Multilocular radiolucencies odontogenic keratocyst. Bilateral central giant cell connecting repositories. The lesion was removed by curettage and a histopathological. A nonneoplastic inflammatory lesion, usually of the jaw or gingiva, containing large, multinucleated cells. Between the giant cells are monocluate variants with similar nuclear profiles. Central giant cell granuloma cgcg is a relatively uncommon benign bony lesion of a variably aggressive nature, accounting for less than 7%. Central giant cell granuloma is an uncommon benign intraosseus lesion of jaws. The objective was to investigate the clinical and radiological characteristics of central giant cell granulomas cgcgs of the jaws. Therefore, diagnosis requires a systemic investigation for lesion differentiation. We herein describe an intriguing case of a 21yearold male patient who was. The differential diagnosis comprises central giant cell granuloma, giant cell tumor of bone, and osteitis fibrosa cystica brown tumor in combination with hyperparathyroidism. Central giant cell granuloma cgcg is a benign intraosseous lesion that occurs in long bones. Brown tumor of the maxillary sinus in a patient with primary. Central giant cell granuloma cgcg of the jaw is a benign osteolytic lesion.
Recently, bisphosphonates have been used to treat central giant cell lesions. Central giant cell granuloma and fibrous dysplasia occurring in the same jaw is rarely reported in the literatures. Central giant cell granuloma was 1st described in jaws by jaffe 1953. Although central giant cell granulomas cgcgs appear to be benign, their radiographic findings are active. Nonsurgical treatment methods, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. Central giant cell granuloma in anterior maxilla shwetang goswami1, haripriya2, yashwanth yadav3, ram mohan4 abstract. These findings suggested a differential diagnosis of central giant cell granuloma cgcg, aneurysmal bone cyst, or cystic calcifying odontogenic tumor. Central giant cell granuloma is a benign lesion of the jaws which is sometimes aggressive locally.
Consent was gathered from patient investigated in this study. Mr imaging depicted a right temporal expansile multiloculated lesion, with hyper and hypointense signal. The findings are consistent with central giant cell. Central giant cell granuloma is an uncommon benign proliferative lesion occurring. Cone beam ct scans of a circumscribed giant cell granuloma. Central giant cell granuloma is a benign, intraosseous lesion of the jaws which exhibits a spectrum of clinical behavior ranging from nonaggressive to aggressive variants. Central giant cell granuloma cgcg of the jaw bones is a rare benign intraosseous lesions that is commonly seen as indolent lesions in the mandible anterior to the first molar. Giant cell granuloma description of giant cell granuloma. Granulomata definition of granulomata by medical dictionary. Based on the history and clinical findings a provisional diagnosis of adenomatoid odontogenic tumor and a differential diagnosis of central giant cell granuloma, ameloblastoma, fibroosseous lesion were given. Peripheral giant cell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma.
It may become aggressive leading to expansion and perforation of the cortex. Central giant cell granuloma cgcg is a benign, proliferative, intraosseous and nonodontogenic lesion of unknown etiology. Achieving the correct diagnosis is reportedly difficult because cgcgs are very similar to odontogenic jaw tumors. The lesion principally affects the mandible and maxilla. Differential diagnosis of granulomatous lung disease. Central giant cell granuloma cgcg is a benign bone lesion which can be locally aggressive or may be asymptomatic in nature. Central giant cell granuloma and osteitis fibrosa cystica. Giantcell lesions of the paranasal sinuses, including the giant cell reparative granuloma, the brown tumor of hyperparathyroidism, the true giant cell tumor, cherubism, and the aneurysmal bone cyst, are uncommon entities. Peripheral giant cell granuloma is the most common jaw located giant cell lesion. Peripheral giant cell granuloma or so called giant cell epulis is the most common oral giant cell lesion. An aggressive central giant cell granuloma treated successfully by conventional surgery mariam mezzour, karima elharti and wafaa elwady abstract central giant cell granuloma is a rather rare lesion of the jaws aetiology of which is still completely unknown but thought to be of a reactive process to some unknown stimuli. A retrospective analysis of a 20year database was performed regarding both clinical and radiological features of 22 patients affected with cgcgs of the jaws. Central giant cell granuloma, benign jaw tumor, molar, recurrent pericoronitis, multinucleated giant cells. Differential diagnosis of oral maxillofacial lesions.
