Central Giant Cell Granuloma of Mandible

JDSOR 10.5005/ jp-journals-10039-1011 Gaurav Sapra et al CASE REPORT Central Giant Cell Granuloma of Mandible 1 5 Gaurav Sapra, 2Madhusudan Astekar, 3Santhosh Kumar S Hiremath, 4Mohit Sharma Ashutosh Agarwal, 6Saurabh Roy ABSTRACT The central giant cell granuloma is an uncommon, benign and proliferative lesion whose eti categorize it as a bone-related lesion, not a tumor, although its clinical behavior and radiographic features often are those associated with teeth displacement, root resorption or bone cell granuloma in a 23-year-old female patient associated with a painful swelling and facial asymmetry in the left mandibular analysis, all the classic features were noted and diagnosis of an aggressive central giant cell granuloma was made without posterior jaws, often crossing the midline, and the mandible is more commonly affected than the maxilla. Clinical behavior is variable and some of the lesions may exhibit a locally aggressive growth pattern with rapid tumor extension associated with teeth displacement, root resorption or bone cortical perforation. Neville et al consider this entity to be a non-neoplastic lesion6 and the World Health Organization (WHO) categorize it as a bone-related lesion, not a tumor, although its clinical behavior and radiographic features often are those associated with a benign tumor.7 It affects females more often than males, in a 2:1 ratio and is seen most 8 Histologically, the features of CGCG are indistinguishable from the brown tumor of hyperparathyroidism and from giant cell lesions of genetic disorders, such as cherubism, bone cyst, and giant cell tumor which mimic central giant cell Keywords: Benign tumor, Cherubism, Central giant cell How to cite this article: Source of support: Nil None of this histological similarity, it has been hypothesized that CGCG may have a genetic etiology, although there is no convincing evidence to support this hypothesis. CASE REPORT the Dental OPD complaining of a painful swelling in the left mandibular region since 1 year. It started as a painless swelling in the left mandibular canine region and gradually progressed to present size. Patient had recently given birth INTRODUCTION The central giant cell granuloma (CGCG) of the jaws symbolizes a non-neoplastic and localized benign proliferation which may sometime shows aggressive osteolytic 2 behavior.1 The lesion commonly occurs as a solitary radiolucency with a multilocular appearance or less commonly, a unilocular appearance. It is more prevalent in the anterior than the 2 6 Corresponding Author: 44 of swelling was observed during the third trimester of pregnancy. Extraoral examination revealed minor facial asymmetry in the left mandibular region. All the lymph nodes were examined and found to be of normal size and consistency. expansion of cortical plates was also evident. Overlying gingiva and alveolar mucosa was smooth and color similar to the adjacent normal mucosa. No mobility of tooth was associated. On palpation, tenderness was observed in the involved area. On radiographic assessment, two well JDSOR Central Giant Cell Granuloma of Mandible the radiolucencies were extending till superior border of mandibular canal. S a provisional clinical diagnosis of benign odontogenic neoplasm was made. After surgical exposure under local anesthesia, the incisional biopsy from representative area was carried received in department of oral pathology. The tissue was cut in many pieces to ensure proper embedding and sectioning. On histopathological analysis, the hematoxylin and eosin stained sections revealed loose delicate exceedingly interspersed with plump to spindle shaped proliferating around the periphery of the lesion were evident. Numerous multinucleated giant cells, varying in size and predominantly concentrated near endothelial lined blood vessels along with numerous foci of extravasated blood were observed the lesion was diagnosed as ‘central giant cell granuloma’. DISCUSSION In (GCRG) as a benign lesion affecting the mandible and maxilla.2 Some authors suggested using the more neutral term ‘central giant cell lesion’ to describe this process, but most authors accept CGCG as better terminology. The term CGCG has been proposed to be used to describe both for a reactive response to hemorrhage or trauma, and a neoplasm. Chuong et al suggested that the term ‘nonaggressive’ and ‘aggressive’ should be used with CGCG based on clinical behavior. When CGCG is a slow-growing lesion, it can be asymptomatic and discovered on a routine radiographs, while the rapidly expanding aggressive variety is characterized by pain and facial swelling.12 The present and pain. Variable reports have been published regarding gender predilection, but the CGCG occur more commonly in females with a female-male ratio of approximately 2:1. The In presently with the above observations regarding age and sex. It has Figs 1A to D: Journal of Dental Sciences and Oral Rehabilitation, January-March 2014;5(1):44-47 45 Gaurav Sapra et al been noted that the development of CGCG occasionally coincides with the onset of pregnancy. A study showed that increased levels of estrogen were responsible for the progression of CGCG in jaw. In present case, though the lesion has started before pregnancy, the size of the lesion was considerably increased during the third trimester of pregnancy. As per the previous literature, the lesions develop twice as often in the mandible with site predilection anterior to the of life.16 In the case presented here, the lesion occurred just distal to canine and extending till the second molar region of left mandibular arch. Radiographic appearance of CGCG can be unilocular of the jaw) is also microscopically indistinguishable from CGCG, but its usually bilateral presentation, in a young individual with a hereditary autosomal dominant mode, allows its recognition. The traditional treatment of CGCG is represented by surgical removal via an intraoral approach and the extent of tissue removal ranges from a simple curettage to an en bloc resection. Curettage alone, or in combination with a periosteal bone resection is the treatment modality most often used. Curettage has also been supplemented with cryosurgery and peripheral ostectomy. The surgical defect usually heals by secondary intention. The prognosis was good and no recurrence was found after a follow-up of margins. Root resorption and tooth displacement may also be evident.17 CONCLUSION without any root resorption. The radiographic appearance is indistinguishable from that of odontogenic cyst, aneurysmal pain. Diagnosis of CGCG remains a challenge for oral pathologists. There are many lesions which mimic CGCG clinically and histopathologically. These conditions must be fibrous tissue containing multiple foci of hemorrhage, aggregations of multinucleated giant cells and occasional trabeculae of bone.7 In presently reported case, all the classic histopathological features were noted and diagnosis The case reported here represents an aggressive CGCG REFERENCES occurred in a larger proportion of aggressive lesions.18 The pain and facial asymmetry as seen in present case also Numerous lesions as cherubism, fibrous dysplasia, primary and secondary hyperparathyroidism (brown tumor), in differential diagnosis. GCT is distinctly unusual in the jaw; moreover, giant cells are regularly and uniformly distributed in GCT, while they are clumped in areas separated Radiologic features of central giant cell granuloma of the jaws. chodimitropoulos D. immunohistochemical expression by the stromal spindle-shaped cells in the central giant cell granuloma of the jaws. Med Oral stroma. Aneurysmal bone cysts show large sinusoidal similarity has been reported in brown tumors and CGCG, phosphatase and good renal function help in diagnosis of CGCG and excluding the condition of hyperparathyroidism. 46 cell granuloma of the mandibular condyle: a case report and JDSOR Central Giant Cell Granuloma of Mandible a clinical, radiologic and histopathologic study. Oral Surg Oral of central giant-cell lesions of the jaw. Oral Surg Oral Med Oral pathologic features and AgNOR counts between aggressive and of giant cell reparative granuloma during pregnancy. Arch Paludetti G. Advanced giant cell reparative granuloma of the mandible: radiological features and surgical treatment. Acta Journal of Dental Sciences and Oral Rehabilitation, January-March 2014;5(1):44-47 47