal bone cyst, brown tumour of hyperparathyroidism, and giant cell lesions of Ramon syndrome, Noonan syndrome, neurofibromatosis and Jaffe-Campanacci syndrome. A recent insight into their molecular genetics and pathogenesis, with identification of KRAS, FGFR1 and TRPV4 mutations, allows for better diagnostic differentiation and opens the door to the use of pathway inhibitors in the treatment of recurrent or dysmorphic lesions. In this review, we provide an updated summary of the clinical and pathological features of oral cavity giant cell granulomas that help with their precise diagnosis and management.
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Affiliation(s)
- Atif Ahmed
- Pathology and Laboratory Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA .,Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Aparna Naidu
- Oral Pathology, University of Missouri Kansas City, Kansas City, Missouri, USA
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11
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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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12
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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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13
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Chen Y, Zhang J, Han Y, Troulis MJ, August M. Benign Pediatric Jaw Lesions at Massachusetts General Hospital Over 13 Years. J Oral Maxillofac Surg 2020; 78:1124-1135. [DOI: 10.1016/j.joms.2020.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/13/2022]
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14
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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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15
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Zhang Q, He Z, Wang G, Jiang H. Radiotherapy for recurrent central Giant cell granuloma: a case report. Radiat Oncol 2019; 14:130. [PMID: 31324249 PMCID: PMC6642559 DOI: 10.1186/s13014-019-1336-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/11/2019] [Indexed: 12/30/2022] Open
Abstract
Background Central giant cell granuloma (CGCG) is a rare, non-neoplastic, benign lesion that exhibits expansive and osteolytic biological behavior. CGCG treatment and management is challenging for clinicians. Case presentation This report presents the treatment and management of recurrent, aggressive CGCG after surgical resection. After informed consent was obtained, the patient underwent radiotherapy. The lesion size was reduced significantly, with no evidence of recurrence or malignant transformation. Conclusions This treatment experience indicates that radiotherapy can be used as a rescue treatment for complicated CGCG involving vital neurovascular structures of the cranial base.
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Affiliation(s)
- Qi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical University and Tumor Hospital Affiliated to Bengbu Medical University, 287 Changhuai Road, Bengbu, Anhui, 233004, People's Republic of China.,Anhui Province Key Laboratory of Translational Cancer Research Affiliated to Bengbu Medical University, Bengbu, 233004, China
| | - Zelai He
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical University and Tumor Hospital Affiliated to Bengbu Medical University, 287 Changhuai Road, Bengbu, Anhui, 233004, People's Republic of China.,Anhui Province Key Laboratory of Translational Cancer Research Affiliated to Bengbu Medical University, Bengbu, 233004, China
| | - Gengming Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical University and Tumor Hospital Affiliated to Bengbu Medical University, 287 Changhuai Road, Bengbu, Anhui, 233004, People's Republic of China.,Anhui Province Key Laboratory of Translational Cancer Research Affiliated to Bengbu Medical University, Bengbu, 233004, China
| | - Hao Jiang
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical University and Tumor Hospital Affiliated to Bengbu Medical University, 287 Changhuai Road, Bengbu, Anhui, 233004, People's Republic of China. .,Anhui Province Key Laboratory of Translational Cancer Research Affiliated to Bengbu Medical University, Bengbu, 233004, China.
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16
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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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17
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Abdelqader S, Roche N, Manfredi L, Papon JF, Maman L, Ferré F. Giant-cell granuloma: 2 case reports. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2018007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction: Giant-cell granuloma (GCG) is a benign tumor occurring almost exclusively in the jaws. These lesions remain rare but can sometime have an aggressive behavior. In this article, we will describe and follow two cases of GCG. Observations: The first case is a referred female patient, who presents a mandibular swelling. Its clinical and radiological aspects lead us to do a biopsy, with a histological result of GCG. The second case is a patient with a terminal kidney failure, referred for a buccal swelling in the upper left jaw. The cone-beam computed tomography X-ray shows a compartmentalized lesion with blurry limits. An excisional biopsy is performed and the histological diagnosis is a GCG. Discussion: Although the first patient suffers from no systemic disease, the second one presents a terminal kidney failure resulting in a chronic hyperparathyroidism. Hyperparathyroidism can activate osteoclastic resorption and create bone lesions such as brown tumors. Conclusion: The slow and asymptomatic growth of these lesions often result in a late diagnosis. It should be kept in mind as a differential diagnosis when dealing with an osteolytic lesion of the jaws with no clear etiology, especially if hyperparathyroidism or kidney failure is associated.