Although there is not enough evidence that this lesion promotes reparative process, it was denominated reparative giant cell granuloma 2, 2530. Extremely aggressive behavior of central giant cell granuloma. Brown tumors can affect the mandible, maxilla, clavicle, ribs, and pelvic bones. We describe our experience in managing this lesion by intralesional triamci. The most common treatment is curettage,which has a high recurrence rate, particularly in more. Central giant cell lesions granuloma radiology reference. The clinical differential diagnosis most often includes other reactive lesions of the gingiva including pyogenic granuloma and peripheral giant cell granuloma. The purpose of this study was to determine the ct characteristics and describe possible mr imaging features of gcg of the craniofacial bones. Also called giant cell reparative granuloma central if intraosseous. Central giant cell lesion cgcl is a benign lesion which has unpredictable biologic behaviour and is amenable to a plethora of treatment alternatives. Although there is not enough evidence that this lesion promotes reparative process, it was denominated reparative giant cell granuloma. Differential diagnosis of oral maxillofacial lesions differential diagnosis of oral maxillofacial lesions1. Central giant cell granuloma cgcg, formerly called giant cell reparative granuloma, is a nonneoplastic proliferative lesion of unknown etiology. Giant cell reparative granuloma, central definition of.
Despite this, a recurrence rate of 1520% is often quoted, and in these cases treatment may need to be more aggressive and may need to consist of an en bloc resection. In this case study age, sex, and the location of the central giant cell granuloma agrees with the available literature, however the uncommon periapical location combined with the morbidity of the canine pulp made the diagnosis difficult. Central giant cell lesion may arise sporadically or in association with cherubism, noonan syndrome, jaffecampanacci syndrome, neurofibromatosis type 1, or ramon syndrome 6, 7. Differential diagnosis of radiolucent lesions of the jaws. We present a 42yearold greek woman, with a rare case of. There is a further population of bland, spindled, fibroblastslike cells with associated hemosiderin and scattered inflammation. A case of a 36yearold male with a central giant cell lesion.
Full text pimary hyperparathyroidism as central giant cell. Central giant cell granuloma cgcg of the jaws is a benign, intraosseous, osteolytic lesion of debatable etiology. Treatment of central giant cell lesions using bisphosphonates. Peripheral giant cell granuloma pgcg is a nonneoplastic lesion that may affect any region of the gingiva or alveolar mucosa of edentulous and toothed areas, preferentially in the mandible and rarely occurring in children. Granuloma, abscess, cyst traumatic bone cyst incisive canal cyst paradental infected buccal cyst median mandibular cyst periapical cemental dysplasia benign cementoblastoma central giant cell granuloma.
Although it is a benign disease process, it can also be locally destructive. Plain radiographic and computedtomographic studies of these lesions are described and the differential diagnosis. The patient has been followed for 12 months without recurrence figures 6 and 7. The patient followed up 3 months after the surgery. Central giant cell granuloma and fibrous dysplasia occurring. This report describes the clinical and histopathological findings of a pgcg diagnosed in the maxilla of a 9yearold boy associated with a tooth erupting improperly and a. Our case demonstrates the importance of considering cgcg in the differential diagnosis of rapidly progressive mandibular lesions in the pediatric population. It may exhibit aggressive biologic behavior, characterized by localized swelling, pain, rapid growth, bony expansion, cortical. Aggressive central giant cell granuloma of the mandible, a. Annular elastolytic giant cell granuloma aegcg should be kept in the differential diagnosis when assessing a middleaged woman with recurring annular plaques with a raised border. These tumors become severely invasive with the stimulus of surgery, resembling malignant tumors.
The usual diagnostic tests were not sufficient for accurate diagnosis and treatment. Case report open access radiotherapy for recurrent central giant cell granuloma. Giant cell granuloma is an uncommon bony lesion in the head and neck region, most commonly affecting the maxilla and mandible. We report a case of large temporal giant cell reparative granuloma in a 72yearold man. Cgcg lacks in clinical and radiographical pathognomonic features to distinguish from. Peripheral giantcell granuloma an overview sciencedirect. Brown tumors are rare focal giant cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. This article describes a case of central giant cell granuloma in the right posterior region of the mandible in a 10 yearold boy.
