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Sonpal PM, Mundada BP, Bhola N, Gupta C, Dodal K. Unraveling Cherubism: Examining the Classical "Eye to Heaven" Phenomenon. Cureus 2024; 16:e62277. [PMID: 39006690 PMCID: PMC11246183 DOI: 10.7759/cureus.62277] [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: 05/13/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Cherubism, an infrequent disorder with paramount autosomal importance, predominantly targets the mandible, with occasional involvement of the maxilla. Manifesting in childhood, it typically improves over time but never fully resolves in adulthood. Clinically, it presents as a uniform enlargement of the bones, and when the upper jaw is involved, it can create a cherub-like appearance with exposure to the sclera. As the volume grows, it can cause symptoms such as dental misalignment, delayed tooth eruption, speech difficulties, and tooth loss, in addition to psychological and cosmetic effects that require medical attention. The disorder progresses naturally in youngsters, exhibiting phases of expansion, stabilization, and regression. Cherubism initially is encountered in early childhood, reaches its peak during early years, balances out around puberty, and then steadily recedes after that. We describe the example of a male patient, age 20, who sought correction due to worries about his appearance. He had a bilateral mandibular angle and malar edema. The patient's aesthetic discontent was satisfactorily resolved with surgical intervention, and further pharmaceutical therapy was implemented during follow-up visits.
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Affiliation(s)
- Parmarth M Sonpal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhushan P Mundada
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitin Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chetan Gupta
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ketan Dodal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Cailleaux PE, Porporatti AL, Cohen-Solal M, Kadlub N, Coudert AE. Pharmacological management of cherubism: A systematic review. Front Endocrinol (Lausanne) 2023; 14:1104025. [PMID: 36998472 PMCID: PMC10044089 DOI: 10.3389/fendo.2023.1104025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVE The aim of this systematic review was to determine if there exists an efficacious drug treatment for cherubism, based on published studies. METHODS This systematic review included observational case studies reporting pharmacological management of cherubism. We developed specific search strategies for PubMed (including Medline), ScienceDirect, Web of Science. We evaluated the methodological quality of the included studies using criteria from the Joanna Briggs Institute's critical appraisal tools. RESULTS Among the 621 studies initially identified by our search script, 14 were selected for inclusion, of which five were classified as having a low risk of bias, four as having an unclear risk, and five a high risk. Overall, 18 cherubism patients were treated. The sample size in each case study ranged from one to three subjects. This review identified three types of drugs used for cherubism management: calcitonin, immunomodulators and anti-resorptive agents. However, the high heterogeneity in case reports and the lack of standardized outcomes precluded a definitive conclusion regarding the efficacy of any treatment for cherubism. CONCLUSIONS The present systematic review could not identify an effective treatment for cherubism due to the heterogeneity and limitations of the included studies. However, in response to these shortcomings, we devised a checklist of items that we recommend authors consider in order to standardize the reporting of cherubism cases and specifically when a treatment is given toward identification of an efficacious cherubism therapy. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022351044, identifier CRD42022351044.
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Affiliation(s)
- Pierre-Emmanuel Cailleaux
- Université Paris Cité, Institut National de la Santé et de la recherche médicale (Inserm) U1132 Biologie de l'os et du cartilage (BIOSCAR), Paris, France
- *Correspondence: Pierre-Emmanuel Cailleaux, ; Amélie E. Coudert,
| | - André Luís Porporatti
- Faculté or Unité de formation et de recherche (UFR) d’Odontologie, Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité, Paris, France
| | - Martine Cohen-Solal
- Faculté or Unité de formation et de recherche (UFR) de Médecine, Université Paris Cité, Institut National de la Santé et de la recherche médicale (Inserm) U1132 Biologie de l'os et du cartilage (BIOSCAR), Hôpital Lariboisière, Paris, France
| | - Natacha Kadlub
- Faculté or Unité de formation et de recherche (UFR) de Médecine, Université Paris Cité, Inserm 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Amélie E. Coudert
- Faculté or Unité de formation et de recherche (UFR) d’Odontologie, Université Paris Cité, Institut National de la Santé et de la recherche médicale (Inserm) U1132 Biologie de l'os et du cartilage (BIOSCAR), Paris, France
- *Correspondence: Pierre-Emmanuel Cailleaux, ; Amélie E. Coudert,
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3
