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Latorre CG, Atalah CN, Marshall Baburizza M. Denosumab as treatment of central giant cell granuloma of the jaws. a scoping review. Oral Maxillofac Surg 2024; 28:1029-1045. [PMID: 38539018 DOI: 10.1007/s10006-024-01245-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/17/2024] [Indexed: 08/18/2024]
Abstract
Denosumab has been considered a treatment option for Central Giant Cell Granuloma (CGCG) a benign locally aggressive osteolytic lesion of the jaws. This study aimed to perform a scoping review of CGCG treated with Denosumab. The research question was: What is Denosumab's effectiveness in treating CGCG of the jaws? Studies that used Denosumab as a treatment for CGCGs in the jaws were selected following PRISMA-ScR guidelines, using Pubmed/Medline, Scopus, and Springer Link databases, among others. Demographics, clinical information, dosing, efficacy, adverse drug reactions (ADRs), and imaging tests used to assess the evolution of the lesions were extracted. Twenty-one studies were selected. Sixty patients with a mean age of 23.2 years were treated with Denosumab, 42% with 120 mg subcutaneously monthly, additional doses on days 1, 8, and 15 for month 1 in adults. In children, dosing was adjusted by weight to 60 or 70 mg. To avoid ADRs 500 mg of calcium and 400 IU of vitamin D orally were used. Initial effective response was reported after 1-3 months, with recurrence of 19.6% and ADRs in 74% of cases. Denosumab is effective for CGCG with monthly subcutaneous doses of 120 mg, 60 or 70 mg in patients < 45 or 50 kg for ≥ 12 months with calcium and vitamin D supplementation until remission changes are observed. Extensive or refractory lesions were the main indications. Common ADRs were hypo and hypercalcemia. Further studies are needed to define dose and supplementation protocols to avoid ADRs during and after therapy.
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Affiliation(s)
| | | | - Maureen Marshall Baburizza
- Faculty of Dentistry, Universidad Andres Bello, Viña del Mar, Chile.
- Oral Pathology and Oral Medicine Unit, Faculty of Dentistry, Universidad Andres Bello, Quillota 980, Viña del Mar, Chile.
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Doshi A, Bhola N, Agarwal A. Giant Cells, Giant Impact: A Case of Aggressive Central Giant Cell Granuloma in the Mandible. Cureus 2024; 16:e58881. [PMID: 38800208 PMCID: PMC11117025 DOI: 10.7759/cureus.58881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Central giant cell granuloma (CGCG) is a bone lesion characterized by fibrous tissue containing areas of bleeding, giant cells with multiple nuclei, and trabeculae of woven bone. It is considered to be a local bone repair response, possibly triggered by inflammation, bleeding, or local injury. CGCG is more prevalent in females and can occur across a wide age range, typically diagnosed at a young age. Mandibular involvement is more common than maxillary involvement, with most lesions in the posterior region often extending into the ascending ramus. Management of aggressive CGCG can involve non-surgical (medical) and surgical treatment modalities. Surgical approaches vary from simple curettage to en bloc resection depending on various factors discussed in this case report.
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Affiliation(s)
- Akash Doshi
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitin Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anchal Agarwal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Capucha T, Krasovsky A, Abdalla-Aslan R, Ginini JG, Noy D, Emodi O, Rachmiel A, Shilo D. Central giant cell granuloma of the jaws-long-term clinical and radiological outcomes of surgical and pharmacological management. Clin Oral Investig 2024; 28:200. [PMID: 38453790 PMCID: PMC10920455 DOI: 10.1007/s00784-024-05585-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To compare long-term results of different treatment modalities in central giant cell granuloma of the maxillofacial-skeleton. Primary resection may result in major defects. Alternative treatments include pharmacological agents. As yet there has been no consensus on the use of the variety of treatment options, and few studies have reported clarifying long-term results. MATERIALS AND METHODS This retrospective study on 22 patients with 25 lesions evaluated clinical, radiological and histological features, treatment preformed and lesion recurrence. Success was defined as regression/calcification and failure as recurrence, progression or un-responsiveness. RESULTS Of the presenting patients, 77% were under age 40. Lesion prevalence was higher in the anterior mandible and left posterior maxilla. Most cases exhibited pain, tooth-mobility or mucosal-expansion. The appearance was predominantly unilocular in the maxilla and multilocular in the mandible, which also exhibited higher prevalence of cortical perforation. Up to 80% of lesions were classified as aggressive. Intralesional steroids/calcitonin were used in 7 cases. Mean follow-up was 39.8 months. Two cases showed recurrence. In 71% of the cases treated pharmacologically, calcification/regression were observed. CONCLUSIONS Our analysis indicates better outcomes using a combined approach, including both pharmacological and surgical treatments in large aggressive lesions. Pharmacological treatment resulted in decreased size or well-defined lesions, thus reducing the need for extensive bone resection. Dual treatment with corticosteroids and calcitonin showed no superior outcomes, but a larger cohort should be assessed. CLINICAL RELEVANCE There are several protocols for treatment of central-giant-cell-granuloma lesions, but most are not fully established. It is important to report results that contribute to the establishment of proven protocols. This report attempts to establish the relevance of the combined approach: pharmacological treatment followed by surgical resection.
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Affiliation(s)
- Tal Capucha
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Andrei Krasovsky
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | | | | | - Dani Noy
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Omri Emodi
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Adi Rachmiel
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dekel Shilo
- Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel.
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Thakare P, Prakash NL, Mahajan AM, Bhadage CJ. Appearances can be deceptive - Innocuous swelling on the gingiva masking an aggressive lesion within the maxilla. J Oral Maxillofac Pathol 2024; 28:142-145. [PMID: 38800423 PMCID: PMC11126259 DOI: 10.4103/jomfp.jomfp_205_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/01/2023] [Accepted: 07/17/2023] [Indexed: 05/29/2024] Open
Abstract
The central giant cell granuloma displays a varied biologic behaviour ranging from simple reactive lesions to aggressive neoplasms. The pathogenicity still remains enigmatic and needs to be differentiated from other giant cell containing lesions. Both maxilla and mandible are affected and 80% involve the region anterior to the first premolar region. CGCL arises centrally within bone, whereas PGCG is a gingival soft tissue lesion. Clinical and radiographic correlation is required to rule out a peripheral giant cell granuloma. The case described here was a rare presentation of a large epulis clinically with involvement of maxilla radiographically and was histologically diagnosed as a central giant cell lesion.
