Recurrent case of central giant cell granuloma with multiple soft tissue involvement

An Intraosseous Giant Cell Granuloma: An Uncommon Presentation

The giant cell granuloma is an identical reactive lesion which is mostly progressive in nature. The clinical behavior of these lesions varies from indolent to aggressive variant. The central form of giant cell granuloma involves the craniofacial bone, followed by long bones of hands and feet. These lesions are usually asymptomatic lesions and are discovered incidentally during routine radiographic examination. Radiograph features reveal multilocular jaw lesions, generally anterior to the first molar regions. Histologically, the lesion shows proliferating spindle-shaped stromal cells in a fibrovascular connective tissue stroma, which characteristically contains multiple multinucleated giant cells. Hemorrhage and hemosiderin pigmentations are often seen in tumor. Central giant cell granuloma is often confused with giant cell tumor of bone histologically. Here, we report a young male who was found to have large central giant cell granuloma in the anterior part of the mandible. The surgical treatment approach of central giant cell granuloma is discussed in this article.

Diagnostic difficulty of an aggressive and recurrent giant cell granuloma: a short case report

Introduction: The central giant cell granuloma (CGCG) is a rare benign lesion of the jaws, rarely aggressive,mostly affecting the mandible in children and young adults. The diagnosis may be difficult, complementaryhistological analyses being necessary to differentiate it from other giant cell tumours. Observation: A 28-year-old woman consulted for a painful gingival swelling surrounding the inferior right second molar. Cone Beam (CBCT) showed anunilocular radiolucent mandibular lesion. Histological examination performed after the curettage of the lesion could not differentiate between a peripheral GCG with bone extension, a giant cell tumour (GCT) or a CGCG. The patient was lost of view for 4 months until an aggressive recurrence. Asegmental mandibulectomy in disease-free margin was performed. Immunohistochemical and genetic testscomplementary to histology finally permitted to concludeto a CGCG. The patient presented no recurrence in 4 years of follow-up. Discussion: Surgical removal in disease-free margin is the gold standard treatment in aggressive CGCG. Nonetheless, literature reports alternative pharmacological treatments alone or in addition to surgery. In this case, the aggressiveness of the tumour and the absence of patient compliance for follow-up have led to the decision of a radical treatment of the recurrence. Conclusion: Aggressive CGCG requires a rapid diagnosis and a primary disease-free margin surgical resection to avoid mutilating treatment of the recurrence.

Combination therapies for the treatment of recurrent central giant cell lesion in the maxilla: a case report

Background

Central giant cell lesion is a non-neoplastic proliferation, usually asymptomatic, of unknown etiology. The purpose of this case report is to report the diagnosis and the treatment of a recurrent central giant cell lesion in the maxilla.

Case presentation

A 31-year-old Brazilian woman presented to our Surgery Service for evaluation of a cystic lesion in her teeth 13 and 15, although she had previously received endodontic treatment for her teeth 13 and 15 without regression of the lesion. On clinical examination, an increase and painless swelling was observed in her right jaw. An excisional biopsy of the lesion was performed under general anesthesia; the material was sent for pathological examination and a diagnosis compatible with central giant cell lesion was made. She presented again, 10 months after the removal of the lesion, with a recurrent lesion that surrounded her incisors, canine, and right premolar. We suggested that she underwent treatment with intralesional corticosteroids injection. The lesion was significantly reduced and the remainder of the lesion was enucleated. She is monitored at 3-month intervals; at 6 months postoperatively there has been no recurrence.

Conclusions

Central giant cell lesion can have a high degree of invasiveness, which increases the importance of early diagnosis. Combination therapies can provide a favorable prognosis. Periodic monitoring is recommended, thus avoiding the chance of a relapse.