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Barut O, Mukdad M, Danielsson K, Legrell PE, Sjöström M. Giant cell granuloma and neurofibroma in the mandible of a patient with neurofibromatosis type 1: a long-term follow-up case report with radiological and surgical aspects and a review of the literature. BMC Oral Health 2024; 24:792. [PMID: 39004713 PMCID: PMC11247863 DOI: 10.1186/s12903-024-04543-9] [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: 04/04/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) of the brain is frequently performed on patients with neurofibromatosis type 1 (NF1), to detect and follow-up intracranial findings. In addition, NF1-related pathologies can appear in the jaws. This case study investigates if it is advantageous to assess the depicted parts of the jaws in the imaging of NF1 patients with intracranial findings, thereby detecting jaw pathologies in their initial stages. CASE PRESENTATION We report on the 3-year management with clinical and radiological follow-ups of a central giant cell granuloma and a neurofibroma in the mandible of a patient with NF1 who underwent examinations with brain MRIs. A review of the mandible in the patient's MRIs disclosed lesions with clear differences in progression rates. CONCLUSION NF1-related jaw pathologies may be detected in the early stages if the depicted parts of the jaws are included in the assessment of the imaging of NF1 patients with intracranial findings. This could impact the treatment of eventual pathologies before lesion progression and further damage to the vicinity.
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Affiliation(s)
- Oya Barut
- Oral and Maxillofacial Radiology, Umeå University Hospital, Umeå, Sweden.
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden.
| | - Marcel Mukdad
- Oral and Maxillofacial Surgery, Umeå University Hospital, Umeå, Sweden
| | - Karin Danielsson
- Orofacial Medicine, Department of Odontology, Umeå University, Umeå, Sweden
| | - Per Erik Legrell
- Oral and Maxillofacial Radiology, Umeå University Hospital, Umeå, Sweden
| | - Mats Sjöström
- Oral and Maxillofacial Surgery, Department of Odontology, Umeå University, Umeå, Sweden
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2
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Sarangi S, A C LR, Narayanan V, Gurram P, Subramanian A. Indulging into the Enigma of the Central Giant Cell Granuloma: A Case Report. Cureus 2024; 16:e65068. [PMID: 39170997 PMCID: PMC11336516 DOI: 10.7759/cureus.65068] [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: 06/26/2024] [Accepted: 07/21/2024] [Indexed: 08/23/2024] Open
Abstract
The oral cavity surprises us with a humongous variety of lesions. Central giant cell granuloma (CGCG) is one such rare presentation. The etiology of CGCG is controversial, which ranges from initially being considered a reparative lesion to currently being hypothesized as a mesenchymal proliferative jaw lesion. Clinically, CGCG is not a typical presenting lesion. It may be asymptomatic or even manifest as a slow-growing swelling. This entity most commonly occurs in younger females, particularly situated in the mandible. Here is a case report of a 31-year-old female with CGCG.
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Affiliation(s)
- Shweta Sarangi
- Department of Oral and Maxillofacial Surgery, Sri Ramaswamy Memorial Kattankulathur Dental College and Hospital, Chengalpattu, IND
| | - Lakshmi Rathan A C
- Department of Oral and Maxillofacial Surgery, Sri Ramaswamy Memorial Kattankulathur Dental College and Hospital, Sri Ramaswamy Memorial Institute of Science and Technology, Chengalpattu, IND
| | - Vivek Narayanan
- Department of Oral and Maxillofacial Surgery, Sri Ramaswamy Memorial Kattankulathur Dental College and Hospital, Sri Ramaswamy Memorial Institute of Science and Technology, Chengalpattu, IND
| | - Prashanthi Gurram
- Department of Oral and Maxillofacial Surgery, Sri Ramaswamy Memorial Kattankulathur Dental College and Hospital, Sri Ramaswamy Memorial Institute of Science and Technology, Chengalpattu, IND
| | - Abinaya Subramanian
- Department of Oral and Maxillofacial Surgery, Sri Ramaswamy Memorial Kattankulathur Dental College and Hospital, Sri Ramaswamy Memorial Institute of Science and Technology, Chengalpattu, IND
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3
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Friedrich RE, Rutkowski R, Gosau M. Multiple central giant cell granuloma of the jaws: diagnostic signposts of Noonan syndrome and RASopathy. Oral Maxillofac Surg 2024; 28:991-997. [PMID: 38347383 PMCID: PMC11144677 DOI: 10.1007/s10006-024-01209-2] [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: 07/12/2023] [Accepted: 01/07/2024] [Indexed: 06/04/2024]
Abstract
Noonan syndrome (NS) is a phenotypically variable inherited multi-system disorder. Maxillofacial findings can be diagnostic, especially in the evaluation of discrete facial dysmorphia. Diagnostic landmark findings of therapeutic relevance for the jaws such as central giant cell granuloma (CGCG) are rare in NS. However, recent molecular genetic studies indicate that these rare, benign lesions are neoplasms and more common in specific syndromes grouped under the umbrella term RASopathies. A specialist surgical diagnosis can be helpful in identifying the underlying disease. This report outlines diagnosis and treatment of a case of CGCG for which jaw diagnosis became the key to identifying a syndromic disease.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, 20246, Hamburg, Germany.
