Traditional treatment has been local curettage, although aggressive subtypes have a high tendency to recur. Central giant cell granuloma cgcg is a benign lesion of the jaws with an unknown etiology. This is in contrast to the giant cell tumor of long bones, where the giant cells are more evenly distributed. Correlating all clinical features and all investigation we finally diagnosed this case as central giant cell granuloma. Seven cgcgs were treated with intralesional injection of. Formerly called giant cell reparative granuloma giant cell lesion primarily of jaw, also other craniofacial bones and short tubular bones of hands and feet may be response to injury but some cases behave aggressively giant cells have features. 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. The etiology is unknown, but is thought to be a reactive process, possibly secondary to trauma or inflammation. It normally presents as a soft tissue purplishred nodule consisting of multinucleated giant cells. Central giant cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings. Central giant cell granuloma of the mandibular condyle. Ct and mr imaging of giant cell granuloma of the craniofacial. Clinicopathological profile of central giant cell granulomas. After this the lesion was completely excised and thorough curettage of the area was done under general anesthesia fig4.
Does not represent a true neoplasm but a reactive lesion. The objective was to investigate the clinical and radiological characteristics of central giant cell granulomas cgcgs of the jaws. Peripheral giant cell granuloma clinical presentation. Aggressive central giant cell granuloma mimicking peripheral. The term giant cell reparative granuloma gcrg was first used by jaffe in 1953.
Nonsurgical treatment methods, such as intralesional. Central giant cell granuloma of the anterior maxilla. The peripheral giant cell granuloma has an unknown etiology, with some dispute as to whether this lesion represents a reactive or neoplastic process. However, most authorities believe peripheral giant cell granuloma is a reactive lesion. Recently, bisphosphonates have been used to treat central giant cell lesions.
Discussion the central giant cell granuloma is a benign. Full text pimary hyperparathyroidism as central giant. These tumors become severely invasive with the stimulus of surgery, resembling malignant tumors. Combined treatment of aggressive central giant cell granuloma in the lower jaw. Central giant cell granuloma cgcg is a localised benign condition of the jaws. Follow up of one year was done and during this period no recurrence of the lesion was noticed fig5. The appearance is generally distinctive with multinucleated giant cells spread throughout the lesion but often focal in distribution around areas of possible hemorrhage figure 4. This peripheral giant cell granuloma involved the maxillary gingiva associated with an erupting central incisor of a 6yearold girl. Radiologically, it is usually a welldefined radiolucent defect with hazy opacity, classically described. Recurrent central giant cell granuloma in the mandible. Peripheral giant cell granuloma or the socalled giant cell epulis is the most common oral giant cell lesion.
The referring doctor had suggested a diagnosis of eruption. Central giant cell lesions granuloma radiology reference. The term giant cell lesion gcl defines a group of intraosseous nonodontogenic benign lesions with multinucleated giant cells gcs. A clinical and histomorphologic comparison of the central giant cell granuloma and the giant cell tumor. Clinical features, radiographic and histopathologic.
Based on its clinical and radiological features,the. Peripheral giant cell granuloma or so called giant cell epulis is the most common oral giant cell lesion. Several entities in the jaws can share this histology, including. Aggressive central giant cell granuloma of the mandible, a. Central giant cell granuloma is an uncommon benign intraosseus lesion of jaws. Interventions for central giant cell granuloma cgcg of the jaws source. Treatment of central giant cell lesions using bisphosphonates. Central giant cell granuloma cgcg is a benign intraosseous lesion of the. We report an unusual case of giant cell reparative granuloma gcrg arising in the nasal cavity of a 7yearold girl.
There is much controversy regarding it arising as a result of trauma and its connection with the giant. Clinically and radiologically, a differentiation between aggressive and nonaggressive lesions can be made. It does not constitute a true neoplasm, but rather a reactive lesion caused by local irritation or trauma. Giant cell granuloma is a benign reactive osseous proliferation that shares many features with aneurysmal bone cyst. A case of a 36yearold male with a central giant cell lesion.
Peripheral giant cell granuloma pgcg is a nonneoplastic, tumorlike reactive lesion occurring exclusively on gingivaalveolar crest. Central giant cell granuloma of the posterior maxilla. Central giant cell granuloma of the anterior maxilla sholapurkar. Gcrg is an uncommon benign lesion that is most commonly found. A retrospective analysis of a 20year database was performed regarding both clinical and radiological features. Cgcg is a localized osteolitic lesion with varied biologic behavior of aggression which affects the jaw bones16. Aggressive variant of central giant cell granuloma austin.
