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Central Report giant cell granuloma of a case The central giant cell granuloma IS a

Central

Report

giant cell granuloma

of a case

Central Report giant cell granuloma of a case The central giant cell granuloma IS a tumor
Central Report giant cell granuloma of a case The central giant cell granuloma IS a tumor
Central Report giant cell granuloma of a case The central giant cell granuloma IS a tumor

The

central

giant

cell

granuloma

IS

a tumor

that

has

great

potential

for

the

displacement

of

teeth

 

and

the

development

of

a facial

deformity.

Although

its

cause

and

behavior

are

still

matters

for

discussion,

 

its

early

diagnosis

and

treatment

are

a priority.

We

describe

a patient

 

with

a

large

benign

 

central

giant

cell

granuloma

of

the

anterior

mandible.

 

The

clinical,

radiographic,

and

histologic

appearance,

as

well

as

the

appropriate

treatment.

are

discussed

in

light

of

the

current

 

literature.

 

(OH.U

SI

KC. OK.\I

Mm

OH\I

t’\irio~.

lW3;75:2X6-Y1

 

T he

central

giant

cell

granuloma

(CGCG)

i>

;I

permanent

 

Iirht

hlcuspid

to

the

distal

aspect

01

the

right

common

 

reactive

nonneoplastic

 

lesion

of

the

jaw.

I~’

permanent

lateral

in&or.

The

swelling

 

\\us

hard

to palpa-

.lalfe

first

used

the

term

“giant

cell

reparative

 

gran-

tion.

consistent

 

with

bone.

 

and

U;IS

covered

with

normal

uloma”

in

1953

to distinguish

this

lesion

of

the

j;lM

I~UCOS;I.

t’ressure

did

not

elicit

any

exudate

or

any

tender--

from

sion

the giant

of the

long

cell

tumor.

a histologically

bones.J

Although

once

similar

believed

to

Ic-

be

ness.

minimal

and

there

swelling

D;I~

of

no

the

presence

lingual

of

aspect

paresthesia.

of

the

There

mandible.

\\;I\

and

   

~11 other

tissues

 

of

the

oral

cavity

\lere

\+ithin

normal

lim-

separate

entities.

it

is now

thought

that

these

repre-

it\

 

sent

the

same

disease

process.

and

only

manifest

 

Kadlographh

 

or

the

patient

Included

 

LI panoramic

viev.

themselves differently

 

b>

the

site

of occurrcncc

and

ouclusal

wa4.

croswxtional

 

tomogram5.

and axial

con-

the

age

of

the

patient.

The

CGCG

is typically

found

lputed

torrqraph~

 

(Fig.

I

).

These

revealed

;I

large.

~~\cll-

in persons

under

the

age

of

30 (75%)

and

has

;I

prc-

L:ircurnscrihed.

 

unilocular

radiolucenq

 

that

mcasurcd

5

dilection

 

for

women

(64’:;

).‘.

The

preferred

site

for

WI

X

4

c‘nt

in

!/it‘

midline

ol’the

mandible

(Fig.

3).

The

le.-

the

occurrence

 

of CGCG

is

in

the

facial

bones.

hut

Gon

exknded

l’rom

the

mesi~l

root

surface

(II‘

the

left

per-

reports”,

of

other

sites

including

the temporal.

eth-

manen

 

lirst

hiLucpid

to

the

mesial

root

suri‘acc

of’

the

right

moid,

and

sphenoid

bones

do c.xi\t.

 

permanent

cu\pid.

The

\ertic:tl

extension

 

\\;I\

from

the

 

nccka

01’ the

mandibular

anterior

teeth

to

the

inferior

cor-

CASEREPORT

 

IC\

01‘ ihc

rnxntiihic.

with

no

rexu-ption

 

01‘ the

roots

01’ !hc

 

lccth

noted.

Modcr:ite

huccal

expansion

*;I\

presenl.

~$1111

.1\ 1-kbear-old

 

Ilkp;lnic

male

came

to

the

CJniverGty

01

\r\eri:

th~nn~ns

 

01

the

c‘ortical

plate.