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Morice A, Joly A, Ricquebourg M, Maruani G, Durand E, Galmiche L, Amiel J, Vial Y, Cavé H, Belhous K, Piketty M, Cohen-Solal M, Berdal A, Collet C, Picard A, Coudert AE, Kadlub N. Cherubism as a systemic skeletal disease: evidence from an aggressive case. BMC Musculoskelet Disord 2020; 21:564. [PMID: 32825821 PMCID: PMC7441549 DOI: 10.1186/s12891-020-03580-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background Cherubism is a rare autosomal dominant genetic condition caused by mutations in the SH3BP2 gene. This disease is characterized by osteolysis of the jaws, with the bone replaced by soft tissue rich in fibroblasts and multinuclear giant cells. SH3BP2 is a ubiquitous adaptor protein yet the consequences of SH3BP2 mutation have so far been described as impacting only face. Cherubism mouse models have been generated and unlike human patients, the knock-in mice exhibit systemic bone loss together with a systemic inflammation. Case presentation In light of these observations, we decided to search for a systemic cherubism phenotype in a 6-year-old girl with an aggressive cherubism. We report here the first case of cherubism with systemic manifestations. Bone densitometry showed low overall bone density (total body Z-score = − 4.6 SD). Several markers of bone remodelling (CTx, BALP, P1NP) as well as inflammation (TNFα and IL-1) were elevated. A causative second-site mutation in other genes known to influence bone density was ruled out by sequencing a panel of such genes. Conclusions If this systemic skeletal cherubism phenotype should be confirmed, it would simplify the treatment of severe cherubism patients and allay reservations about applying a systemic treatment such as those recently published (tacrolimus or imatinib) to a disease heretofore believed to be localised to the jaws.
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Affiliation(s)
- Anne Morice
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France. .,Université Paris Descartes, 75006, Paris, France. .,APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique, 75015, Paris, France. .,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France.
| | - Aline Joly
- APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique, 75015, Paris, France.,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France
| | - Manon Ricquebourg
- BIOSCAR, INSERM U1132, Université de Paris, Hôpital Lariboisière, 75010, Paris, France.,Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France
| | - Gérard Maruani
- Université Paris Descartes, 75006, Paris, France.,Institut Necker Enfants-Malades, INSERM U1151 - CNRS UMR 8253, Université Paris Descartes-Sorbonne Paris Cité, 75014, Paris, France.,Service de Physiologie, Hôpital Necker - Enfants Malades and Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
| | - Emmanuel Durand
- IR4M - Université Paris-Sud, CNRS, Université Paris-Saclay, F91401, Orsay, France
| | - Louise Galmiche
- Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, Service d'Anatomopathologie et cytologie, 75015, Paris, France
| | - Jeanne Amiel
- Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, Département de Génétique Médicale, 75015, Paris, France
| | - Yoann Vial
- APHP, Hôpital Robert Debré, Département de Génétique, 75019, Paris, France.,INSERM UMR 1131, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Hélène Cavé
- APHP, Hôpital Robert Debré, Département de Génétique, 75019, Paris, France.,INSERM UMR 1131, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Kahina Belhous
- APHP, Necker Enfants Malades, Service d'imagerie médicale pédiatrique, 75015, Paris, France
| | - Marie Piketty
- APHP, Necker Enfants Malades, Service des Explorations Fonctionnelles, 75015, Paris, France
| | - Martine Cohen-Solal
- Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France
| | - Ariane Berdal
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France.,UFR Odontologie, Garancière, Université Paris Diderot, 75006, Paris, France
| | - Corinne Collet
- BIOSCAR, INSERM U1132, Université de Paris, Hôpital Lariboisière, 75010, Paris, France.,Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France
| | - Arnaud Picard
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France.,Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique, 75015, Paris, France.,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France
| | - Amelie E Coudert
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France.,Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France.,UFR Odontologie, Garancière, Université Paris Diderot, 75006, Paris, France
| | - Natacha Kadlub
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France.,Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique, 75015, Paris, France.,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France
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Cherubism: a systematic literature review of clinical and molecular aspects. Int J Oral Maxillofac Surg 2020; 50:43-53. [PMID: 32620450 DOI: 10.1016/j.ijom.2020.05.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/10/2020] [Indexed: 12/13/2022]
Abstract
The purpose of this review was to integrate the clinical, radiological, microscopic, and molecular data of published cherubism cases, in addition to therapeutic approaches, to provide more concise information about the disease. An electronic search was undertaken in September 2019. Eligibility criteria included publications having enough clinical, radiological, and histological information to confirm the diagnosis. A total of 260 publications reporting 513 cherubism cases were included. Familial history was observed in 310/458 cases (67.7%). SH3BP2 mutations were reported in 101/108 cases (93.5%) and mainly occurred at protein residues 415, 418, 419, and 420. Retrospective clinical grading was possible in 175 cases. Advanced clinical grading was associated with tooth agenesis, but not with other clinical, radiological, and genetic features. Specific amino acid substitutions of SH3BP2 mutations were not associated with the clinical grading of the disease. 'Wait and see' was the most common therapeutic approach. In a small number of cases, drugs were used in the treatment, with variable response. In conclusion, there is no clear correlation between the genotype and the phenotype of the disease, but additional genomic and gene expression regulation information is necessary for a better understanding of cherubism.
