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