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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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Sakaki H, Matsumiya T, Furudate K, Kobayashi W, Kon T, Itoh R, Kimura H. Identification of a point mutation in the SH3BP2 gene in cherubism. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Aloni MN, Kambere RS, Molua A, Dilu JN, Tshibassu PM, Kazadi-Lukusa A, Ngiyulu RM, Kalengayi RM, Ehungu JLG. Cherubism in sub-saharan Africa: a first case-report in a child. Rare Tumors 2015; 7:5675. [PMID: 25918610 PMCID: PMC4387356 DOI: 10.4081/rt.2015.5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/20/2014] [Accepted: 11/23/2014] [Indexed: 12/03/2022] Open
Abstract
Cherubism is rare disease and has been rarely reported in African pediatric population. We report here the case of a 10-year-old child who was referred to our hospital for bilateral jaws swelling. Physical examination revealed bilateral swelling symmetry of the face. Histopathological examination of the biopsy specimen showed loose fibrous stroma, proliferating fibrous connective with tissue interspersed with multinucleated giant cells, small thin walled blood vessels and scattered sparse mononuclear inflammatory infiltrate. Our patient presented cherubism. Cherubism is rarely described in children living in sub-Saharan Africa. Genetic and molecular investigations plays an important role in diagnosis but were not available in poor resources settings in developing countries such as the Democratic Republic of Congo.
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Affiliation(s)
- Michel Ntetani Aloni
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University Hospital of Kinshasa, University of Kinshasa , Democratic Republic of Congo
| | - Renault Sitwaminya Kambere
- Department of Pathology, University Hospital of Kinshasa, School of Medicine, University Hospital of Kinshasa, University of Kinshasa , Democratic Republic of Congo
| | - Antoine Molua
- Department of Radiolology, University Hospital of Kinshasa, School of Medicine, University Hospital of Kinshasa, University of Kinshasa , Democratic Republic of Congo
| | - Joseph Nzinga Dilu
- Department of Stomatology and Maxillofacial Surgery, University Hospital of Kinshasa, School of Medicine, University Hospital of Kinshasa, University of Kinshasa , Democratic Republic of Congo
| | - Pierre Manianga Tshibassu
- Division of Gastroenterology and Neurology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University Hospital of Kinshasa, University of Kinshasa , Democratic Republic of Congo
| | - Aimé Kazadi-Lukusa
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University Hospital of Kinshasa, University of Kinshasa , Democratic Republic of Congo
| | - René Makuala Ngiyulu
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University Hospital of Kinshasa, University of Kinshasa , Democratic Republic of Congo
| | - Raphael Mbona Kalengayi
- Department of Pathology, University Hospital of Kinshasa, School of Medicine, University Hospital of Kinshasa, University of Kinshasa , Democratic Republic of Congo
| | - Jean Lambert Gini Ehungu
- Division of Pediatric Hemato-Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University Hospital of Kinshasa, University of Kinshasa , Democratic Republic of Congo
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Mukai T, Ishida S, Ishikawa R, Yoshitaka T, Kittaka M, Gallant R, Lin YL, Rottapel R, Brotto M, Reichenberger EJ, Ueki Y. SH3BP2 cherubism mutation potentiates TNF-α-induced osteoclastogenesis via NFATc1 and TNF-α-mediated inflammatory bone loss. J Bone Miner Res 2014; 29:2618-35. [PMID: 24916406 PMCID: PMC4262741 DOI: 10.1002/jbmr.2295] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 05/19/2014] [Accepted: 06/02/2014] [Indexed: 01/03/2023]
Abstract
Cherubism (OMIM# 118400) is a genetic disorder with excessive jawbone resorption caused by mutations in SH3 domain binding protein 2 (SH3BP2), a signaling adaptor protein. Studies on the mouse model for cherubism carrying a P416R knock-in (KI) mutation have revealed that mutant SH3BP2 enhances tumor necrosis factor (TNF)-α production and receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclast differentiation in myeloid cells. TNF-α is expressed in human cherubism lesions, which contain a large number of tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cells, and TNF-α plays a critical role in inflammatory bone destruction in homozygous cherubism mice (Sh3bp2(KI/KI) ). The data suggest a pathophysiological