| | - Rico Rutkowski
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, 20246, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, 20246, Hamburg, Germany
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4
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Ari I, Adiloglu S, Aktas A, Yasan GT, Usman E, Aksoy S. Incidence, treatment method and recurrence rate in giant cell granulomas: Retrospective study. J Craniomaxillofac Surg 2024; 52:697-703. [PMID: 38641523 DOI: 10.1016/j.jcms.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/12/2024] [Indexed: 04/21/2024] Open
Abstract
Central and peripheral giant cell granulomas are benign entities mostly seen in mandibular anterior region at female individuals, usually with observed recurrence. Their etiology is still unclear, as is the optimal method for treating them. The aim of this study was to evaluate the incidence, treatment methods, recurrence rates, and initial and definitive correlation of central and peripheral giant cell granulomas. Patients who were referred to our clinic between 2013 and 2023 and who had the lesions' definitive diagnosis as "central giant cell granuloma" (CGCG) or "peripheral giant cell granuloma" (PGCG) were included in the study. Demographic data, recurrence rates, treatment methods, lesion location, clinical behaviors, and sizes were noted on the reports. A total of 30 lesions in 23 patients (14 PGCG and 9 CGCG) were evaluated in this study. The mean follow-up time was 62.6 months; 8 of 23 patients had systemic disease. While only 1 patient was observed to have cortical bone destruction in PCGC, all patients were found to have cortical bone destruction in CGCG (p < 0.05). In both lesions, the correlation of preliminary and definitive diagnosis was evaluated, and it was found to be 50% in PGCG while it was 77.7% in CGCG. The recurrence rates were 21.4% in PGCG and 33.3% in CGCG. Curettage was applied in all patients. Additional treatments (intralesional steroid injections, denasumab applications, resection, and graft application) were performed in 5 patients who were found to have CGCG (p = 0.004). However, there was no significant relation between treatment method and recurrence in CGCG (p > 0.05). Various peripheral lesions could mimic PGCG; thus, curettage therapy could be appropriate in the treatment of PGCG. Nevertheless, in some cases of CGCG, additional treatment methods could be more effective for preventing recurrence and any other complications.
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Affiliation(s)
- Ilgin Ari
- Hacettepe University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey.
| | - Selen Adiloglu
- Hacettepe University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Alper Aktas
- Hacettepe University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Göknur Topaloglu Yasan
- Hacettepe University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Ecem Usman
- Hacettepe University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Sena Aksoy
- Hacettepe University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
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5
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Desai OV, Kshirsagar R, Singh V, Nair VS, Sane V, Jain S, Agarwal R. Central Giant Cell Granuloma of the Mandible: A Case Report. Cureus 2024; 16:e57729. [PMID: 38711708 PMCID: PMC11073805 DOI: 10.7759/cureus.57729] [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] [Accepted: 04/06/2024] [Indexed: 05/08/2024] Open
Abstract
This article presents a clinical case of a central giant cell granuloma (CGCG) resembling a periapical lesion of endodontic origin. A 39-year-old, otherwise healthy male patient was referred to the department of oral and maxillofacial surgery for its diagnosis and subsequent management. The patient presented with an asymptomatic, progressively increasing intraoral swelling associated with the mandibular left para-symphysis region. On radiographic evaluation, a unilocular radiolucent lesion involving 33-34 teeth was noted. An incisional biopsy presented a giant cell lesion, following which surgical curettage was done. Histopathological examination was in accordance with the diagnosis of CGCG. Therefore, it is imperative for clinicians to accurately diagnose and rule out similarly presenting lesions.
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Affiliation(s)
- Ojas V Desai
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Rajesh Kshirsagar
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Vikram Singh
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Vivek S Nair
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Vikrant Sane
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
| | - Saurabh Jain
- Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, Pune, IND
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6
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Dareh MTB, Andisheh‐Tadbir A, Aghakouchakzadeh A. Evaluation of the relationship between the expression of AgNOR and Ki67 with the recurrence rate in central granulomatous giant cell lesions: A case-control. Clin Exp Dent Res 2024; 10:e870. [PMID: 38506305 PMCID: PMC10952119 DOI: 10.1002/cre2.870] [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: 07/20/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Giant cell granuloma is a local nonneoplastic lesion that is divided into two categories, based on its site of occurrence: Central and peripheral giant cell granuloma. Central giant cell granuloma is an intraosseous lesion that has a tendency to recure even in surgically treated cases. Several studies have proven that there is an association between different lesions clinical behavior and their histological features. The aim of this study was to evaluate the expression of AgNOR and Ki67 in lesions with and without recurrency. MATERIAL AND METHODS Files and records of 35 patients who had been histologically diagnosed with central giant cell granuloma were investigated. Histological features were studied after performing AgNOR staining and Ki67 marker. The data were analyzed by chi-square, Fisher, and T-test. RESULTS Acquired data indicated that the count of AgNOR staining and Ki67 marker was significantly higher in lesions with recurrency than the lesions with no recurrency. The same results were attained from Ki67 intensity. CONCLUSION The current study indicated that AgNOR staining and Ki67 marker have prognostic value in predicting recurrency of central giant cell granuloma lesions.
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Affiliation(s)
- Mina T. B. Dareh
- Student Research Committee, School of DentistryAlborz University of Medical SciencesKarajIran
| | - Azadeh Andisheh‐Tadbir
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Oral and Dental Disease Research CenterShiraz University of Medical SciencesShirazIran
| | - Arezoo Aghakouchakzadeh
- Department of oral and maxillofacial pathology, School of DentistryAlborz University of Medical ScienceKarajIran
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7
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Shasteen AM, Friedman LV, Potluri A, Prasad JL. A subpontine osteolytic lesion of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:666-672. [PMID: 37599187 DOI: 10.1016/j.oooo.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Affiliation(s)
| | - Lauren V Friedman
- University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - Anitha Potluri
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - Joanne L Prasad
- Department of Oral and Craniofacial Sciences/Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.
