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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 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] [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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Rikhotso RE, Khan F. Lytic brown tumour of the mandible as the initial presentation of hyperparathyroidism in a 7-year old girl: A case report. Int J Surg Case Rep 2024; 119:109735. [PMID: 38735218 PMCID: PMC11101889 DOI: 10.1016/j.ijscr.2024.109735] [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: 03/20/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Maxillomandibular involvement with brown tumours is rare, especially in the paediatric population. We present a rare case of a young girl with brown tumour (BT) occurring in the mandible as the first manifestation of hyperparathyroidism. CASE PRESENTATION A 7-year-old black female, presented with a 6-month history of a swelling on the left mandible. Patient had a history of intractable gastrointestinal symptoms such as nausea, vomiting and abdominal cramps. Biopsy confirmed the lesion as a giant cell lesion. Elevated parathyroid hormone (PTH) levels confirmed the diagnosis of a BT of hyperparathyroidism. The patient underwent surgical intervention involving parathyroidectomy. This was followed by segmental resection of the mandibular tumour two years later. CLINICAL DISCUSSION Brown Tumour is a rare, non-neoplastic lesion resulting from abnormal bone metabolism secondary to hyperparathyroidism. BT predominantly arise in long bones and the axial skeleton. Maxillomandibular involvement is very rare. In the present case, after parathyroidectomy, normal PTH and calcium levels were restored, and there was relief of gastrointestinal tract hypercalcaemic symptoms. However, there was no spontaneous regression of the mandibular tumour over a 2-year observation period. Hemimandibulectomy followed by reconstruction with a plate and costochondral graft was then performed. CONCLUSION It is difficult to differentiate BT from other giant cell lesions without blood chemistry revealing hyperparathyroidism. The distinction is imperative to avoid mutilating and aggressive treatment for BTs. Although BTs are amenable for conservative treatment, the present case illustrates that for bigger tumours, in the absence of spontaneous regression, aggressive surgical treatment may be required.
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Affiliation(s)
- Risimati Ephraim Rikhotso
- Department of Maxillofacial and Oral Surgery, Wits School of Oral Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Faheema Khan
- Department of Maxillofacial and Oral Surgery, Wits School of Oral Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa
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3
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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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4
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Mohammadi F, Bashizadehfakhar H, Aliasghari S, Gholamhoseini Z. Aggressive Multiple Central Giant Cell Granulomas of the Jaws. Case Rep Dent 2023; 2023:5410229. [PMID: 38322589 PMCID: PMC10845258 DOI: 10.1155/2023/5410229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 02/08/2024] Open
Abstract
Central giant cell granuloma (CGCG) is considered a benign intraosseous lesion with a varied range of clinical features in two subtypes, including aggressive and non-aggressive lesions. This study presents a 9-year-old boy with multiple bilateral CGCG in the mandible without any systemic disease or specific syndrome. Clinical, radiographic, and histopathological findings demonstrated the aggressive lesions. It is discussed how the differential diagnosis and treatment can be determined based on the patient's age as well as the size and manner of the lesion.
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Affiliation(s)
- Farnoush Mohammadi
- Craniofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Oral and Maxillofacial Surgery Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoorieh Bashizadehfakhar
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Aliasghari
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Gholamhoseini
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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5
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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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6
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Ghosh A, Lakshmanan M, Manchanda S, Bhalla AS, Kumar P, Bhutia O, Mridha AR. Contrast-enhanced multidetector computed tomography features and histogram analysis can differentiate ameloblastomas from central giant cell granulomas. World J Radiol 2022; 14:329-341. [PMID: 36186516 PMCID: PMC9521432 DOI: 10.4329/wjr.v14.i9.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/05/2022] [Accepted: 09/02/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography (CT) images has been reported for the differentiation between ameloblastomas and central giant cell granulomas (CGCGs).
AIM To describe differentiating multidetector CT (MDCT) features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis.
METHODS MDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors. Histogram analysis was used to compare the extent of enhancement of the soft tissue. Fisher’s exact tests and Mann–Whitney U test were used for statistical analysis (P < 0.05).
