Central giant cell granuloma of the mandibular condyle: a rare presentation

Central giant cell granuloma in the posterior region of mandible mimicking a fibro-osseous lesion and hemangioma: a case report

BACKGROUND

A central giant cell granuloma (CGCG) is a benign, proliferative, intraosseous, and non-odontogenic lesion occurring primarily in children and young adults. On the histological level, it is characterized by numerous multinucleated giant cells scattered randomly throughout a sea of spindle-shaped mesenchymal stromal cells which are dispersed throughout the fibrovascular connective tissue stroma containing areas of haemorrhage. When it comes to radiographic features, CGCG can have an array of variations, ranging from well-defined expansile lesions to ill-defined and destructive lesions, with or without expansion.

CASE PRESENTATION

This case report reviews an 11-year-old Caucasian patient with a chief complaint of slow-growing swelling involving the right posterior mandibular region. The cone beam computed tomography (CBCT) revealed an ill-defined mixed lesion mimicking both fibro-osseous lesion and hemangioma. However, microscopic examination revealed multinucleated giant cells in a fibrous stroma suggestive of central giant cell granuloma.

CONCLUSION

Our intent in reporting this case is to highlight the importance of thorough clinical, radiographical and histopathological examination for accurate diagnosis and therapeutic interventions as well as to emphasize the importance of taking different possibilities into consideration when examining bony swellings in the head and neck region.

Central Giant Cell Granuloma in the Mandibular Condyle in a Teenager. A Case Report with Literature Review

Central giant cell granulomas (CGCG) are not common in the mandibular condyle. In teenagers, the problem is more complex because of difficulties in diagnosis and treatment involving the potential growth of the mandibular process and development of the face. In this short communication a case is presented of an eleven-year-old female under diagnosis of central giant cell granuloma affecting the mandibular condyle treated surgically in two steps using a condylectomy and vertical ramus osteotomy at the first time and later orthognathic surgery, showing the clinical evolution after 13 years of follow-up. In addition, we performed a review of the scientific reports related to CGCG in the mandibular condyle to compare this treatment with others, in terms of follow-up and results. We concluded that the CGCG affecting the mandibular head can be properly treated with low condilectomy, vertical mandibular ramus sliding osteotomy, and discopexy.

Central giant cell granuloma of the mandibular condyle: additional case and literature review

Introduction: Central giant cell granuloma (CGCG) of the jaws is not a common lesion. Only five cases are reported in the mandibular condyle. Observation: A 25 year-old male presented with preauricular swelling and a premature occlusal contact on the molars. The lesion had radiological features of aggressiveness and a high metabolic uptake. Initial biopsy was misleading. The lesion was treated surgically by resection. Discussion: Histologically, CGCG are very similar to other giant cell lesions such as GCT (Giant cell Tumor) or BTH (brown tumor of hyperparathyroidism). The standard treatment is surgical either by curettage or resection. Only 6 cases have been described in the literature, including this one. The diagnosis is difficult, relying on a bundle of clinical, radiological and histological arguments. However, radical surgery should be performed to avoid the tumor recurrence. The genetic mutations associated with CGCG (notably TRPV4 and RAS pathway) may explain why this tumor is mostly found in the dental part of the jaws and only rarely in the mandibular condyle.

Central giant cell granuloma of the mandibular condyle: A rare case and a literature review

INTRODUCTION

Central giant cell granuloma is a benign intraosseous lesion; tumours in the condylar region are rarely reported.

CASE PRESENTATION

We present the case of a 60-year-old woman with preauricular swelling, limitation of joint motion and pain on only the right side.

DISCUSSION

The patient was evaluated based on her preoperative clinical manifestations, by orthopantomography and computed tomography (CT). CT revealed a lesion on the right condylar head. Surgery was scheduled based on this imaging finding, histological findings from an incisional biopsy specimen, and the patient's indications and symptoms.

CONCLUSION

Of all reported cases of central giantcell granuloma, only five (including this case) were located in the mandibular condyle.

An aggressive central giant cell granuloma in a pediatric patient: case report and review of literature

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.

Mandibular condylar pseudocyst: an introduction to the orthodontist

The aims of this article are to introduce mandibular condylar pseudocysts to orthodontists, present 2 relevant case reports, and discuss possible differential diagnoses. Condylar pseudocyst is a radiologic variant of pterygoid fovea, which is the site of insertion of the lateral pterygoid muscle to the head of the mandibular condyle. A pathognomonic picture of a solitary well-defined radiolucency with radiopaque borders, located on the anterior aspect of the condyle in an asymptomatic orthodontic patient, is characteristic.