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5
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Deconte D, Correia EPE, Haubert G, de Souza V, Correia JD, Maahs MAP, Zen PRG, Fiegenbaum M, Rosa RFM. Unusual Characteristics and Variable Expressivity in a Brazilian Family with Cherubism. J Pediatr Genet 2020; 10:63-69. [PMID: 33552642 DOI: 10.1055/s-0040-1705095] [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: 12/31/2019] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
Abstract
Cherubism is a rare genetic condition characterized by a bone nonneoplastic disease. We aimed to report a 6-year-old girl with cherubism presenting similar cases in the maternal family. However, her mother and grandmother seemed to be asymptomatic. The patient had an enlarged and asymmetric jaw with multiple enlarged cervical lymph nodes that increased in size with time. Sanger sequencing revealed a heterozygous mutation in exon 9 of SH3BP2 not only in the patient but also in her mother. Thus, we observed a variable expression and a probably reduced penetrance within the family, as well as unusual characteristics of the patient (in this case, the asymmetrical involvement of the jaw).
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Affiliation(s)
- Desirée Deconte
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Géssica Haubert
- Graduation in Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Vinicius de Souza
- Graduation in Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Jamile Dutra Correia
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Marcia Angelica Peter Maahs
- Department of Speech Language Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Paulo Ricardo Gazzola Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Department of Clinical Medicine, Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre and Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Marilu Fiegenbaum
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Department of Basic Health Sciences, Human Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Rafael Fabiano Machado Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Department of Clinical Medicine, Clinical Genetics, Universidade Federal de Ciências da Saúde de Porto Alegre and Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
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6
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Argyris PP, Gopalakrishnan R, Hu Y, Reichenberger EJ, Koutlas IG. Clinicopathologic and Molecular Characteristics of Familial Cherubism with Associated Odontogenic Tumorous Proliferations. Head Neck Pathol 2017; 12:136-144. [PMID: 28721660 PMCID: PMC5873491 DOI: 10.1007/s12105-017-0837-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
Abstract
Cherubism is a rare autosomal dominant condition affecting the jaws and caused by mutations in the gene encoding for the adapter protein SH3BP2 that maps to chromosome 4p16.3. Cherubism is characterized by symmetrically developing bone lesions in the maxilla and mandible. The lesions have been radiographically and histopathologically well-described. Here, we present a family with cherubism with two of its members featuring odontogenic tumorous proliferations in association with persistent central giant cell lesions (CGCL). Specifically, the proband, a 25-year-old male, developed a radiolucent lesion characterized histologically by central odontogenic fibroma-like proliferation in association with a CGCL component, while his mother, at age 57, was diagnosed with primary intraosseous odontogenic carcinoma with areas of benign fibro-osseous lesions. In both patients the lesions occurred in the anterior mandible and presented with clinical enlargement. The son underwent incisional biopsy and did not have additional treatment. His mother underwent extensive mandibulectomy due to widespread tumor. The son has two affected children with classic cherubism while a third child at age 5, had not shown any features of the disease. Mutation analysis of three affected members resulted in the identification of a heterozygous mutation in SH3BP2 (c.1244G>C; p.Arg415Pro). To the best of our knowledge, association of cherubism with odontogenic neoplastic lesions has hitherto not been reported in the literature, thus suggesting a relationship between cherubism with disturbed odontogenesis.
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Affiliation(s)
- Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN, 55455, USA
| | - Rajaram Gopalakrishnan
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN, 55455, USA
| | - Ying Hu
- Department of Reconstructive Sciences, University of Connecticut, Farmington, CT, USA
| | - Ernst J Reichenberger
- Department of Reconstructive Sciences, University of Connecticut, Farmington, CT, USA
| | - Ioannis G Koutlas
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN, 55455, USA.