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8
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Liu Y, Housley Smith M, Patel PB, Bilodeau EA. Pediatric Gnathic Bony and Mesenchymal Tumors. Pediatr Dev Pathol 2023; 26:621-641. [PMID: 37232383 DOI: 10.1177/10935266231170744] [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] [Indexed: 05/27/2023]
Abstract
Evaluation of bone pathology within the head and neck region, particularly the gnathic bonesis is complex, demonstrating unique pathologic processes. In part, this variation is due to odontogenesis and the embryological cells that may be involved, which can contribute to disease development and histologic variability. As with any boney pathosis, the key is to have clinical correlation, particularly with radiographic imaging prior to establishing a definitive diagnosis. This review will cover those entities that have a predilection for the pediatric population, and while it is not all inclusive, it should serve as a foundation for the pathologist who is evaluating bony lesions involving the craniofacial skeleton.
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Affiliation(s)
- Yingci Liu
- Rutgers School of Dental Medicine, Newark, NJ, USA
| | | | - Paras B Patel
- Center for Oral Pathology, Dallas, TX, USA
- Oral and Maxillofacial Pathology ProPath, Dallas, TX, USA
| | - Elizabeth Ann Bilodeau
- Oral & Maxillofacial Pathology, Director, UDHS Oral Pathology Laboratory, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
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9
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Arumugam SD, Kanniyappan B, Giri U, Muthanandam S. Aggressive giant cell lesion of mandible-confusing to common: true neoplasm versus reactive lesion. BMJ Case Rep 2023; 16:e253499. [PMID: 37142281 PMCID: PMC10163411 DOI: 10.1136/bcr-2022-253499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Destructive lesions in the craniofacial region especially in the jawbones, if associated with giant cells, include a spectrum of lesions that pose difficulty in diagnosis. The nature of such a lesion in the jawbones is questionable about whether it is a reactive/benign lesion or aggressive/non-aggressive. Clinical, radiological and histopathological correlation may be a reliable indicator to differentiate between the qualities of the lesion, which directly accounts for effective and individual planning of the treatment. Here we present a case of a woman in her late 20s with an unusual destructive lesion of the mandible.
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Affiliation(s)
- Santha Devy Arumugam
- Oral & Maxillofacial Pathology and Oral Microbiology, Sri Balaji Vidyapeeth University, Pondicherry, India
| | - Bharathraj Kanniyappan
- Oral & Maxillofacial Surgery, Sri Balaji Vidyapeeth University, Pondicherry, Puducherry, India
| | - Umamaheswari Giri
- Oral & Maxillofacial Pathology and Oral Microbiology, Sri Balaji Vidyapeeth University, Pondicherry, India
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10
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Hoarau E, Quilhot P, Baaroun V, Lescaille G, Campana F, Lan R, Rochefort J. Oral giant cell tumor or giant cell granuloma: How to know? Heliyon 2023; 9:e14087. [PMID: 36923864 PMCID: PMC10008978 DOI: 10.1016/j.heliyon.2023.e14087] [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: 12/02/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction The distinction between giant cell tumors and giant cell granulomas is challenging, as both entities have overlapping diagnostic criteria, especially in oral locations. The two entities have similar clinical and radiological presentations, but they differ in their prognoses. Objective The main objective of this study was to list the clinical, radiological, histological, and prognostic features of maxillomandibular giant cell tumors and giant cell granulomas cases n order to assess their value as a diagnostic referral factor that may allow the distinction between maxillo-mandibular giant cell granuloma and giant cell tumor. Study design Data of maxillomandibular giant cell granulomas and giant cell tumors were assessed through a scoping review and a pre-existing systematic review of literature. We have also realized a bicentric retrospective study. Results Various criteria facilitate the differential diagnosis like age, size, locularity and presence of necrosis zone but not the gender. The most discriminating factors was symptomatology (reported in 72% of GCTs while only 15% of GCGs) and the distribution pattern of giant cells in the stroma (homogeneously dispersed in 80% of GCTs versus grouped in clusters in 86.7% of GCGs). Recurrences were most described for giant cell tumors than giant cell granulomas. Malignant transformation and pulmonary metastasis were exclusively reported for giant cell tumors. Conclusion As clinical and radiological elements are not sufficient to distinguish between these two entities, immunohistochemistry and molecular genetics can be represent diagnostic biomarkers to distinguish giant cell granulomas and giant cell tumors in oral cavity. We have attempted to define the main criteria for the differentiation of giant cell tumor and giant cell granuloma and propose a decision tree for the management of single maxillomandibular giant cell lesions.