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Affiliation(s)
- Piyush Thakare
- Department of Oral and Maxillofacial Surgery, M.G.V’s K.B.H. Dental College and Hospital, Nashik, Maharashtra, India
| | - Nilima L. Prakash
- Department of Oral Pathology and Microbiology, M.G.V’s K.B.H. Dental College and Hospital, Nashik, Maharashtra, India
| | - Aarti M. Mahajan
- Department of Oral Pathology and Microbiology, M.G.V’s K.B.H. Dental College and Hospital, Nashik, Maharashtra, India
| | - Chetan J. Bhadage
- Oral Medicine and Radiology, M.G.V’s K.B.H. Dental College and Hospital, Nashik, Maharashtra, India
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Mukdad M, Barut O, Sjöström M. Intralesional corticosteroid injections as first option for management of giant cell lesion of the lower jaw in a 56-year-old patient: A case report and brief literature review. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pediatric Maxillary Giant Cell Tumors: Surgical Management by Transoral and Endoscopic Transnasal Enucleation and Curettage. J Craniofac Surg 2022; 33:e747-e750. [DOI: 10.1097/scs.0000000000008689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022] Open
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Camarini C, de Souza Tolentino E. Non-surgical treatment as an alternative for the management of central giant cell granuloma: a systematic review. Clin Oral Investig 2022; 26:2111-2132. [PMID: 34599398 DOI: 10.1007/s00784-021-04193-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/21/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of non-surgical treatment as an alternative in the management of central giant cell granuloma (CGCG). MATERIAL AND METHODS A literature search was carried out in accordance with the PRISMA statement in order to answer the question "Are non-surgical treatments effective as an alternative in the treatment of CGCG?". Two examiners independently assessed eligibility, risk of bias, and extracted data, which included therapeutic protocol, side effects, and need for surgical supplementation. RESULTS Among 1712 studies, 15 were included, totaling 145 patients. Calcitonin, intralesional corticosteroids, and denosumab were the medications used. For calcitonin (n = 61), complete remission was found in 30 cases. For intralesional triamcinolone (n = 68), reduction in size was observed in most cases (n = 39). Four cases received subcutaneous denosumab and showed absence of active bone metabolism in the region, of which three presented ossification. Combination of drug therapies (n = 29) was reported in one study and included subcutaneous interferon and oral imatinib. More and less side effects were found for interferon and corticosteroids, respectively. Forty percent of patients required additional surgical treatment. CONCLUSION Despite the side effects presented and the need for additional surgery in some patients, in general, all non-surgical treatments could provide positive results as an alternative for the management of CGCG, especially with regard to reducing the size of the lesion. CLINICAL RELEVANCE CGCG is a benign bone lesion that mainly affects young individuals. Although the most common therapy is surgery, its contraindication in some patients, the large extension, and high recurrence rate of the aggressive variant have led the search for non-surgical therapies.
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Affiliation(s)
- Camila Camarini
- Department of Dentistry, Maringá State University, Avenida Mandacaru, Maringá, Paraná, 87080-000, Brazil.
| | - Elen de Souza Tolentino
- Department of Dentistry, Maringá State University, Avenida Mandacaru, Maringá, Paraná, 87080-000, Brazil
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Sclerostin Immunohistochemical Staining in Aggressive Maxillofacial Giant Cell Lesions: Initial Results and Potential Therapeutic Target. J Craniofac Surg 2021; 33:790-793. [PMID: 34753866 DOI: 10.1097/scs.0000000000008344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Maxillofacial (MF) giant cell lesions (GCLs) are benign, often locally aggressive lesions with potential for recurrence. Systemic treatments have included interferon alpha, calcitonin, bisphosphonates, and denosumab. Sclerostin (SOST) is typically thought to be a negative regulator of bone metabolism and anti-SOST agents have been used to treat osteoporosis; however, its role in central giant cell granuloma is unknown. The purpose of this study was to evaluate the expression of SOST in MF GCLs. MATERIALS AND METHODS This was a retrospective study of patients with MF GCLs treated at a single institution between 1993 and 2008 with a minimum follow-up of 6 months. Representative tissue was used to create a tissue microarray and SOST immunohistochemical (IHC) staining and grading was performed. The primary outcomes were IHC staining of the stromal cells and giant cells. The secondary outcomes included correlation of IHC staining and patient predictor variables including clinically benign and aggressive lesions. All analyses were completed using univariate statistical tests. RESULTS A total of 37 subjects were included (29 clinically aggressive and 8 clinically benign). Sclerostin staining was present in 30 of 37 subjects (81%). Of these, 22 (60%) had stromal cell staining and 28 (76%) had giant cell staining. The presence or absence of staining, of either cell type, was not associated with aggressiveness, presence of clinical symptoms, tumor size, previous interferon therapy, previous surgery, or the race or age of the patient. DISCUSSION Maxillofacial GCLs have an overall high level of SOST staining; however, the role of SOST in treatment and prognosis is unknown and warrants further study.
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Angiogenesis pattern and H3.3 histone mutation in aggressive and non-aggressive central giant cell lesions. Arch Oral Biol 2021; 130:105218. [PMID: 34364170 DOI: 10.1016/j.archoralbio.2021.105218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate angiogenesis in central giant cell lesions (CGCL) and its association with biological behavior. In addition, investigation of the histone H3.3 mutation was performed. DESIGN Thirty-eight cases of CGCL were classified as aggressive (n = 9) or nonaggressive (n = 29). Cases were submitted to immunohistochemistry to compare angiogenesis using Wilms' tumor protein 1 (WT1), platelet endothelial cell adhesion molecule (CD31) and endoglin (CD105) between groups. To verify the presence of genic mutation, histone H3.3 was investigated. RESULTS WT1 was expressed in mononuclear and giant cells of all cases. CD31 and CD105 were expressed in CGCL microvessels, with a higher CD105 microvascular density than CD31. No statistically significant difference was observed between groups. None of the cases studied showed the histone mutation. CONCLUSIONS There was no difference between aggressive and nonaggressive lesions regarding the angiogenic markers. The expression of WT1 and CD105 suggests that CGCL presents a tumoral vascular pattern with high neoangiogenic activity. The absence of histone mutation may indicate that CGCL is not a true giant cell tumor.