RESULTS Twelve CGCGs and 33 ameloblastomas were reviewed. Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle. CGCGs were multilocular (58.3%), with a mixed lytic sclerotic appearance (75%). Soft tissue component was present in 91% of CGCGs, which showed hyperenhancement (compared to surrounding muscles) in 50% of cases, while the remaining showed isoenhancement. Matrix mineralization was present in 83.3% of cases. Ameloblastomas presented as a unilocular (66.7%), lytic (60.6%) masses with solid components present in 81.8% of cases. However, the solid component showed isoenhancement in 63%. No matrix mineralization was present in 69.7% of cases. Quantitatively, the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis (P < 0.05), with a minimum enhancement of > 49.05 HU in the tumour providing 100% sensitivity and 85% specificity in identifying a CGCG.
CONCLUSION A multilocular, lytic sclerotic lesion with significant hyperenhancement in soft tissue, which spares the angle of the mandible and has matrix mineralization, should indicate prospective diagnosis of CGCG.
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Affiliation(s)
- Adarsh Ghosh
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Meyyappan Lakshmanan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Prem Kumar
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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7
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Aurora JK, Chauhan H, Loomba K, Potlia I. Novel regimen of combined intralesional triamcinolone and salmon calcitonin nasal spray to treat a large central giant cell granuloma. Natl J Maxillofac Surg 2022; 13:S131-S135. [PMID: 36393951 PMCID: PMC9651218 DOI: 10.4103/njms.njms_185_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/08/2021] [Accepted: 06/10/2021] [Indexed: 06/16/2023] Open
Abstract
About 10% benign tumors of the jaw are known to be central giant cell granulomas (CGCGs) affecting mandible more than maxilla. They are more commonly seen among young females, mean age range being 10-25 years. The aggressive variants of CGCG require surgical intervention, leaving colossal disfiguring defects. This being the reason for many nonsurgical alternative therapies as calcitonin injections and nasal spray, intralesional steroid injections and subcutaneous interferon injections advocated for its management. Although the exact success rate of using these nonsurgical therapies are not fully known, they provide the advantage of being conservative in nature, as majority of the patients are young adults. This lack of accurate regimen is due to paucity of randomized control trials and systematic reviews addressing the topic. This manuscript attempts to present a novel regimen protocol which was followed for a case of CGCG, right mandible on a 22-year-old female patient, for a period of 1.5 years and trailed by a follow-up of 2 years.
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Affiliation(s)
- Jitender Kumar Aurora
- Department of Oral and Maxillofacial Surgery, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Himanshu Chauhan
- Department of Oral and Maxillofacial Surgery, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Kapil Loomba
- Department of Conservative Dentistry and Endodontics, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Ipshita Potlia
- Department of Public Health Dentistry, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
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8
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Kumar J, Vanagundi R, Manchanda A, Mohanty S, Meher R. Radiolucent Jaw Lesions: Imaging Approach. Indian J Radiol Imaging 2021; 31:224-236. [PMID: 34316130 PMCID: PMC8299495 DOI: 10.1055/s-0041-1729769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Jaw lesions are a wide array of benign, malignant, and locally aggressive lesions. On radiography, they can appear radiolucent, mixed, or radioopaque. The imaging appearances of radiolucent jaw lesions are markedly overlapping. The role of the radiologist is to formulate a narrow differential diagnosis based on imaging characteristics and aid appropriate management decisions. The aim of this pictorial review is to familiarize the reader with the imaging approach to radiolucent jaw lesions, which form the bulk of jaw lesions in clinical practice.
