Radiographic features of central giant cell granuloma of the jaws in children

Cone-beam computed tomographic imaging of central giant cell granuloma: A comprehensive review

Purpose

The aim of this study was to characterize the cone-beam computed tomographic (CBCT) imaging features of central giant cell granuloma (CGCG) of the jawbone.

Materials and Methods

This study retrospectively reviewed 26 CBCT studies of histologically proven cases of CGCG during a period of 20 years, from 1999 to 2019. Patients’ demographic data were recorded, and radiographic features were assessed (location, border, cortication, appearance of the internal structure, locularity, septation, expansion, cortical perforation, effects on surrounding tissue, whether the lesion crossed the midline, and lesion volume).

Results

In this study, CGCGs were seen almost twice as often in the mandible than in the maxilla, and 64.7% of mandibular lesions involved the anterior region. Only 26.9% of lesions crossed the midline, a feature that was considered characteristic of CGCG. Furthermore, 65.4% of lesions were unilocular and 34.6% were multilocular. The correlation between a lesion’s size and its locularity was statistically significant, and larger lesions showed a multilocular appearance. The mean volume of multilocular lesions was greater than that of unilocular lesions.

Conclusion

CGCGs showed variable radiographic features on CBCT, and this imaging modality is highly effective at demonstrating the radiographic spectrum and lesional extent of CGCGs in the jawbone.

Giant Cell Granulomas of Jaws: a Clinicopathologic Study

Objectives

The purpose of present study was to investigate and correlate the histological findings in central giant cell granuloma and peripheral giant cell granuloma of jaws with clinical and radiographic interpretations of the lesion.

Material and Methods

In present study, data from 14 cases of central giant cell granuloma (CGCG) and 9 cases of peripheral giant cell granuloma (PGCG) were analysed, focusing on demographic, clinical and radiographic features. For each patient, microscopic slides were assessed in terms of histologic features of giant cells i.e. number of giant cells, mean number of nuclei/giant cell, pattern of distribution, size and relative size index of giant cells, percentage fractional surface area (FSA) occupied by giant cells and stromal characteristics. Data collected was subjected to statistical analysis. Fisher-exact test, Pearson's correlation coefficient, one-way ANOVA test and Student's t-test were used for analysis.

Results

No significant difference was found between PGCG and CGCG in relation to all the traits that were evaluated. It was observed that mean number of giant cells and mean FSA was more in aggressive CGCG as compared to non-aggressive CGCG.

Conclusions

Further studies on large sample size are required to confirm the relationship between histomorphometric features of giant cells and behaviour of giant cell granulomas of jaws.

Clinicopathological profile of central giant cell granulomas: An institutional experience and study of immunohistochemistry expression of p63 in central giant cell granuloma

Background:

The central giant cell granuloma(CGCG) of bone constitutes about 10% of benign jawbone lesions. It affects females more often than males, mandible than maxilla. Biological behavior of CGCG ranges from a slow growing asymptomatic swelling to an aggressive process. True giant cell tumor (GCT) should be distinguished from CGCG. The histological distinction between these lesions depends on quite subtle differences. Expression of p63 has been demonstrated in GCT of bone conversely, has not been detected in CGCG. Therefore this short study attempts to study the expression of p63 in CGCG in conjunction with clinicopathological profile of the cases reported in the institute.

Aims and objectives:

To review all the cases of CGCGs of the jaws reported in the institute from 1998 to 2015 and study their clinicopathological profile.

To study the immunohistochemical (IHC) expression of p63 in CGCG cases

Methods and materials:

The retrospective study reviewed records for clinically and histopathologically diagnosed cases of CGCG from the archives of department of Oral pathology. Data was recorded and analyzed. These cases were subjected for IHC analysis for expression of p63, also RANK, RANKL in selected cases to study the nature of giant cells.