Oral surgery, oral medicine, and oral pathology, 66, 197208. Case report giant cell granuloma of the maxilla usman haider uzbek, iram mushtaq oral and maxillofacial unit, department of dentistry, ayub medical college, abbottabad. Peripheral giant cell granuloma pubmed central pmc. Peripheral giant cell granuloma is a common benign and reactive gingival epulis in oral cavity. Giant cell reparative granuloma, central definition of. Prompt diagnosis and management can greatly improve longterm outcomes. The central giant cell granuloma cgcg is a nonneoplastic entity,which may be able to cause considerable osseous destruction. Fibrous dysplasia is a benign fibroosseous lesion arising in an intramedullary location. Because of its overwhelming incidence on the gingiva. Central giant cell lesion cgcl is a benign lesion which has unpredictable biologic behaviour and is amenable to a plethora of treatment alternatives. 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. An aggressive central giant cell granuloma in a pediatric patient. Sinonasal tract or nasopharyngeal involvement is uncommon but can occur. There is a further population of bland, spindled, fibroblastslike cells with associated hemosiderin and scattered.
The central giant cell granuloma or cgcg is a relatively uncommon pathological condition accounting for less than 7% of all benign lesions of the jaws. It usually presents as a purplishred soft tissue nodule consisting of multinucleated giant cells in. Central giant cell lesions granuloma dr yuranga weerakkody and assoc prof frank gaillard et al. Radiological and epidemiological aspects of central giant cell. A central giant cell granuloma is a type of bone lesion that appears along the jaw. There is a an increase in the mitotic activity along with a difference in histomorphic analysis which indicates increase in the fusion of resident macrophages and recruitment of monocytes and also there is higher metabolic activity of multinucleated giant cells that shows an aggressive clinical behavior. The central giant cell granuloma cgcg was first described by jaffe in 1953 as a giant cell reparative granuloma of the jaw bones.
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. The lesions occur more frequently in females than in males and are more often located in the mandible than in the maxilla. Final diagnosis of central giant cell granuloma was given. The referring doctor had suggested a diagnosis of eruption cyst. Histopathology showing connective tissue stroma with multinucleated giant cells. The central giant cell granuloma cgcg was first described by jaffe in 1953 as a giantcell reparative granuloma of the jaw bones.
Central giant cell lesion of mandible managed by intralesional triamcinolone. Central giant cell granuloma appears references as poorly defined unilocular radiolucency or multilocular radiolucency with scalloped borders. We herein describe an intriguing case of a 21yearold male patient who was. Central giant cell granuloma, benign jaw tumor, molar, recurrent pericoronitis, multinucleated giant cells. 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. A biopsy was performed and a histologic diagnosis of central giant cell lesion consistent with central giant cell granuloma was reported. Clinical examination shows a dusky purple, sessile or pedunculated, smoothsurfaced, domeshaped papule or nodule. The purpose of this study was to determine the ct characteristics and describe possible mr imaging features of gcg of the craniofacial bones. Extremely aggressive behavior of central giant cell granuloma. It is also known as giant cell epulis, osteoclastoma, giant cell.
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. Central giant cell granuloma is a benign intraosseous lesion of the jaws. Management of central giant cell granuloma of the jaws. The findings are consistent with central giant cell. Intralesional corticosteroid injection for central giant cell granuloma. Giantcell reparative granuloma, features of cgcg is its ability to cross the midline of the traumatic bone cyst and fibrous fibrooseous.
Central giant cell granuloma cgcg is a benign intraosseous lesion. Central giant cell lesion of mandible managed by intralesional. The etiology of cgcg is unknown, but some indications implicate genetic abnormalities79. It is a noncancerous condition that is usually painless, but irritation and open lesions in the mouth can lead. Several entities in the jaws can share this histology, including hyperparathyroidism, cherubism and the central giant cell granuloma cgcg 1.
Giant cell granuloma an overview sciencedirect topics. The lesion is a slowgrowing and destructive and produces a unilocular or multilocular radiolucency in the bone. Central giant cell granuloma cgcg is a benign intraosseous lesion that occurs in long. The central giant cell granulomacgcg of bone constitutes about 10% of benign. Although central giant cell granulomas cgcgs appear to be benign, their radiographic findings are active. Central giant cell granuloma cgcg is an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of hemorrhage, aggregations of multinucleated giant cells and occasionally. Central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness.
A retrospective analysis of a 20year database was performed regarding both clinical and radiological features of 22 patients affected with cgcgs of the jaws. A 5year populationbased study estimated its incidence at 0. Prognostic significance of cortical perforation in the recurrence of central giant cell granulomas of the jaws. This lesion probably does not represent a true neoplasm. It was first described as central giant cell reparative granuloma by jaffe h l in the year 1953. The central giant cell reparative granuloma of the jaws.