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Affiliation(s)
- Jyoti Kumar
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Rajesh Vanagundi
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Alpana Manchanda
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Sujata Mohanty
- Department of Oral And Maxillofacial surgery Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Ravi Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
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9
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Pediatric Mandibular Central Giant Cell Granuloma: Neoadjuvant Immunotherapy to Minimize Surgical Resection. J Craniofac Surg 2021; 32:e267-e269. [PMID: 32969939 DOI: 10.1097/scs.0000000000007112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT Central giant cell granuloma (CGCG) is a relatively uncommon benign bony lesion accounting for approximately 7% of all non-neoplastic lesions of the jaw. The clinical behavior of CGCG can vary from a slow-growing, painless lesion to fast-growing and locally destructive. When such a lesion involves the mandible, this can be quite debilitating for the patient, inhibiting oral intake and requiring an extensive resection and bone graft reconstruction. The authors present a case of effectively decreasing the surgical morbidity associated with a large and rapidly growing CGCG of the mandible in a pediatric patient. Neoadjuvant immunotherapy with denosumab (human monoclonal antibody) facilitated treatment of the tumor without the need for a large resection which would have otherwise necessitated a vascularized bony mandibular reconstruction. Consideration of neoadjuvant medical management of CGCG as the primary treatment is advocated.
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10
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Ahmed A, Naidu A. Towards better understanding of giant cell granulomas of the oral cavity. J Clin Pathol 2021; 74:483-490. [PMID: 33858937 DOI: 10.1136/jclinpath-2020-206858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/08/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022]
Abstract
Giant cell granulomas are enigmatic lesions of the oral cavity characterised by a peculiar combined proliferation of mononuclear and multinucleated giant cells in a mesenchymal stromal background. Central and peripheral giant cell granulomas may have similar pathogenesis and histology but differ in their location and biological behaviour. It is important to differentiate them from other giant cell lesions that can occur in the oral cavity, such as giant cell tumour of the bone, aneurysmal bone cyst, brown tumour of hyperparathyroidism, and giant cell lesions of Ramon syndrome, Noonan syndrome, neurofibromatosis and Jaffe-Campanacci syndrome. A recent insight into their molecular genetics and pathogenesis, with identification of KRAS, FGFR1 and TRPV4 mutations, allows for better diagnostic differentiation and opens the door to the use of pathway inhibitors in the treatment of recurrent or dysmorphic lesions. In this review, we provide an updated summary of the clinical and pathological features of oral cavity giant cell granulomas that help with their precise diagnosis and management.
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Affiliation(s)
- Atif Ahmed
- Pathology and Laboratory Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA .,Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Aparna Naidu
- Oral Pathology, University of Missouri Kansas City, Kansas City, Missouri, USA
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11
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Tebbutt JE, Markose G, Graham RM. Use of three-dimensional planning and guidance technology in surgical correction of central giant cell granuloma-induced facial deformity. Ann R Coll Surg Engl 2021; 103:381-382. [PMID: 33851892 DOI: 10.1308/rcsann.2020.7116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J E Tebbutt
- Community Dental Service, Browning Centre, Bournemouth, UK
| | - G Markose
- East Lancashire Hospitals NHS Trust, UK
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12
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Shaia JK, Winston JS, Campbell J, Kowalewska J. Educational Case: Giant Cell Tumor of the Bone in Both the Axial and Appendicular Skeleton. Acad Pathol 2021; 8:23742895211008657. [PMID: 33889720 PMCID: PMC8040597 DOI: 10.1177/23742895211008657] [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: 01/18/2021] [Revised: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Jacqueline K Shaia
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Janet S Winston
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - John Campbell
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jolanta Kowalewska
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
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13
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Murugan K, Jose D, Sathiasekar A, Kumar D. Central giant cell granuloma in a 10-year-old pediatric patient - A rare entity in posterior mandible with CBCT findings: A case report. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2021. [DOI: 10.4103/jiaomr.jiaomr_206_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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14
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The effects of IL-4 and RANKL on viability of giant cell granuloma patients' monocytes. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Kholaki O, Metter D, Tandon R, Schlieve T. Tumorigenic Potential of Granulocyte Colony-Stimulating Factor Therapy-A Case Report and Review of Literature. J Oral Maxillofac Surg 2020; 78:2219-2225. [PMID: 32628932 DOI: 10.1016/j.joms.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022]