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18
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Huguet G, Piot B, Cassagnau E, Simon JF, Lesclous P. Rare agressive form of giant-cell granuloma: a three years follow-up case report and discussion about medical therapeutic solutions. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2018021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Central giant cell granuloma (CGCG) is a rare and benign intraosseous lesion that usually occurs in the mandible and the maxilla. It might be aggressive. Nowadays, several treatments exist. Observation: This case report, with a three years follow-up, was about an aggressive and recurring form of CGCG exclusively managed by surgical approach. Comments: Several pharmacologic approaches are possible (intralesional injections of glucocorticoids, administration of calcitonin, alpha-2a interferon, denosumab) and could be an interesting alternative or complement to the surgical management when CGCG is aggressive, recurring, or non resectable. Conclusion: Surgical approach is the gold standard for the treatment of CGCG but sometimes, pharmacologic approaches could be proposed. According to the scientific literature, denosumab appears as a reliable and effective treatment but more prospective studies are needed.
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19
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Altan H, Altan A, Erağca R, Yildirim E, Akbulut N. Surgical treatment of central giant cell granuloma in child and follow-up for 18 months. PEDIATRIC DENTAL JOURNAL 2018. [DOI: 10.1016/j.pdj.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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21
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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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22
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Bouloux GF, Roser SM, Abramowicz S. Pediatric Tumors of the Temporomandibular Joint. Oral Maxillofac Surg Clin North Am 2018; 30:61-70. [PMID: 29153238 DOI: 10.1016/j.coms.2017.08.003] [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] [Indexed: 12/19/2022]
Abstract
The incidence of tumors and pseudotumors of the temporomandibular joint (TMJ) in the pediatric population is low. They are often challenging to recognize unless associated with signs and symptoms that may erroneously be interpreted as TMJ dysfunction. Tumors of the TMJ can be divided into 3 categories based on the nature and type of precursor cell involved in the tumor: benign tumors, malignant tumors, and pseudotumors. This article discusses the most common entities in these categories.
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Affiliation(s)
- Gary F Bouloux
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Steven M Roser
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA; Section of Dentistry/Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30322, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA; Section of Dentistry/Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30322, USA.
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23
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Chrcanovic BR, Gomes CC, Gomez RS. Central giant cell lesion of the jaws: An updated analysis of 2270 cases reported in the literature. J Oral Pathol Med 2018; 47:731-739. [PMID: 29751369 DOI: 10.1111/jop.12730] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To review all available data published on central giant cell lesion (CGCL) of the jaws into a comprehensive analysis of its clinical/radiological features, with emphasis on the predictive factors associated with its recurrence. METHODS An electronic search was undertaken in 5 databases (February/2018), looking for reporting cases of CGCLs. RESULTS A total of 365 publications were included, comprising 2270 lesions. CGCLs were more prevalent in women and the mandible. Cortical bone perforation occurred in 50% of the cases. Marginal/segmental resection was more often performed in larger lesions, and drug therapy was more frequent in small lesions. Recurrence was reported in 232 of 1316 cases (17.6%). The recurrence rate of the aggressive lesions (22.8%) after surgical treatment was higher than non-aggressive lesions (7.8%). Four of 5 CGCLs showed partial/total regression with pharmacological treatment. Aggressive lesions showed a worse response to corticosteroids than non-aggressive lesions. For the lesions submitted to surgery as the first treatment, curettage, enucleation, or marginal resection in relation to segmental resection, aggressive lesions, cortical bone perforation, and tooth root resorption were associated with increased recurrence rate. Recurrence related to a combination of surgical/pharmacological treatment could not be evaluated due to the variety of protocols. CONCLUSIONS Aggressive CGCLs recur more often than the non-aggressive ones. Despite sometimes showing poor response to corticosteroid injection or surgical curettage, a combination of both treatment strategies should be considered in aggressive cases to reduce morbidities associated with radical surgery. The best protocol to manage aggressive and non-aggressive lesions remains to be determined.