Results and Conclusion:

This paper is an institutional experience of clinicopathological profile of diagnosed cases of CGCG. Clinicopathological findings were in concurrent with previous literature. Total number of cases was ten. Six occurred in females and four in males. Most of them occurred in the second decade, more commonly involving mandible. Three cases showed recurrence. Histologically most showed classical features. Expression of p63 showed negativity in all the cases in accordance with the previous studies. RANK and RANKL showed strong and diffuse immunoexpression in both mononuclear and giant cells. Thus study supports the finding that p63 expression can be used to differentiate between CGCG and GCT. However, more number of studies with larger sample size are required to confirm reliability of using p63 as a distinguishing marker between GCT and CGCG.

Central giant cells lesion: Report of a conservative management

Central giant cells lesion (CGCL) is defined as a benign intraosseous destructive pathology. It is classified as aggressive or nonaggressive, depending on their clinical, imaginologic, and histological behavior. The behavior, location, and extension of the lesion added to the patient's age will determine the choice of the treatment, either surgical or clinical. Thereby, the aim of this work is to review the literature related to the CGCL, as well as to present a clinical case report of a 22-year-old female patient, affected with an injury on the left side of her jaw. After the diagnosis, it was decided to carry out a conservative treatment with intralesional injections of triamcinolone (10 mg/ml). The injections were performed once a week for 6 weeks. The progress of the patient was satisfactory, and after 4 years, it has been observed through imaging and clinical bone formation examinations with complete remission of the injury and no signs of recurrence.

Fibro-Osseous and Other Lesions of Bone in the Jaws

Fibroosseous lesions in the jaws have similar histologic and radiographic features. Despite their similarity, management varies significantly. In this article, common fibroosseous lesions and key radiographic features are described. Many of the fibroosseous lesions are diagnosed radiographically, without performing histologic examinations. For some of the fibroosseous lesions, for example, periapical osseous dysplasia, histologic examination is contraindicated. Cherubism and fibrous dysplasia have specific radiographic findings; these conditions can be diagnosed radiographically. Accurate diagnosis conditions is essential; some conditions do not require any intervention, while others require surgical resection. Patient demographics, for example, age, gender, and race, play important roles in diagnosis.

Pharmacological and surgical therapy for the central giant cell granuloma: A long-term retrospective cohort study

PURPOSE

This is a retrospective cohort study of patients with a central giant cell granuloma (CGCG) treated at a single center to assess and compare the different surgical and non-surgical approaches.

MATERIAL AND METHODS

A cohort with a single histologically proven non-syndrome-related CGCG was selected and reviewed. Patients were allocated to group I (surgery), group II (pharmacotherapy), and group III (pharmacotherapy and surgery). The primary outcome was long-term radiologic response using computed tomography. Secondary outcomes were intermediate radiologic responses and occurrence and severity of side effects.

RESULTS

Thirty-three subjects were included in the study. The surgical group (n = 4) included 1 patient with progression during follow-up and a relatively high post-surgical morbidity. Twenty-nine patients started on various pharmacological treatment regimens (groups II and III). Fourteen patients could be managed without additional surgery. One of these lesions showed progression during follow-up. The other 15 lesions underwent additional surgery, and none showed progression during follow-up. Interferon treatment was associated with the most side effects.

CONCLUSION

Pharmacological agents have a role in the treatment of aggressive and non-aggressive CGCGs by limiting the renewed progression during long-term follow up and the extent and morbidity of surgical treatment.