Appraisal of jaw swellings in a Nigerian tertiary healthcare facility

Introduction: The mandible and maxilla can be the site of myriads of lesions that may be categorized as neoplastic, cystic, reactive and infective or inflammatory. Literature reviewing jaw swellings in an amalgamated fashion are uncommon, probably because aetiologies for these swellings are varied. However, to appreciate their relative relationship, it is essential to evaluate the clinico-pathologic profile of jaw swellings. The aim of this appraisal is to describe the array of jaw swellings seen at our hospital from 1990 to 2011, to serve as a reference database. Material and Methods: Biopsy records of all histologically diagnosed cases of jaw swellings seen at the department of Oral Pathology, University College Hospital between January 1990 and December 2011 were retrieved, coded and inputted into SPSS version 20. Data on prevalence, age, sex, site and histological diagnosis were analysed descriptively for each category of jaw swellings. All patients below 16 years were regarded as children. Results: A total of 638 jaw swellings were recorded in the 22-year study period. The Non Odontogenic Tumours (NOT) were the commonest, accounting for 46.2% of all jaw swellings. Odontogenic Tumours (OT) formed 45% of all adult jaw swelling while it formed 25.2% in children and adolescents. Ameloblastoma was the commonest while the most common NOT was ossifying fibroma (OF). Chronic osteomyelitis of the jaws was about 6 times commoner in adult females than males and mostly involved the mandible. The most common malignant jaw swelling was Burkitts’ lymphoma (BL) that was about 7 times more in children than adults. Osteogenic sarcoma was the most common malignancy in adults. Conclusion: Jaw swellings are extensively varied in types and pattern of occurrence. This study has categorized jaw swellings in a simple but comprehensive fashion to allow for easy referencing in local and international data acquisition and epidemiological comparison.

Key words:Jaw swellings, odontogenic, Nigeria.

Central giant cell granuloma of the mandibular condyle: a case report and review of the literature

Central giant cell granuloma (CGCG) is a benign intraosseous lesion. The true nature of this lesion is controversial and remains unknown; the three competing theories are that it could be a reactive lesion, a developmental anomaly or a benign neoplasm. Furthermore, the actual aetiology of CGCG is still unclear, although inflammation, haemorrhage and local trauma have all been suggested; it has also been hypothesized that CGCG may have a genetic aetiology. Lesions central to the mandibular condylar head are very rare, with only three documented cases in the English language literature, none of which elaborates on the CT features. In this case report, a 31-year-old male patient complaining of a left pre-auricular mass underwent radiographic investigation. CT images revealed a lesion central to the mandibular condyle and demonstrated features that were highly suggestive of CGCG. The patient underwent surgical curettage, and the subsequent histopathological examination confirmed the diagnosis of CGCG. 3 years after the procedure the patient presented with a recurrence and underwent complete resection of the mandibular condyle with immediate reconstruction. This report presents CT characteristics of a rare occurrence of CGCG of the mandibular condyle, compares it with other published cases and poses the question of the role of radiology in predicting the degree of aggressive behaviour of these lesions before surgery.

Central giant cell granuloma of the jaws: clinical and radiological evaluation of 22 cases

OBJECTIVE

The objective was to investigate the clinical and radiological characteristics of central giant cell granulomas (CGCGs) of the jaws.

METHODS

A retrospective analysis of a 20-year database was performed regarding both clinical and radiological features of 22 patients affected with CGCGs of the jaws.

RESULTS

Fourteen women and 8 men were included with the age range of 7-81 years (mean 31.7 years). Among the 22 lesions, 16 were located in the mandible and 6 in the maxilla. Painless swelling was the most common clinical feature in 18 of all cases. Limited mouth opening was noted in 2 patients where the lesions involved the condyle. Radiographically, 13 lesions were homogeneously osteolytic and 9 lesions were trabeculated. Fifteen lesions were unilocular and 14 lesions presented with well-defined but not sclerotic margins. CT images in 5 patients clearly showed the trabeculation within the lesions. The follow-up ranged from 1.5 to 11 years with a mean period of 5 years. Three out of 9 aggressive and 1 out of 13 nonaggressive lesions developed recurrence.

CONCLUSIONS

Diagnosis of CGCGs of the jaws depends on both correct interpretation of clinical, radiographic and pathological data. Differentiation between aggressive and nonaggressive CGCGs should be considered to improve individual treatment planning.

Peripheral giant cell granuloma of the mandibular condyle presenting as a preauricular mass

Preauricular mass is a common symptom for patients presenting to the otorhinolaryngologist with parotid disease. Some rare extraparotid lesions, originating from the temporomandibular joint and the mandible itself, also share the same localization and therefore are to be taken into consideration for the differential diagnosis with parotid lesions. Giant cell granuloma (GCG) was first described by Jaffe in 1953. Peripheral GCG (PGCG) is an exophytic soft tissue lesion originating from the periodontal ligament and periosteum. It is located only within the oral cavity. Central GCG (CGCG) is an uncommon benign fibro-osseous lesion generally presenting as an expansible mass with cortical bone defect. It is generally located in the mandible. The brown tumor of hyperparathyroidism and giant cell tumor must be ruled out because of the microscopic similarities of these lesions. The first case of PGCG of the mandible condyle is presented, and attention is drawn to mandibular diseases for the differential diagnosis of the preauricular mass.