Abstract
An association between granulocyte colony-stimulating factor therapy (G-CSFT) in patients with glycogen storage disease type Ib (GSDIb) and the development of giant cell lesions of the maxillofacial complex has emerged. We have reported, to the best of our knowledge, the fourth case of giant cell granuloma (GCG) in a patient with GSDIb undergoing G-CSFT. GSDIb can present with hypoglycemia, hypertriglyceridemia, and neutropenia. G-CSFT has often been used in the treatment of recurrent infections or sepsis caused by neutropenia and to treat inflammatory bowel disease and diarrhea. The current reported data are lacking in both the association and the potential causation of G-CSFT and the development of giant cell tumors. Given the prevalence of GSDIb and its therapy, oral and maxillofacial surgeons should be aware of the tumorigenic potential of G-CSFT in patients with GSDIb. In the present report, we have described the case of a 17-year-old patient with GSDIb undergoing GCSFT who presented with a peripheral and central GCG. She was treated but presented again 13 months later with concerns for a new primary lesion. We have also discussed GSDIb, G-CSFT, and the current data, highlighting the association between G-CSFT for GSDIb, the potential mechanism of GCG development, the use of adjuvant therapy, and the need for close follow-up of this population. The purpose of the present case report is to highlight the presentation, management, and follow-up of giant cell lesions in patients with GSDIb treated with G-CSFT.
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Affiliation(s)
- Omar Kholaki
- Resident Surgeon, Department of Oral and Maxillofacial Surgery, Parkland/UT Southwestern, Dallas, TX.
| | - David Metter
- Pediatric Pathology Fellow, Department of Pathology, UT Southwestern and Children's Health, Dallas, TX
| | - Rahul Tandon
- Resident Surgeon, Department of Oral and Maxillofacial Surgery, Parkland/UT Southwestern, Dallas, TX
| | - Thomas Schlieve
- Assistant Professor of Surgery and Residency Program Director, Department of Oral and Maxillofacial Surgery, Parkland/UT Southwestern, Dallas, TX
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16
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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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17
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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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Sivapathasundharam B, Biswas PG, Preethi S. The World Health Organization classification of odontogenic and maxillofacial bone tumors: An appraisal. J Oral Maxillofac Pathol 2019; 23:178-186. [PMID: 31516220 PMCID: PMC6714253 DOI: 10.4103/jomfp.jomfp_211_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022] Open
Abstract
Classification is the process of grouping similar entities under one category for the ease of their comprehension and better handling. Medical classification dates back to the days of William Farr who is credited with the development of a nosology, which later served as the forerunner for the modern-day disease classification by ICD. The WHO system of classification is a time-honoured system that has prevailed from decades together and is under constant evolution. The classification of odontogenic tumours was first formulated by Pierre Paul Broca and has undergone several transformations over years. Though the earlier classifications and their modifications by several authors and even by the WHO appeared to be fitting for their time, the latest edition of WHO classification of odontogenic and maxillofacial bone tumours neither seems to be complete nor perfect, even at the present context. It is unfortunate that even with the advancement of molecular biology, the present WHO classification on Odontogenic and Maxillofacial bone tumours, fails to serve as a 'reference standard' in the true sense of the term. This article highlights the limitations of the current classification with constructive criticism that may help in further improvement.
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Affiliation(s)
- B Sivapathasundharam
- Department of Oral Pathology and Microbiology, Meenakshi Academy of Higher Education and Research, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Protyusha Guha Biswas
- Department of Oral Pathology and Microbiology, Meenakshi Academy of Higher Education and Research, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - S Preethi
- Department of Oral Pathology and Microbiology, Meenakshi Academy of Higher Education and Research, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
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Early detection of cherubism with eventual bilateral progression: a literature review and case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:e77-e83. [PMID: 30287203 DOI: 10.1016/j.oooo.2018.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/09/2018] [Accepted: 08/22/2018] [Indexed: 01/08/2023]
Abstract
Cherubism is a rare familial disease of childhood that commonly affects the bilateral mandible and maxilla and typically resolves in adulthood. It has been shown to have a male predilection and has been mapped to the SH3 BP2 gene. Only 2 cases of unilateral cherubism have been documented in the literature; in the first case, the contralateral side was eventually affected. Although rare, unilateral cherubism presents a diagnostic dilemma. This case report describes a unique presentation of unilateral cherubism that progressed to affect the contralateral side and describes some of the considerations in the diagnosis and treatment of unilateral benign giant cell lesions of the jaws.