relationship between mutant SH3BP2 and TNF-α-mediated bone loss by osteoclasts. Therefore, we investigated whether P416R mutant SH3BP2 is involved in TNF-α-mediated osteoclast formation and bone loss. Here, we show that bone marrow-derived M-CSF-dependent macrophages (BMMs) from the heterozygous cherubism mutant (Sh3bp2(KI/+) ) mice are highly responsive to TNF-α and can differentiate into osteoclasts independently of RANKL in vitro by a mechanism that involves spleen tyrosine kinase (SYK) and phospholipase Cγ2 (PLCγ2) phosphorylation, leading to increased nuclear translocation of NFATc1. The heterozygous cherubism mutation exacerbates bone loss with increased osteoclast formation in a mouse calvarial TNF-α injection model as well as in a human TNF-α transgenic mouse model (hTNFtg). SH3BP2 knockdown in RAW264.7 cells results in decreased TRAP-positive multinucleated cell formation. These findings suggest that the SH3BP2 cherubism mutation can cause jawbone destruction by promoting osteoclast formation in response to TNF-α expressed in cherubism lesions and that SH3BP2 is a key regulator for TNF-α-induced osteoclastogenesis. Inhibition of SH3BP2 expression in osteoclast progenitors could be a potential strategy for the treatment of bone loss in cherubism as well as in other inflammatory bone disorders.
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Affiliation(s)
- Tomoyuki Mukai
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, MO, USA
| | - Shu Ishida
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, MO, USA
- Department of Periodontal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, JAPAN
| | - Remi Ishikawa
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, MO, USA
- Department of Molecular Biology and Biochemistry, Okayama University Medical School, Okayama, JAPAN
| | - Teruhito Yoshitaka
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, MO, USA
| | - Mizuho Kittaka
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, MO, USA
- Department of Periodontal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, JAPAN
| | - Richard Gallant
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, MO, USA
| | - Yi-Ling Lin
- UCLA School of Dentistry, Los Angeles, CA, USA
| | - Robert Rottapel
- Ontario Cancer Institute and the Campbell Family Cancer Research Institute, University of Toronto, Toronto, Canada
- Division of Rheumatology, Department of Medicine, Saint Michael's Hospital, Toronto, Canada
| | - Marco Brotto
- School of Nursing & Health Studies and School of Medicine, University of Missouri-Kansas City, MO, USA
| | - Ernst J. Reichenberger
- Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Yasuyoshi Ueki
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, MO, USA
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Cowan RW, Singh G. Giant cell tumor of bone: a basic science perspective. Bone 2013; 52:238-46. [PMID: 23063845 DOI: 10.1016/j.bone.2012.10.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/27/2012] [Accepted: 10/01/2012] [Indexed: 12/26/2022]
Abstract
Comprehending the pathogenesis of giant cell tumor of bone (GCT) is of critical importance for developing novel targeted treatments for this locally-aggressive primary bone tumor. GCT is characterized by the presence of large multinucleated osteoclast-like giant cells distributed amongst mononuclear spindle-like stromal cells and other monocytes. The giant cells are principally responsible for the extensive bone resorption by the tumor. However, the spindle-like stromal cells chiefly direct the pathology of the tumor by recruiting monocytes and promoting their fusion into giant cells. The stromal cells also enhance the resorptive ability of the giant cells. This review encompasses many of the attributes of GCT, including the process of giant cell formation and the mechanisms of bone resorption. The significance of the receptor activator of nuclear factor-κB ligand (RANKL) in the development of GCT and the importance of proteases, including numerous matrix metalloproteinases, are highlighted. The mesenchymal lineage of the stromal cells and the origin of the hematopoietic monocytes are also discussed. Several aspects of GCT that require further understanding, including the etiology of the tumor, the mechanisms of metastases, and the development of an appropriate animal model, are also considered. By exploring the current status of GCT research, this review accentuates the significant progress made in understanding the biology of the tumor, and discusses important areas for future investigation.