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Affiliation(s)
- E. Hoarau
- Service Odontologie, Assistance Publique Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière, Paris, France
- Aix Marseille Univ, APHM, Timone Hospital, Oral Surgery Department, Marseille, France
| | - P. Quilhot
- Médecine Sorbonne Université, Paris, France
- Department of Pathology, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - V. Baaroun
- Service Odontologie, Assistance Publique Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière, Paris, France
- Université Paris Cité, Faculté de Santé, UFR Odontologie, Paris, France
| | - G. Lescaille
- Service Odontologie, Assistance Publique Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière, Paris, France
- Université Paris Cité, Faculté de Santé, UFR Odontologie, Paris, France
| | - F. Campana
- Aix Marseille Univ, APHM, INSERM, MMG, Timone Hospital, Oral Surgery Department, Marseille, France
| | - R. Lan
- Aix Marseille Univ, APHM, CNRS, EFS, ADES, Timone Hospital, Oral Surgery Department, Marseille, France
| | - J. Rochefort
- Service Odontologie, Assistance Publique Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière, Paris, France
- Université Paris Cité, Faculté de Santé, UFR Odontologie, Paris, France
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11
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Green P, Vasilyeva D, Philipone E, Koslovsky DA. Mandibular radiolucency in a 59-year-old woman. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:661-667. [PMID: 35400626 DOI: 10.1016/j.oooo.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Parker Green
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Daria Vasilyeva
- Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Elizabeth Philipone
- Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - David A Koslovsky
- Private practice, New York, NY, USA; Division of Oral and Maxillofacial Surgery, Columbia University Irving Medical Center, New York, NY, USA
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12
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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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13
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Koutrakis NE, Vasilyeva D, Friedman JM. Mandibular radiolucency in an 11-year-old girl. J Am Dent Assoc 2022; 154:530-534. [PMID: 35725659 DOI: 10.1016/j.adaj.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/03/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
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Sclerostin Immunohistochemical Staining in Aggressive Maxillofacial Giant Cell Lesions: Initial Results and Potential Therapeutic Target. J Craniofac Surg 2021; 33:790-793. [PMID: 34753866 DOI: 10.1097/scs.0000000000008344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Maxillofacial (MF) giant cell lesions (GCLs) are benign, often locally aggressive lesions with potential for recurrence. Systemic treatments have included interferon alpha, calcitonin, bisphosphonates, and denosumab. Sclerostin (SOST) is typically thought to be a negative regulator of bone metabolism and anti-SOST agents have been used to treat osteoporosis; however, its role in central giant cell granuloma is unknown. The purpose of this study was to evaluate the expression of SOST in MF GCLs. MATERIALS AND METHODS This was a retrospective study of patients with MF GCLs treated at a single institution between 1993 and 2008 with a minimum follow-up of 6 months. Representative tissue was used to create a tissue microarray and SOST immunohistochemical (IHC) staining and grading was performed. The primary outcomes were IHC staining of the stromal cells and giant cells. The secondary outcomes included correlation of IHC staining and patient predictor variables including clinically benign and aggressive lesions. All analyses were completed using univariate statistical tests. RESULTS A total of 37 subjects were included (29 clinically aggressive and 8 clinically benign). Sclerostin staining was present in 30 of 37 subjects (81%). Of these, 22 (60%) had stromal cell staining and 28 (76%) had giant cell staining. The presence or absence of staining, of either cell type, was not associated with aggressiveness, presence of clinical symptoms, tumor size, previous interferon therapy, previous surgery, or the race or age of the patient. DISCUSSION Maxillofacial GCLs have an overall high level of SOST staining; however, the role of SOST in treatment and prognosis is unknown and warrants further study.
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15
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Kahlon GK, Tilak K, Kondamudi N. Worsening Lower Jaw Swelling and Pain in a Teenager: Differential Diagnosis and Management. Cureus 2021; 13:e18296. [PMID: 34722071 PMCID: PMC8547371 DOI: 10.7759/cureus.18296] [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: 09/26/2021] [Indexed: 11/05/2022] Open
Abstract
Giant cell granuloma is a rare, benign non-neoplastic, aggressive tumor that originates mainly from the maxilla and mandible. It affects all age groups and is more commonly seen in children. We describe a 17-year-old female that presented to the Pediatrics Emergency room with a history of right lower jaw pain. Examination revealed a bone-like buccal vestibular swelling on the lower right tooth, a bone-like lingual swelling, and a pink gingival overgrowth lesion. The biopsy of the lesion revealed a central giant cell granuloma. Tissue biopsy with histopathological examination is diagnostic and surgical excision is the gold standard of treatment.
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Affiliation(s)
| | - Kedar Tilak
- Pediatrics, The Brooklyn Hospital Center, New York, USA
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16
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Case reports: An aggressive central giant cell granuloma of the jaws in two pediatric patients. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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17
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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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18
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Tobón-Arroyave SI, Isaza-Guzmán DM, Flórez-Moreno GA. Immunohistochemical Comparative Study of Aggressive and Non-aggressive Central Giant Cell Lesions of the Jaws Based on the Tenascin-C Expression Profile. J Histochem Cytochem 2021; 69:475-484. [PMID: 34120502 PMCID: PMC8246529 DOI: 10.1369/00221554211025479] [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: 03/01/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to compare the immunohistochemical expression of tenascin-C (Tn-C) regarding clinicopathological variables and its association with the clinical behavior of central giant cell lesions (CGCLs). Forty-eight paraffin-embedded samples of CGCLs were selected. Based on clinical and radiographic features, the lesions were classified as aggressive (A-CGCLs) and non-aggressive (NA-CGCLs) subtypes. Histological assessment included the microvessel count (MVC), multinucleated giant cell (MGC) count, and the proportion of tissue area involved by mononuclear stromal cells/interstitial fibrosis. Immunoreactivity, immunolocalization, and distribution patterns of Tn-C were studied immunohistochemically. The association between Tn-C expression and clinicopathological characteristics was analyzed separately and adjusted for confounders using logistic regression models. A significantly greater proportion of cases with moderate-to-intense, intracellular, and diffuse staining of Tn-C was observed in A-CGCLs. CGCLs with a size ≥3.3 cm, fast growth, cortical disruption, high MVC/MGC counts, and low interstitial fibrosis showed a significantly greater frequency of moderate-to-intense, intracellular, and diffuse staining. Logistic regression analysis indicated a strong/independent association of these three immunohistochemical parameters with the aggressiveness of lesions. These data appear to suggest a possible role for Tn-C in the etiopathogenesis of CGCLs of the jaws, where its upregulation might favor the destructive behavior of A-CGCLs.