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7
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Comprehensive surgical management of cherubism with orbital involvement. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Degala S, Mahesh KP, Monalisha. Cherubism: a case report. J Maxillofac Oral Surg 2015; 14:258-62. [PMID: 25861190 DOI: 10.1007/s12663-013-0474-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 01/14/2013] [Indexed: 11/28/2022] Open
Abstract
Cherubism is a benign, self-limiting fibro-osseous lesion characterized by bilateral symmetric painless expansion of jaw which is more prominent in mandible than in maxilla. Males are commonly affected (2:1) and with greater severity. It becomes noticeable in early childhood and gradually regresses after puberty. Although cherubism is considered as a familial/inherited disease but many sporadic cases have been reported in literature with no familial history. Osteoblastic and osteoclastic remodeling replaces normal bone by excessive amount of fibrovascular tissue containing multinucleated giant cells. Here, we present a case report of cherubism in a 10 year old boy describing the clinical, histological, biochemical and radiographic features.
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Affiliation(s)
- Saikrishna Degala
- Department of OMFS, JSS Dental College and Hospital, JSS University, Mysore, Karnataka India
| | - K P Mahesh
- Oral Medicine & Radiology, JSS University, Mysore, Karnataka India
| | - Monalisha
- Department of OMFS, JSS Dental College and Hospital, JSS University, Mysore, Karnataka India
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Sekerci AE, Balta B, Dundar M, Hu Y, Reichenberger EJ, Etoz OA, Nazlim S, Bayrakdar IS. A c.1244G>A (p.Arg415Gln) mutation in SH3BP2 gene causes cherubism in a Turkish family: report of a family with review of the literature. Med Oral Patol Oral Cir Bucal 2014; 19:e340-4. [PMID: 24608212 PMCID: PMC4119308 DOI: 10.4317/medoral.19496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/20/2013] [Indexed: 11/05/2022] Open
Abstract
Objectives: The present study was aimed at advancing the understanding of the pathogenesis of cherubism by presenting a case study based on history, physical examination, typical radiological features, molecular and histopathological laboratory tests and a review of the literature.
Study Design: This study began with a 7-year-old boy who was referred due to mandibular overgrowth. A panoramic radiograph revealed multilocular radiolucent lesions of the upper/lower jaws suggestive of cherubism. Overall, a total of four family members were tested for SH3BP2 mutations, namely two siblings and their parents. Both siblings had been clinically diagnosed with cherubism; however, the parents were clinically normal. Peripheral blood was collected from all participants and genomic DNA sequencing was carried out.
Results: A missense mutation was found in the two affected siblings and their asymptomatic mother. The mutation was a 1244 G>A transversion which resulted in an amino acid substitution from arginine to glutamine (p.Arg415Gln) in exon 9.
Conclusions: The present study emphasized the importance of further clinical and molecular investigation even when only a single case of cherubism is identified within a family. Genotype-phenotype association studies in individuals with cherubism are necessary to provide important insights into the molecular mechanisms associated with this disease.
Key words:Cherubism, mandible, maxilla, SH3BP2, gene analysis, CBCT.
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Affiliation(s)
- Ahmet-Ercan Sekerci
- Erciyes University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Kayseri-Turkey,
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Tsodoulos S, Ilia A, Antoniades K, Angelopoulos C. Cherubism: a case report of a three-generation inheritance and literature review. J Oral Maxillofac Surg 2013; 72:405.e1-9. [PMID: 24280174 DOI: 10.1016/j.joms.2013.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/15/2022]
Abstract
Cherubism is a rare, non-neoplastic pathologic entity first described by Jones in 1933. It affects mostly younger individuals and is usually inherited. Cherubism presents as a painless jaw enlargement that affects both the maxilla and the mandible and is characterized by replacement of the osseous tissue by fibrous connective tissue. Radiologically, the lesions appear as multiple, multilocular radiolucent spaces with distinct borders divided by bony septations, which often dramatically alter the shape and size of the jaw structures. These often result in marked facial abnormalities. Cervical lymphadenopathy is not uncommon in those affected. The disease is self-limited and can reverse itself with time. Approximately 250 cases have been reported in published studies, mostly affecting males. The purpose of our report was to present a case of cherubism diagnosed in a young girl and the long-term (3 generations) follow-up evaluation of her mother and grandmother, both of whom had been diagnosed with the same pathologic entity.