Central giant cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings. Traditional treatment has been local curettage, although aggressive subtypes have a high tendency to recur. Ameloblastoma circumscribed benign tumors of neural origin. Central giant cell lesions the central giant cell granuloma, also known as cgcl or giant cell lesion, was first described by jaffe in 1953. An aggressive central giant cell granuloma in a pediatric. Central giant cell granuloma a case report balaji p. The central giant cell granuloma is an uncommon, benign and proliferative pathological condition accounting for less than 7% of all benign lesions of the jaws whose etiology is not clearly explained. Central giant cell granuloma of the posterior maxilla. Central giant cell granulomas are benign tumours of the mandible, presenting in children and young adults. Peripheral giant cell granuloma differential diagnoses. Peripheral giant cell granuloma in a child associated with. Central giant cell granuloma cgcg is a benign lesion of the jaws with an unknown etiology. But the term reparative is obsolete, as cgcg causes the destruction of involved bones. Periapical radiolucencies this website provides over 0 free medical books and more for.
Radiologic features, including those seen with computed tomography, of central giant cell granuloma of the jaws. Ct and mr imaging of giant cell granuloma of the craniofacial. Giant cell granuloma gcg is an uncommon, benign, proliferative, intraosseous lesion representing etiology is unknown, but is thought to be a reactive process, possibly secondary to trauma or inflammation. The true nature of these lesions is unknown but, as they are invariably destructive, the term reparative giant cell granuloma. Intralesional corticosteroid injection for central giant cell. Prompt diagnosis and management can greatly improve longterm outcomes. The differential diagnosis of peripheral giant cell granuloma includes lesions with very similar clinical and histopathological features such as cgcl, pyogenic granuloma, peripheral ossifying fibroma. Radiotherapy for recurrent central giant cell granuloma. Its etiology is unknown and its biological behavior is poorly understood.
Peripheral giant cell granuloma is an infrequent reactive, exophytic lesion of the oral cavity, also known as giant cell epulis, osteoclastoma, giant cell reparative granuloma, or giant cell hyperplasia. Granulomatous disorders comprise a large family sharing the histological denominator of granuloma formation. The differential diagnosis of cgcl includes the socalled brown tumor of hyperparathyroidism btoh, pgcg, and giant cell tumor of bone gctb. The diagnosis and management of giant cell lesions of the jaws. This peripheral giant cell granuloma involved the maxillary gingiva associated with an erupting central incisor of a 6yearold girl. Central giant cell lesions granulomas, also known as giant cell reparative cystsgranulomas, occurs. It is twice as common in females and is more likely to occur before age 30. Clinically and radiologically, a differentiation between aggressive and nonaggressive lesions can be made. Central giant cell granuloma anterior to first molars mandible maxilla. Some, however, consider it to be a giant cell tumor occurring in both benign and. Peripheral giant cell granuloma refers to the gingiva giant cell epulis. The central giant cell granuloma cgcg is an uncommon benign bony lesion that accounts for less than 7% of all benign lesions of the jaws in toothbearing areas. Based on the histopathology, the differential diagnosis was revised to include only lesions with a histology compatible with cgcg, as shown in table 2. This condition is a slowgrowing, asymptomatic lesion that usually affects children and young adults, predominantly females.
Central giant cell granuloma cgcg is a localised benign condition of the jaws. Central giant cell granuloma cgcg is a rare, nonneoplastic, benign lesion that exhibits expansive and osteolytic biological behavior. The differential diagnosis of peripheral giant cell granuloma includes lesions with very similar clinical and histopathological features such as cgcl, pyogenic granuloma, peripheral ossifying fibroma, fibrous hyperplasia, inflamed irritation fibroma, hemangioma, lymphangioma, amelanotic melanoma and metastatic tumors 3, 20, 21, 34. It was jaffe who first introduced the term central giant cell reparative granuloma to distinguish this lesion from the giant cell. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, pyogenic granuloma and peripheral ossifying fibroma. Aug 22, 2012 central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness. Surgery was performed with the patient under general anaesthesia after nasal intubation, using a right preauricular approach.