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Affiliation(s)
- Sergio Iván Tobón-Arroyave
- Laboratory of Oral Pathology and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Diana María Isaza-Guzmán
- Laboratory of Oral Pathology and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Gloria Amparo Flórez-Moreno
- Laboratory of Oral Pathology and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
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19
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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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20
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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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21
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Radiolucent lesion of the posterior mandible in a 47-year-old man. J Am Dent Assoc 2021; 153:184-188. [PMID: 33745681 DOI: 10.1016/j.adaj.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/07/2021] [Accepted: 01/22/2021] [Indexed: 11/23/2022]
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22
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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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23
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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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24
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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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25
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Omami G. Multicentric Synchronous Giant Cell Granulomas of the Mandible. EAR, NOSE & THROAT JOURNAL 2020; 101:NP178-NP179. [PMID: 32894701 DOI: 10.1177/0145561320953230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Galal Omami
- Division of Oral Medicine, Diagnosis and Radiology, Department of Oral Health Practice, 160339University of Kentucky College of Dentistry, Lexington, KY, USA
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26
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Musbah T, Omami G. Ill-defined lytic mandibular lesion. J Am Dent Assoc 2020; 151:692-695. [DOI: 10.1016/j.adaj.2019.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
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27
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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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Bodhankar K, Bansal S, Jashnani K, Desai RS. Immunohistochemical expression of stem cell markers OCT-4 and SOX-2 in giant cell tumor, central giant cell granuloma, and peripheral giant cell granuloma. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:78-84. [PMID: 32493681 DOI: 10.1016/j.oooo.2020.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/25/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to evaluate and compare the immunohistochemical expression of OCT-4 and SOX-2 and to determine their use in differentiating giant cell tumor (GCT) from central giant cell granuloma (CGCG) and peripheral giant cell granuloma (PGCG). STUDY DESIGN Formalin-fixed, paraffin-embedded tissue blocks of 10 histopathologically diagnosed cases of GCT, CGCG, or PGCG were examined for anti-OCT-4 and anti-SOX-2 antibodies. Nuclear staining of stromal mononuclear cells and multinucleated giant cells was considered positive for OCT-4 and SOX-2 expression. RESULTS Nuclear immunoexpression of OCT-4 in stromal mononuclear cells was observed in 80% (8 of 10) of GCT cases, whereas none of the CGCG and PGCG cases showed OCT-4 immunoreactivity. SOX-2 immunoreactivity was negative in GCT, CGCG, and PGCG. CONCLUSIONS OCT-4 immunopositivity in GCT can be used as a cancer stem cell marker to differentiate GCT from CGCG and PGCG. The presence of OCT-4 in GCT versus its complete absence in CGCG and PGCG suggests that these three conditions are separate entities. The absence of stem cell marker OCT-4 and SOX-2 raises questions regarding their role in the pathogenesis of CGCG and PGCG.
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Affiliation(s)
- Kshitija Bodhankar
- Post-graduate Student, Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai, India
| | - Shivani Bansal
- Professor (Additional), Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai, India.
| | - Kusum Jashnani
- Professor and Head, Department of Pathology, BYL Nair Charitable Hospital and T.N Medical College, Mumbai, India
| | - Rajiv S Desai
- Professor and Head, Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai, India
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29
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Melo-Muniz VRV, Nunes FD, Cangussu MCT, Cury PR, Xavier FCA, de Azevedo RA, Leitão ÁCGH, de Faro Valverde L, Carneiro Júnior B, Dos Santos JN. Central giant cell granuloma: A clinicopathological and immunohistochemical study of macrophages, blood vessels, lymphatic vessels and regulatory proteins. Ann Diagn Pathol 2020; 46:151526. [PMID: 32339965 DOI: 10.1016/j.anndiagpath.2020.151526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study seeks to investigate immunohistochemical parameters that could distinguish non-aggressive Central giant cell granuloma (CGCG) from aggressive CGCG, two groups of lesions which differ in their clinical and radiographic features and prognosis. MATERIAL AND METHODS 12 cases of non-aggressive CGCG and 11 cases of aggressive CGCG were investigated and associated the immunohistochemical expression of macrophages (CD68 and CD163), blood vessels (CD34 and CD105), lymphatic vessels (D2-40) and regulator proteins (p63 and Ki-67). Clinical and radiographic features were also studied. RESULTS Associations between all proteins in non-aggressive and aggressive CGCG were not significant (p > 0.05). With respect to non-aggressive CGCG, there were no significant correlations, while in aggressive CGCG there was a significant positive correlation between CD68 and CD163 (p = 0.031), between CD34 and D2-40 proteins (p = 0.04), whereas a significant negative correlation was observed between CD105 and CD68 (p = 0.040). However, regardless of aggressiveness of CGCG, there was a significant positive correlation between CD68 and CD163 (p = 0,04). Among the clinical and immunohistochemical aspects, only the symptomatology was a significant risk factor for the occurrence of aggressive CGCG (OR = 12.00/p = 0.016). CONCLUSION Macrophages and angiogenesis contribute to their maintenance and development of CGCG. In addition, immunohistochemistry used here was not able to differentiate their aggressiveness. However, symptomatology was proved to be a risk factor for the occurrence of aggressive CGCG. It is possible that clinical features, particularly symptomatology, represent the most appropriate parameter to attempt to distinguish GCCG.
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Affiliation(s)
- Vinicius Rio Verde Melo-Muniz
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Fábio Daumas Nunes
- Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Patrícia Ramos Cury
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Flávia Caló Aquino Xavier
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil; Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Roberto Almeida de Azevedo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Águida Cristina Gomes Henriques Leitão
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil; Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Bráulio Carneiro Júnior
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Southwest University of Bahia, Jequié, Bahia, Brazil
| | - Jean Nunes Dos Santos
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil; Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil.