Within

the

radiolw

Texas Health Science center for routine dental procedure\.

The patient’s mother \vas particularI>

odontic consultation for his mandibular anterior teeth that

interested

in an

orth-

cent>

~mpacttzd

appeared

c‘ro\\

;I radiopaque

n and

p;rrti:ll

 

structure

root

oi’the

consistent

m;tndihul:lr

with

left

the

per--

had

shifted.

tvaluatiun

revealed

;I

retained

left

primar!

m~nen~

the

IWOII

~uspld

\\crc

ho

inotcxi.

other

calcifications

\+ithin

the

lumen

01

cuspid.

and

the

nxlndibular

anterior

incisor

teeth

ucre

se-

On

the

baGa

of

the

clinical

 

and

radiographIc

irndings,

i hc

vcrcly

lar

inclined

swelling

to

was

the

noted

patient’s

from

the

left.

4

rnesial

large.

labial

aspect

of

vcstibu-

the

left

tliit‘erential

iiic

keratocybt.

diagn&s

(‘GC(;

included

dentigerouj

. aneury-smal

hone

c‘!xt.

\t.

c)

odonto=c-

amclohlas-

 

toma.

and

ameloblastic

libroma

 
hone c‘!xt. \t. c) odonto=c- amclohlas-   toma. and ameloblastic libroma  
hone c‘!xt. \t. c) odonto=c- amclohlas-   toma. and ameloblastic libroma  
hone c‘!xt. \t. c) odonto=c- amclohlas-   toma. and ameloblastic libroma  

ORAL

Volume

SURGERY

ORAI

7.5. Number

MEDICINE

3

ORAL

P~rw~.oc;v

Potter

and Tiner

287

7.5. Number MEDICINE 3 ORAL P~rw~.oc;v Potter and Tiner 287 Fig. 1. Panoramic radiograph reveals large,
Fig. 1. Panoramic radiograph reveals large, circular, well-defined radiolucent lesion of anterior mandible
Fig.
1.
Panoramic
radiograph
reveals large,
circular,
well-defined
radiolucent
lesion
of anterior
mandible
Impacted
mandibular
left cuspid
is observed
projecting
into
lesion.
Fig.
2.
Preoperative
axial
computerized
tomograph
shows
well-circumscribed,
unilocular,
lo\n, density
symphysis
lesion.
with
a. yellowish
substance.
Using
a handpiece,
a
and the postoperative
course
was
uneventful
with

was made and the spongy, vascular

lesion was

evidence of recurrence (Fig. 4).

DISCUSSION

The

CGCG

typically

appears

as a multilocular,

diolucent

lesion

that

occurs

in the tooth-bearing

mixed

large window

no

ra-

areas

removed

by thorough

curettage

and sent for histologic

ex-

amination.

The

impacted

mandibular

left cuspid

was then

easily

removed.

After

irrigation

with

saline

solution

and

packing

the bony defect with

a thrombin-soaked

absorbable

gelatin

sponge (Gelfoam),

the flap was repositioned

and

SLI-

tured.

The gross specimen

tissue that

was well

tiple

cellular hbrovascular

measured

circumscribed,

sections showed

consisted 3.3 cm X with numerous stroma,

of a grayish-pink

giant

with

mass of

lesion

Mul-

within

a

3.3 cm X a rubbery benign consistent

1.6 cm. The

consistency.

cells

the histologic

picture

of CGCG

(Fig.

was followed

3).

The patient

closely for a period

of 2 years

of

the

jaws

previously

occupied

by

the

deciduous

teeth.