Peripheral Giant Cell Granuloma in a Child Associated with Ectopic Eruption and Traumatic Habit with Control of Four Years

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. This report describes the clinical and histopathological findings of a PGCG diagnosed in the maxilla of a 9-year-old boy associated with a tooth erupting improperly and a traumatic habit. The patient did not present anything noteworthy on extraoral physical examination or medical history, but the habit of picking his teeth and "poking" the gingiva. The oral lesion consisted of an asymptomatic, rounded, pink colored, smooth surface, soft tissue injury with fibrous consistency and approximated size of 1.5 cm located in the attached gingiva between the upper left permanent lateral incisor and the primary canine of the same side. Excisional biopsy was performed through curettage and removal of the periosteum, periodontal ligament, and curettage of the involved teeth with vestibular access. The histopathological analysis led to the diagnosis of PGCG. The prompt diagnosis and treatment of the PGCG resulted in a more conservative surgery and a reduced risk for tooth and bone loss and recurrence of the lesion. After four years of control, patient had no relapse of the lesion and good gingival and osseous health.

Does a difference exist in inferior alveolar canal displacement caused by commonly encountered pathologic entities? An observational study

PURPOSE

The aim of the present study was to investigate whether a difference exists in the location of the displaced inferior alveolar canal (IAC) and neurovascular bundle (toward the buccal or lingual cortex) among odontogenic tumors and vascular lesions. If some consistency exists in the manner in which the canal and bundle are displaced on radiographic examination, the nature of the mandibular lesion under examination could be anticipated. This information would assist the surgical team in treatment planning, diagnostic biopsy, and resection, especially in cases of intraosseous vascular pathologic findings.

MATERIALS AND METHODS

A retrospective review of the computed tomography images obtained for odontogenic tumors and vascular anomalies treated at the Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, from January 2000 to June 2010 was undertaken. The IAC and neurovascular bundle were traced from the lingula to the mental foramina, and its location within the mandible was recorded at 3 specific points.

RESULTS

In the odontogenic tumor group, we found that the canal with the neurovascular bundle was displaced either toward the buccal cortex of the mandible or the inferior border, but it was never identified lingually. In contrast, all the vascular anomalies had displaced the structures toward the lingual aspect of the mandible at all selected points.

CONCLUSIONS

To our knowledge, this is the first study to have examined the potential differences in the displacement of the inferior alveolar neurovascular bundle caused by the 2 commonly encountered pathologic entities in the maxillofacial skeleton: odontogenic tumors and vascular anomalies. We identified a striking difference in the manner of the IAC and its contents that was consistent among the tumors in the 2 groups. The location of the IAC in relationship to the pathologic entity under investigation could prove valuable in the differential diagnosis and assist with planning the biopsy. Additional investigation with a larger number of cases of these 2 groups of lesions involving the mandible is warranted to confirm our preliminary findings.

Multidetector computed tomography of jaw lesions in children and adolescents

Jaw lesions in paediatric and adolescent population are uncommon and can arise in odontogenic or non-odontogenic tissues. With the advent of multidetector computed tomography (MDCT), algorithm for imaging jaw lesions has changed dramatically. This pictorial essay describes the imaging appearance of commonly encountered jaw lesions in children and adolescents with emphasis on MDCT findings.

Central giant cell granuloma of the jaws: clinical and radiological evaluation of 22 cases

OBJECTIVE

The objective was to investigate the clinical and radiological characteristics of central giant cell granulomas (CGCGs) of the jaws.

METHODS

A retrospective analysis of a 20-year database was performed regarding both clinical and radiological features of 22 patients affected with CGCGs of the jaws.

RESULTS

Fourteen women and 8 men were included with the age range of 7-81 years (mean 31.7 years). Among the 22 lesions, 16 were located in the mandible and 6 in the maxilla. Painless swelling was the most common clinical feature in 18 of all cases. Limited mouth opening was noted in 2 patients where the lesions involved the condyle. Radiographically, 13 lesions were homogeneously osteolytic and 9 lesions were trabeculated. Fifteen lesions were unilocular and 14 lesions presented with well-defined but not sclerotic margins. CT images in 5 patients clearly showed the trabeculation within the lesions. The follow-up ranged from 1.5 to 11 years with a mean period of 5 years. Three out of 9 aggressive and 1 out of 13 nonaggressive lesions developed recurrence.

