The lesion was removed by curettage and a histopathological examination was carried out. Abstract central giant cell granuloma is an uncommon benign intraosseus lesion of jaws. Noonan syndrome associated with central giant cell granuloma. Recurrent central giant cell granuloma in the mandible. Pdf central giant cell granuloma of mandible mohit. In rare cases, it can appear as a localized periradicular area and mimic an endodontic lesion. Central giant cell granuloma cgcg of the jaw is a benign osteolytic lesion. This report presents the treatment and management of recurrent, aggressive cgcg after surgical resection.
The central giant cell granuloma cgcg of the jaws is a rare benign tumour of the mandible lower jaw and the maxilla upper jaw characterized by destruction of the bone, loss of symmetry of the face and displacement of teeth and tooth germs, especially in younger patients. Oral surg oral med oral pathol oral radiol endod 2007. The central giant cell granuloma is an uncommon, benign and proliferative lesion whose etilogy is not well defined. Worth in the last edition of his radiology textbook in 19815 does describe a group of central giant cell granulomas, which were treated by diagnostic biopsy only. An aggressive central giant cell granuloma in a pediatric patient. Management of central giant cell granuloma of the jaws with. Tumorinduced osteomalaciarickets is a rare paraneoplastic disorder associated with a tumorproducing fibroblast growth factor 23 fgf23. Mar 21, 2012 central giant cell granuloma formerly called as giant cell reparative granuloma is a non neoplastic proliferative lesion of unknown etiology. Tumorinduced rickets in a child with a central giant cell. Seven cgcgs were treated with intralesional injection of. 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. Jun 19, 2018 this peripheral giant cell granuloma involved the maxillary gingiva associated with an erupting central incisor of a 6yearold girl. 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. Surgically treated central giant cell granuloma in sixyearold.
Central giant cell granuloma cgcg, also termed as reparative giant cell granuloma, is an uncommon benign intraosseous lesion affecting the maxilla and mandible, which consists of massive fibrohistiocytic proliferation and heavily hemosiderin laden multinucleated giant. Central giant cell lesions granulomas, also known as giant cell reparative cystsgranulomas, occurs. The most common treatment is curettage,which has a high recurrence rate, particularly in more. Central giant cell granuloma cgcg of the jaws is a benign, intraosseous, osteolytic lesion of debatable etiology. Oral surg oral med oral pathol oral radiol endod 93. The most common treatment is curettage,which has a high recurrence rate, particularly in more aggressive lesions. Other treatments such as interferon ifn and calcitonin. Apr 23, 2008 we report a case of noonan syndrome associated with central giant cell granuloma. Thought to represent a reparative response to intrabony haemorrhage and. This peripheral giant cell granuloma involved the maxillary gingiva associated with an erupting central incisor of a 6yearold girl. Central giant cell granuloma cgcg is defined by the world health organization as an intraosseous lesion consisting of cellular fibrous. Central giant cell granuloma a case report balaji p. It is actually an asymptomatic lesion which becomes evident during routine radiographic examination or as a result of painless but visible expansion of. Peripheral giant cell granuloma or so called giant cell epulis is the most common oral giant cell lesion.
It occurs most commonly in mandible, but can also occur in maxilla. Central giant cell lesions cgcls are benign intraosseous proliferative lesions that occur in the maxilla and mandible primarily during the first to third decades of life. An aggressive central giant cell granuloma in a pediatric. Often called as peripheral giant cell reparative granuloma. Unusual mandibular lesion of central odontogenic fibroma. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, pyogenic granuloma and peripheral ossifying fibroma. Histologically, multinucleated giant cells are prominent throughout the fibroblastic stroma and are often clustered around areas of haemorrhage. Giant cell granuloma gcg is an uncommon, benign, proliferative, intraosseous lesion representing oct 31, 2012 central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior. Tumorinduced rickets in a child with a central giant cell granuloma. Traditional treatment has been local curettage, although aggressive subtypes have a high tendency to recur. Intralesional steroid treatment of central giant cell. Seven cgcgs were treated with intralesional injection of corticosteroids. Surgical treatment has been the traditional accepted modality reducing chances of recurrence.
Peripheral giantcell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. Jul 19, 2019 central giant cell granuloma cgcg is a rare, nonneoplastic, benign lesion that exhibits expansive and osteolytic biological behavior. Cgcg treatment and management is challenging for clinicians. 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. Central giant cell granuloma usually is an asymptomatic lesion, which may become evident during routine radiographic examination or as a result of painless but visible expansion of the affected jaw. This patient report describes a recurrent central giant cell granuloma involving the body of the mandible in a 48yearoldwoman. Pdf recurrent central giant cell granuloma in the mandible.