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de Arruda JAA, Martins AFL, Abreu LG, Mesquita RA, von Zeidler SV, Estrela C, Mendonça EF. Central giant cell granuloma of the maxilla: Long-term follow-up of a patient treated with an adjuvant corticosteroid. SPECIAL CARE IN DENTISTRY 2021; 41:399-407. [PMID: 33471401 DOI: 10.1111/scd.12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Central giant cell granuloma (CGCG) is one of the most intriguing lesions of the jaws and its nature has not yet been fully elucidated. Clinically, some CGCG behave more aggressively, while others have an indolent course. In cases of aggressive CGCG of the maxilla, effective personalized therapies are worth understanding. CASE REPORT We report here a challenging case of aggressive CGCG in a 15-year-old girl which was misdiagnosed as an endodontic lesion. Radiographically, a large osteolytic lesion involving the hard palate from the central incisor to the second premolar, extending into the nasal cavity, with loss of the lamina dura and cortical resorption was observed. The lesion expanded aggressively after extensive curettage. With possible mutilation and defects due to a more radical approach to the lesion, treatment with systemic prednisone and intralesional triamcinolone hexacetonide associated with a calcitonin nasal spray was instituted. The decision in favor of this therapeutic strategy was made after careful immunohistochemical analysis of calcitonin and glucocorticoid receptors. The H-score for the staining of glucocorticoid and calcitonin receptors in multinucleated giant cells was 222 and 153.6, respectively. The lesion reduced in size, and no adverse effects associated with medications were observed. Another curettage was performed, and only fibrous connective tissue was found. The patient is in follow-up for 11 years without evidence of recurrence. CONCLUSION Pharmacological agents hold clinical promise in cases of aggressive CGCG affecting the maxilla of pediatric patients. Investigating the expression of calcitonin and glucocorticoid receptors in order to plan treatment is very helpful in the decision to manage aggressive CGCG.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandra Ventorin von Zeidler
- Department of Pathology and Post-graduation Program in Biotechnology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Carlos Estrela
- Department of Stomatologic Sciences, School of Dentistry, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
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Nogueira RLM, Osterne RLV, Lima Verde RMB, Azevedo NO, Teixeira RC, Cavalcante RB. Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant cell lesions: a prospective study. Br J Oral Maxillofac Surg 2020; 58:e283-e289. [PMID: 32792199 DOI: 10.1016/j.bjoms.2020.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022]
Abstract
The aim of this prospective study was to report on the response to treatment of central giant cell lesions (CGCL) with intralesional corticosteroid injections. Consecutive cases of CGCL were treated with a biweekly intralesional injection of 20mg/ml triamcinolone hexacetonide diluted in an anaesthetic solution of 2% lidocaine/epinephrine 1:200 000 at the proportion 1:1. All patients were monitored using cone beam computed tomography. Eleven patients were treated; their ages ranged from 15-34 (mean 22 years); and eight lesions were in the mandible, and three in the maxilla. Three cases were diagnosed as non-aggressive, and eight as aggressive. Six cases presented good results (four aggressive and two non-aggressive); three cases presented a moderate response (two aggressive and one non-aggressive); and two had a poor response to treatment (both aggressive). In four cases with a good response, osteoplasty was done. In all cases with a moderate response, the remaining lesion was curetted. Cases with a poor response were submitted to either curettage or denosumab injections. Corticotherapy, as main or neoadjuvant therapy, may be an option for treatment of CGCL.
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Affiliation(s)
- R L M Nogueira
- Department of Dental Clinic, Discipline of Oral and Maxillofacial Surgery and Stomatology, Federal University of Ceara School of Dentistry, Fortaleza, Brazil; Department of Oral and Maxillofacial Surgery, Memorial Batista Hospital, Fortaleza, Brazil
| | - R L V Osterne
- Department of Pathology, University of Fortaleza/Universidade de Fortaleza, School of Medicine, Fortaleza, Brazil
| | - R M B Lima Verde
- Christus University Center (Centro Universitário Christus), School of Dentistry, Fortaleza, Brazil; Federal University of Ceara School of Dentistry, Fortaleza, Brazil.
| | - N O Azevedo
- Federal University of Ceara School of Dentistry, Fortaleza, Brazil
| | - R C Teixeira
- Department of Oral Radiology, University of Fortaleza/Universidade de Fortaleza, School of Dentistry, Fortaleza, Brazil
| | - R B Cavalcante
- Department of Oral Pathology, University of Fortaleza/Universidade de Fortaleza, School of Dentistry, Fortaleza, Brazil
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Smriti K, John E, Pentapati KC, Gadicherla S, Bhagania M. Intra-Lesional Medicaments for the Management of Intra-Osseous Lesions of Maxilla and Mandible - Systematic Review. J Int Soc Prev Community Dent 2020; 10:36-45. [PMID: 32181219 PMCID: PMC7055339 DOI: 10.4103/jispcd.jispcd_295_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
Abstract
Aims and Objectives: This study aimed to review the success or remission of intralesional medicaments in the management of intraosseous lesions in the oral cavity. Materials and Methods: A comprehensive search was performed in two databases (PubMed and Scopus). Research articles, case reports, case series, and clinical trials were included. Review articles, lesions not involving the bone, incomplete reporting, any other treatment other than intralesional medicaments to treat intraosseous bone lesions, publications without any treatment, and letter to editor were excluded. Data on remission (complete, partial, or no remission), details and regimen of the intervention, number of participants, and follow-up in months were recorded. Results: A total of 653 publications were available for title and abstract screening after the removal of duplicates. Seven articles were excluded, which were not in English. After title and abstract screening, a total of 88 publications were available for full-text screening. Fifty-five articles were included in qualitative synthesis. A total of 168 patients from 55 publications were evaluated. Minimum follow-up was 1 month and maximum was 264 months. More than two-third (n = 38) of the publications were case reports on single patient. More than two-third (n = 38) of the publications had complete remission. Conclusion: Intralesional medications have shown variable success rates. Extensive lesions may undergo intralesional medications followed by surgical management.
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Affiliation(s)
- Komal Smriti
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Evit John
- MPH Candidate, School of Public Health, University of Texas Health Sciences Centre, Houston, Texas, USA
| | - Kalyana-Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manish Bhagania
- Oral and Maxillofacial Surgery, Boston University, Boston, MA, USA
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Gomes CC, Diniz MG, Bastos VC, Bernardes VF, Gomez RS. Making sense of giant cell lesions of the jaws (GCLJ): lessons learned from next-generation sequencing. J Pathol 2019; 250:126-133. [PMID: 31705763 DOI: 10.1002/path.5365] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 01/09/2023]
Abstract
Next-generation sequencing has revealed mutations in several bone-related lesions and was recently used to uncover the genetic basis of giant cell lesions of the jaws (GCLJ). Consistent with their benign nature, GCLJ show a low tumor mutation burden. They also harbor somatic, heterozygous, mutually exclusive mutations in TRPV4, KRAS, or FGFR1. These signature mutations occur only in a subset of lesional cells, suggesting the existence of a 'landscaping effect', with mutant cells inducing abnormal accumulation of non-mutant cells that form the tumor mass. Osteoclast-rich lesions with histological similarities to GCLJ can occur in the jaws sporadically or in association with genetically inherited syndromes. Based on recent results, the pathogenesis of a subgroup of sporadic GCLJ seems closely related to non-ossifying fibroma of long bones, with both lesions sharing MAPK pathway-activating mutations. In this review, we extrapolate from these recent findings to contextualize GCLJ genetics and we highlight the therapeutic implications of this new information. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Carolina C Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marina G Diniz
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Victor C Bastos
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vanessa F Bernardes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ricardo S Gomez
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Bonolis A, Euvrard E, Meyer C, Louvrier A. Central giant-cell granuloma located in the mandibular symphyseal region of a child. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2017039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Central giant-cell granuloma (CGCG) is a rare mandibular tumor. The originality of this case lies in its clinical presentation, with a delay in treatment despite a significant aesthetic impact. Observation: An 8-year-old boy whose chin had been swelling for three (3) months was referred to have a consultation. The medical imaging examination revealed a well-defined osteolytic lesion of about 3 cm and round in shape. The lesion was surgically treated by enucleation. The anatomopathological examination provided evidence of a CGCG. Conclusion: Postoperative period was aesthetically acceptable, there were no nervous or dental lesions and no relapse at the 6-month follow-up.