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Affiliation(s)
- Spyridon Tsodoulos
- Associate Professor, Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Ilia
- Dentist, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos Antoniades
- Professor, Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Angelopoulos
- Consultant, Department of Maxillofacial Radiology, Bronx Veterans Affairs Hospital, Bronx, NY
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Fernandes Gomes M, Ferraz de Brito Penna Forte L, Hiraoka CM, Augusto Claro F, Costa Armond M. Clinical and surgical management of an aggressive cherubism treated with autogenous bone graft and calcitonin. ISRN DENTISTRY 2011; 2011:340960. [PMID: 21991467 PMCID: PMC3169853 DOI: 10.5402/2011/340960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 10/10/2010] [Indexed: 11/23/2022]
Abstract
Cherubism is a rare autosomal-dominant inherited syndrome and is usually self-limiting; it starts in early childhood and involutes by puberty. It is a benign fibroosseous disease, characterized by excessive bone degradation of the upper and lower jaws followed by development of fibrous tissue masses. The purpose of this clinical report is to describe a rare and aggressive form of cherubism on an adult female patient that has been treated in our Bioscience Center for Special Health Care Needs-CEBAPE. The patient was firstly submitted to the surgical procedure with partial curettage of the lesion, and the cavity was filled with autogenous cancellous bone and bone marrow grafts. Furthermore, the support treatment used was the administration of salmon calcitonin by nasal spray during the first year after the preconized procedure. At 4-year followup, we confirmed the stomatognathic system improvement and esthetic rehabilitation, which led to a significant increase in the patient's quality of life.
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Affiliation(s)
- Mônica Fernandes Gomes
- Bioscience Center for Special Health Care Needs (Centro de Biociências Aplicado a Pacientes com Necessidades Especiais/CEBAPE-UNESP), São José dos Campos Dental School of the São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
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12
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13
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Carvalho Silva E, Carvalho Silva GC, Vieira TC. Cherubism: Clinicoradiographic Features, Treatment, and Long-Term Follow-Up of 8 Cases. J Oral Maxillofac Surg 2007; 65:517-22. [PMID: 17307601 DOI: 10.1016/j.joms.2006.05.061] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 02/14/2006] [Accepted: 05/31/2006] [Indexed: 11/17/2022]
Affiliation(s)
- Edgard Carvalho Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Peñarrocha M, Bonet J, Mínguez JM, Bagán JV, Vera F, Mínguez I. Cherubism: a clinical, radiographic, and histopathologic comparison of 7 cases. J Oral Maxillofac Surg 2006; 64:924-30. [PMID: 16713807 DOI: 10.1016/j.joms.2006.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Cherubism is an uncommon fibro-osseous disorder of the jaws that presents with varying degrees of involvement and a tendency toward spontaneous remission. Lesions are characterized by replacement of bone with fibrovascular tissue containing abundant multinucleated giant cells. We attempted to study the relationships among the degree of cherubism, the radiographic extent of the jaw lesions, the histopathologic findings, and the clinical course of 7 patients. PATIENTS AND METHODS In 7 patients diagnosed with cherubism, we evaluated the degree of fibrosis and perivascular cuffing, the presence of focal hemosiderin deposits, and giant multinucleated cell density (absent, few, moderate, or severe). Clinical course and progression were also assessed using a 4-point scale (improvement, no changes, modest progression, and marked progression). RESULTS The patients were followed up for an average of 8.5 years. Two patients exhibited clinical and radiographic improvement, while 3 showed no changes, and 2 progressed despite surgical treatment in 1 of them. CONCLUSION The course of cherubism in 1 of our patients may represent evidence of an association between the presence of abundant multinucleated giant cells, an increased extent of the lesions, and a more aggressive behavior of the disease.
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Affiliation(s)
- Miguel Peñarrocha
- Oral Surgery, Faculty of Medicine and Dentistry, Valencia University, Valencia, Spain.
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15
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Gomes MF, de Souza Setúbal Destro MF, de Freitas Banzi EC, dos Santos SH, Claro FA, de Oliveira Nogueira T. Aggressive behaviour of cherubism in a teenager: 4-years of clinical follow-up associated with radiographic and histological features. Dentomaxillofac Radiol 2005; 34:313-8. [PMID: 16120883 DOI: 10.1259/dmfr/32866350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cherubism is a rare hereditary fibro-osseous childhood disease characterized by bone degradation and fibrous tissue replacement at the angles of the mandible and at the tuberosity areas of the maxilla that leads to prominence of the lower face and an appearance reminiscent of the cherub's portrayal in Renaissance art. This disease has an autosomal dominant hereditary characteristic. The purpose of this report is to analyse laboratory tests, clinicopathological and radiographic features of cherubism and its intraoral manifestations in a patient during 4-years of follow-up, correlating the features observed in this case with those of the literature. Also discussed is the atypical and aggressive behaviour of this case during puberty.
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Affiliation(s)
- M F Gomes
- Faculdade de Odontologia de São José dos Campos, UNESP, Departamento de Biociências e Diagnóstico Oral, São Paulo, Brasil.
