AGGRESSIVE MANDIBULAR OSTEOLYTIC LESION IN A CHILD: A DIAGNOSIS CHALLENGE AND MANAGEMENT

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Benign osteolytic lesions are common in children and include true neoplasms and tumor-like lesions. A 7-year-old female patient presented with swelling in the left hemiface with 3 months of evolution. Facial asymmetry and mouth opening limitation were observed on extraoral examination. Intraorally, the lesion had a normal color and firm consistency. Computed tomography revealed an osteolytic isodense lesion in the left posterior mandible and zygomatic arch. The patient's medical history was not contributory. The diagnosis of incisional biopsy was suggestive of ossifying fibroma with osteosarcoma-like areas. The patient underwent resection of the lesion and rehabilitation. Microscopically, the surgical specimen showed proliferation of multinucleated giant cells and ovoid to spindle-shaped mononuclear mesenchymal cells as well as immature bone trabeculae exhibiting osteocytes and osteoblastic pavimentation, both atypical, in connective tissue with variables density. The final diagnosis was central giant cell granuloma. The patient has been followed up, showing no signs of local complications. Benign osteolytic lesions are common in children and include true neoplasms and tumor-like lesions. A 7-year-old female patient presented with swelling in the left hemiface with 3 months of evolution. Facial asymmetry and mouth opening limitation were observed on extraoral examination. Intraorally, the lesion had a normal color and firm consistency. Computed tomography revealed an osteolytic isodense lesion in the left posterior mandible and zygomatic arch. The patient's medical history was not contributory. The diagnosis of incisional biopsy was suggestive of ossifying fibroma with osteosarcoma-like areas. The patient underwent resection of the lesion and rehabilitation. Microscopically, the surgical specimen showed proliferation of multinucleated giant cells and ovoid to spindle-shaped mononuclear mesenchymal cells as well as immature bone trabeculae exhibiting osteocytes and osteoblastic pavimentation, both atypical, in connective tissue with variables density. The final diagnosis was central giant cell granuloma. The patient has been followed up, showing no signs of local complications.