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Al-Sukaini A, Hornicek FJ, Peacock ZS, Kaban LB, Ferrone S, Schwab JH. Immune Surveillance Plays a Role in Locally Aggressive Giant Cell Lesions of Bone. Clin Orthop Relat Res 2017; 475:3071-3081. [PMID: 28725958 PMCID: PMC5670060 DOI: 10.1007/s11999-017-5451-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/14/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Giant cell lesions are locally aggressive intraosseous neoplasms with capacity to metastasize. The role of immune surveillance in the pathophysiology of giant cell lesions is poorly understood, and understanding what role the immune system plays in giant cell lesions may lead to the development of more effective treatment. The aim of this study was to explore the role of immune surveillance in giant cell lesions by examining the expression of the HLA class I and class II antigens and tumor infiltrating lymphocytes. In addition, we examined the role of the immune modulating surface antigen B7-H3, which belongs to the B7 superfamily, a group of molecules that modulates T-cell responses. QUESTIONS/PURPOSES (1) Is an immune response elicited by giant cell lesions? (2) Do clinically relevant human leukocyte antigen (HLA) defects exist in giant cell lesions? (3) Is B7-H3 a clinically relevant immune modulator? METHODS The study sample was derived from the population of patients presenting to the Massachusetts General Hospital for evaluation and management of giant cell lesions from 1993 to 2008. We included patients with histologically confirmed giant cell lesions with a minimum followup of 6 months. Patients with systemic diseases (n = 4 [3%]), syndromes associated with giant cell lesions (n = 4 [3%]), and those without sufficient followup (n = 26 [19%]), inadequate records (n = 7 [5%]), or inadequate tissue available (n = 2 [1%]) were excluded. Tissue microarray, containing 288 tissue cores for 93 patients, was carefully constructed. This contained tissue from 45 patients with maxillofacial lesions, 38 with aggressive and seven with nonaggressive lesions, and 48 patients with axial and appendicular lesions, 30 with aggressive lesions and 18 with nonaggressive lesions. The population mean age was 28 ± 12 years and the duration of followup was 4 ± 3 years. The tissue microarray was immunohistochemically stained with monoclonal antibodies specific for HLA classes I and II and B7-H3 antigens and analyzed for tumor infiltrating lymphocytes. Antigen expression was examined in multinucleated giant cells and mononuclear stromal cells. The results were correlated with local invasion and tumor aggressiveness, which is based on accepted staging criteria. RESULTS Tumor infiltrating lymphocytes were detected in all the tumors. The mean number of CD8+ T cell infiltration was lower in aggressive tumors (median, 4.8; interquartile range [IQR], 0.4-13.4), when compared with nonaggressive tumors (median, 15.8; IQR, 4.3-46.3; p = 0.007). HLA class I antigens were highly expressed by multinucleated giant cells in all tumors, but were lightly expressed on mononuclear stromal cells in 53% (45 of 84) to 73% (56 of 77) of tumors. HLA class I antigen low expression in mononuclear stromal cells was associated with tumor aggressiveness (odds ratio [OR], 4.3; p = 0.005). Low HLA class I expression combined with low CD8+ T cell infiltration was most highly associated with tumor aggressiveness (OR, 7.81; p = 0.011). B7-H3 antigen was expressed in 36.9% mononuclear stroma cells and also was associated with local tumor invasion (OR, 1.36; p < 0.001). Similarly, giant cell lesions with high B7-H3 expression and low CD8+ tumor infiltrating lymphocytes were associated with increased tumor aggressiveness (OR, 8.89; p = 0.0491). CONCLUSIONS Locally aggressive giant cell lesions are associated with low HLA class 1 antigen expression, low CD8+T cell infiltration, and high expression of the immune modulator B7-H3. CLINICAL RELEVANCE Failure of immune surveillance implies that there may be an opportunity to target aspects of the immune surveillance machinery to treat giant cell lesions.
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Affiliation(s)
- Ahmad Al-Sukaini
- 0000 0004 0386 9924grid.32224.35Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
| | - Francis J. Hornicek
- 0000 0004 0386 9924grid.32224.35Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
| | - Zachary S. Peacock
- 0000 0004 0386 9924grid.32224.35Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, MA USA
| | - Leonard B. Kaban
- 0000 0004 0386 9924grid.32224.35Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, MA USA
| | - Soldano Ferrone
- 0000 0004 0386 9924grid.32224.35Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
| | - Joseph H. Schwab
- 0000 0004 0386 9924grid.32224.35Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
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Concomitant Central Giant Cell Granuloma and Aneurysmal Bone Cyst in a Young Child. Case Rep Dent 2017; 2017:6545848. [PMID: 28480084 PMCID: PMC5396429 DOI: 10.1155/2017/6545848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/20/2017] [Accepted: 03/19/2017] [Indexed: 12/04/2022] Open
Abstract
Although Central Giant Cell Granuloma (CGCG) is a benign tumor of the jaw and aneurysmal bone cyst seen in children, its aggressive behavior causes extensive loss of hard tissue requiring wide excision and extensive rehabilitation. We report a rare case of concomitant CGCG and aneurysmal bone cyst in a two-year-old male child, involving the coronoid and condylar process. Young age, large tumor, its aggressive nature, and future growth of orofacial region pose a significant challenge in the management of such conditions. For a successful outcome, the systematic approach to the presurgical evaluation and appropriate treatment planning is essential for such conditions.
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Adjuvant Antiangiogenic Treatment for Aggressive Giant Cell Lesions of the Jaw: A 20-Year Experience at Massachusetts General Hospital. J Oral Maxillofac Surg 2017; 75:105-118. [DOI: 10.1016/j.joms.2016.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 01/08/2023]
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Schreuder WH, van den Berg H, Westermann AM, Peacock ZS, de Lange J. Pharmacological and surgical therapy for the central giant cell granuloma: A long-term retrospective cohort study. J Craniomaxillofac Surg 2016; 45:232-243. [PMID: 28087284 DOI: 10.1016/j.jcms.2016.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 10/01/2016] [Accepted: 11/10/2016] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Willem Hans Schreuder
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. de Lange), Academic Medical Center, Academic Center Dentistry Amsterdam and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Henk van den Berg
- Department of Pediatric Oncology, Academic Medical Center, Emma Children Hospital and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Anne Marie Westermann
- Department of Medical Oncology, Academic Medical Center and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Zachary Scott Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Fruit Street 55, MA, 02114, Boston, United States.