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16
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Meng XM, Yu SF, Yu GY. Clinicopathologic study of 24 cases of cherubism. Int J Oral Maxillofac Surg 2005; 34:350-6. [PMID: 16053841 DOI: 10.1016/j.ijom.2004.09.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2004] [Indexed: 12/13/2022]
Abstract
The authors reviewed 24 cases of familial or nonfamilial cherubism. The age at onset was between 6 and 10 years. It was characterized by bilateral painless swelling of jaws and eyes-to-heaven appearance was visible when the maxillae were affected as well. Radiographs showed well-defined multilocular radiolucencies and with age, thick sclerotic borders were visible. A malocclusive and abnormal dentition, worse in the mandible can be seen. Histopathologically, numerous randomly distributed multinucleated giant cells and vascular spaces within a fibrous connective tissue stroma with or without eosinophilic collagen perivascular cuffing were apparent. Multinucleated giant cells were positive for osteoclastic specific markers, tartrate-resistant acid phosphatase and human alphaV beta3 integrin, 23C6. Results after follow-up were available for 14 cases. Of these, no treatment was carried out in five cases, cherubism resolved (three cases) or grew slowly (two cases); curettage or surgical contouring was performed in seven cases, during the rapid growth of the lesions. This not only gave good immediate results, but also arrested active growth of remnant cherubic lesions and even stimulated bone regeneration. Segmental mandibulectomy followed by reconstruction was performed in two cases with extensive lesion and the risk of pathologic fracture of the mandible, and excellent results were obtained.
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Affiliation(s)
- X-M Meng
- Department of Oral Pathology, Peking University School of Stomatology, Haidian District, Beijing 100081, PR China.
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17
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Fonseca LC, de Freitas JB, Maciel PH, Cavalcanti MGP. Temporal bone involvement in cherubism: case report. Braz Dent J 2004; 15:75-8. [PMID: 15322650 DOI: 10.1590/s0103-64402004000100014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cherubism is a rare benign hereditary fibro-osseous disease involving the mandible and maxilla. We report a case of cherubism in a 10-year-old girl for which the panoramic radiograph was insufficient for diagnosis of the disease. Clinical, histological, and radiological findings were discussed. The CT was taken and it confirmed not only the involvement of the jaws but also of the temporal bone. This was not found in the conventional radiograph.
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18
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Shah N, Handa KK, Sharma MC. Malignant mesenchymal tumor arising from cherubism: a case report. J Oral Maxillofac Surg 2004; 62:744-9. [PMID: 15170291 DOI: 10.1016/j.joms.2003.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Naseem Shah
- All India Institute fo Medical Sciences, New Delhi, India.
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19
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Imai Y, Kanno K, Moriya T, Kayano S, Seino H, Matsubara Y, Yamada A. A missense mutation in the SH3BP2 gene on chromosome 4p16.3 found in a case of nonfamilial cherubism. Cleft Palate Craniofac J 2004; 40:632-8. [PMID: 14577811 DOI: 10.1597/1545-1569_2003_040_0632_ammits_2.0.co_2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Cherubism is a rare hereditary multilocular cystic disease of the jaws, characterized by its typical appearance. Although nonfamilial cases have been reported, it is difficult to distinguish nonfamilial cherubism from central giant cell granuloma. Recent studies have revealed the point mutations in the SH3BP2 gene on chromosome 4p16.3 in cherubism families. In this article, the SH3BP2 gene in nonfamilial cherubism was examined. PATIENT A 21-year-old Japanese woman with nonfamilial cherubism. INTERVENTIONS Genomic DNA was purified from a blood sample obtained from the patient and used for direct sequencing. In addition, a sample of the lesion, resected during surgery, was used for histologic and immunohistochemical purposes. RESULTS Genomic DNA sequencing found a Pro418Arg mutation in the SH3BP2 gene of the patient. In a histochemical analysis, the multinucleated giant cells proved to be strongly positive for PGM-1, KP-1, and tartrate-resistant acid phosphatase and faintly positive for osteopontin. CONCLUSIONS The missense mutation Pro418Arg was identified in the SH3BP2 gene from a nonfamilial case of cherubism. DNA diagnosis may play a significant role in the identification of cherubism.
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Affiliation(s)
- Yoshimichi Imai
- Department of Plastic and Reconstructive Surgery at Tohoku University Graduate School of Medicine, Sendai, Japan.