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30
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Rodríguez FA, Castellón L, Moreno R, Paez E, Aracena Álvarez MI. Noonan syndrome with multiple Giant cell lesions, management and treatment with surgery and interferon alpha-2a therapy: Case report. Birth Defects Res 2020; 112:732-739. [PMID: 32065515 DOI: 10.1002/bdr2.1659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 01/08/2023]
Abstract
We report the case of a 14-year-old girl that was referred to the maxillo facial surgery unit at age 11 years because she exhibited swelling in the right side of her maxilla and right mandible. After a conservative surgery, she started with interferon alpha-2a to avoid recurrence. She has remained in treatment with successful results during her follow up. Considerable reduction of both maxilla and mandible lesions and bone fill have been documented. In addition, her clinical history and phenotype were suggestive of Noonan syndrome. She has short stature, broad and short neck; hypertelorism (increased distance between the eyes); downslanting palpebral fissures; sparse eyebrows and eyelashes; posteriorly rotated ears with fleshy lobes; follicular keratosis over the face, and developmental delay. Her karyotype was 46, XX. Molecular analysis of RAS/MAPK pathway genes showed a SOS1 amino acid substitution of arginine to lysine at position 552 (p.R552K). This case presents the infrequent condition of Noonan syndrome with multiple giant cell lesions (NS/MGCL) that would be the first patient as far as we know treated with surgery and interferon alpha-2a for her giant cell lesions.
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Affiliation(s)
| | - Loreto Castellón
- Maxillofacial Unit, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - Regina Moreno
- Unidad de Genética, Genética - Clínica Alemana, Temuco, Chile
| | - Eduardo Paez
- Hemato - Oncology Unit, Hospital Dr. Hernán Henríquez Aravena, Temuco, Chile
| | - Mariana Inés Aracena Álvarez
- Unit of Genetics and Metabolic diseases, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Unit of Genetics, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
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Dube NC, Moshy JR, Vuhahula EA, Sohal KS. Benign fibro-osseous lesions of the jaws: a clinicopathologic study of 98 Tanzanian patients. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2019026] [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: The benign fibro-osseous lesions (BFOL) are characterized by replacement of the normal bone by cellular fibrous tissue containing various forms of ossification. They encompass common clinical, radiologic and histopathological features and hence pose considerable diagnostic and therapeutic challenges to clinicians and pathologists. Objective: To analyze the clinico-pathological and radiological features of BFOLs of the jaws in patients treated at Muhimbili National Hospital, Tanzania. Material and methods: A retrospective study of files of patients who were diagnosed with BFOLs from January 2011 to December 2013 was done. The collected information included data on demographic characteristics, the duration of the lesion, location of the lesion, presence of swelling, associated symptoms and reported radiological and histological features. Results: A total of 98 patient's records were retrieved. There was a predominance of females (59, 60.2%), with a male to female ratio of 1:1.5. The patient's age at presentation ranged from 5 years to 75 years with a mean age of 29.81 ± 15.28 years. Four types of BFOLs were encountered. Ossifying fibroma were the most frequent (61.2%), followed by fibrous dysplasia (19.4%). Maxilla was more affected than the mandible. Majority (>70%) of the BFOLs were radio-opaque. The common histological features in all four types of BFOL included presence of: woven bone in fibrous stroma, giant cells, loose collagen and foci of hemorrhage. Conclusion: In this sample, BFOLs, were slightly more prevalent in females than males, affecting individuals below 40 years at large. They showed several overlapping clinical, radiological and histological features; thus a combination of different modalities seems necessary for an accurate diagnosis.
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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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Gupta S, Narwal A, Kamboj M, Devi A, Hooda A. Giant Cell Granulomas of Jaws: a Clinicopathologic Study. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2019; 10:e5. [PMID: 31404210 PMCID: PMC6683385 DOI: 10.5037/jomr.2019.10205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/30/2019] [Indexed: 01/10/2023]
Abstract
Objectives The purpose of present study was to investigate and correlate the histological findings in central giant cell granuloma and peripheral giant cell granuloma of jaws with clinical and radiographic interpretations of the lesion. Material and Methods In present study, data from 14 cases of central giant cell granuloma (CGCG) and 9 cases of peripheral giant cell granuloma (PGCG) were analysed, focusing on demographic, clinical and radiographic features. For each patient, microscopic slides were assessed in terms of histologic features of giant cells i.e. number of giant cells, mean number of nuclei/giant cell, pattern of distribution, size and relative size index of giant cells, percentage fractional surface area (FSA) occupied by giant cells and stromal characteristics. Data collected was subjected to statistical analysis. Fisher-exact test, Pearson's correlation coefficient, one-way ANOVA test and Student's t-test were used for analysis. Results No significant difference was found between PGCG and CGCG in relation to all the traits that were evaluated. It was observed that mean number of giant cells and mean FSA was more in aggressive CGCG as compared to non-aggressive CGCG. Conclusions Further studies on large sample size are required to confirm the relationship between histomorphometric features of giant cells and behaviour of giant cell granulomas of jaws.