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20
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Mandibular Mass in a Child with End Stage Renal Disease. Indian J Pediatr 2018; 85:794-795. [PMID: 29076103 DOI: 10.1007/s12098-017-2492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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21
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Noriega-Jalil AB, Valverde-García YA, García-Barajas J, Hernández HG, González-Torres JA, Ramos-Armengol DC, Garrido-Mendoza AP, González-Virla B, Vargas-Ortega G, López-Juárez NG, Mendoza-Zubieta V. Mandibular Brown Tumor as Atypical Presentation of Primary Hyperparathyroidism: two Case Reports And Literature Review. AACE Clin Case Rep 2018. [DOI: 10.4158/ep171967.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rytkönen E, Ottavainen V, Rytkönen A, Uusitalo S, Lehenkari P, Sándor GK. Denosumab Treatment for Aggressive Multiple Recurrent Familial Central Giant-cell Granulomas. Ann Maxillofac Surg 2018; 8:265-269. [PMID: 30693243 PMCID: PMC6327812 DOI: 10.4103/ams.ams_192_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Aggressive familial giant-cell granulomas of the jaws can be severely deforming. Surgical and nonsurgical treatments may be associated with multiple recurrences. Denosumab, a new generation antiresorptive drug, is an osteoclast inhibitor, which may be particularly useful to manage such potentially disfiguring lesions. Materials and Methods: Two sisters, both with a history of multiple recurrent aggressive central giant-cell granuloma (CGCG)-like lesions in both jaws, were referred for management. All lesions were histologically consistent with the diagnosis of CGCG. The lesions were treated surgically with curettage and perilesional injection of triamcinolone. In particular, the older sister had four separate anatomic sites where some of her lesions had multiple recurrences necessitating three repeat procedures. A course of subcutaneous denosumab was administered following the last giant-cell granuloma removal in both sisters. Results: Bony healing was normal. No further recurrences were observed over 3.5 years of follow-up after denosumab therapy in either sister. Conclusions: In this small cohort comprising two sisters with multiple aggressive recurrent giant-cell granuloma lesions at multiple sites in the mouth, subcutaneous denosumab administration was associated with success over 3.5 years of follow-up. This report cautiously adds to the clinical experience in the use of denosumab for the treatment of recurrent aggressive familial CGCG lesions.
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Affiliation(s)
- Eelis Rytkönen
- Department of Oral and Maxillofacial Surgery, Oulu University Hospital, Oulu, Finland
| | - Vuokko Ottavainen
- Department of Oral and Maxillofacial Surgery, Oulu University Hospital, Oulu, Finland
| | - Aleksi Rytkönen
- Department of Pathology, Oulu University Hospital, Oulu, Finland
| | - Sanna Uusitalo
- Department of Oral and Maxillofacial Surgery, Oulu University Hospital, Oulu, Finland
| | - Petri Lehenkari
- Department of Anatomy, University of Oulu, Oulu, Finland.,Department of Orthopaedics, Oulu University Hospital, Oulu, Finland
| | - George K Sándor
- Department of Oral and Maxillofacial Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland
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23
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Jovanović M, Stojanović S. Application of corticosteroids in dentistry. ACTA STOMATOLOGICA NAISSI 2018. [DOI: 10.5937/asn1878888j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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24
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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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Denosumab as a Treatment Alternative for Central Giant Cell Granuloma: A Long-Term Retrospective Cohort Study. J Oral Maxillofac Surg 2017; 76:775-784. [PMID: 29035698 DOI: 10.1016/j.joms.2017.09.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Giant cell granuloma (GCG) of the jaw is a rare disease with high morbidity. Various treatment options have been discussed in the past. Since 2010, a pharmaceutical therapy with denosumab seems to have been successful for giant cell tumors of the femur. The authors hypothesized the equally successful use of denosumab for GCGs of the jaws. MATERIALS AND METHODS In the present retrospective cohort study, 5 patients with large GCGs of the jaws were treated with denosumab with a follow-up of 25 to 49 months. Frequent clinical follow-ups and a radiologic follow-up were performed and systematically analyzed. RESULTS All patients showed a curative treatment response and complete metabolic resolution of the GCGs under treatment with denosumab. CONCLUSION A brief review of the relevant literature and a detailed evaluation of current cases led to the conclusion that denosumab therapy should be considered a therapeutic option for large central GCGs of the jaws. The results of this study suggest denosumab is a successful treatment option. A treatment length no shorter than 12 months is recommended and monitoring of treatment response can be well managed by positron-emission tomographic computed tomography or magnetic resonance imaging.