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20
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Imai Y, Kanno K, Moriya T, Kayano S, Seino H, Matsubara Y, Yamada A. A Missense Mutation in the SH3BP2 Gene on Chromosome 4p16.3 Found in a Case of Nonfamilial Cherubism. Cleft Palate Craniofac J 2003. [DOI: 10.1597/1545-1569(2003)040<0632:ammits>2.0.co;2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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21
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Ozkan Y, Varol A, Turker N, Aksakalli N, Basa S. Clinical and radiological evaluation of cherubism: a sporadic case report and review of the literature. Int J Pediatr Otorhinolaryngol 2003; 67:1005-12. [PMID: 12907058 DOI: 10.1016/s0165-5876(03)00179-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many cases have been published on cherubism since Jones described it first time in three children of the same family [Am. J. Cancer 17 (1933) 946]. Cherubism is an autosomal-dominant disorder in which the normal bone is replaced by cellular fibrous tissue and immature bone. Extracranial skeletal involvement is rarely seen in hereditary and non-hereditary forms of the disorder. The mandible is the most severely affected craniofacial component, in which uncontrolled growth of the malady deteriorates the aesthetic balance of the face. Bilateral swelling of the cheeks, mandibular enlargement and maxillary spongious hypertrophy cause orbital manifestations and tendency of eyes looking up to the sky. Thus, the pathognomic clinical feature resembles the appearance of "raised to heaven" Renaissance cherubs. The sporadic case concerns a child affected by cherubism. Radiographic and clinical data of the patient are presented and brief review of the literature is included.
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Affiliation(s)
- Yasar Ozkan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Buyukciftlik Sok. No. 6, 80200 Nisantasi, Istanbul, Turkey.
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22
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Schultze-Mosgau S, Holbach LM, Wiltfang J. Cherubism: clinical evidence and therapy. J Craniofac Surg 2003; 14:201-6; discussion 207-8. [PMID: 12621291 DOI: 10.1097/00001665-200303000-00012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cherubism is a hereditary childhood disease of autosomal dominant inheritance that is more common in the male sex. Some cases have also revealed a mutation of the gene FGF-RIII (fibroblast growth factor receptor III). The clinical picture of cherubism is characterized by painless symmetrical swelling of the mandible and polycystic destruction of the mandibular bone structure. Complications include delayed dentition, dental root resorption, malalignment of teeth, and impacted teeth. The disease progression comes to a halt of its own accord at the end of puberty. Spontaneous recoveries have been observed. Histologically, multinuclear giant cells with osteoclastic activity, which correspond to a giant cell granuloma, are found in fibrous stroma. It is generally agreed that decisions about surgical intervention should be considered carefully. A case report describes the course of the disease and therapy of a female patient with a periorbital manifestation of cherubism. The latero-orbital enlargement of the intraorbital and latero-orbital region of the zygomatic bone resulted in displacement of the orbital contents with a motility disorder of the eyes. The motility disorder was eliminated by reduction of the diseased hard tissue as well as by carrying out a modeling orbitotomy and by reconstructing an anatomically correct localized and irregular bilateral osseous structure of the zygomatic bone in the intraorbital and latero-orbital region.
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Affiliation(s)
- Stefan Schultze-Mosgau
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany.
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23
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White DK, Street CC, Jenkins WS, Clark AR, Ford JE. Panoramic radiograph in pathology. Atlas Oral Maxillofac Surg Clin North Am 2003; 11:1-53. [PMID: 12725098 DOI: 10.1016/s1061-3315(02)00012-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dean K White
- Division of Oral and Maxillofacial Pathology, College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0298, USA.
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24
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Silva EC, de Souza PEA, Barreto DC, Dias RP, Gomez RS. An extreme case of cherubism. Br J Oral Maxillofac Surg 2002; 40:45-8. [PMID: 11883969 DOI: 10.1054/bjom.2001.0654] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe an 8-year-old boy who presented with severe facial swelling. This progressed rapidly and 17 months later he died of gastrointestinal and pulmonary infections. The diagnosis was initially brown tumour associated with hyperparathyroidism, but this was revised in the light of laboratory investigations that were within the reference ranges, and normal appearance of the parathyroids on exploration to that of an extreme case of cherubism that behaved in a locally aggressive manner.
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Affiliation(s)
- E C Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil
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25
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Abstract
PURPOSE To demonstrate the clinical, radiologic, and histopathologic features of a patient with orbital involvement in cherubism that prompted surgical treatment. DESIGN Single interventional case report. INTERVENTION Findings of the ophthalmic evaluation, computed tomography (CT) scans, intraoperative examination, and light microscopy of the specimens were analyzed. MAIN OUTCOME MEASURES Globe displacement, orbital bony lesions detected on CT scans, histopathology, and postoperative results were assessed. RESULTS A 27-year-old female was seen with a slowly progressive superonasal globe displacement and a temporal orbital mass bilaterally of 6 years' duration. She had a history of cherubism, but her cheeks and jaws had a normal appearance instead of the bilateral fullness of the lower half of the face typical of the disease. CT scans demonstrated multicystic bony lesions arising from the orbital floors bilaterally. The masses were excised using an anterior transcutaneous transseptal orbitotomy. Histopathology demonstrated numerous giant cells in a fibrovascular stroma, confirming the clinical diagnosis of cherubism. Postoperative recovery was complete. CONCLUSIONS Orbital involvement in cherubism may develop beyond puberty, after stabilization or regression of the lesions in the jaws. Patients with cherubism should be routinely evaluated by an ophthalmologist.