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Affiliation(s)
- Shruti Gupta
- Department of Oral Anatomy, Post Graduate Institute of Dental Sciences, Rohtak, HaryanaIndia
| | - Anjali Narwal
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, HaryanaIndia
| | - Mala Kamboj
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, HaryanaIndia
| | - Anju Devi
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, HaryanaIndia
| | - Anita Hooda
- Department of Oral Anatomy, Post Graduate Institute of Dental Sciences, Rohtak, HaryanaIndia
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Giant Cell Lesions of the Maxillofacial Skeleton Express RANKL by RNA In Situ Hybridization Regardless of Histologic Pattern. Am J Surg Pathol 2019; 43:819-826. [DOI: 10.1097/pas.0000000000001257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Etoz M, Asantogrol F, Akyol R. Central giant cell granulomas of the jaws: retrospective radiographic analysis of 13 patients. Oral Radiol 2019; 36:60-68. [DOI: 10.1007/s11282-019-00380-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/24/2019] [Indexed: 12/28/2022]
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Jeyaraj P. Management of Central Giant Cell Granulomas of the Jaws: An Unusual Case Report with Critical Appraisal of Existing Literature. Ann Maxillofac Surg 2019; 9:37-47. [PMID: 31293928 PMCID: PMC6585231 DOI: 10.4103/ams.ams_232_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Central giant cell granuloma (CGCG) is an uncommon, benign but aggressive osteolytic neoplasm of the craniomaxillofacial region, histologically characterized by an abundance of evenly distributed multinucleated giant cells within a sea of spindle-shaped mesenchymal stromal cells, scattered throughout the fibrovascular connective tissue stroma containing areas of hemorrhage. A rapid diagnostic assessment, together with an adequate histopathologic verification, is essential to improve the management and the prognosis of this locally destructive lesion. A rare case of a large destructive CGCG involving the entire right angle of mandible, causing extensive bony resorption, and buccal, medial as well as inferior border cortical expansion with multiple perforations, in a young child is presented. It was treated successfully by enucleation and aggressive curettage followed by peripheral ostectomy preserving the continuity of the mandible. Two adjunctive measures were employed; first, chemical cauterization of the residual bony walls to prevent possible recurrence, for which this tumor is notorious, and second, placement of fresh autologous platelet-rich fibrin within the bony defect to hasten bone fill and reossification, thus obviating the need for a bone graft.
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Affiliation(s)
- Priya Jeyaraj
- Military Dental Centre (Gough Lines), Secunderabad, Telangana, India
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37
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Omami G. Twenty classic signs in oral and maxillofacial radiology. Oral Radiol 2018; 35:3-10. [PMID: 30484206 DOI: 10.1007/s11282-018-0351-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/26/2018] [Indexed: 12/23/2022]
Abstract
Teachers of radiology often employ the use of classic signs to help learners identify the typical appearance of various pathologies. This article is a compendium of simply-described classic signs in oral and maxillofacial radiology, including their use in differential diagnoses.
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Affiliation(s)
- Galal Omami
- Department of Oral Health Practice, Division of Oral Medicine, Diagnosis and Radiology, University of Kentucky College of Dentistry, 800 Rose Street, Room MN-320, Lexington, KY, 40536-0297, USA.
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Chavis SE, Shrikian TM, Haerian A, Edwards SP, Munz SM. Coordinated pediatric reconstruction and rehabilitation of maxillary central giant cell granuloma: A case report. J Am Dent Assoc 2018; 149:1065-1072. [PMID: 30243428 DOI: 10.1016/j.adaj.2018.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/22/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OVERVIEW A 9-year-old girl underwent comprehensive resection and rehabilitation of a central giant cell granuloma that required phased interprofessional collaborative care to optimize treatment decisions and outcome. CASE DESCRIPTION The interprofessional treatment team included an oral and maxillofacial surgeon, maxillofacial prosthodontist, dentist, orthodontist, and speech-language pathologist, and treatment spanned 9 years. Treatment included surgical resection of a central giant cell granuloma and obturation with a removable interim prosthesis. After adequate growth and development, the patient then underwent a surgical free-tissue transfer reconstruction by using virtual surgical planning, followed by dental implant placement and a transitional restoration, subsequent orthodontic therapy, and eventual definitive rehabilitation with an implant-retained fixed hybrid prosthesis. CONCLUSIONS AND PRACTICAL IMPLICATIONS The interprofessional phased and collaborative treatment facilitated an optimal functional and esthetic process in a young patient with transitional and definitive treatments that considered long-term quality-of-life implications.
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Hosur MB, Puranik RS, Vanaki SS, Puranik SR, Ingaleshwar PS. Clinicopathological profile of central giant cell granulomas: An institutional experience and study of immunohistochemistry expression of p63 in central giant cell granuloma. J Oral Maxillofac Pathol 2018; 22:173-179. [PMID: 30158768 PMCID: PMC6097366 DOI: 10.4103/jomfp.jomfp_260_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: The central giant cell granuloma(CGCG) of bone constitutes about 10% of benign jawbone lesions. It affects females more often than males, mandible than maxilla. Biological behavior of CGCG ranges from a slow growing asymptomatic swelling to an aggressive process. True giant cell tumor (GCT) should be distinguished from CGCG. The histological distinction between these lesions depends on quite subtle differences. Expression of p63 has been demonstrated in GCT of bone conversely, has not been detected in CGCG. Therefore this short study attempts to study the expression of p63 in CGCG in conjunction with clinicopathological profile of the cases reported in the institute. Aims and objectives: To review all the cases of CGCGs of the jaws reported in the institute from 1998 to 2015 and study their clinicopathological profile. To study the immunohistochemical (IHC) expression of p63 in CGCG cases
Methods and materials: The retrospective study reviewed records for clinically and histopathologically diagnosed cases of CGCG from the archives of department of Oral pathology. Data was recorded and analyzed. These cases were subjected for IHC analysis for expression of p63, also RANK, RANKL in selected cases to study the nature of giant cells. Results and Conclusion: This paper is an institutional experience of clinicopathological profile of diagnosed cases of CGCG. Clinicopathological findings were in concurrent with previous literature. Total number of cases was ten. Six occurred in females and four in males. Most of them occurred in the second decade, more commonly involving mandible. Three cases showed recurrence. Histologically most showed classical features. Expression of p63 showed negativity in all the cases in accordance with the previous studies. RANK and RANKL showed strong and diffuse immunoexpression in both mononuclear and giant cells. Thus study supports the finding that p63 expression can be used to differentiate between CGCG and GCT. However, more number of studies with larger sample size are required to confirm reliability of using p63 as a distinguishing marker between GCT and CGCG.