The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examinations but was histopathologically diagnosed as cgcg. It normally presents as a soft tissue purplishred nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells. The clinical behaviour of cgcg is variable being aggressive and associated with. Central giant cell lesions granulomas, also known as giant cell reparative cystsgranulomas, occurs. Also called giant cell reparative granuloma central if intraosseous. Central giant cell granuloma cgcg is a benign, proliferative, intraosseous and nonodontogenic lesion of unknown etiology. Central giant cell granuloma cgcg is a rare benign osteolytic lesion of the jawbone. The most common treatment has been surgical curettage. Between the giant cells are monocluate variants with similar nuclear profiles. Data were recorded and analyzed for clinical features with reference to age. Central giant cell granuloma cgcg formerly called giant cell reparative granuloma is a nonneoplastic proliferative lesion of unknown etiology. Peripheral giant cell granuloma in a child associated with.
There is a further population of bland, spindled, fibroblastslike cells with associated hemosiderin and scattered inflammation. Central giant cell granuloma cgcg is an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of hemorrhage, aggregations of multinucleated giant. 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. Central giant cell granuloma and fibrous dysplasia occurring in. Multifocal central giant cell granuloma a case report ncbi. The purpose of this study was to determine the ct characteristics and describe possible mr imaging features of gcg. Central giantcell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings. It is also known as giant cell epulis, osteoclastoma, giant cell reparative granuloma or giant cell hyperplasia. Peripheral giant cell granuloma pgcg is the most common oral giant cell lesion appearing as a soft tissue extraosseous purplishred nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells. Alternative pharmacologic therapy for aggressive central giant. Other authors classify gccg according to their clinical and radiographic characteristics 58. 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.
Clinically, it appear as pyogenic granuloma, peripheral ossifying. The clinical behavior of cgcg of the jaws is variable and difficult to predict. Achieving the correct diagnosis is reportedly difficult because cgcgs are very similar to odontogenic jaw tumors. Aggressive central giant cell granuloma occurring as peripheral one is a very rare case and the treatment of aggressive central giant cell granuloma with curettage has shown a high recurrence rate within a. Nonsurgical treatment methods, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. Diagnosis of central giant cell granuloma is normally made histologically from an incisional biopsy.
It is twice as common in females and is more likely to occur before age 30. Katz, giant cell reparative granuloma outside the jaw bone. Giant cell granuloma gcg is an uncommon, benign, proliferative, intraosseous lesion representing benign jaw lesions. It is a localized osteolytic lesion with the varied biologic behavior of aggression which affects the jaw bones. Cgcg ranges from a slow growing asymptomatic swelling to a rapidly enlarging aggressive lesion. Central giant cell granuloma was 1st described in jaws by jaffe 1953. The peripheral giant cell granuloma, also known as giant cell epulis, pgcl or giant cell hyperplasia, is the most common giant cell lesion in the oral cavity. Based on its clinical behavior and radiographic features. Radiological and epidemiological aspects of central giant. The mandible is twice as likely to be involved as the maxillary1,2,5. Peripheral giant cell granuloma is, for all practical purposes, a sitespecific variant of pyogenic granuloma embedded with osteoclastlike multinucleated giant cells and arising exclusively from the periodontal. Central giant cell granuloma cgcg is a benign intraosseous lesion of the jaws that is found predominantly in children and young adults. Peripheral giantcell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. A histological comparison of the giant cells in the central giant cell granuloma of the jaws and the giant cell tumor of long bone.
It is often difficult to make a clinical diagnosis. A clinical, radiologic and histopathologic study of 26 cases ooo 2006. We describe our experience in managing this lesion by intralesional triamcinolone. Previously, the lesion was called peripheral giant cell reparative granuloma. Is a common lesion and appears more frequently than does the peripheral giant cell granulomais found predominantly in children and young adultsaffects males. It is an uncommon tumor in jaws, its etiology and pathogenesis is unknown. Central giantcell granuloma cgcg is a localised benign condition of the jaws. Central giant cell granuloma venkateshwarlu et, al 6. This lesion probably does not represent a true neoplasm, but rather may be reactive in nature. The clinical behaviour o f central giant cell g ranuloma ranges from a slow growing asymptomatic swelling to an aggressive lesion that presents pain, local bone destruction, root resorption or. However, it is now considered to be a true neoplasm. Intralesional corticosteroid injection for central giant. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examination but was histopathologically diagnosed as cgcg. The borders of the radiolucency may be either sclerotic or ill defined.
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