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. de Lange), Academic Medical Center, Academic Center Dentistry Amsterdam and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Surgical Treatment, Oral Rehabilitation, and Orthognathic Surgery After Failure of Pharmacologic Treatment of Central Giant Cell Lesion: A Case Report. J Oral Maxillofac Surg 2016; 74:2567.e1-2567.e10. [DOI: 10.1016/j.joms.2016.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 11/21/2022]
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Benign Tumors of the Spine: Has New Chemotherapy and Interventional Radiology Changed the Treatment Paradigm? Spine (Phila Pa 1976) 2016; 41 Suppl 20:S178-S185. [PMID: 27488295 DOI: 10.1097/brs.0000000000001818] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Clinically based systematic review. OBJECTIVE To determine the role of (A) medical treatment and (B) interventional radiology as either adjuvant or stand-alone treatment in primary benign bone tumors of the spine. METHODS A multidisciplinary panel of spine surgeons, radiation oncologists, and medical oncologists elaborated specific focused questions regarding aneurysmal bone cyst, giant cell tumor, and osteoid osteoma. Denosumab, bisphosphonate, interferon, bone marrow aspirate, doxycycline, thermal ablation, and selective arterial embolization were identified as areas of interest for the article. A systematic review was performed through MEDLINE and EMBASE. Recommendations based on the literature review and clinical expertise were issued using the GRADE system. RESULTS The overall quality of the literature is very low with few multicenter prospective studies. For giant cell tumor, combination with Denosumab identified 14 pertinent articles with four multicenter prospective studies. Nine studies were found on bisphosphonates and six for selective arterial embolization. The search on aneurysmal bone cyst and selective arterial embolization revealed 12 articles. Combination with Denosumab, Doxycycline, and bone marrow aspirate identified four, two, and three relevant articles respectively. Eleven focused articles were selected on the role of thermal ablation in osteoid osteoma. CONCLUSION Alternative and adjuvant therapy for primary benign bone tumors have emerged. Their ability to complement or replace surgery is now being scrutinized and they may impact significantly the algorithm of treatment of these tumors. Most of the data are still emerging and further research is desirable. Close collaboration between the different specialists managing these pathologies is crucial. LEVEL OF EVIDENCE N/A.
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Choy E, Hornicek FJ, Chen YL, Rosenthal DI, Kerr DA. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 26-2016. A 28-Year-Old Woman with Back Pain and a Lesion in the Lumbar Spine. N Engl J Med 2016; 375:779-88. [PMID: 27557305 DOI: 10.1056/nejmcpc1505482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Edwin Choy
- From the Department of Medicine, Division of Hematology-Oncology (E.C.), and the Departments of Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Massachusetts General Hospital, and the Departments of Medicine (E.C.), Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Harvard Medical School - both in Boston
| | - Francis J Hornicek
- From the Department of Medicine, Division of Hematology-Oncology (E.C.), and the Departments of Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Massachusetts General Hospital, and the Departments of Medicine (E.C.), Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Harvard Medical School - both in Boston
| | - Yen-Lin Chen
- From the Department of Medicine, Division of Hematology-Oncology (E.C.), and the Departments of Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Massachusetts General Hospital, and the Departments of Medicine (E.C.), Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Harvard Medical School - both in Boston
| | - Daniel I Rosenthal
- From the Department of Medicine, Division of Hematology-Oncology (E.C.), and the Departments of Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Massachusetts General Hospital, and the Departments of Medicine (E.C.), Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Harvard Medical School - both in Boston
| | - Darcy A Kerr
- From the Department of Medicine, Division of Hematology-Oncology (E.C.), and the Departments of Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Massachusetts General Hospital, and the Departments of Medicine (E.C.), Orthopedic Surgery (F.J.H.), Radiation Oncology (Y.-L.C.), Radiology (D.I.R.), and Pathology (D.A.K.), Harvard Medical School - both in Boston
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Tabrizi R, Fardisi S, Zamiri B, Amanpour S, Karagah T. Can calcitonin nasal spray reduce the risk of recurrence of central giant cell granuloma of the jaws? A double-blind clinical trial. Int J Oral Maxillofac Surg 2016; 45:756-9. [DOI: 10.1016/j.ijom.2016.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/29/2015] [Accepted: 02/29/2016] [Indexed: 12/30/2022]
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Central Giant Cell Granuloma of the Mandible Requiring Multiple Treatment Modalities: A Case Report. J Oral Maxillofac Surg 2016; 74:1596-607. [PMID: 27000410 DOI: 10.1016/j.joms.2016.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 01/04/2023]
Abstract
Central giant cell granuloma (CGCG) is a relatively rare non-neoplastic, intraosseous lesion that exhibits a wide spectrum of clinical behavior, and its management can be particularly challenging even for experienced clinicians. The etiopathogenesis of this disease process remains unclear, although factors such as trauma, inflammatory foci, and a genetic predisposition have been implicated. Although multiple treatment modalities have been used with varying degrees of success, there is no accepted algorithm for therapeutic intervention and little is known about the reasons for success or failure of a given treatment. This article reviews the epidemiology, presentation, classification, and currently used therapies for CGCG while describing the clinical course and successful therapeutic outcome of a young female patient with an aggressive CGCG of the mandible.
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Nonodontogenic Cysts of the Jaws and Treatment in the Pediatric Population. Oral Maxillofac Surg Clin North Am 2016; 28:31-44. [DOI: 10.1016/j.coms.2015.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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O'Connell JE, Bowe C, Murphy C, Toner M, Kearns GJ. Aggressive giant cell lesion of the jaws: a review of management options and report of a mandibular lesion treated with denosumab. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:e191-8. [DOI: 10.1016/j.oooo.2015.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/23/2015] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
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Central giant cell granuloma of the mandibular condyle: a case report, literature review, and discussion of treatment. ORAL AND MAXILLOFACIAL SURGERY CASES 2015. [DOI: 10.1016/j.omsc.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Gupta B, Stanton N, Coleman H, White C, Singh J. A novel approach to the management of a central giant cell granuloma with denosumab: A case report and review of current treatments. J Craniomaxillofac Surg 2015; 43:1127-32. [DOI: 10.1016/j.jcms.2015.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 03/15/2015] [Accepted: 04/10/2015] [Indexed: 11/30/2022] Open
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Abstract
Oral and maxillofacial surgeons are often involved in the diagnosis and treatment of vascular neoplasms of the head and neck. An incorrect diagnosis may lead to improper or unnecessary treatment. This article reviews the diagnosis and management of vascular tumors.
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Abstract
There are no approved medical therapies for the treatment of pediatric central giant cell granuloma (CGCG), a benign but potentially aggressive tumor of the jaw. Zoledronic acid (ZA), a third-generation bisphosphonate, has been used in CGCG occurring in adults. We describe 4 patients with CGCG treated with ZA, 3 of whom achieved resolution of disease up to 4 years of follow-up. Our experience suggests that ZA may be considered as treatment for pediatric CGCG.