Although

 

the

lesion

is usually

located

in close

proximity

 

to

the

teeth,

some

cases

of CGCG

have

been

reported

in

the

edentulous

patient.‘,

’ These

le-

sions

commonly

occur

in

the

mandible

(675,)

as op-

posed

anterior

these lesions

to the maxilla segment.

will

(3 1‘%I), with In the mandibular cross the midline.

a predilection

anterior

The

CGCG

for the

regions,

occurs

most frequently in the young, with Ihc greukxt achieve significant hi/e before it is
most frequently in the young, with Ihc greukxt achieve significant hi/e before it is
most frequently in the young, with Ihc greukxt achieve significant hi/e before it is
most frequently in the young, with Ihc greukxt achieve significant hi/e before it is
most frequently in the young, with Ihc greukxt achieve significant hi/e before it is

most

frequently

in

the

young,

with

Ihc

greukxt

achieve

significant

hi/e before

it is diapnoscd.“’

Ex-

occurrence

between

the ages of

IO and

I9

years.

LX-

pansion

of the cortex

is seen with

the larger lesions.

sions that occur

in persons

over

the age of

49 arc

e\.-

but

perforation

should

be considered

rare.

With

tremety

uncommon.

increasing

sire of the lesion, facial deformity

and dis-

The clinical

and radiographic

presentation

of

Ihc

placement

of the teeth wilt

be seen. and casts

of tooth

CGCG

often includes

an asymptomatic

swelling that

resorption

have been reported.x.

“I

The

CGCG

wilt

reaches a sufficient

size that the patient

begins to no-

appear

as ;I radiotucency

with

some degree of corti-

tice the deformity. Although on occasion the initial

cation of the margins being present. The smaller te-

finding

will

be made after

routine

radiographic

cx-

sions will appear radiographically

as unitocular, and

amination.

it

is more

common

for

the

CGCG

to

with

increasing

si/e,

the appearance

of “wispy”

bon!

is more common for the CGCG to with increasing si/e, the appearance of “wispy” bon!

@\I.

SLR(oFK\

OK,\1

MI

I~ICIUI.

OR,‘,l.

P4TtiOl.OG\

Potter and Tiller

289

Volume

75,

Number

:

septae becomes

a prominent

feature.

Because of the

2.

Bondi

R,

Urso

C,

Santucci

B,

Santucci

M.

Giant

cell

lesion

of

recurrent

nature

 

of

the

CGCG,

radiographic

fol-

the

jaw:

case

report.

 

Tumori

1988;74:479-X4.

 

low-up

should be continued

until evidence of bony re-

3.

Cassalty

M,

Greenberg

 

A.

Kopp

W.

Bilateral

giant

cell

gran-

ulomata

of

the

mandible:

report

of

case.

J

Am

Dent

Assoc

generation

is apparent.”

 

1988;l

17:731-3.

Histologically,

the CGCG

appears

with

a uniform

 

4.

Jaffe

H.

Giant

cell

reparative

granuloma.

traumatic

bone

cyst.

 

and

fibrous

(fibro-osseous)

 

dysplasia

ofjaw

bones.

OK\I

SI,K(;

stroma

that

consists

of

spindle-shaped

 

fibroblasts.

OR~I

Mw

OKAL

PATHOL

1953;6:159-75.

 

Within

this

stroma,

multinucleated

giant

cells

wi!l

5

Stimson

P.

McDaniel

 

R.

Traumatic

bone

cyst.

aneurysmal

 

usually

be

found

accumulating

 

around

 

numerous

 

bone

cyst,

and

central

giant

cell

granuloma-pathogeneticallq

 
   

related

lesions’?

J

Endod

1989;15:164-7.

 

vascular channels and in areas of hemorrhage.

The

6.

Ciappetta

P,

Salvati

 

M.

Bernardi

C.

Raw

A,

Dilorenro

N.

presence of the giant cells is variable

and can at times

Giant

cell

reparative

granuloma

of

the

skull

base

mimicking

an

be found to be evenly distributed throughout the con-

intracranial

tumor:

case

report

and

review

of

the

literature.

Surg

Neurol

1990;33:52-6.

 

nective tissue stroma.

Less aggressive

CGCG

tend to

7.

Tesluk

H,

Senders

C.

Dublin

A.

Case

report

562:

giant

cell

re-

have smaller giant cells with

 

fewer

 

numbers

of

parative

granuloma

of

the

temporal

boric.