Central giant cell granuloma cgcg is a rare, nonneoplastic, benign lesion that exhibits expansive and osteolytic biological behavior. Central giant cell granulomas are benign tumours of the mandible, presenting in children and young adults. We present a child with symptoms of rickets as the first clinical sign of a central giant cell granuloma cgcg with high serum levels of fgf23, a hormone associated with decreased phosphate resorption. Nonsurgical treatments with alphainterferon, calcitonin, and corticosteroids have. Central giant cell lesion cgcl is a benign lesion which has unpredictable biologic behaviour and is amenable to a plethora of treatment alternatives. Surgical treatment such as simple curettage, simple curettage. The most common treatment for central giant cell granuloma of the jaws is thorough curettage, especially for smaller, less aggressive examples. Intralesional corticosteroid injection for central giant cell. Divided into non and aggressive subtypes, the aggressive subtype is relatively rare. Central giant cell granuloma is a benign lesion of the jaws which is sometimes aggressive locally. The diagnosis and management of giant cell lesions of the jaws ncbi. A solid swelling was observed in the area of the lower incisors.
The histopathological diagnosis was central giant cell granuloma. Central giant cell granuloma cgcg, also termed as reparative giant cell granuloma, is an uncommon benign intraosseous lesion affecting the maxilla and mandible, which consists of massive fibrohistiocytic proliferation and heavily hemosiderin laden multinucleated giant cells. Thought to represent a reparative response to intrabony haemorrhage and inflammation, cgcg was once regarded as a reactive lesion. 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 granuloma cgcg is a benign intraosseous lesion of the jaws that is found predominantly in children and young adults. Central giant cell granuloma a case report balaji p, balaji. Pdf central giant cell granuloma is an uncommon, benign, and proliferative lesion whose. Surgery was performed with the patient under general anaesthesia after nasal intubation, using a right preauricular approach. Central giant cell granuloma is an uncommon, benign, and proliferative lesion whose etiology is not defined. We report the results of the intralesional steroid injections for the management of central giant cell granuloma cgcg of the jaws. Cgcg lacks in clinical and radiographical pathognomonic features to distinguish from. Casereport munzenmayer j1, tapia p 2, zeballos j, martinez a 3, compan a4, urra a 5, spencer ml6 summary this case report describes a 19yearold female patient with a central giant cell granuloma in the left mandibular condyle, treated with en bloc resection. Jaffe hl 1953 giantcell reparative granuloma, traumatic bone cyst and. Recently, bisphosphonates have been used to treat central giant cell lesions. Central giant cell granuloma of the maxilla bmj case reports. Also called giant cell reparative granuloma central if intraosseous. This patient report describes a recurrent central giant cell.
Cgcg lacks in clinical and radiographical pathognomonic features to distinguish from common lesions occurring in this region. This patient report describes a recurrent central giant cell granuloma. However, recurrence is noted in approximately 20% of cases. Aug 22, 2012 central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness. The condition was first identified in 1953 by jaffe, who initially termed this lesion as a central giant cell reparative granuloma. Central giant cell granuloma cgcg, formerly called giant cell reparative granuloma, is a nonneoplastic proliferative lesion of an unknown aetiology. It is considered widely to be a nonneoplastic lesion although formerly designated as. Nonsurgical treatments with alpha interferon aifn, calcitonin. The case described here involved maxilla which was treated with surgical excision. Central giant cell lesions granuloma dr yuranga weerakkody and assoc prof frank gaillard et al. The lesion was removed by curettage and a histopathological. Recurrent lesions may be managed by further curettage. A 9yearold boy was complaining of swelling in the floor of the mouth.
The central giant cell granuloma cgcg is considered a benign, nonneoplastic lesion of bone found in a younger age group who are usually less than 30 years of age. Central giant cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings. Peripheral giant cell granuloma common tumor like growth in the oral cavity. Central giant cell granuloma cgcg is a relatively uncommon benign bony lesion of a variably aggressive nature. Central giant cell granuloma cgcg is a localised benign condition of the jaws. The diagnosis and management of giant cell lesions of the jaws. It may exhibit aggressive biologic behavior, characterized by localized swelling, pain, rapid growth, bony expansion, cortical perforation, tooth displacement, and root resorption. Who categorize it as a bonerelated lesion, not a tumor, although its clinical behavior and. The clinical, radiographical, surgical and histopathological features are discussed. Central giant cell granulomas cgcgs may manifest as radiolucencies anywhere in the mandible or maxilla. We describe our experience in managing this lesion by intralesional triamci. Central giant cell granuloma cgcg is an uncommon benign.