CONCLUSIONS

Diagnosis of CGCGs of the jaws depends on both correct interpretation of clinical, radiographic and pathological data. Differentiation between aggressive and nonaggressive CGCGs should be considered to improve individual treatment planning.

Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options

Central giant cell granuloma (CGCG) is a benign lesion of the jaws with an unknown etiology. Clinically and radiologically, a differentiation between aggressive and non-aggressive lesions can be made. The incidence in the general population is very low and patients are generally younger than 30 years. Histologically identical lesions occur in patients with known genetic defects such as cherubism, Noonan syndrome, or neurofibromatosis type 1. Surgical curettage or, in aggressive lesions, resection, is the most common therapy. However, when using surgical curettage, undesirable damage to the jaw or teeth and tooth germs is often unavoidable and recurrences are frequent. Therefore, alternative therapies such as injection of corticosteroids in the lesion or subcutaneous administration of calcitonin or interferon alpha are described in several case reports with variable success. Unfortunately, randomized clinical trials are very rare or nonexistent. In the future, new and theoretically promising therapy options, such as imatinib and OPG/AMG 162, will be available for these patients.

Aspectos radiológicos e epidemiológicos do granuloma central de células gigantes

OBJETIVO: Este estudo teve como objetivo avaliar os principais aspectos radiográficos e epidemiológicos das lesões de células gigantes (granulomas centrais de células gigantes e tumores marrons do hiperparatireoidismo). MATERIAIS E MÉTODOS: A amostra consistiu de 26 lesões de células gigantes diagnosticadas em 22 pacientes divididos em dois grupos, um deles composto por 17 pacientes que não tinham hiperparatireoidismo (grupo A) e o outro formado por cinco pacientes portadores de tal distúrbio (grupo B). RESULTADOS: O sexo feminino (72,7%) foi o mais acometido. As lesões ocorreram mais freqüentemente na segunda década de vida, com média de idade de 27 anos. A mandíbula (61,5%) foi o arco mais envolvido. Radiograficamente, 57,7% das lesões eram multiloculares e 42,3% eram uniloculares com limites definidos. Todas as 26 lesões provocaram expansão óssea, 15,4% produziram reabsorção radicular, 50% causaram deslocamento dentário e 11,5% produziram dor. Na mandíbula, 18,7% das lesões cruzavam a linha média. O grupo A apresentou 66,7% das lesões na mandíbula e o grupo B mostrou igualdade na distribuição das lesões entre os arcos. O grupo A apresentou 66,7% das lesões multiloculares e 33,3%, uniloculares. O grupo B apresentou 62,5% das lesões uniloculares e 37,5%, multiloculares. CONCLUSÃO: As lesões de células gigantes podem manifestar-se, radiograficamente, com um amplo espectro, desde pequenas lesões uniloculares de crescimento lento até extensas lesões multiloculares. Elas apresentam características de benignidade, embora algumas lesões possam demonstrar um comportamento localmente agressivo.

Clinical and radiological features of central giant-cell lesions of the jaw

OBJECTIVE

The purpose of this study was to evaluate the clinical and radiological features of central giant-cell lesions that were diagnosed in The Netherlands between January 1, 1990, and January 1, 1995.

STUDY DESIGN

A population-based retrospective study was carried out, examining all patients with a central giant-cell lesion from this period.

RESULTS

In 83 patients there was a central giant-cell granuloma (89 lesions). Aggressive signs and symptoms (pain, paresthesia, or root resorption) were found in 16 (19.3%) patients. Multiple lesions occurred in 3 (3.6%) patients. The overall recurrence rate was 26.3%, and there was a higher recurrence rate in patients who exhibited aggressive signs and symptoms than in patients without these features (RR 1.6). In 5 patients a clinical diagnosis of cherubism or concomitant neurofibromatosis type 1 was made (14 lesions).