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Vaishya R, Agarwal AK, Vijay V. 'Salvage Treatment' of Aggressive Giant Cell Tumor of Bones with Denosumab. Cureus 2015; 7:e291. [PMID: 26251767 PMCID: PMC4524749 DOI: 10.7759/cureus.291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/30/2015] [Indexed: 12/22/2022] Open
Abstract
Giant cell tumor of the bone (GCTB) presents as a lytic lesion of epiphyseometaphyseal regions of the long bones usually during the second to the fourth decade with female predilection. Histologically, they are formed of neoplastic mononuclear cells with a higher receptor activator of nuclear factor kappa-B ligand (RANKL) expression responsible for the aggressive osteolytic nature of the tumour. RANKL helps in the formation and functioning of osteoclasts. A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts. Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible. Denosumab may play a crucial role, especially in the management of such difficult lesions. We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.
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Tarsitano A, Del Corso G, Pizzigallo A, Marchetti C. Aggressive Central Giant Cell Granuloma of the Mandible Treated With Conservative Surgical Enucleation and Interferon-α-2a: Complete Remission With Long-Term Follow-Up. J Oral Maxillofac Surg 2015; 73:2149-54. [PMID: 25985764 DOI: 10.1016/j.joms.2015.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
Central giant cell granuloma (CGCG) is a benign tumor of the jaws. Aggressive lesions present a strong tendency toward recurrence after surgical enucleation; thus, en bloc resection and microvascular bone free flap transfer are usually performed. However, in young patients, aggressive surgical treatment is a not always suitable solution. This report describes the case of a young female patient who developed an aggressive recurrence of CGCG after its diagnosis and enucleation from the mandible. Surgical enucleation with subcutaneous injection of interferon-α-2a was performed. The patient was evaluated every 6 weeks, and after 6 months radiographic evidence of complete bone regeneration was obtained. No sign of recurrence was seen after 8 years of follow-up. A review of the literature proved that interferon treatment is an effective strategy to avoid extensive surgery in patients with aggressive CGCG.
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Affiliation(s)
- Achille Tarsitano
- Researcher, Department of Biomedical and Neuromotor Sciences, Section of Maxillofacial Surgery, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Giacomo Del Corso
- PhD student, Department of Biomedical and Neuromotor Sciences, Section of Oral Science, University of Bologna, Bologna, Italy.
| | - Angelo Pizzigallo
- Medical Doctor, Department of Biomedical and Neuromotor Sciences, Section of Maxillofacial Surgery, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Claudio Marchetti
- Professor of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Sciences, Section of Maxillofacial Surgery, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
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Central giant cell granuloma of posterior maxilla: first expression of primary hyperparathyroidism. Case Rep Endocrinol 2015; 2015:170412. [PMID: 25692050 PMCID: PMC4321084 DOI: 10.1155/2015/170412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/27/2014] [Accepted: 12/28/2014] [Indexed: 12/30/2022] Open
Abstract
A case of 19-year-old male patient reported with the chief complaint of slowly growing diffuse painless swelling over the right part of the face from last 6 months. Intraoral examination revealed a swelling on right side of palate in relation to molar region with buccal cortical plate expansion. Radiographic examination (orthopantograph and 3DCT) showed large multilocular radiolucency in right maxilla with generalized loss of lamina dura. Incisional biopsy was done and specimen was sent for histopathological examination which showed multinucleated giant cells containing 15-30 nuclei. Based on clinical, radiological, and histopathological findings provisional diagnosis of central giant cell granuloma was made. Blood tests after histopathology demonstrated elevated serum calcium level and alkaline phosphatase level. Immunoassay of parathyroid hormone (PTH) level was found to be highly elevated. Radiographic examination of long bones like humerus and femur, mandible, and skull was also done which showed osteoclastic lesions. Considering the clinical, radiographic, histopathological, and blood investigation findings, final diagnosis of brown tumour of maxilla was made. The patient underwent partial parathyroidectomy under general anaesthesia to control primary hyperparathyroidism. Surgical removal of the bony lesion was done by curettage. The patient has been followed up for 1 year with no postoperative complications and the lesion healed uneventfully.
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Merritt H, Yin VT, Pfeiffer ML, Wang WL, Sniegowski MC, Esmaeli B. Treatment Challenges with Benign Bone Tumors of the Orbit. Ocul Oncol Pathol 2015; 1:111-20. [PMID: 27171013 DOI: 10.1159/000368651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/25/2014] [Indexed: 11/19/2022] Open
Abstract
Benign mesenchymal tumors of the craniofacial complex present unique challenges for orbital surgeons because of their potential for orbital compartment syndrome, ocular morbidity, and facial disfigurement and because definitive surgical management may be associated with significant morbidity. While the precise classification of such lesions depends on radiologic as well as histologic evaluations and remains controversial, benign tumors involving the bony walls of the orbit share features of bony expansion, facial deformity, and the potential to cause significant orbital and ophthalmic morbidity. We herein present 2 cases of benign mesenchymal tumors with bony involvement in the orbitofacial region (1 juvenile ossifying fibroma and 1 central giant cell granuloma) and review the current management of similar benign fibro-osseous and reactive bone lesions of the orbit. These rare entities presented share common orbital and ophthalmic manifestations and remain without any effective definitive treatment options.
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Affiliation(s)
- Helen Merritt
- Orbital Oncology and Ophthalmic Plastic Surgery Program, Department of Plastic Surgery, Houston, Tex., USA; Ruiz Department of Ophthalmology and Visual Science, The University of Texas Health Science Center at Houston, Houston, Tex., USA
| | - Vivian T Yin
- Orbital Oncology and Ophthalmic Plastic Surgery Program, Department of Plastic Surgery, Houston, Tex., USA
| | - Margaret L Pfeiffer
- Orbital Oncology and Ophthalmic Plastic Surgery Program, Department of Plastic Surgery, Houston, Tex., USA; Ruiz Department of Ophthalmology and Visual Science, The University of Texas Health Science Center at Houston, Houston, Tex., USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Tex., USA
| | - Matthew C Sniegowski
- Orbital Oncology and Ophthalmic Plastic Surgery Program, Department of Plastic Surgery, Houston, Tex., USA
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery Program, Department of Plastic Surgery, Houston, Tex., USA
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Management of Central Giant Cell Granuloma With Subcutaneous Denosumab Therapy. J Oral Maxillofac Surg 2014; 72:2469-84. [DOI: 10.1016/j.joms.2014.06.456] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/13/2014] [Accepted: 06/30/2014] [Indexed: 11/22/2022]
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Santiago-Dieppa DR, Hwang LS, Bydon A, Gokaslan ZL, McCarthy EF, Witham TF. L4 and L5 spondylectomy for en bloc resection of giant cell tumor and review of the literature. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 5:151-7. [PMID: 25364329 PMCID: PMC4212699 DOI: 10.1055/s-0034-1387804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 07/08/2014] [Indexed: 11/17/2022]
Abstract
Study Design Case report and review of the literature. Objective We present the case of a two-level lumbar spondylectomy at L4 and L5 for en bloc resection of a giant cell tumor (GCT) and lumbopelvic reconstruction. Methods A 58-year-old woman presented with a 7-month history of progressive intractable back and leg pain secondary to a biopsy-proven Enneking stage III GCT of the L4 and L5 vertebrae. The patient underwent a successful L4–L5 spondylectomy and lumbopelvic reconstruction using a combined posterior and anterior approach over two operative stages. Results Postoperative complications included a deep wound infection and a cerebrospinal fluid leak; however, following surgical debridement and long-term antibiotic treatment, the patient was neurologically intact with minimal pain and there was no evidence of tumor recurrence or instrumentation failure at more than 2 years of follow-up. Conclusion Spondylectomy that achieves en bloc resection is a viable and effective treatment option that can be curative for Enneking stage III GCTs involving the lower lumbar spine. The lumbosacral junction represents a challenging anatomic location for spinal reconstruction after spondylectomy with unique technical considerations.