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Affiliation(s)
- Robert W Cowan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Moskovszky L, Idowu B, Taylor R, Mertens F, Athanasou N, Flanagan A. Analysis of giant cell tumour of bone cells for Noonan syndrome/Cherubism-related mutations. J Oral Pathol Med 2012; 42:95-8. [DOI: 10.1111/j.1600-0714.2012.01194.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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de Matos FR, de Moraes M, Nonaka CFW, de Souza LB, de Almeida Freitas R. Immunoexpression of TNF-α and TGF-β in central and peripheral giant cell lesions of the jaws. J Oral Pathol Med 2011; 41:194-9. [DOI: 10.1111/j.1600-0714.2011.01075.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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SH3BP2-encoding exons involved in cherubism are not associated with central giant cell granuloma. Int J Oral Maxillofac Surg 2011; 40:851-5. [PMID: 21680150 DOI: 10.1016/j.ijom.2011.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 04/03/2011] [Accepted: 04/08/2011] [Indexed: 11/21/2022]
Abstract
Central giant cell granuloma (CGCG) is a benign lesion with unpredictable biological behaviour ranging from a slow-growing asymptomatic swelling to an aggressive lesion associated with pain, bone and root resorption and also tooth displacement. The aetiology of the disease is unclear with controversies in the literature on whether it is mainly of reactional, inflammatory, infectious, neoplasic or genetic origin. To test the hypothesis that mutations in the SH3BP2 gene, as the principal cause of cherubism, are also responsible for, or at least associated with, giant cell lesions, 30 patients with CGCG were recruited for this study and subjected to analysis of germ line and/or somatic alterations. In the blood samples of nine patients, one codon alteration in exon 4 was found, but this alteration did not lead to changes at the amino acid level. In conclusion, if a primary genetic defect is the cause for CGCG it is either located in SH3BP2 gene exons not yet related to cherubism or in a different gene.
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Sadri D, Hejazi M, Jahanbani J, Forouzandeh A. Quantitative analysis of argyrophilic nuclear organizer regions in giant cell lesions of jaws. J Oral Pathol Med 2010; 39:431-4. [PMID: 20202088 DOI: 10.1111/j.1600-0714.2009.00872.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Giant cell lesions of the jaws are considerably similar according to histopathologic characteristics yet show different clinical behaviors. These lesions include central giant cell granuloma (CGCG), aneurysmal bone cyst, Cherubism, and Brown tumor associated with hyperparathyroidism. The present study aimed to investigate AgNORs count in these lesions as a proliferative marker and to determine whether it can be used to discriminate between them or not. METHODS Forty-one cases of giant cell lesions of jaws were retrived from Oral Pathology Department (1987-2007). They included 21 cases of CGCG, eight cases of aneurysmal bone cyst (ABC), six cases of Cherubism, six cases of Brown tumor. The mean AgNORs count was calculated for all cases. To compare mean AgNORs in groups of lesions, ANOVA test was performed. RESULTS Mean AgNOR counts were: (0/85 +/- 0/29) in CGCG, (0/76 +/- 0/32) in ABC (0/87 +/- 0/10) in Cherubism and (0/82 +/- 0/16) in Brown tumor. A significant difference was not observed in AgNOR counts among these groups of lesions. CONCLUSIONS Jaws giant cell containing lesions have no acceptable differences in mean AgNORs.
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Affiliation(s)
- Donia Sadri
- Oral and Maxillofacial Pathology Department, Islamic Azad University Dental School, Tehran, Iran.