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Age and Expression of CD163 and Colony-Stimulating Factor 1 Receptor (CD115) Are Associated With the Biological Behavior of Central Giant Cell Granuloma. J Oral Maxillofac Surg 2017; 75:1414-1424. [DOI: 10.1016/j.joms.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/01/2017] [Accepted: 01/02/2017] [Indexed: 12/19/2022]
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Abstract
Tumor-induced osteomalacia (TIO) is a rare cause of hypophosphatemia involving overproduction of fibroblast growth factor 23. TIO has been described largely in adults with small mesenchymal tumors. We report a case of TIO in a child who presented with knee pain and radiographic findings concerning for rickets, and was found to have maxillomandibular giant cell lesions. The patient was treated with oral phosphorus and calcitriol, surgical debulking, and intralesional corticosteroids, which resulted in tumor regression and normalization of serum fibroblast growth factor 23 and phosphorus. This case illustrates the occurrence of this rare paraneoplastic syndrome in children and adds to our knowledge about clinical manifestations and pathologic findings associated with pediatric TIO.
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Melville JC, Couey MA, Tong MS, Marx RE. Regeneration of a Tooth in a Tissue-Engineered Mandible After Resection of a Central Giant Cell Tumor. Demonstrating Evidence of Functional Matrix Theory and Ectodermal Origin of Teeth in a Human Model-A Case Report. J Oral Maxillofac Surg 2016; 75:850-857. [PMID: 27780691 DOI: 10.1016/j.joms.2016.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 01/08/2023]
Abstract
Central giant cell tumors (CGCTs) are uncommon lesions occurring in the jaw. They are benign but locally destructive osteolytic lesions. They usually occur in pediatric patients 5 to 15 years of age. Multiple noninvasive modalities of treatment (intralesional steroids, interferon, calcitonin, and denosumab) have been described for those lesions, but for those that are refractory to treatment, enucleation and curettage or resection is a curative surgery. This case report describes a pediatric patient who was diagnosed with an aggressive CGCT of the left mandible encompassing the right angle to the condyle. The lesion became refractory to noninvasive treatments and immediate resection and reconstruction was performed using principles of tissue engineering. After 5 years of close observation, the patient showed normal morphology and growth of his mandible, but surprisingly developed a left mandibular third molar (tooth 17) in the site of the mandibular resection and reconstruction. This is the first case report in the literature to show the spontaneous development of teeth in a human reconstructed mandible, contributing evidence toward the functional matrix theory of mandibular growth and ectodermal origin of teeth.