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Affiliation(s)
- David R Santiago-Dieppa
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Lee S Hwang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ali Bydon
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Edward F McCarthy
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Schreuder WH, Coumou AW, Kessler PA, de Lange J. Alternative Pharmacologic Therapy for Aggressive Central Giant Cell Granuloma: Denosumab. J Oral Maxillofac Surg 2014; 72:1301-9. [DOI: 10.1016/j.joms.2014.02.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/27/2014] [Accepted: 02/01/2014] [Indexed: 12/26/2022]
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Cornelis F, Truchetet ME, Amoretti N, Verdier D, Fournier C, Pillet O, Gille O, Hauger O. Bisphosphonate therapy for unresectable symptomatic benign bone tumors: a long-term prospective study of tolerance and efficacy. Bone 2014; 58:11-6. [PMID: 24120668 DOI: 10.1016/j.bone.2013.10.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 09/30/2013] [Accepted: 10/03/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the long-term tolerance of bisphosphonates proposed as an alternative therapeutic option for symptomatic unresectable benign bone tumors and to evaluate the long-term efficacy of this treatment. METHODS From March 2007 to March 2011, patients with unresectable symptomatic benign bone tumors were consecutively included in this institutional review board-approved study and treated with bisphosphonates. Prospectively long-term follow-up is reported. The study endpoints were to describe the long-term tolerance, the clinical evolution of pain for each patient and the radiological success defined as a complete disappearance of inflammation and ossification of the bone lesion. All complications and side effects were recorded. RESULTS Eight patients (mean age 16 years; range 7-42) with various tumor subtypes were included: aneurysmal bone cysts (N=5), Langerhans cell histiocytosis (N=1), osteoblastoma (N=1), and a giant cell tumor (N=1). Tumors were located in cervical (N=4) or thoracic (N=1) vertebrae, femoral shaft (N=1), acetabulum (N=1) and sacrum (N=1). Mean number of bisphosphonate cycles was 3 (range: 1-6) over a median period of 10 months. The median clinical and imaging follow-up period was 21 months (6 to 63 months). No severe complications due to treatment or lesion recurrence were reported. Pain disappeared within 6 weeks of the first cycle for all but one patient. Ossification of the bone lesion was observed for all patients but one, complete for two and partial for the five others. CONCLUSIONS Bisphosphonates appear to be an effective option without adverse effects for the non-operative management of symptomatic benign bone tumors.
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Affiliation(s)
- F Cornelis
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
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Abstract
This article will review current thoughts with regard to the etiology, histopathology, diagnosis, and management of giant cell lesions of the jaws. It will attempt to point out the differences between these lesions and giant cell lesions elsewhere in the body and also the current techniques for medical management of these conditions including steroid injections, calcitonin treatment, and alpha interferon treatment.
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Affiliation(s)
- Anthony M Pogrel
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA
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Abramowicz S, Goldwaser BR, Troulis MJ, Padwa BL, Kaban LB. Primary Jaw Tumors in Children. J Oral Maxillofac Surg 2013; 71:47-52. [DOI: 10.1016/j.joms.2012.04.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 04/23/2012] [Accepted: 04/27/2012] [Indexed: 12/26/2022]
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Aggressive giant cell granuloma of the jaws treated with interferon alpha: a report of two cases. Ir J Med Sci 2012; 182:163-70. [DOI: 10.1007/s11845-012-0858-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
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Dufresne A, Derbel O, Cassier P, Vaz G, Decouvelaere AV, Blay JY. Giant-cell tumor of bone, anti-RANKL therapy. BONEKEY REPORTS 2012; 1:149. [PMID: 24363925 DOI: 10.1038/bonekey.2012.149] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/04/2012] [Indexed: 01/30/2023]
Abstract
Giant-cell tumor of bone (GCTB) is a rare osteolytic tumor of the bone. Although classified as a benign tumor, GCTB is characterized by local aggressiveness and risk of local recurrence. In addition, GTCB can in some cases lead to the development of so-called 'benign' chest metastases. Surgical resection by intralesional curettage with high-speed burring and polymethylmethacrylate cement is the standard treatment for resectable tumors. In cases of metastatic or unresectable disease (when planned surgical procedure is impossible or would result in severe morbidity), medical treatments such as cytotoxic chemotherapy or interferon-α have limited efficacy. Bisphosphonates have been proposed as a therapeutic option to reduce osteoclast activity. In bone, various pathological states may result from an imbalance in the RANK (receptor activator of nuclear factor kappa-B)/RANKL (receptor activator of nuclear factor kappa-B ligand)/OPG (osteoprotegerin) pathway. Involvement of the RANKL pathway in pathogenesis of GCTB was first proposed in 2000. Denosumab is a fully human monoclonal antibody that binds and inhibits RANKL, thereby preventing the activation of the RANK pathway. As it showed the possibility to counteract osteoclast activation in GCTB and prevent the known physiopathological role of RANKL, denosumab has been under evaluation in the clinic as a treatment for GCTB since 2005. Results of a first Phase II trial demonstrate the therapeutic potential of denosumab to inhibit progressive bone destruction and metastatic progression in patients with unsalvageable giant-cell tumor (GCT), and have also provided key insights into the biology of GCT. Denosumab is currently a therapeutic option for patients with unresectable GCTB but its place in the global therapeutic strategy has not yet been defined.