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Affiliation(s)
- F Colombo
- Department of Ophthalmology and Eye Hospital, University of Erlangen-Nürnberg, Erlangen, Germany
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26
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Von Wowern N. Cherubism: a 36-year long-term follow-up of 2 generations in different families and review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:765-72. [PMID: 11113824 DOI: 10.1067/moe.2000.108438] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To clarify the relationships between the varying clinical or radiographic features of cherubism. STUDY DESIGN Nonparametric statistics were used in a long-term follow-up of 18 patients through 2 generations from 6 Danish families. RESULTS The radiographic grade of cherubism was significantly related to sex, maximal buccal bone expansion, course of cherubism, and number of aplasia or ectopic impacted teeth, but it was not related to families. Normal dentition in nonaffected regions was present or was obtained in 14 of 14 patients (age, >14 years). Surgical treatment did not provoke growth of lesional tissue in 22 of 22 cases. Radiographically, the bone structure in the lesional areas was related to age in all grades of cherubism: new bone formation in radiolucent areas (age, >20 years), normal bone structure with multilocular sketches (age, 32 to 39 years), and completely normal bone structure (age, >41 years), also found in 7 of 7 carriers of cherubism (age, >32 years). CONCLUSIONS This group analysis verifies the knowledge of cherubism previously based on cumulative reviews of findings in single-family and case reports.
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Affiliation(s)
- N Von Wowern
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Copenhagen, Denmark
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27
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Timoşca GC, Găleşanu RM, Cotuţiu C, Grigoraş M. Aggressive form of cherubism: report of a case. J Oral Maxillofac Surg 2000; 58:336-44. [PMID: 10716121 DOI: 10.1016/s0278-2391(00)90069-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G C Timoşca
- University of Medicine and Pharmacy, Iaşi, Romania.
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28
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Ekim M. A swollen face in a girl on haemodialysis. Nephrol Dial Transplant 2000; 15:283. [PMID: 10648688 DOI: 10.1093/ndt/15.2.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Stiller M, Urban M, Golder W, Tiziani V, Reichenberger E, Frege J, Opitz C, Peters H. Craniosynostosis in cherubism. ACTA ACUST UNITED AC 2000. [DOI: 10.1002/1096-8628(20001211)95:4<325::aid-ajmg6>3.0.co;2-r] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mangion J, Rahman N, Edkins S, Barfoot R, Nguyen T, Sigurdsson A, Townend JV, Fitzpatrick DR, Flanagan AM, Stratton MR. The gene for cherubism maps to chromosome 4p16.3. Am J Hum Genet 1999; 65:151-7. [PMID: 10364527 PMCID: PMC1378085 DOI: 10.1086/302454] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cherubism is a rare familial disease of childhood characterized by proliferative lesions within the mandible and maxilla that lead to prominence of the lower face and an appearance reminiscent of the cherubs portrayed in Renaissance art. Resolution of these bony abnormalities is often observed after puberty. Many cases are inherited in an autosomal dominant fashion, although several cases without a family history have been reported. Using two families with clinically, radiologically, and/or histologically proved cherubism, we have performed a genomewide linkage search and have localized the gene to chromosome 4p16.3, with a maximum multipoint LOD score of 5. 64. Both families showed evidence of linkage to this locus. Critical meiotic recombinants place the gene in a 3-cM interval between D4S127 and 4p-telomere. Within this region a strong candidate is the gene for fibroblast growth factor receptor 3 (FGFR3); mutations in this gene have been implicated in a diverse set of disorders of bone development.
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Affiliation(s)
- J Mangion
- Section of Cancer Genetics, Institute of Cancer Research, Sutton, Surrey, United Kingdom
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31
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A case of hereditary cherubism. Oral Radiol 1999. [DOI: 10.1007/bf02489755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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32
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Kalantar Motamedi MH. Treatment of cherubism with locally aggressive behavior presenting in adulthood: report of four cases and a proposed new grading system. J Oral Maxillofac Surg 1998; 56:1336-42. [PMID: 9820222 DOI: 10.1016/s0278-2391(98)90618-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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