Central giant cell granuloma resistant to calcitonin nasal. It usually presents as a purplishred soft tissue nodule consisting of multinucleated giant cells. Aggressive variant of central giant cell granuloma austin. Traditional treatment has been local curettage, although aggressive subtypes. Giant cell granuloma an overview sciencedirect topics. From the radiographic exam, we observed a radiolucent image in the mandibular bone with welldefined limits extending from the apical region of tooth 33. 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. Conventional management is surgical and consists of enucleation and curettage. Central giant cell granuloma cgcg is a lesion that appears to be unique to the jaws, 1115 although the socalled giant cell reaction of the hands and feet shares many features.
Multifocal central giant cell lesions of the maxillofacial skeleton. Alternative treatment for central giant cell reparative granuloma. Treatment of central giant cell lesions using bisphosphonates. Differential diagnoses of both benign and malignant lesions related to the central giant cell tumor. Central giant cell granuloma associated with central ossifying fibroma of the jaws. The case report is of a 30 year old male, who complained of a slowly expanding swelling in the maxilla in the left premolar region. This case report presents an uncommon location of cgcg which was not accurately diagnosed nor timely treated. The combination therapy included local infiltration of corticosteroids along with surgical enucleation of the lesion. Central giant cell granuloma of the mandible american.
Radiotherapy for recurrent central giant cell granuloma. We present a case of an aggressive central giant cell granuloma cgcg in a six yearold female. In recent years, the treatment of central giant cell granuloma cgcg has become focused on the inhibition of osteoclast differentiation and proliferation. After informed consent was obtained, the patient underwent radiotherapy. It is twice as common in females and is more likely to occur before age 30. Interventions for central giant cell granuloma of the jaws. Central giant cell granuloma formerly called as giant cell reparative granuloma is a non neoplastic proliferative lesion of unknown etiology. Case report giant cell granuloma of the maxilla usman haider uzbek, iram mushtaq oral and maxillofacial unit, department of dentistry, ayub medical college, abbottabad. Oct 19, 2015 we report the results of the intralesional steroid injections for the management of central giant cell granuloma cgcg of the jaws.
The referring doctor had suggested a diagnosis of eruption cyst. Pdf on jun 7, 2019, nilotpol kashyap and others published central. Here we are attempting to report a case of cgcg which has been given combination therapy. The central giant cell granuloma or cgcg is a fibroosseous lesion which is considered to be reactive in nature by many authors. Does not represent a true neoplasm but a reactive lesion. 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. Medications that were developed for the treatment of giant cell tumor of bone and bone resorption from metastatic skeletal disease have shown some success in the treatment. Pogrel ma, regezi ja, harris st, goldring sr 1999 calcitonin treatment for central giant cell. Central giant cell granuloma of the mandibular condyle.
Central giant cell granuloma is an uncommon benign intraosseus lesion of jaws. The referring doctor had suggested a diagnosis of eruption. Because of its overwhelming incidence on the gingiva, the condition is associated with two other diseases, pyogenic granuloma. Divided into non and aggressive subtypes, the aggressive subtype is relatively rare and can occasionally progress rapidly, resulting in significant morbidity. Central giant cell granuloma of the jaws and giant cell. Micrograph of a central giant cell granuloma showing the characteristic giant cells with surrounding cells that have nuclei that are dissimilar to those in the giant cells. Cgcg was formerly regarded as a reparative process and was, accordingly, called central giant cell reparative granuloma. The central giant cell granuloma is often found in the mandible, anterior to the first. Management of central giant cell granuloma of the jaws. A case of a 36yearold male with a central giant cell lesion. Whitaker sb, waldron ca 1993 central giant cell lesions of the jaws. Giant cell granuloma gcg is an uncommon, benign, proliferative, intraosseous lesion representing central giant cell granuloma. However, insomepublications, authors disagreeonthe type of surgery that should be performed.
Nonsurgical treatment methods, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. 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. Central giant cell granuloma of the mandible requiring multiple treatment modalities. Jaffe hl 1953 giant cell reparative granuloma, traumatic bone cyst and. We describe our experience in managing this lesion. Radiographs of a biopsyproven central giant cell granuloma of the left anterior mandible in a 23yearold female a represents the lesion at the time of biopsy and b represents the lesion some 18 months later. Central giant cell granuloma cgcg is a benign aggressive destructive osteolytic lesion of osteoclastic origin. An aggressive central giant cell granuloma treated successfully by. The central giant cell granuloma cgcg of the jaws is a rare benign tumour of the mandible lower jaw and the maxilla upper jaw characterized by destruction of the bone, loss of.
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