Central giant cell lesions granulomas, also known as giant cell reparative cystsgranulomas, occurs almost exclusively in the mandible, although cases in the skull and maxilla have been reported. In 1953, jaffe described it as reparative granuloma of jaw bones 1. A granuloma is a focal compact collection of inflammatory cells, mononuclear cells predominating, usually as a result of the persistence of a nondegradable product and of active cell. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. The lesion was surgically removed under local anesthesia and the specimen was sent to histopathology for evaluation which revealed multinucleated giant. Giant cell reparative granuloma definition of giant cell. The condition was first identified in 1953 by jaffe, who initially termed this lesion as a central giant cell reparative granuloma. A clinicopathological classification of granulomatous. The histopathological diagnosis was central giant cell granuloma. Jun 19, 2018 the peripheral giant cell granuloma has an unknown etiology, with some dispute as to whether this lesion represents a reactive or neoplastic process. Definition of granuloma a granuloma is a focal aggregation of inflammatory cells, activated macrophages epithelioid histiocytes, langhans giant.
Giant cell granuloma definition of giant cell granuloma by. Central giant cell granuloma is an uncommon benign proliferative lesion occurring more commonly in the anterior mandible. Central giantcell granuloma cgcg is a localised benign condition of the jaws. Divided into non and aggressive subtypes, the aggressive subtype is relatively rare.
An aggressive central giant cell granuloma treated. It is microscopically similar to the central giant cell granuloma of bone, being characterized by a proliferation of multinucleated giant cells that resemble osteoclasts. Granuloma annulare successfully treated using fractional photothermolysis with a 1,550nm erbiumdoped yttrium aluminum garnet fractionated laser. The peripheral giant cell granuloma is a relatively common tumorlike growth that develops on the gingiva or alveolar ridge. Central giant cell granuloma cgcg is an uncommon, benign, proliferative, and nonodontogenic lesion whose etiology is not defined. The article reports the case of a child who was initially seen in her general dentists office, then referred to an oral and maxillofacial surgeon. It is the most frequent giant cell lesion of the jaws, and originates from the connective tissue of the periosteum or from the periodontal. The referring doctor had suggested a diagnosis of eruption cyst. It originates from periosteum or from periodontal membrane as a response to local irritation or chronic. The term giant cell reparative granuloma gcrg was first used by jaffe in 1953, to distinguish these lesions from giant cell tumor of long bones. Central giant cell lesions granuloma dr yuranga weerakkody and assoc prof frank gaillard et al. The lesion was surgically removed under local anesthesia and the specimen was sent to histopathology for evaluation which revealed multinucleated giant cells in a highly vascular connective tissue with chronic inflammatory. Central giant cell granuloma cgcg is a relatively uncommon benign bony lesion of a variably aggressive nature, accounting for less than 7% of all benign jaw lesions.
Central giant cell granuloma of the mandibular condyle. Giant cell granuloma gcg is an uncommon, benign, proliferative, intraosseous lesion representing central giant cell granuloma agrees with the available literature, however the uncommon periapical location combined with the morbidity of the canine pulp made the diagnosis difficult. However, most authorities believe peripheral giant cell granuloma is a reactive lesion. Central giant cell granuloma of the mandible american. Giant cell granuloma an overview sciencedirect topics. The differential diagnosis of cgcl includes the socalled brown tumor of hyperparathyroidism. Central giant cell granuloma cgcg is defined by the world health organization as an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of hemorrhage, aggregations of multinucleated. It usually presents as a purplishred soft tissue nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells. It is an uncommon tumor in jaws, its etiology and pathogenesis is unknown. The histological feature reveal central giant cell granuloma and fibrous dysplasia. Conventional management is surgical and consists of enucleation and curettage. The central giant cell granuloma is an uncommon lesion only seen in the toothbearing regions of the jaws, most commonly in the mandible and typically in the second and third decades.
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