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Affiliation(s)
- Mahadevi B Hosur
- Department of Oral Pathology, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Rudrayya S Puranik
- Department of Oral Pathology, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Shreenivas S Vanaki
- Department of Oral Pathology, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Surekha R Puranik
- Department of Oral Medicine, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Pramod S Ingaleshwar
- Department of Oral Pathology, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
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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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41
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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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42
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Clinical Pathologic Conference Case 4. Oral Surg Oral Med Oral Pathol Oral Radiol 2018. [DOI: 10.1016/j.oooo.2018.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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43
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Aksakalli N. Evaluation of the osteopontin in oral peripheral and central giant cell granuloma. INDIAN J PATHOL MICR 2018; 61:18-21. [DOI: 10.4103/ijpm.ijpm_214_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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44
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Buraczewski T, Potluri A, Costello BJ, Bilodeau EA. Multilocular radiolucency of the anterior mandible. J Am Dent Assoc 2017; 148:840-845. [PMID: 29080606 DOI: 10.1016/j.adaj.2017.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 08/04/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
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45
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Abstract
Fibroosseous lesions in the jaws have similar histologic and radiographic features. Despite their similarity, management varies significantly. In this article, common fibroosseous lesions and key radiographic features are described. Many of the fibroosseous lesions are diagnosed radiographically, without performing histologic examinations. For some of the fibroosseous lesions, for example, periapical osseous dysplasia, histologic examination is contraindicated. Cherubism and fibrous dysplasia have specific radiographic findings; these conditions can be diagnosed radiographically. Accurate diagnosis conditions is essential; some conditions do not require any intervention, while others require surgical resection. Patient demographics, for example, age, gender, and race, play important roles in diagnosis.
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Affiliation(s)
- Mansur Ahmad
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
| | - Laurence Gaalaas
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA
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46
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Khan A, Peters SM, Han C, Yoon AJ, Philipone EM. A 23-year-old female with a painless left mandibular swelling. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:519-524. [PMID: 28964765 DOI: 10.1016/j.oooo.2017.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/04/2017] [Accepted: 08/18/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Alia Khan
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Scott M Peters
- Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA
| | - Chang Han
- Private Practice, Hackensack, NJ, USA
| | - Angela J Yoon
- Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA
| | - Elizabeth M Philipone
- Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA.
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47
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Khoueir N, Mhawej R, Ghorra C, Haddad A. Giant cell granuloma: Report of a rare location in the hard palate and review of the literature. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1303331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Nadim Khoueir
- Department of Otolaryngology – Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Rachad Mhawej
- Department of Otolaryngology – Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Department of Pathology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Amine Haddad
- Department of Otolaryngology – Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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48
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Wastner BDF, Silva WPPD, Schussel JL, Stramandinoli-Zanicotti RT, Sassi LM. Simultaneous Occurrence of Central Giant Cell Granuloma and Odontogenic Keratocyst in Mandible. THE BULLETIN OF TOKYO DENTAL COLLEGE 2017; 58:171-175. [PMID: 28954952 DOI: 10.2209/tdcpublication.2016-0018] [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: 11/06/2022]
Abstract
Odontogenic keratocysts and central giant cell granulomas are distinct entities of separate origin that may appear simultaneously in the jaw, making them difficult to differentiate. The objectives of this paper are to report a case of a 54-year-old man presenting with a large lesion in the right mandible and to describe the histological characteristics of that lesion. Imaging revealed tumefaction and multilobulation. The case was surgically managed. Histopathological examination revealed that the lesion was a hybrid of an odontogenic keratocyst and a central giant cell granuloma. It remains unclear as to whether this lesion represented a coincidental or related injury. Since both types of lesion involved have a high rate of recurrence, however, long-term follow-up is scheduled.
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Affiliation(s)
| | | | - Juliana Lucena Schussel
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Hospital.,Department of Stomatology, Universidade Federal do Paraná
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Chandna P, Srivastava N, Bansal V, Wadhwan V, Dubey P. Peripheral and Central Giant Cell Lesions in Children: Institutional Experience at Subharti Dental College and Hospital. Indian J Med Paediatr Oncol 2017; 38:440-446. [PMID: 29333009 PMCID: PMC5759061 DOI: 10.4103/ijmpo.ijmpo_17_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: Giant cell lesions (GCG) are a group of varied lesions that contain a multitude of multinucleated, osteoclast like giant cells within connective tissue stroma. These include giant cell granulomas which may be central (CGCG), if they lie within the jaw bone, or, peripheral (PGCG) if they lie within the soft tissue. Giant cell granulomas comprised 9.29% of all oral lesions. This case series comprises of 5 giant cell lesions in children between the ages of 4 to 12 years. Materials and Methods: A retrospective analysis was conducted of all patients who were diagnosed with giant cell lesions and treated over a period of 10 years (from August 2004 to August 2014) at Subharti Dental College and Hospital, Meerut, India. Results: A total of 5 giant cell lesions were identified in this case series, of which 2 cases were diagnosed as PGCG and 3 cases as CGCG. Surgical excision and curettage was performed for 2 peripheral lesions under local anesthesia while 1 central lesion was excised under general anesthesia. Two central lesions were treated with a non-surgical approach using intralesional corticosteroid. Conclusion: Our experience suggests that a correct diagnosis and complete surgical excision with curettage is effective in complete management of oral giant cell lesions in the pediatric age group.
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Affiliation(s)
- Preetika Chandna
- Department of Paedodontics and Preventive Dentistry, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Nikhil Srivastava
- Department of Paedodontics and Preventive Dentistry, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Vishal Bansal
- Department of Oral and Maxillofacial Surgery, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Vijay Wadhwan
- Department of Oral and Maxillofacial Pathology and Microbiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Prajesh Dubey
- Department of Oral and Maxillofacial Surgery, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
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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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