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Affiliation(s)
- James C Melville
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Sciences Center at Houston, School of Dentistry, Houston, TX.
| | - Marcus A Couey
- Resident PGY-5, Department of Oral and Maxillofacial Surgery, University of Texas Health Sciences Center at Houston, School of Dentistry, Houston, TX
| | - Matthew S Tong
- Resident PGY-2, Department of Oral and Maxillofacial Surgery, University of Texas Health Sciences Center at Houston, School of Dentistry, Houston, TX
| | - Robert E Marx
- Professor and Chief, Department of Oral and Maxillofacial Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL
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Aditya A, Aditya P. Central Giant Cell Granuloma of Jaw with Multiple, Multifocal Recurrences. J Clin Diagn Res 2016; 10:ZJ03-4. [PMID: 27656591 DOI: 10.7860/jcdr/2016/20357.8263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/31/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Amita Aditya
- Reader, Department of Oral Medicine and Radiology, Sinhgad Dental College and Hospital , Pune, Maharashtra, India
| | - Priyam Aditya
- Consultant Prosthodontist, Aditya's Dental Privilege , Baner Road, Pune, Maharashtra, India
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Abstract
Most pathologic lesions of the jaws or of oral mucosa are treated successfully by surgical interventions. For treatment of the central giant cell lesion, aneurysmal bone cysts, histiocytosis of the mandible, hemangioma, odontogenic keratocyst, Paget disease, oral submucous fibrosis, and oral lichen planus, medical management consisting of intralesional injections, sclerosing agents, and systemic bisphosphonates is as successful as surgical procedures with fewer complications. Pharmacology of agents used and protocols are presented.
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Affiliation(s)
- Orrett E Ogle
- Mona Dental Program, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica; Oral and Maxillofacial Surgery, Woodhull Medical Center, Brooklyn, NY, USA.
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Huan CM, Norzila AB. Giant Cell Reparative Granuloma Mimicking Aneurysmal Bone Cyst in Proximal Phalanx of Toe. Malays Orthop J 2016; 10:55-56. [PMID: 28435549 PMCID: PMC5333705 DOI: 10.5704/moj.1603.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Giant Cell Reparative Granuloma (GCRG) of phalanx is uncommon. It is a benign osteolytic lesion but can be locally aggressive. GCRG has certain radiology and histological features that are similar to other giant cell lesions of the bone. We present a case report of a young patient with giant cell reparative granuloma of proximal phalanx of left third toe. The bone lesion was successfully treated surgically.
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Affiliation(s)
- C M Huan
- Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan Malaysia
| | - A B Norzila
- Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan Malaysia
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Giant Cell Tumor of the Maxilla in a Teenaged Patient. J Craniofac Surg 2015; 26:e373-4. [PMID: 26080274 DOI: 10.1097/scs.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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El Hadidi YN, Ghanem AA, Helmy I. Injection of steroids intralesional in central giant cell granuloma cases (giant cell tumor): Is it free of systemic complications or not? A case report. Int J Surg Case Rep 2015; 8C:166-70. [PMID: 25699662 PMCID: PMC4353960 DOI: 10.1016/j.ijscr.2015.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 01/08/2023] Open
Abstract
Central giant tumors commonly occur in long bones. In the oral and maxillofacial region, a counterpart coined with the term Central giant cell granuloma exists. Choung and Kaban classified central giant cell granulomas based on clinical and radiographic findings. The classification includes aggressive and non-aggressive variants. However, to date there has been no molecular method of distinguishing the variants. Different lines of treatment had been reported. The aggressive form showed high recurrence rates with conservative surgical treatment. Intra-lesional steroid, calcitonin, interferon, bisphosphonates and denosumab; have been administered as a treatment lines. Several reports support the injection of intra lesional steroids and its successful outcome. An Egyptian, nine years old female presented with a facial swelling affecting lower left side of the mandible. Biopsy confirmed it to be a CGCG. The treatment plan was intralesional steroid injections to avoid resection of the mandible. The treatment showed acceptable progress but was associated with cushinoid appearance of patient. This forced the operating team to halt the steroid injections and resolute to adjunctive surgical curettage yet sparing the mandible from resection. One-year follow up showed no recurrence, however, the patient still suffers mild cushinoid appearance.
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Affiliation(s)
- Yasser Nabil El Hadidi
- Instructor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Egypt.
| | - Amr Amin Ghanem
- Lecturer of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Egypt
| | - Iman Helmy
- Professor of Oral Pathology, Faculty of Dentistry, Ain Shams University, Egypt
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