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Affiliation(s)
- Armelle Dufresne
- Cancer Research Center of Lyon (CRCL), Department of 'Immunity, Virus and Microenvironnement', UMR INSERM 1052-CNRS 5286, Leon Berard Cancer Center , Lyon, France
| | - Olfa Derbel
- Medical Oncology Department, Leon Berard Cancer Center , Lyon, France
| | - Philippe Cassier
- Cancer Research Center of Lyon (CRCL), Department of 'Immunity, Virus and Microenvironnement', UMR INSERM 1052-CNRS 5286, Leon Berard Cancer Center , Lyon, France . ; Medical Oncology Department, Leon Berard Cancer Center , Lyon, France
| | - Gualter Vaz
- Surgery Department, Edouard Herriot Hospital , Lyon, France
| | | | - Jean-Yves Blay
- Cancer Research Center of Lyon (CRCL), Department of 'Immunity, Virus and Microenvironnement', UMR INSERM 1052-CNRS 5286, Leon Berard Cancer Center , Lyon, France . ; Medical Oncology Department, Leon Berard Cancer Center , Lyon, France
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Peacock ZS, Resnick CM, Susarla SM, Faquin WC, Rosenberg AE, Nielsen GP, Schwab JH, Hornicek F, Ebb DH, Dodson TB, Kaban LB. Do histologic criteria predict biologic behavior of giant cell lesions? J Oral Maxillofac Surg 2012; 70:2573-80. [PMID: 22365980 DOI: 10.1016/j.joms.2011.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/14/2011] [Accepted: 12/01/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine whether the clinical behavior of giant cell lesions (GCLs) or their anatomic location can be differentiated by histologic criteria alone. MATERIALS AND METHODS We performed a retrospective study of patients with GCLs treated at Massachusetts General Hospital between 1993 and 2008. Predictor variables were histologic parameters: number of giant cells (GCs) per high-power field, number of nuclei per GC, GC size, stromal cellularity, stromal type, presence of hemorrhage and reactive osteoid, and blinded pathologists' prediction of location and behavior. Outcome variables were clinical behavior (aggressive or nonaggressive) and GCL location, that is, maxillofacial (MF) or axial/appendicular (AA). Descriptive and bivariate statistics were computed with statistical significance set at P ≤ .05. RESULTS The sample included 88 subjects: 41 MF GCLs (35 aggressive) and 47 AA GCLs (28 aggressive). Aggressive AA lesions had more GCs per high-power field, larger mean GC size, and increased stromal cellularity, and they more frequently had a mononuclear stroma when compared with aggressive MF lesions (P < .05). There were no significant histologic differences between aggressive and nonaggressive MF lesions or between nonaggressive MF and nonaggressive AA lesions. Aggressive AA lesions had more nuclei/GC than nonaggressive AA lesions (P = .03). Using histologic criteria only, blinded pathologists predicted clinical behavior in only 45% of cases (κ = 0.19, P = .09). They predicted a lesion's location in 82% of cases with fair agreement (κ = 0.44, P < .01). CONCLUSIONS Results of this study indicate that histologic differences between aggressive and nonaggressive GCLs are insufficient for pathologists to differentiate them consistently regardless of location.
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Affiliation(s)
- Zachary S Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA.
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Woo SB. Nonodontogenic Intraosseous Lesions. ORAL PATHOLOGY 2012:382-431. [DOI: 10.1016/b978-1-4377-2226-0.00016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Controversy in the Treatment of Central Giant Cell Granuloma: In Search of Evidence-Based Treatment. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Triantafillidou K, Venetis G, Karakinaris G, Iordanidis F. Central Giant Cell Granuloma of the Jaws: A Clinical Study of 17 Cases and a Review of the Literature. Ann Otol Rhinol Laryngol 2011; 120:167-74. [DOI: 10.1177/000348941112000305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objectives: The aim of this prospective study was to evaluate the outcome of treatment of a group of 17 patients with central giant cell granuloma (CGCG) who were treated in our clinic. Methods: A group of 17 patients with CGCG were treated in the Clinic of Oral and Maxillofacial Surgery of the “G. Papanikolaou” hospital in Thessaloniki. The age range was from 7 to 60 years. Eight patients were male and 9 patients were female. Because most of our patients (11) were less than 30 years old, the aim of the treatment was to eradicate the lesions without functional problems. All of the patients were treated by excision via curettage without a continuity defect and peripheral osteotomy. For 2 patients, the treatment was continued (after the first recurrence) with salmon calcitonin. Results: The follow-ups ranged from 1 to 15 years. All of the patients were free of the disease, without features of recurrence and without functional or aesthetic problems. Conclusions: Surgery has usually been considered to be the best method of treatment for CGCG. Most authors have proposed conservative surgical procedures (excision via curettage), especially for young patients. For aggressive lesions, supplementary treatment with calcitonin would provide good results.
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Aggressive Central Giant Cell Granuloma of the Mandible. J Oral Maxillofac Surg 2010; 68:2537-44. [DOI: 10.1016/j.joms.2009.06.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 06/30/2009] [Indexed: 02/06/2023]
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Abstract
Level of Evidence: V, Expert Opinion
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Affiliation(s)
- Christopher Bibbo
- Foot & Ankle Section, Department of Orthopaedics, Marshfield Clinic, Marshfield, WI 54449, USA.
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Resnick CM, Margolis J, Susarla SM, Schwab JH, Hornicek FJ, Dodson TB, Kaban LB. Maxillofacial and axial/appendicular giant cell lesions: unique tumors or variants of the same disease?--A comparison of phenotypic, clinical, and radiographic characteristics. J Oral Maxillofac Surg 2010; 68:130-7. [PMID: 20006167 DOI: 10.1016/j.joms.2009.04.106] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 04/21/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE The relationship between giant cell lesions (GCLs) of the maxillofacial (MF) skeleton and those of the axial/appendicular (AA) skeleton has been long debated. The present study compared the clinical and radiographic characteristics of subjects with MF and AA GCLs. MATERIALS AND METHODS This was a retrospective cohort study of patients treated for GCLs at Massachusetts General Hospital from 1993 to 2008. The predictor variables included tumor location (MF or AA) and clinical behavior (aggressive or nonaggressive). The outcome variables included demographic, clinical, and radiographic parameters, treatments, and outcomes. Descriptive and bivariate statistics were computed, and P <or= .05 was considered significant. RESULTS The sample included 93 subjects: 45 with MF (38 with aggressive and 7 with nonaggressive) and 48 with AA (30 with aggressive and 18 with nonaggressive). Comparing the patients with MF and AA GCLs, those with MF lesions presented younger (P < .001), and the lesions were more commonly asymptomatic (P < .001), smaller (P < .001), and managed differently (P < .001) than AA lesions. When stratified by clinical behavior, aggressive tumors were diagnosed earlier than nonaggressive tumors (P < .001). Controlling for location and clinical behavior, patients with MF aggressive lesions were younger (P < .001) than those with AA aggressive lesions. MF nonaggressive lesions were more commonly asymptomatic (P = .04), smaller (P = .05), and less commonly locally destructive (P = .05) than AA nonaggressive lesions. CONCLUSIONS These results suggest that MF and AA GCLs represent a similar, if not the same, disease. Comparing the aggressive and nonaggressive subgroups, more similarities were found than when evaluating without stratification by clinical behavior. The remaining differences could be explained by the likelihood that MF tumors are diagnosed earlier than AA tumors because of facial exposure and dental screening examinations and radiographs.
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Affiliation(s)
- Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
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