CONCLUSION

In a general population, large and aggressive lesions are less common than suggested by the literature. Multiple lesions, however, occur more frequently than previously assumed. In patients with aggressive signs and symptoms, surgical curettage is not an effective therapy.

Central giant cell granuloma

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 tooth-bearing areas. Its etiology is unknown and its biological behavior is poorly understood. This condition is a slow-growing, asymptomatic lesion that usually affects children and young adults, predominantly females. The following report illustrates the differential diagnosis, surgery, final diagnosis and pathology of a fast-growing CGCG in a 4-year-old girl.

Central giant cell granulomas: a systematic review of the radiographic characteristics with the addition of 20 new cases

OBJECTIVES

The radiographic characteristics of central giant cell granuloma (CGCG) vary to a great extent. This study sought to relate the radiographic and clinical features of several cases, which were confirmed histopathologically, as central giant cell granulomas, and to systematically review the relevant literature.

METHODS

Twenty cases with an established histopathological diagnosis of CGCG were received from the Department of Oral Pathology. The correlation between any two categorical variables was tested using Chi-square or Fischer's test, with alpha=0.01. A systematic review of the literature was performed using electronic and manual searches.

RESULTS

There was no gender predominance. Nearly 81% of the lesions were located in the deciduous tooth bearing area of the mandible and in 35% of the cases the lesions crossed the midline. The correlation between the size of the lesion and its appearance was statistically significant with larger lesions assuming a multilocular appearance. Most lesions (55%) were radiolucent while wispy opacification and trabeculation was evident in 50% of the lesions. The borders of the lesions were well defined in 65% of the cases and scalloping was seen in 53%. Displacement of teeth and/or other anatomic structures was seen in 50% of the cases while root resorption was found in 37%. The lesions perforated the cortex in 50% of the cases. Two cases, presented with paresthesia of the lip.

CONCLUSIONS

Central giant cell granuloma demonstrates clinical and radiographic features of a benign lesion with some aggressive characteristics.

Intralesional corticosteroids as an alternative treatment for central giant cell granuloma

Four cases of central giant cell granuloma were treated with intralesional infiltration of a solution of Kenacort-A (10 mg/mL, triamcinolone aqueous suspension SQUIBB) and either (1) Lidocaine 2% with epinephrine 1:200,000 Marcaine or (2) Bupivacaine, 50% mixture by volume. These cases were originally diagnosed by radiographic and histologic studies in 3 Guatemalan males--ages 31, 34, and 6 years old--and a 21/2-year-old Guatemalan girl. The average dosage of the aforementioned solution was 6 mL (equivalent to 30 mg of triamcinolone) for the adults and 5 mL (equivalent to 25 mg of triamcinolone) for the pediatric patients. Before treatment, an endocrinologist evaluated all of the patients to rule out hyperparathyroidism. Also before treatment, an incisional biopsy of the lesion was obtained from each patient for microscopic examination. Follow-up radiographs for all the cases showed progressive improvement and eventual resolution of the lesions.

3D-CT vascular setting protocol using computer graphics for the evaluation of maxillofacial lesions

In this paper we present the aspect of a mandibular giant cell granuloma in spiral computed tomography-based three-dimensional (3D-CT) reconstructed images using computer graphics, and demonstrate the importance of the vascular protocol in permitting better diagnosis, visualization and determination of the dimensions of the lesion. We analyzed 21 patients with maxillofacial lesions of neoplastic and proliferative origins. Two oral and maxillofacial radiologists analyzed the images. The usefulness of interactive 3D images reconstructed by means of computer graphics, especially using a vascular setting protocol for qualitative and quantitative analyses for the diagnosis, determination of the extent of lesions, treatment planning and follow-up, was demonstrated. The technique is an important adjunct to the evaluation of lesions in relation to axial CT slices and 3D-CT bone images.