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Affiliation(s)
| | - Carolina Cavalieri Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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24
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Kurucu N, Akyuz C, Ergen FB, Yalcin B, Kosemehmetoglu K, Ayvaz M, Varan A, Aydin B, Kutluk T. Denosumab treatment in aneurysmal bone cyst: Evaluation of nine cases. Pediatr Blood Cancer 2018; 65. [PMID: 29286564 DOI: 10.1002/pbc.26926] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/04/2017] [Accepted: 11/17/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Aneurysmal bone cyst (ABC) is a benign bone tumor. Curettage and bone grafting is the common treatment. Here, we retrospectively evaluate nine patients treated with denosumab. PROCEDURE Nine patients with ABC, mostly pelvic and vertebral, treated with denosumab were analyzed retrospectively. A 70 mg/m2 denosumab dose was used weekly in the first month, and then monthly. Clinical and radiological responses to treatment were evaluated. RESULTS In all patients, clinical symptoms including pain and limping regressed completely within 3 months. Radiological evaluation revealed changes in lesion size and content. In six patients, overall volume reduction in the range of 18-82% was detected. Decreases in the size and number of cysts were detected in eight patients. In five patients, fat signal appeared on follow-up imaging. No major side effects were observed during treatment. Median follow-up time after treatment was 15 months. At 5 months, severe hypercalcemia was observed in two patients due to rebound increase in osteoclastic activity. Subsequent to denosumab treatment, three patients underwent surgery for clinical or radiological recurrence. CONCLUSIONS Our results showed that denosumab provided a meaningful clinical and radiological improvement in ABC. It may be a treatment option, especially in spinal and pelvic tumors with potentially high surgical morbidity. However, late rebound hypercalcemia may restrict its use. Studies with more cases are required for routine use of denosumab in ABC.
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Affiliation(s)
- Nilgun Kurucu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Canan Akyuz
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Bilge Ergen
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bilgehan Yalcin
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kemal Kosemehmetoglu
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ayvaz
- Department of Orthopedia, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Varan
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burca Aydin
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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25
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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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26
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Denosumab as a Treatment Alternative for Central Giant Cell Granuloma: A Long-Term Retrospective Cohort Study. J Oral Maxillofac Surg 2017; 76:775-784. [PMID: 29035698 DOI: 10.1016/j.joms.2017.09.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Giant cell granuloma (GCG) of the jaw is a rare disease with high morbidity. Various treatment options have been discussed in the past. Since 2010, a pharmaceutical therapy with denosumab seems to have been successful for giant cell tumors of the femur. The authors hypothesized the equally successful use of denosumab for GCGs of the jaws. MATERIALS AND METHODS In the present retrospective cohort study, 5 patients with large GCGs of the jaws were treated with denosumab with a follow-up of 25 to 49 months. Frequent clinical follow-ups and a radiologic follow-up were performed and systematically analyzed. RESULTS All patients showed a curative treatment response and complete metabolic resolution of the GCGs under treatment with denosumab. CONCLUSION A brief review of the relevant literature and a detailed evaluation of current cases led to the conclusion that denosumab therapy should be considered a therapeutic option for large central GCGs of the jaws. The results of this study suggest denosumab is a successful treatment option. A treatment length no shorter than 12 months is recommended and monitoring of treatment response can be well managed by positron-emission tomographic computed tomography or magnetic resonance imaging.
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