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Amaral FR, Brito JAR, Perdigão PF, Carvalho VM, de Souza PEA, Gomez MV, De Marco L, Gomez RS. NFATc1 and TNFα expression in giant cell lesions of the jaws. J Oral Pathol Med 2010; 39:269-74. [DOI: 10.1111/j.1600-0714.2009.00855.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bilodeau E, Chowdhury K, Collins B. A case of recurrent multifocal central giant cell granulomas. Head Neck Pathol 2009; 3:174-8. [PMID: 19644538 PMCID: PMC2715452 DOI: 10.1007/s12105-009-0119-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 05/08/2009] [Indexed: 10/27/2022]
Abstract
One case of recurrent multifocal central giant cell granulomas (CGCG) is presented. Initially, the lesions presented concurrently in the maxilla and mandible with subsequent recurrence in the mandible. Now, two recurrences are seen in the maxillary sinus and ethmoid region. The literature regarding multifocal CGCG is reviewed.
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Affiliation(s)
- Elizabeth Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA USA
| | - Khalid Chowdhury
- Center for Craniofacial & Skull Base Disorders/Department of Otolaryngology, University of Colorado, Denver, CO USA
| | - Bobby Collins
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA USA
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Carvalho VM, Perdigão PF, Amaral FR, de Souza PEA, De Marco L, Gomez RS. Novel mutations in the SH3BP2 gene associated with sporadic central giant cell lesions and cherubism. Oral Dis 2008; 15:106-10. [PMID: 19017279 DOI: 10.1111/j.1601-0825.2008.01499.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Central giant cell lesion (CGCL) is a reactive bone lesion that occurs mainly in the mandible, characterized by the multinucleated osteoclast-like giant cells in a background of oval to spindle-shaped mononuclear cells. The etiology is unknown and occurs more commonly in young adults. Cherubism, a rare disease found predominantly in females has histologic characteristics indistinguishable from those of CGCL and is caused by mutations mostly present in exon 9 of the SH3BP2 gene. In this study, we investigated four cases of CGCL and one case of cherubism. DNA was extracted from peripheral blood and tumor tissue and all coding and flanking regions of the SH3BP2 amplified by PCR and directly sequenced to identify underlying mutations. Two novel mutations were found; a heterozygous missense mutation c.1442A>T (Q481L) in exon 11 in one sporadic case of CGCL and a heterozygous germline and tumor tissue missense mutation c.320C>T (T107M) in exon 4 in one patient with cherubism. These findings open a new window to investigate the possible relationship between the pathogenesis of the cherubism and CGCL.
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Affiliation(s)
- V M Carvalho
- Department of Pharmacology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Lietman SA, Yin L, Levine MA. SH3BP2 is an activator of NFAT activity and osteoclastogenesis. Biochem Biophys Res Commun 2008; 371:644-8. [PMID: 18440306 DOI: 10.1016/j.bbrc.2008.04.080] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 04/11/2008] [Indexed: 10/22/2022]
Abstract
Heterozygous activating mutations in exon 9 of SH3BP2 have been found in most patients with cherubism, an unusual genetic syndrome characterized by excessive remodeling of the mandible and maxilla due to spontaneous and excessive osteoclastic bone resorption. Osteoclasts differentiate after binding of sRANKL to RANK induces a number of downstream signaling effects, including activation of the calcineurin/NFAT (nuclear factor of activated T cells) pathway. Here, we have investigated the functional significance of SH3BP2 protein on osteoclastogenesis in the presence of sRANKL. Our results indicate that SH3BP2 both increases nuclear NFATc1 in sRANKL treated RAW 264.7 preosteoclast cells and enhances expression of tartrate resistant acid phosphatase (TRAP), a specific marker of osteoclast differentiation. Moreover, overexpression of SH3BP2 in RAW 264.7 cells potentiates sRANKL-stimulated phosphorylation of PLCgamma1 and 2, thus providing a mechanistic pathway for the rapid translocation of NFATc1 into the nucleus and increased osteoclastogenesis in cherubism.
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Affiliation(s)
- Steven A Lietman
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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