Calcitonin nasal spray for treatment of central giant cell granuloma: Clinical, radiological, and histological findings and immunohistochemical expression of calcitonin and glucocorticoid receptors

Abstract

To provide clinical, radiological, and histopathologic analyses of 5 patients with central giant cell granuloma (CGCG) treated with calcitonin nasal spray; to compare the results to 11 well-documented cases in the literature; and to evaluate lesions for immunohistochemical expression of calcitonin receptors (CTR) and glucocorticoid receptors (GCR). Five patients with CGCG were treated with calcitonin nasal spray, 200 to 400 IU/day, for 13 to 64 months. CTR and GCR expression were examined at different treatment times. No lesions showed significant clinical and/or radiological improvement in size. The main benefit was thickening of the cortical plates. All patients eventually underwent curettage and continued calcitonin treatment. Significant radiological improvement was noticed 2 to 4 months postsurgical procedure. Each lesion exhibited a different immunoprofile for CTR and GCR, pretreatment and during treatment. CTR disappeared after long-term calcitonin treatment. GCR exhibited variable changes. Long-term nasal spray calcitonin was ineffective for CGCG management compared with calcitonin injections. It is suggested that lesions with an undesirable response should be evaluated for CTR and GCR expression at different treatment times for maximal benefit of calcitonin treatment.