Quantification of periapical bone destruction in mice by micro-computed tomography

Bacterial infections of the dental pulp result in tissue destruction and periapical bone resorption. The availability of genetically engineered mouse strains is a major advantage in the use of this model system for studies of periapical pathogenesis. The main limitation of the mouse model is its small size, and the necessity for laborious histologic analyses to quantify periapical bone destruction. In the present study, we evaluated the use of a new technology, high-resolution micro-computed tomography (micro-CT), for the rapid and non-invasive quantification of periapical bone destruction. Periapical lesions were induced in the lower first molars of mice by exposing the pulp to the oral environment. Mandibles were harvested on day 21 after pulp exposure, and were subjected to micro-CT analysis, with 17-microm-thick radiographic sections. Samples were then decalcified, embedded, and sectioned for histology. The cross-sectional area of periapical lesions was determined by image analysis of corresponding micro-CT and histologic sections. The results showed a highly significant correlation between micro-CT and histology (p < 0.0001), with mean differences of 4. 1% (range, 0.9 to 7.2%) between the two methods. The mean error associated with image analysis was 4.9% for images obtained by both micro-CT and histology. The variability of replicate (n = 5) independent micro-CT determinations was 3.4%, less than that associated with the image analysis error. These results demonstrate that micro-CT imaging is a rapid, reproducible, and non-invasive method, that gives results that are closely comparable with those obtained by histology. Micro-CT appears to have utility for the accurate quantification of changes in bone architecture in small biological specimens.

Trigeminal neuropathy: improved imaging with a dental computed tomography software program

PURPOSE

This study evaluated the use of images obtained by a dental computed tomography (CT) software program in the diagnosis and treatment of trigeminal neuropathy associated with jaw abnormality.

PATIENTS AND METHODS

Twelve patients with jaw abnormality associated with trigeminal neuropathy as the presenting symptom were studied by plain film radiography (PFR) and by a dental CT software program (DS) that displays multiple panoramic and cross-sectional views of the mandible and maxilla. The two modalities were compared for delineation of the integrity of mandibular foramen, mandibular canal, mental foramen, incisive foramen, and incisive canal. Also, displacement of the neurovascular bundle was evaluated and scored.

RESULTS

The DS was superior to PFR in showing the bony integrity of the foramina and canals in the jaws, as well as the degree of displacement of the neurovascular bundle.

CONCLUSION

DS should be the study of choice for evaluating trigeminal neuropathy associated with abnormalities of the jaws.

Growth potential of peripheral giant cell granuloma

PURPOSE

The purpose of this study was to investigate the association of selected demographic, systemic health, and oral health characteristics of patients with large (> 2 cm) peripheral giant cell granuloma and to assess its growth potential and the possible underlying causes.

METHODS

A series of 79 cases including 15 subjects with lesions 2 to 5 cm in the largest diameter is presented. Age, sex, site, size, systemic health, oral hygiene, and report of oral dryness of subjects with large lesions were compared with those of subjects with small lesions (< 2 cm).

RESULTS

No differences were found in mean age between the small lesion group (mean age = 31 +/- 6 years) and the large lesion group (mean age 53 +/- 24.2 years). Female predilection (male/female ratio 1:1.5, 1:2.75.) was more significant in patients with large lesions. No statistically significant differences were found in systemic health score (mean American Society of Anesthesiology score 1.39, 1.53). Oral hygiene score (percent calculus 78% +/- 3.1%, 95% +/- 2.7%, percent gingival bleeding 58% +/- 3.6%, 73% +/- 5.4%, percent deep pocket 30% +/- 2.8%, 42% +/- 3.1) was better among the patients with small lesions. The percentage of patients with a report of oral dryness was significantly higher (3.1%, 27%) among patients with large lesions.

CONCLUSIONS

Findings from this study suggest that patients with large (> 2 cm) peripheral giant cell granuloma lesions are more likely to be women with lower oral hygiene scores and xerostomia. Further studies are required to measure the relative risk of these factors.