Skeletal

Radio1

nuclei.‘.

“-‘3

Attempts

 

to predict

the degree

of

ag-

 

1989;18:599-602.

 

8.

Cohen

M,

Hertzanu

 

Y.

Radiologic

features.

including

those

gressiveness

of CGCG

suggest

that there

is no signif-

seen

with

computed

tomography.

 

of

the

giant

cell

granuloma

 

icant

correlation

between

the giant

cells

and the

ag-

of

the

jaws.

OR,\I

SL KC; ORAL

MFD

OWI

P\III~I

1988:

gressive

behavior. I2 nor is there any way of predicting

of CGCG

9.

65:2X5-61.

Marshall

M,

DeBoom

G.

Enlarging

soft

tissue

ma\\

involving

 

their nature.‘j

The histologic

presentation

   

the

mandibular

left

alveolar

ridge.

J

Am

Dent

Acsoc

1988;

is identical

to the Brown

tumor

of hyperparathyroid-

I 16:707-9.

 

ism. A complete medical work-up and radiographic

 

IO

Cohen

M.

Grossman

 

.E, Thompson

S.

Features

of

the

central

 

giant

cell

granuloma

of

the

jaws

xenografted

in

nude

mice.

examination for multiple lesions is always indicated.

OKAI

S~JKG

ORAL

Mm

OKAL

P~THOI

1988;66:209-17.

Treatment

of

the

CGCG

consists

 

of

thorough

II

High

A.

Mathews

 

A.

The

importance

of

radiography

in

curettage

of the affected

area. Although

10% to 15%

ass&sing

the

behaviour

of

an

aggressive

giant

cell

lesion

of

the

     

ia&s.

Dentomaxillofiac

 

Radio1

1989;18:36-X.

 

of these lesions do recur,’

the locally

aggressive

giant

I2

&kurdt

A.

Pogrel

M,

Kaban

L,

Chew

K.

Mayall

B.

Central

cell lesions

have

a higher

rate

of

recurrence.‘”

 

In

giant

cell

granulomas

 

of

the

jaws:

nuclear

DNA

anctlqsis

using

highly aggressive

 

lesions

of significant

 

sire,

en bloc

 

image

cytometry.

 

Int

J

Oral

Maxillofac

Surg

1989;18:3-6.

     

I3

llorner

K.

Central

giant

cell

granuloma

of

the

jaw\:

a clmico-

resection

should

 

be considered.

 

In

rare

cases

when

radiological

study.

Clin

Radio1

1989:40:622-h.

complete

removal

is not possible

because of the loca-

I4

Chuong

R,

Kaban

L,

Kozakewich

 

H,

Perez-Ataydc

A.

Central

tion

of the lesion,

radiation

therapy

may

be used

in

giant

Maxillofac

cell

lesions

Surg

of

the

jaws:

19X6:44:708-13.

a clinicopathologic

study.

J

Oral

conjunction with the surgical procedure.’

 

However,

 

IS

Smith

P.

Marrogi

A,

Delfino

J.

Multifocal

central

giant

cell

caution must be exercised because of the potential for

lesions

of

the

maxillofacial

 

skeleton:

a

case

rcpor?.

.I

Oral

sarcomatous

transformation.7.

‘j

Maxillofac

Surg

1990:4X:300-5.

 

REFERENCES

 

B.D.

Tiner.

DDS.

 

MD

I.

Auclair

I’.

Cuenin

P,

Kratochvil

F.

Slater

L,

Ellis

G.

A

clin-

University

of

Texas

 

Health

Science

Center

ical

and

histomorphologic

 

comparison

of

the

central

giant

ccl1

Department

of

Oral

and

Maxillofacial

 

Surgeq

granuloma

and

lhr

giant

cell

tumor.

OR41

SI

KG

ORAl

MFII

7703

Floyd

Curl

 

Drive

OKZI

l’\rl1ol

198X:66:197-208.

 

San

Antonio.

TX

78284-790X